601
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Nong L, Liang W, Yu Y, Xi Y, Liu D, Zhang J, Zhou J, Yang C, He W, Liu X, Li Y, Chen R. Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia. J Crit Care 2019; 56:12-17. [PMID: 31785505 PMCID: PMC7126932 DOI: 10.1016/j.jcrc.2019.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/10/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022]
Abstract
Purpose This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure. Materials and methods This was a single-center prospective randomized study. All patients undergoing FOB-guided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. The NIV group were intubated through a sealed hole in a specially designed face mask during continuous NIV support with 100% oxygen. Control patients were intubated with removal of the mask and no ventilatory support. Results We enrolled 106 patients, including 53 in each group. Pulse oxygen saturation (SpO2) after preoxygenation (99% (96%–100%) vs. 96% (90%–99%), p = .001) and minimum SpO2 during intubation (95% (87%–100%) vs. 83% (74%–91%), p < .01) were both significantly higher in the NIV compared with the control group. Severe hypoxemic events (SpO2 < 80%) occurred less frequently in the NIV group than in controls (7.4% vs. 37.7%, respectively; p < .01). Conclusions Continuous NIV support during FOB-guided nasal intubation can prevent severe desaturation during intubation in critically ill patients with respiratory failure. Trial registration: ClinicalTrials.gov, NCT02462668. Registered on 25 May 2015, https://www.clinicaltrials.gov/ct2/results?term=NCT02462668. Our study is the first to evaluate NIV during FOB-guided nasotracheal intubation. NIV support during FOB-guided nasotracheal intubation was effectively prevented severe desaturation during intubation. We used a specially-designed intubation face mask to ensure that there was no interruption of NIV support during intubation.
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Affiliation(s)
- Lingbo Nong
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weibo Liang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuheng Yu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yin Xi
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongdong Liu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Zhou
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun Yang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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602
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Barrett NA, Hart N, Camporota L. Assessment of Work of Breathing in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. COPD 2019; 16:418-428. [PMID: 31694406 DOI: 10.1080/15412555.2019.1681390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The assessment of the work of breathing (WOB) of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) is difficult, particularly when the patient first presents with acute hypercapnia and respiratory acidosis. Acute exacerbations of COPD patients are in significant respiratory distress and noninvasive measurements of WOB are easier for the patient to tolerate. Given the interest in using alternative therapies to noninvasive ventilation, such as high flow nasal oxygen therapy or extracorporeal carbon dioxide removal, understanding the physiological changes are key and this includes assessment of WOB. This narrative review considers the role of three different methods of assessing WOB in patients with acute exacerbations of COPD. Esophageal pressure is a very well validated measure of WOB, however the ability of patients with acute exacerbations of COPD to tolerate esophageal tubes is poor. Noninvasive alternative measurements include parasternal electromyography (EMG) and electrical impedance tomography (EIT). EMG is easily applied and is a well validated measure of neural drive but is more likely to be degraded by the electrical environment in intensive care or high dependency. EIT is less well validated as a tool for WOB in COPD but extremely well tolerated by patients. Each of the different methods assess WOB in a different way and have different advantages and disadvantages. For research into therapies treating acute exacerbations of COPD, combinations of EIT, EMG and esophageal pressure are likely to be better than only one of these.
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Affiliation(s)
- N A Barrett
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - N Hart
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - L Camporota
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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603
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Pérez-Terán P, Marín-Corral J, Dot I, Masclans JR. Response to the editor: Aeration changes induced by high flow nasal cannula are more homogeneous than those generated by non-invasive ventilation in healthy subjects. J Crit Care 2019; 57:277-278. [PMID: 31711711 DOI: 10.1016/j.jcrc.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Purificación Pérez-Terán
- Critical Care Department, Hospital del Mar, GREPAC - IMIM, Barcelona, Spain; UAB/UPF, School of Medicine, Spain.
| | - Judith Marín-Corral
- Critical Care Department, Hospital del Mar, GREPAC - IMIM, Barcelona, Spain; UAB/UPF, School of Medicine, Spain
| | - Irene Dot
- Critical Care Department, Hospital del Mar, GREPAC - IMIM, Barcelona, Spain
| | - Joan Ramon Masclans
- Critical Care Department, Hospital del Mar, GREPAC - IMIM, Barcelona, Spain; UAB/UPF, School of Medicine, Spain; HISpaFlow, Grupo Español Multidiscipinar de Terapia de Soporte con Alto Flujo en Adultos, Spain
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604
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Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology 2019; 25:348-354. [DOI: 10.1016/j.pulmoe.2019.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
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605
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Clinical decision support recommending ventilator settings during noninvasive ventilation. J Clin Monit Comput 2019; 34:1043-1049. [PMID: 31673945 DOI: 10.1007/s10877-019-00409-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
NIV therapy is used to provide positive pressure ventilation for patients. There are protocols describing what ventilator settings to use to initialize NIV; however, the guidelines for titrating ventilator settings are less specific. We developed an advisory system to recommend NIV ventilator setting titration and recorded respiratory therapist agreement rates at the bedside. We developed an algorithm (NIV advisor) to recommend when to change the non-invasive ventilator settings of IPAP, EPAP, and FiO2 based on patient respiratory parameters. The algorithm utilized a multi-target approach; oxygenation, ventilation, and patient effort. The NIV advisor recommended ventilator settings to move the patient's respiratory parameters in a preferred target range. We implemented a pilot study evaluating the usability of the NIV advisor on 10 patients receiving critical care with non-invasive ventilation (NIV). Respiratory therapists were asked their agreement on recommendations from the NIV advisor at the patient's bedside. Bedside respiratory therapists agreed with 91% of the ventilator setting recommendations from the NIV advisor. The POB and VT values were the respiratory parameters that were most often out of the preferred target range. The IPAP ventilator setting was the setting most often considered in need of changing by the NIV advisor. The respiratory therapists agreed with the majority of the recommendations from the NIV advisor. We consider the IPAP recommendations informative in providing the respiratory therapist assistance in targeting preferred POB and Vt values, as these values were frequently out of the target ranges. This pilot implementation was unable to produce the results required to determine the value of the EPAP recommendations. The FiO2 recommendations from the NIV advisor were treated as ancillary information behind the IPAP recommendations.
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606
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Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care 2019; 9:122. [PMID: 31641959 PMCID: PMC6805835 DOI: 10.1186/s13613-019-0597-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background Non-invasive ventilation (NIV) is preferred as the initial ventilatory support to treat acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). High-flow nasal cannula (HFNC) may be an alternative method; however, the effects of HFNC in hypercapnic COPD are not well known. This preliminary study aimed at assessing the physiologic effects of HFNC at different flow rates in hypercapnic COPD and to compare it with NIV. Methods A prospective physiologic study enrolled 12 hypercapnic COPD patients who had initially required NIV, and were ventilated with HFNC at flow rates increasing from 10 to 50 L/min for 15 min in each step. The primary outcome was the effort to breathe estimated by a simplified esophageal pressure–time product (sPTPes). The other studied variables were respiratory rate, oxygen saturation (SpO2), and transcutaneous CO2 pressure (PtcCO2). Results Before NIV initiation, the median [interquartile range] pH was 7.36 [7.28–7.37] with a PaCO2 of 51 [42–60] mmHg. sPTPes per minute was significantly lower with HFNC at 30 L/min than 10 and 20 L/min (p < 0.001), and did not significantly differ with NIV (median inspiratory/expiratory positive airway pressure of 11 [10–12] and [5–5] cmH2O, respectively). At 50 L/min, sPTPes per minute increased compared to 30 L/min half of the patients. Respiratory rate was lower (p = 0.003) and SpO2 was higher (p = 0.028) with higher flows (30–50 L/min) compared to flow rate of 10 L/min and not different than with NIV. No significant differences in PtcCO2 between NIV and HFNC at different flow rates were observed (p = 0.335). Conclusions Applying HFNC at 30 L/min for a short duration reduces inspiratory effort in comparison to 10 and 20 L/min, and resulted in similar effect than NIV delivered at modest levels of pressure support in hypercapnic COPD with mild to moderate exacerbation. Higher flow rates reduce respiratory rate but sometimes increase the effort to breathe. Using HFNC at 30 L/min in hypercapnic COPD patients should be further evaluated. Trial registration Thai Clinical Trials Registry, TCTR20160902001. Registered 31 August 2016, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2008.
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Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Prapinpa Phuangchoei
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Jamsak Tscheikuna
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nattakarn Praphruetkit
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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607
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Chu CM, Piper A. Non-invasive ventilation: A glimpse into the future. Respirology 2019; 24:1140-1142. [PMID: 31625248 DOI: 10.1111/resp.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Chung-Ming Chu
- Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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608
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Thille AW, Muller G, Gacouin A, Coudroy R, Decavèle M, Sonneville R, Beloncle F, Girault C, Dangers L, Lautrette A, Cabasson S, Rouzé A, Vivier E, Le Meur A, Ricard JD, Razazi K, Barberet G, Lebert C, Ehrmann S, Sabatier C, Bourenne J, Pradel G, Bailly P, Terzi N, Dellamonica J, Lacave G, Danin PÉ, Nanadoumgar H, Gibelin A, Zanre L, Deye N, Demoule A, Maamar A, Nay MA, Robert R, Ragot S, Frat JP. Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial. JAMA 2019; 322:1465-1475. [PMID: 31577036 PMCID: PMC6802261 DOI: 10.1001/jama.2019.14901] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE High-flow nasal oxygen may prevent postextubation respiratory failure in the intensive care unit (ICU). The combination of high-flow nasal oxygen with noninvasive ventilation (NIV) may be an optimal strategy of ventilation to avoid reintubation. OBJECTIVE To determine whether high-flow nasal oxygen with prophylactic NIV applied immediately after extubation could reduce the rate of reintubation, compared with high-flow nasal oxygen alone, in patients at high risk of extubation failure in the ICU. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial conducted from April 2017 to January 2018 among 641 patients at high risk of extubation failure (ie, older than 65 years or with an underlying cardiac or respiratory disease) at 30 ICUs in France; follow-up was until April 2018. INTERVENTIONS Patients were randomly assigned to high-flow nasal oxygen alone (n = 306) or high-flow nasal oxygen alternating with NIV (n = 342) immediately after extubation. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients reintubated at day 7; secondary outcomes included postextubation respiratory failure at day 7, reintubation rates up until ICU discharge, and ICU mortality. RESULTS Among 648 patients who were randomized (mean [SD] age, 70 [10] years; 219 women [34%]), 641 patients completed the trial. The reintubation rate at day 7 was 11.8% (95% CI, 8.4%-15.2%) (40/339) with high-flow nasal oxygen and NIV and 18.2% (95% CI, 13.9%-22.6%) (55/302) with high-flow nasal oxygen alone (difference, -6.4% [95% CI, -12.0% to -0.9%]; P = .02). Among the 11 prespecified secondary outcomes, 6 showed no significant difference. The proportion of patients with postextubation respiratory failure at day 7 (21% vs 29%; difference, -8.7% [95% CI, -15.2% to -1.8%]; P = .01) and reintubation rates up until ICU discharge (12% vs 20%, difference -7.4% [95% CI, -13.2% to -1.8%]; P = .009) were significantly lower with high-flow nasal oxygen and NIV than with high-flow nasal oxygen alone. ICU mortality rates were not significantly different: 6% with high-flow nasal oxygen and NIV and 9% with high-flow nasal oxygen alone (difference, -2.4% [95% CI, -6.7% to 1.7%]; P = .25). CONCLUSIONS AND RELEVANCE In mechanically ventilated patients at high risk of extubation failure, the use of high-flow nasal oxygen with NIV immediately after extubation significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03121482.
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Affiliation(s)
- Arnaud W. Thille
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM Centre d’Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Grégoire Muller
- Groupe Hospitalier Régional d’Orléans, Médecine Intensive Réanimation, Orléans, France
| | - Arnaud Gacouin
- Centre Hospitalier Universitaire de Rennes, Hôpital Ponchaillou, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Rémi Coudroy
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM Centre d’Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Maxens Decavèle
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Romain Sonneville
- Hôpital Bichat–Claude Bernard, Médecine Intensive Réanimation, AP-HP, Université Paris Diderot, Paris, France
| | - François Beloncle
- Centre Hospitalier Universitaire d’Angers, Département de Médecine Intensive Réanimation, Université d’Angers, Angers, France
| | - Christophe Girault
- Centre Hospitalier Universitaire de Rouen, Hôpital Charles Nicolle, Département de Réanimation Médicale, Normandie Université, UNIROUEN, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Laurence Dangers
- Centre Hospitalier Universitaire Félix Guyon, Service de Réanimation Polyvalente, Saint Denis de la Réunion, France
| | - Alexandre Lautrette
- Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied, Service de Réanimation Médicale, Clermont-Ferrand, France
| | - Séverin Cabasson
- Centre Hospitalier de La Rochelle, Service de Réanimation, La Rochelle, France
| | - Anahita Rouzé
- Centre Hospitalier Universitaire de Lille, Centre de Réanimation, Université de Lille, Lille, France
| | - Emmanuel Vivier
- Hôpital Saint-Joseph Saint-Luc, Réanimation Polyvalente, Lyon, France
| | - Anthony Le Meur
- Centre Hospitalier Universitaire de Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Jean-Damien Ricard
- Hôpital Louis Mourier, Réanimation Médico-Chirurgicale, AP-HP, INSERM, Université Paris Diderot, UMR IAME 1137, Sorbonne Paris Cité, Colombes, France
| | - Keyvan Razazi
- Hôpitaux universitaires Henri Mondor, Service de Réanimation Médicale DHU A-TVB, AP-HP, Créteil, France
| | - Guillaume Barberet
- Groupe Hospitalier Régional Mulhouse Sud Alsace, site Emile Muller, Service de Réanimation Médicale, Mulhouse, France
| | - Christine Lebert
- Centre Hospitalier Départemental de Vendée, Service de Médecine Intensive Réanimation, La Roche Sur Yon, France
| | - Stephan Ehrmann
- Centre Hospitalier Régional Universitaire de Tours, Médecine Intensive Réanimation, CIC 1415, Réseau CRICS-Trigger SEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | | | - Jeremy Bourenne
- Centre Hospitalier Universitaire La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, Marseille, France
| | - Gael Pradel
- Centre Hospitalier Henri Mondor d’Aurillac, Service de Réanimation, Aurillac, France
| | - Pierre Bailly
- Centre Hospitalier Universitaire de Brest, Médecine Intensive Réanimation, Brest, France
| | - Nicolas Terzi
- Centre Hospitalier Universitaire Grenoble Alpes, Médecine Intensive Réanimation, INSERM, Université Grenoble-Alpes, U1042, HP2, Grenoble, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, Université Cote d’Azur, Nice, France
| | - Guillaume Lacave
- Centre Hospitalier de Versailles, Service de Réanimation Médico-Chirurgicale, Le Chesnay, France
| | - Pierre-Éric Danin
- Centre Hospitalier Universitaire de Nice, Réanimation Médico-Chirurgicale Archet 2, INSERM U 1065, Nice, France
| | - Hodanou Nanadoumgar
- Centre Hospitalier Universitaire de Poitiers, Réanimation Chirurgicale, Poitiers, France
| | - Aude Gibelin
- Hôpital Tenon, Réanimation et USC médico-chirurgicale, CARMAS, AP-HP, Faculté de médecine Sorbonne Université, Collegium Galilée, Paris, France
| | - Lassane Zanre
- Centre Hospitalier Emile Roux, Service de Réanimation, Le Puy en Velay, France
| | - Nicolas Deye
- Hôpital Lariboisière, Réanimation Médicale et Toxicologique, AP-HP, INSERM UMR-S 942, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Adel Maamar
- Centre Hospitalier Universitaire de Rennes, Hôpital Ponchaillou, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Mai-Anh Nay
- Groupe Hospitalier Régional d’Orléans, Médecine Intensive Réanimation, Orléans, France
| | - René Robert
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM Centre d’Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Stéphanie Ragot
- INSERM Centre d’Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM Centre d’Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
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609
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
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Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
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610
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Lago AF, Gastaldi AC, Mazzoni AAS, Tanaka VB, Siansi VC, Reis IS, Basile-Filho A. Comparison of International Consensus Conference guidelines and WIND classification for weaning from mechanical ventilation in Brazilian critically ill patients: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e17534. [PMID: 31626115 PMCID: PMC6824706 DOI: 10.1097/md.0000000000017534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The knowledge of weaning ventilation period is fundamental to understand the causes and consequences of prolonged weaning. In 2007, an International Consensus Conference (ICC) defined a classification of weaning used worldwide. However, a new definition and classification of weaning (WIND) were suggested in 2017. The objective of this study was to compare the incidence and clinical relevance of weaning according to ICC and WIND classification in an intensive care unit (ICU) and establish which of the classifications fit better for severely ill patients. This study was a retrospective cohort study in an ICU in a tertiary University Hospital. Patient data, such as population characteristics, mechanical ventilation (MV) duration, weaning classification, mortality, SAPS 3, and death probability, were obtained from a medical records database of all patients, who were admitted to ICU between January 2016 and July 2017. Three hundred twenty-seven mechanically ventilated patients were analyzed. Using the ICC classification, 82% of the patients could not be classified, while 10%, 5%, and 3% were allocated in simple, difficult, and prolonged weaning, respectively. When WIND was used, 11%, 6%, 26%, and 57% of the patients were classified into short, difficult, prolonged, and no weaning groups, respectively. Patients without classification were sicker than those that could be classified by ICC. Using WIND, an increase in death probability, MV days, and tracheostomy rate was observed according to weaning difficult. Our results were able to find the clinical relevance of WIND classification, mainly in prolonged, no weaning, and severely ill patients. All mechanically ill patients were classified, even those sicker with tracheostomy and those that could not finish weaning, thereby enabling comparisons among different ICUs. Finally, it seems that the new classification fits better in the ICU routine, especially for more severe and prolonged weaning patients.
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Affiliation(s)
- Alessandra Fabiane Lago
- Intensive Care Unit, Hospital das Clínicas de Ribeirão Preto
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Ada Clarice Gastaldi
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Amanda Alves Silva Mazzoni
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Vanessa Braz Tanaka
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Vivian Caroline Siansi
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Isabella Scutti Reis
- Department of Physiotherapy, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of Sao Paulo
| | - Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of Sao Paulo, SP, Brazil
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611
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Affiliation(s)
- Bartolomé R Celli
- From the Pulmonary and Critical Care Division, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (B.R.C.); and the National Heart and Lung Institute, Imperial College London, London (J.A.W.)
| | - Jadwiga A Wedzicha
- From the Pulmonary and Critical Care Division, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (B.R.C.); and the National Heart and Lung Institute, Imperial College London, London (J.A.W.)
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612
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Rodriguez M, Thille AW, Boissier F, Veinstein A, Chatellier D, Robert R, Le Pape S, Frat JP, Coudroy R. Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study. Ann Intensive Care 2019; 9:101. [PMID: 31511996 PMCID: PMC6738360 DOI: 10.1186/s13613-019-0578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/05/2019] [Indexed: 01/04/2023] Open
Abstract
Background High-flow nasal oxygen therapy (HFOT) is a promising first-line therapy for acute respiratory failure. However, its weaning has never been investigated and could lead to unnecessary prolonged intensive-care unit (ICU) stay. The aim of this study is to assess predictors of successful separation from HFOT in critically ill patients. We performed a retrospective monocenter observational study over a 2-year period including all patients treated with HFOT for acute respiratory failure in the ICU. Those who died or were intubated without prior HFOT separation attempt, who were treated with non-invasive ventilation at the time of HFOT separation, or who received HFOT as a preventive treatment during the post-extubation period were excluded. Results From the 190 patients analyzed, 168 (88%) were successfully separated from HFOT at the first attempt. Patients who failed separation from HFOT at the first attempt had longer ICU length of stay than those who succeeded: 10 days (7–12) vs. 5 (4–8), p < 0.0001. Fraction of inspired oxygen (FiO2) ≤ 40% and a respiratory rate-oxygenation (ROX) index (calculated as the ratio of SpO2/FiO2 to the respiratory rate) ≥ 9.2 predicted successful separation from HFOT with sensitivity of 85% and 84%, respectively. Conclusions FiO2 ≤ 40% and ROX index ≥ 9.2 were two predictors of successful separation from HFOT at the bedside. Prospective multicenter studies are needed to confirm these results.
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Affiliation(s)
- Maeva Rodriguez
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Florence Boissier
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Anne Veinstein
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Delphine Chatellier
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | - René Robert
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Sylvain Le Pape
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Remi Coudroy
- Médecine Intensive et Réanimation, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France. .,INSERM CIC 1402, ALIVE Group, Université de Poitiers, Poitiers, France.
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613
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[The obese patient and acute respiratory failure, a challenge for intensive care]. Rev Mal Respir 2019; 36:971-984. [PMID: 31521432 DOI: 10.1016/j.rmr.2018.10.621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
As a result of the constantly increasing epidemic of obesity, it has become a common problem in the intensive care unit. Morbid obesity has numerous consequences for the respiratory system. It affects both respiratory mechanics and pulmonary gas exchange, and dramatically impacts on the patient's management and outcome. With the potential for causing devastating respiratory complications, the particular anatomical and physiological characteristics of the respiratory system of the morbidly obese subject should be carefully taken into consideration. The present article reviews the management of obese patients in respiratory failure, from noninvasive ventilation to tracheostomy, including postural and technical issues, and explains the physiologically based ventilatory strategy both for NIV and invasive mechanical ventilation up to the weaning from the ventilatory support.
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614
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He H, Sun B, Liang L, Li Y, Wang H, Wei L, Li G, Guo S, Duan J, Li Y, Zhou Y, Chen Y, Li H, Yang J, Xu X, Song L, Chen J, Bao Y, Chen F, Wang P, Ji L, Zhang Y, Ding Y, Chen L, Wang Y, Yang L, Yang T, Weng H, Li H, Wang D, Tong J, Sun Y, Li R, Jin F, Li C, He B, Sun L, Wang C, Hu M, Yang X, Luo Q, Zhang J, Tan H, Wang C. A multicenter RCT of noninvasive ventilation in pneumonia-induced early mild acute respiratory distress syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:300. [PMID: 31484582 PMCID: PMC6727327 DOI: 10.1186/s13054-019-2575-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/19/2019] [Indexed: 01/18/2023]
Abstract
RATIONALE Our pilot study suggested that noninvasive ventilation (NIV) reduced the need for intubation compared with conventional administration of oxygen on patients with "early" stage of mild acute respiratory distress syndrome (ARDS, PaO2/FIO2 between 200 and 300). OBJECTIVES To evaluate whether early NIV can reduce the need for invasive ventilation in patients with pneumonia-induced early mild ARDS. METHODS Prospective, multicenter, randomized controlled trial (RCT) of NIV compared with conventional administration of oxygen through a Venturi mask. Primary outcome included the numbers of patients who met the intubation criteria. RESULTS Two hundred subjects were randomized to NIV (n = 102) or control (n = 98) groups from 21 centers. Baseline characteristics were similar in the two groups. In the NIV group, PaO2/FIO2 became significantly higher than in the control group at 2 h after randomization and remained stable for the first 72 h. NIV did not decrease the proportion of patients requiring intubation than in the control group (11/102 vs. 9/98, 10.8% vs. 9.2%, p = 0.706). The ICU mortality was similar in the two groups (7/102 vs. 7/98, 4.9% vs. 3.1%, p = 0.721). Multivariate analysis showed minute ventilation greater than 11 L/min at 48 h was the independent risk factor for NIV failure (OR, 1.176 [95% CI, 1.005-1.379], p = 0.043). CONCLUSIONS Treatment with NIV did not reduce the need for intubation among patients with pneumonia-induced early mild ARDS, despite the improved PaO2/FIO2 observed with NIV compared with standard oxygen therapy. High minute ventilation may predict NIV failure. TRIAL REGISTRATION NCT01581229 . Registered 19 April 2012.
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Affiliation(s)
- Hangyong He
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Engineering Research Center for Diagnosis and Treatment of Pulmonary and Critical Care, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Engineering Research Center for Diagnosis and Treatment of Pulmonary and Critical Care, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Lirong Liang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Engineering Research Center for Diagnosis and Treatment of Pulmonary and Critical Care, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - He Wang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - Luqing Wei
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics College of Chinese Armed Police Forces, Tianjin, China
| | - Guofeng Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics College of Chinese Armed Police Forces, Tianjin, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Duan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ying Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yusheng Chen
- The Pulmonary Department, Fujian Province Hospital, Fuzhou, Fujian Province, China
| | - Hongru Li
- The Pulmonary Department, Fujian Province Hospital, Fuzhou, Fujian Province, China
| | - Jingping Yang
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Inner Mongolia Medical College, Baotou, Inner Mongolia Autonomous Region, China
| | - Xiyuan Xu
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Inner Mongolia Medical College, Baotou, Inner Mongolia Autonomous Region, China
| | - Liqiang Song
- The Pulmonary Department, Xijing Hospital of the Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Jie Chen
- The Pulmonary Department, Xijing Hospital of the Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Yong Bao
- The Pulmonary Department, The Third People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Feng Chen
- The Pulmonary Department, The Third People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Ping Wang
- Department of Critical Care Medicine, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Lixi Ji
- Department of Critical Care Medicine, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Yongxiang Zhang
- Department of Respiratory Medicine, People's Hospital of Beijing Daxing District, Beijing, China
| | - Yanyan Ding
- Department of Respiratory Medicine, People's Hospital of Beijing Daxing District, Beijing, China
| | - Liangan Chen
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Ying Wang
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Lan Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi Province, China
| | - Tian Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi Province, China
| | - Heng Weng
- The Pulmonary Department, Lung Disease Hospital of Fujian Fuzhou, Fuzhou, Fujian Province, China
| | - Hongyan Li
- The Pulmonary Department, Lung Disease Hospital of Fujian Fuzhou, Fuzhou, Fujian Province, China
| | - Daoxin Wang
- The Pulmonary Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Tong
- The Pulmonary Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongchang Sun
- The Pulmonary Department, Beijing Tongren Hospital, Beijing, China
| | - Ran Li
- The Pulmonary Department, Beijing Tongren Hospital, Beijing, China
| | - Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, the Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Chunmei Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, the Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Bei He
- The Pulmonary Department, Peking University Third Hospital, Beijing, China
| | - Lina Sun
- The Pulmonary Department, Peking University Third Hospital, Beijing, China
| | - Changzheng Wang
- The Pulmonary Department, Xinqiao Hospital Army Medical University, Chongqing, China
| | - Mingdong Hu
- The Pulmonary Department, Xinqiao Hospital Army Medical University, Chongqing, China
| | - Xiaohong Yang
- Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Qin Luo
- Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jin Zhang
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Province, China
| | - Hai Tan
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Province, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Road, Chaoyang District, Beijing, 100029, China. .,Department of Respiratory Medicine, Capital Medical University, Beijing, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China.
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615
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Kink E, Erler L, Fritz W, Funk GC, Gäbler M, Krenn F, Kühteubl G, Schindler O, Wanke T. Beatmung bei COPD: von der Präklinik bis zur außerklinischen Beatmung. Eine Übersicht des Arbeitskreises für Beatmung und Intensivmedizin der österreichischen Gesellschaft für Pneumologie. Wien Klin Wochenschr 2019; 131:417-427. [PMID: 31111203 DOI: 10.1007/s00508-019-1515-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper was created by the Austrian Society of Pneumology (Working group Ventilation and Intensive Care) to summarize the specific characteristics of mechanical ventilation in patients presenting with chronic obstructive pulmonary disease (COPD). The main differences in pathophysiology and mechanical ventilation are shown, including acute respiratory failure and out-of-hospital mechanical ventilation.
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Affiliation(s)
- Eveline Kink
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Hörgas 30, 8112, Gratwein-Straßengel, Österreich
| | - Lorenz Erler
- Abteilung für Lungenkrankheiten, Leoben, Österreich
| | - Wilfried Fritz
- Klinische Abteilung für Lungenkrankheiten, Universitätsklinikum für Innere Medizin, LKH.-Univ. Klinikum Graz, Graz, Österreich
| | | | - Martin Gäbler
- Institut für Präventiv- und Angewandte Sportmedizin, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Mitterweg 10, 3500, Krems an der Donau, Österreich
| | | | | | - Otmar Schindler
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Hörgas 30, 8112, Gratwein-Straßengel, Österreich
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616
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Pulliam KE, Pritts TA. Non-Invasive Ventilatory Support In the Elderly. CURRENT GERIATRICS REPORTS 2019; 8:153-159. [PMID: 32509503 PMCID: PMC7274080 DOI: 10.1007/s13670-019-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The first description of non-invasive ventilation use began in the 1920s. Since then, its role in patient care has evolved through increased clinical knowledge and scientific advancements. The utilization of non-invasive ventilation has broadened from initial application in acute in-hospital ICU settings to now include the outpatient settings. This review discusses the history of non-invasive ventilation and its role in acute in-hospital chronic obstructive pulmonary disease (COPD) exacerbations, cardiogenic pulmonary edema, and weaning from mechanical ventilation in the elderly. The elderly population represents a significant portion of patients hospitalized for the aforementioned conditions. These groups often have more limitations related to the use of invasive mechanical ventilation (IMV), therefore, it is essential to understand the impact of non-invasive ventilation on hospital outcomes. RECENT FINDINGS There is strong clinical evidence supporting the use of non-invasive ventilation in patients with respiratory failure secondary to acute COPD exacerbations and cardiogenic pulmonary edema. When compared to standard medical management of these conditions, there is a consistent and significant reduction in the rate of endotracheal intubation and in-hospital mortality. SUMMARY The basis of noninvasive ventilation applicability has been determined by significant reduction in mortality and intubation rates. Although survival benefits have been observed, there still remain limitations to the clinical applicability of non-invasive ventilation in certain patient populations and conditions that require further investigation.
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Affiliation(s)
- Kasiemobi E Pulliam
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, Ohio 45267-0558
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, Ohio 45267-0558
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617
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Rahaghi F, Omert L, Clark V, Sandhaus RA. Managing the Alpha-1 patient in the ICU: Adapting broad critical care strategies in AATD. J Crit Care 2019; 54:212-219. [PMID: 31614323 DOI: 10.1016/j.jcrc.2019.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/17/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
Alpha-1 Antitrypsin Deficiency (AATD) is a progressive pulmonary disease under-recognized or misdiagnosed by clinicians. Patients with AATD can develop a variety of organ-specific complications and as a result, often require hospitalization and treatment within critical care and ICU settings. Due to the complexity of AATD there are minimal guidelines in place to address the specific and highly variable needs of these patients in the critical care setting. This review presents clinical considerations with respect to the management of patients with AATD and provides treatment recommendations for these patients in the critical care setting. In addition, we have outlined certain aspects of the care of this patient population that may be of interest to critical care practitioners. With greater disease awareness and earlier diagnosis the onset of symptoms can be delayed, which will ultimately reduce the frequency of deleterious health consequences.
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Affiliation(s)
- Franck Rahaghi
- Pulmonary and Critical Care Division, Cleveland Clinic Florida, Weston, Florida, United States.
| | - Laurel Omert
- CSL Behring, King of Prussia, PA, United States.
| | - Virginia Clark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, United States.
| | - Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, United States.
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618
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Ergan B, Oczkowski S, Rochwerg B, Carlucci A, Chatwin M, Clini E, Elliott M, Gonzalez-Bermejo J, Hart N, Lujan M, Nasilowski J, Nava S, Pepin JL, Pisani L, Storre JH, Wijkstra P, Tonia T, Boyd J, Scala R, Windisch W. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J 2019; 54:13993003.01003-2019. [DOI: 10.1183/13993003.01003-2019] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/13/2019] [Indexed: 02/07/2023]
Abstract
BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
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619
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Artacho Ruiz R, Artacho Jurado B, Caballero Güeto F, Cano Yuste A, Durbán García I, García Delgado F, Guzmán Pérez JA, López Obispo M, Quero Del Río I, Rivera Espinar F, Del Campo Molina E. Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. Med Intensiva 2019; 45:80-87. [PMID: 31455561 DOI: 10.1016/j.medin.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/28/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV). METHODS A retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included. RESULTS Out of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). CONCLUSIONS RR after two hours of treatment, and FiO2 and ROXI after 8hours of treatment, were the best predictors of success of HFNC. RR<29rpm, FiO2<0.59 and ROXI>5.98 were associated with a lesser risk of MV.
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Affiliation(s)
- R Artacho Ruiz
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España; Servicio de Medicina Intensiva, Hospital Cruz Roja, Córdoba, España.
| | - B Artacho Jurado
- Emergency Assessment Unit, John Radcliffe, Oxford University Hospital, Oxford, Reino Unido
| | - F Caballero Güeto
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España; Servicio de Medicina Intensiva, Hospital Cruz Roja, Córdoba, España
| | - A Cano Yuste
- Servicio de Urgencias, Hospital Quirón-Salud, Córdoba, España
| | - I Durbán García
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España
| | - F García Delgado
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España
| | - J A Guzmán Pérez
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España
| | - M López Obispo
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España; Dirección Médica, Hospital Cruz Roja, Córdoba, España
| | - I Quero Del Río
- Servicio de Medicina Intensiva, Hospital Quirón-Salud, Córdoba, España
| | - F Rivera Espinar
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España
| | - E Del Campo Molina
- Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España
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620
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Moore JA, Esquinas AM, Mina B. Multi-organ mechanical support for acute respiratory failure with renal failure-Considerations for future research. CLINICAL RESPIRATORY JOURNAL 2019; 13:598-599. [PMID: 31343824 DOI: 10.1111/crj.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Alan Moore
- Department of Medicine, Lenox Hill Hospital, New York, New York.,Pulmonary & Critical Care Department, Lenox Hill Hospital, New York, New York
| | | | - Bushra Mina
- Pulmonary & Critical Care Department, Lenox Hill Hospital, New York, New York
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621
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Coudroy R, Pham T, Boissier F, Robert R, Frat JP, Thille AW. Is immunosuppression status a risk factor for noninvasive ventilation failure in patients with acute hypoxemic respiratory failure? A post hoc matched analysis. Ann Intensive Care 2019; 9:90. [PMID: 31414246 PMCID: PMC6692798 DOI: 10.1186/s13613-019-0566-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background Recent European/American guidelines recommend noninvasive ventilation (NIV) as a first-line therapy to manage acute hypoxemic respiratory failure in immunocompromised patients. By contrast, NIV may have deleterious effects in nonimmunocompromised patients and experts have been unable to offer a recommendation. Immunocompromised patients have particularly high mortality rates when they require intubation. However, it is not clear whether immunosuppression status is a risk factor for NIV failure. We assessed the impact of immunosuppression status on NIV failure in a post hoc analysis pooling two studies including patients with de novo acute hypoxemic respiratory failure treated with NIV. Patients with hypercapnia, acute exacerbation of chronic lung disease, cardiogenic pulmonary edema, or with do-not-intubate order were excluded. Results Among the 208 patients included in the analysis, 71 (34%) were immunocompromised. They had higher severity scores upon ICU admission, higher pressure-support levels, and minute ventilation under NIV, and were more likely to have bilateral lung infiltrates than nonimmunocompromised patients. Intubation and in-ICU mortality rates were higher in immunocompromised than in nonimmunocompromised patients: 61% vs. 43% (p = 0.02) and 38% vs. 15% (p < 0.001), respectively. After adjustment or using a propensity score-matched analysis, immunosuppression was not associated with intubation, whereas it remained independently associated with ICU mortality with an adjusted odds ratio of 2.64 (95% CI 1.24–5.67, p = 0.01). Conclusions Immunosuppression status may directly influence mortality but does not seem to be associated with an increased risk of intubation in patients with de novo acute hypoxemic respiratory failure treated with NIV. Studies in this specific population are needed. Electronic supplementary material The online version of this article (10.1186/s13613-019-0566-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rémi Coudroy
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | - Tài Pham
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Keenan Research Center and Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Florence Boissier
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | - René Robert
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France. .,INSERM CIC 1402, ALIVE, Université de Poitiers, Poitiers, France.
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622
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Coudroy R, Frat JP, Ehrmann S, Pène F, Terzi N, Decavèle M, Prat G, Garret C, Contou D, Bourenne J, Gacouin A, Girault C, Dellamonica J, Malacrino D, Labro G, Quenot JP, Herbland A, Jochmans S, Devaquet J, Benzekri D, Vivier E, Nseir S, Colin G, Thévenin D, Grasselli G, Assefi M, Guerin C, Bougon D, Lherm T, Kouatchet A, Ragot S, Thille AW. High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol. BMJ Open 2019; 9:e029798. [PMID: 31401603 PMCID: PMC6701687 DOI: 10.1136/bmjopen-2019-029798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure. METHODS AND ANALYSIS This study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180. ETHICS AND DISSEMINATION The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02978300.
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Affiliation(s)
- Rémi Coudroy
- Médecine Intensive et Réanimation, INSERM CIC 1402, groupe ALIVE, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Médecine Intensive et Réanimation, INSERM CIC 1402, groupe ALIVE, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Stephan Ehrmann
- Médecine Intensive et Réanimation, CIC 1415, CRICS-TriggerSEP research network, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, CHRU de Tours, Tours, France
| | - Frédéric Pène
- Médecine Intensive et Réanimation, Université Paris Descartes, Hôpital Cochin, APHP, Paris, France
| | - Nicolas Terzi
- Médecine Intensive et Réanimation, INSERM, Université Grenoble-Alpes, U1042, HP2, CHU Grenoble Alpes, Grenoble, France
| | - Maxens Decavèle
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Gwenaël Prat
- Médecine Intensive et Réanimation, CHU de Brest, Brest, France
| | - Charlotte Garret
- Médecine Intensive et Réanimation, CHU de Nantes, Nantes, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Jeremy Bourenne
- Médecine Intensive et Réanimation, Réanimation des Urgences, Aix-Marseille Université, CHU La Timone 2, Marseille, France
| | - Arnaud Gacouin
- Service des Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Hôpital Ponchaillou, Rennes, France
| | - Christophe Girault
- Service de Réanimation Médicale, Normandie Univ, Unirouen, UPRES EA-3830, Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | | | | | - Guylaine Labro
- Medical Intensive Care Unit, Research Center EA3920, University of Franche-Comté, Hôpital Jean Minjoz, Besançon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, INSERM U1231, Equipe Lipness, Université Bourgogne-Franche-Comté, UMR1231 Lipides, Nutrition, Cancer, équipe Lipness, LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, INSERM, CIC 1432, Module Epidémiologie Clinique, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, CHU Dijon, Dijon, France
| | - Alexandre Herbland
- Service de Réanimation, Centre hospitalier Saint Louis, La Rochelle, France
| | - Sébastien Jochmans
- Service de Réanimation, Centre hospitalier Sud-Ile-de France, Melun, France
| | - Jérôme Devaquet
- Medical-Surgical Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Dalila Benzekri
- Médecine Intensive et Réanimation, Groupe Hospitalier Régional d'Orléans, Orléans, France
| | - Emmanuel Vivier
- Reanimation Polyvalente, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Saad Nseir
- Centre de Réanimation, Université de Lille, CHU de Lille, Lille, France
| | - Gwenhaël Colin
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Didier Thévenin
- Service de Réanimation Polyvalente, CH de Lens, Lens, France
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mona Assefi
- Multidisciplinary Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, School of Medicine, University Pierre and Marie Curie (UPMC), Pitié-Salpétrière Hospital, APHP, Paris, France
| | - Claude Guerin
- Service de Médecine Intensive-Réanimation, Université de Lyon, INSERM 955, Créteil, Hôpital de La Croix-Rousse, Hospices civils de Lyon, Lyon, France
| | - David Bougon
- Service de Réanimation, Centre Hospitalier Annecy Genevois, Annecy, France
| | | | | | - Stéphanie Ragot
- INSERM CIC 1402, Biostatistics, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive et Réanimation, INSERM CIC 1402, groupe ALIVE, Université de Poitiers, CHU de Poitiers, Poitiers, France
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623
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Kapil S, Wilson JG. Mechanical Ventilation in Hypoxemic Respiratory Failure. Emerg Med Clin North Am 2019; 37:431-444. [DOI: 10.1016/j.emc.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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624
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Diaz de Teran T, Barbagelata E, Cilloniz C, Nicolini A, Perazzo T, Perren A, Ocak Serin S, Scharffenberg M, Fiorentino G, Zaccagnini M, Khatib MI, Papadakos P, Rezaul Karim HM, Solidoro P, Esquinas A. Non-invasive ventilation in palliative care: a systematic review. Minerva Med 2019; 110:555-563. [PMID: 31359741 DOI: 10.23736/s0026-4806.19.06273-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologies. For patients with end-stage chronic respiratory diseases, the use of NIV following the onset of acute or severe chronic respiratory failure is a valid option when intubation has been excluded. EVIDENCE ACQUISITION The following electronic databases were searched from their inception to January 2000 to December 2017: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), the Cochrane Database of Systematic Reviews, ACP Journal Club database. EVIDENCE SYNTHESIS The available evidence strongly supports the use of NIV in patients presenting with an exacerbation of chronic obstructive pulmonary disease, as well end-stage neuromuscular disease. Few studies support the use of NIV in end-stage interstitial lung disease and in morbid obesity patients. In patients with cancer has been recommend offering NIV as palliative care to improve dyspnea. CONCLUSIONS The decision regarding the treatment should be made by the patient, ideally before reaching the terminal stage and after having a frank dialogue with healthcare professionals and family members.
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Affiliation(s)
- Teresa Diaz de Teran
- Unit of Sleep and Non-Invasive Ventilation, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Elena Barbagelata
- Department of Internal Medicine, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Catia Cilloniz
- Department of Pneumology, Clinical Institute of Thoracic Surgery, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clínic, Barcelona, University of Barcelona (UB), Barcelona, Spain.,Unit SGR 911, Center for Biomedical Network Research for Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antonello Nicolini
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
| | - Tommaso Perazzo
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Andreas Perren
- Department of Intensive Care, Regional Hospital of Bellinzona, Bellinzona, Switzerland
| | - Sibel Ocak Serin
- University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Martin Scharffenberg
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Diseases, and Rehabilitation, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Marco Zaccagnini
- Department of Anesthesia and Critical Care, McGill University Health Center, Montreal, QC, Canada
| | - Mohamad I Khatib
- Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Peter Papadakos
- Department of Anesthesiology, University of Rochester, Rochester, NY, USA
| | - Habib M Rezaul Karim
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Paolo Solidoro
- Unit of Pneumology U, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Esquinas
- Unit of Intensive Care, Morales Meseguer Hospital, Murcia, Spain
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625
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Barrett NA, Kostakou E, Hart N, Douiri A, Camporota L. Extracorporeal carbon dioxide removal for acute hypercapnic exacerbations of chronic obstructive pulmonary disease: study protocol for a randomised controlled trial. Trials 2019; 20:465. [PMID: 31362776 PMCID: PMC6664508 DOI: 10.1186/s13063-019-3548-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/29/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common cause of chronic respiratory failure and its course is punctuated by a series of acute exacerbations which commonly lead to hospital admission. Exacerbations are managed through the application of non-invasive ventilation and, when this fails, tracheal intubation and mechanical ventilation. The need for mechanical ventilation significantly increases the risk of death. An alternative therapy, extracorporeal carbon dioxide removal (ECCO2R), has been shown to be efficacious in removing carbon dioxide from the blood; however, its impact on respiratory physiology and patient outcomes has not been explored. METHODS/DESIGN A randomised controlled open label trial of patients (12 in each arm) with acute exacerbations of COPD at risk of failing conventional therapy (NIV) randomised to either remaining on NIV or having ECCO2R added to NIV with a primary endpoint of time to cessation of NIV. The change in respiratory physiology following the application of ECCO2R and/or NIV will be measured using electrical impedance tomography, oesophageal pressure and parasternal electromyography. Additional outcomes, including patient tolerance, outcomes, need for readmission, changes in blood gases and biochemistry and procedural complications, will be measured. Physiological changes will be compared within one patient over time and between the two groups. Healthcare costs in the UK system will also be compared between the two groups. DISCUSSION COPD is a common disease and exacerbations are a leading cause of hospital admission in the UK and worldwide, with a sizeable mortality. The management of patients with COPD consumes significant hospital and financial resources. This study seeks to understand the feasibility of a novel approach to the management of patients with acute exacerbations of COPD as well as to understand the underlying physiological changes to explain why the approach does or does not assist this patient cohort. Detailed respiratory physiology has not been previously undertaken using this technique and there are no other randomised controlled trials currently in the literature. TRIAL REGISTRATION ClinicalTrials.gov, NCT02086084.
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Affiliation(s)
- Nicholas A. Barrett
- Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH UK
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Eirini Kostakou
- Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH UK
| | - Nicholas Hart
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
- Lane Fox Respiratory Unit, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH UK
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King’s College London, London, WC2R 2LS UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
| | - Luigi Camporota
- Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH UK
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
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626
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Cortegiani A, Longhini F, Carlucci A, Scala R, Groff P, Bruni A, Garofalo E, Taliani MR, Maccari U, Vetrugno L, Lupia E, Misseri G, Comellini V, Giarratano A, Nava S, Navalesi P, Gregoretti C. High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial. Trials 2019; 20:450. [PMID: 31331372 PMCID: PMC6647141 DOI: 10.1186/s13063-019-3514-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Noninvasive ventilation (NIV) is indicated to treat respiratory acidosis due to exacerbation of chronic obstructive pulmonary disease (COPD). Recent nonrandomized studies also demonstrated some physiological effects of high-flow nasal therapy (HFNT) in COPD patients. We designed a prospective, unblinded, multicenter, randomized controlled trial to assess the noninferiority of HFNT compared to NIV with respect to the reduction of arterial partial pressure of carbon dioxide (PaCO2) in patients with hypercapnic acute respiratory failure with mild-to-moderate respiratory acidosis. Methods We will enroll adult patients with acute hypercapnic respiratory failure, as defined by arterial pH between 7.25 and 7.35 and PaCO2 ≥ 55 mmHg. Patients will be randomly assigned 1:1 to receive NIV or HFNT. NIV will be applied through a mask with a dedicated ventilator in pressure support mode. Positive end-expiratory pressure will be set at 3–5 cmH2O with inspiratory support to obtain a tidal volume between 6 and 8 ml/kg of ideal body weight. HFNT will be initially set at a temperature of 37 °C and a flow of 60 L/min. At 2 and 6 h we will assess arterial blood gases, vital parameters, respiratory rate, treatment intolerance and failure, need for endotracheal intubation, time spent under mechanical ventilation (both invasive and NIV), intensive care unit and hospital length of stay, and hospital mortality. Based on an α error of 5% and a β error of 80%, with a standard deviation for PaCO2 equal to 15 mmHg and a noninferiority limit of 10 mmHg, we computed a sample size of 56 patients. Considering potential drop-outs and nonparametric analysis, the final computed sample size was 80 patients (40 per group). Discussion HFNT is more comfortable than NIV in COPD patients recovering from an episode of exacerbation. If HFNT would not be inferior to NIV, HFNT could be considered as an alternative to NIV to treat COPD patients with mild-to-moderate respiratory acidosis. Trial registration ClinicalTrials.gov, NCT03370666. Registered on December 12, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3514-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
| | - Federico Longhini
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Paolo Groff
- Emergency Department, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Andrea Bruni
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Maria Rita Taliani
- Emergency Department, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Uberto Maccari
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Luigi Vetrugno
- Department of Anaesthesia and Intensive Care, University of Udine, Udine, Italy
| | - Enrico Lupia
- Emergency Department, "Città della Salute e della Scienza" University Hospital, Torino, Italy
| | - Giovanni Misseri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Vittoria Comellini
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Paolo Navalesi
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
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627
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Maggiore SM, Battilana M, Serano L, Petrini F. Ventilatory support after extubation in critically ill patients. THE LANCET RESPIRATORY MEDICINE 2019; 6:948-962. [PMID: 30629933 DOI: 10.1016/s2213-2600(18)30375-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/29/2022]
Abstract
The periextubation period represents a crucial moment in the management of critically ill patients. Extubation failure, defined as the need for reintubation within 2-7 days after a planned extubation, is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia, longer intensive care unit and hospital stays, and increased mortality. Conventional oxygen therapy is commonly used after extubation. Additional methods of non-invasive respiratory support, such as non-invasive ventilation and high-flow nasal therapy, can be used to avoid reintubation. The aim of this Review is to describe the pathophysiological mechanisms of postextubation respiratory failure and the available techniques and strategies of respiratory support to avoid reintubation. We summarise and discuss the available evidence supporting the use of these strategies to achieve a tailored therapy for an individual patient at the bedside.
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Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.
| | - Mariangela Battilana
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Luca Serano
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Petrini
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy
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628
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Hill NS, Ruthazer R. Predicting Outcomes of High-Flow Nasal Cannula for Acute Respiratory Distress Syndrome. An Index that ROX. Am J Respir Crit Care Med 2019; 199:1300-1302. [PMID: 30694696 PMCID: PMC6543722 DOI: 10.1164/rccm.201901-0079ed] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Nicholas S Hill
- 1 Division of Pulmonary, Critical Care and Sleep Medicine Tufts Medical Center Boston, Massachusetts and
| | - Robin Ruthazer
- 2 Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston, Massachusetts
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629
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Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep 2019; 9:9539. [PMID: 31266972 PMCID: PMC6606632 DOI: 10.1038/s41598-019-45881-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/11/2019] [Indexed: 01/15/2023] Open
Abstract
This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.
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630
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Vargas N, Esquinas AM. Oldest Old With Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Noninvasive Ventilation: 2 Planets Approaching. J Am Med Dir Assoc 2019; 20:923. [DOI: 10.1016/j.jamda.2019.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
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631
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Spannella F, Giulietti F, Giordano P, Sarzani R. Response to: “Oldest Old With Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Noninvasive Ventilation: 2 Planets Approaching”. J Am Med Dir Assoc 2019; 20:923-924. [DOI: 10.1016/j.jamda.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
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632
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Avdeev SN, Truschenko NV, Gaynitdinova VV, Soe AK, Nuralieva GS. Treatment of exacerbations of chronic obstructive pulmonary disease. TERAPEVT ARKH 2019; 90:68-75. [PMID: 30701836 DOI: 10.26442/00403660.2018.12.000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. MATERIALS AND METHODS The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients' demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". RESULTS The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy - in 23,8% of patients, pulmonary rehabilitation - in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests - in 79.8%, blood gases analysis - in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. CONCLUSION Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.
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Affiliation(s)
- S N Avdeev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
| | - N V Truschenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
| | - V V Gaynitdinova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A K Soe
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - G S Nuralieva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
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633
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Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure. Curr Opin Anaesthesiol 2019; 32:150-155. [PMID: 30817387 DOI: 10.1097/aco.0000000000000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. SUMMARY Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment.
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634
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Sehgal IS, Kalpakam H, Dhooria S, Aggarwal AN, Prasad KT, Agarwal R. A Randomized Controlled Trial of Noninvasive Ventilation with Pressure Support Ventilation and Adaptive Support Ventilation in Acute Exacerbation of COPD: A Feasibility Study. COPD 2019; 16:168-173. [PMID: 31161812 DOI: 10.1080/15412555.2019.1620716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Whether the use of adaptive support ventilation (ASV) during noninvasive ventilation (NIV) is as effective as pressure support ventilation (PSV) remains unknown. In this exploratory study, we compared the delivery of NIV with PSV vs. ASV. We randomized consecutive subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) to receive NIV either with the PSV or the ASV mode. The primary outcome was NIV failure (endotracheal intubation, re-institution of NIV within 48 h of discontinuation or mortality). The secondary outcomes were the duration of mechanical ventilation (invasive and noninvasive), the number of NIV manipulations, the visual analogue score (VAS) for physician's ease of use and patient's comfort, and the complications of NIV use. We enrolled 74 subjects (n = 38, PSV; n = 36, ASV; 78.4% males) with a mean (SD) age of 60.5 (9.5) years. The baseline characteristics were similar between the two groups. The overall NIV failure rate was 28.4% and was similar between the two groups (PSV vs. ASV: 34.2% vs. 22.2%, p = 0.31). There was a 9% reduction in the intubation rate with ASV. There were six deaths (PSV vs. ASV: 2 vs 4, p =0.311). There was no difference in the secondary outcomes. The application of NIV using ASV was associated with a similar success rate as PSV in subjects with AECOPD. Due to the small sample size, the results of our study should be confirmed in a larger trial. Trial registry: ww.clinicaltrials.gov (NCT02877524).
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Affiliation(s)
- Inderpaul Singh Sehgal
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Hariprasad Kalpakam
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Sahajal Dhooria
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ashutosh N Aggarwal
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Kuruswamy Thurai Prasad
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ritesh Agarwal
- a Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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635
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Guan L, Zhou L, Song L, Wang L, Chen D, Chen R. Challenges to and opportunities for the implementation of non-invasive positive pressure ventilation in the Asia-Pacific region. Respirology 2019; 24:1152-1155. [PMID: 31157493 DOI: 10.1111/resp.13586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/16/2019] [Accepted: 05/05/2019] [Indexed: 12/20/2022]
Abstract
Non-invasive positive pressure ventilation (NPPV) is undoubtedly one of the most significant advancements in mechanical ventilation technology in the past 30 years. With accumulating evidence from clinical studies and support from clinical guidelines, NPPV is now widely used in hospitals and increasingly prescribed for home therapy in the Asia-Pacific region. However, in comparison with the developed Western countries, overall use of NPPV in the region is lagging behind. This study reviews this imbalance of NPPV use both in the acute and domiciliary settings in the Asia-Pacific region. Important issues related to NPPV use are also discussed along with speculation around potential strategies that could promote wider implementation of NPPV in the region. We hope this review will stimulate interest in the clinical application and potential research avenues for NPPV in the Asia-Pacific region, and promote education and staff training in the technique.
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Affiliation(s)
- Lili Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liqiang Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Lingwei Wang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China
| | - Dandan Chen
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China
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636
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Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: A narrative review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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637
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Martins M, Campôa E, Ferreira M, Reis-Pina P. Autonomy and dyspnea in palliative care: A case report. Pulmonology 2019; 26:105-107. [PMID: 31160236 DOI: 10.1016/j.pulmoe.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Martins
- Unidade de Saúde Familiar do Dafundo, Lisboa, Portugal.
| | - E Campôa
- Serviço de Oncologia Médica, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - M Ferreira
- Unidade de Cuidados Paliativos São Bento Menni, Casa de Saúde da Idanha, Belas, Sintra, Portugal
| | - P Reis-Pina
- Unidade de Cuidados Paliativos São Bento Menni, Casa de Saúde da Idanha, Belas, Sintra, Portugal; Centro de Bioética, Faculdade de Medicina, Universidade de Lisboa, Portugal
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638
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639
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Plotnikow GA, Vasquez D, Pratto R, Carreras L. High-flow nasal cannula in the treatment of acute hypoxemic respiratory failure in a pregnant patient: case report. Rev Bras Ter Intensiva 2019; 30:508-511. [PMID: 30672975 PMCID: PMC6334484 DOI: 10.5935/0103-507x.20180072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022] Open
Abstract
Little evidence exists to support the use of noninvasive mechanical ventilation
for acute hypoxemic respiratory failure. However, considering the complications
associated with endotracheal intubation, we attempted to implement noninvasive
mechanical ventilation in a 24-year-old patient who was 32 weeks pregnant and
was admitted to the intensive care unit with acute hypoxemic respiratory failure
and sepsis secondary to a urinary tract infection. Lack of tolerance to
noninvasive mechanical ventilation led us to use an alternative method to avoid
endotracheal intubation. The use of high-flow nasal cannula allowed to overcome
this situation, wich supports this technique as a treatment option for critical
obstetric patients that is safe for both the mother and fetus.
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Affiliation(s)
| | - Daniela Vasquez
- Unidad de Terapia Intensiva, Sanatorio Anchorena - Buenos Aires, Argentina
| | - Romina Pratto
- Unidad de Terapia Intensiva, Sanatorio Anchorena - Buenos Aires, Argentina
| | - Lucia Carreras
- Unidad de Terapia Intensiva, Sanatorio Anchorena - Buenos Aires, Argentina
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640
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Ambrosino N, Fracchia C. Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review. Pulmonology 2019; 25:289-298. [PMID: 31129045 DOI: 10.1016/j.pulmoe.2019.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The management of symptoms in patients with advanced chronic respiratory diseases needs more attention. This review summarizes the latest evidence on interventions to relieve dyspnoea in these patients. METHODS We searched randomised controlled trials, observational studies, systematic reviews, and meta-analyses published between 1990 and 2019 in English in PubMed data base using the keywords. Dyspnoea, Breathlessness AND: pharmacological and non pharmacological therapy, oxygen, non invasive ventilation, pulmonary rehabilitation, alternative medicine, intensive care, palliative care, integrated care, self-management. Studies on drugs (e.g. bronchodilators) or interventions (e.g. lung volume reduction surgery, lung transplantation) to manage underlying conditions and complications, or tools for relief of associated symptoms such as pain, are not addressed. RESULTS Relief of dyspnoea has received relatively little attention in clinical practice and literature. Many pharmacological and non pharmacological therapies are available to relieve dyspnoea, and improve patients' quality of life. There is a need for greater knowledge of the benefits and risks of these tools by doctors, patients and families to avoid unnecessary fears which might reduce or delay the delivery of appropriate care. We need services for multidisciplinary care in early and late phases of diseases. Early integration of palliative care with respiratory, primary care, and rehabilitation services can help patients and caregivers. CONCLUSION Relief of dyspnoea as well as of any distressing symptom is a human right and an ethical duty for doctors and caregivers who have many potential resources to achieve this.
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Affiliation(s)
- N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy.
| | - C Fracchia
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy
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641
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Marjanovic N, Macé J, Thille AW, Frat JP. Reply to Understanding the benefits of early high-flow nasal cannula for adults with acute hypoxemic respiratory failure in the ED. Am J Emerg Med 2019; 37:1593-1594. [PMID: 31085012 DOI: 10.1016/j.ajem.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- N Marjanovic
- CHU de Poitiers, Service d'Accueil des Urgences, SAMU 86 et Centre 15, France; Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France.
| | - J Macé
- CH de Niort, Service d'Accueil des Urgences, SAMU 79, France
| | - A W Thille
- Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - J P Frat
- Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
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642
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McKinstry S, Singer J, Baarsma JP, Weatherall M, Beasley R, Fingleton J. Nasal high‐flow therapy compared with non‐invasive ventilation in COPD patients with chronic respiratory failure: A randomized controlled cross‐over trial. Respirology 2019; 24:1081-1087. [DOI: 10.1111/resp.13575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/26/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Steven McKinstry
- Medical Research Institute of New Zealand Wellington New Zealand
- Victoria University of Wellington Wellington New Zealand
- Capital and Coast District Health Board Wellington New Zealand
| | - Joseph Singer
- Medical Research Institute of New Zealand Wellington New Zealand
| | - Jan Pieter Baarsma
- Medical Research Institute of New Zealand Wellington New Zealand
- University of Groningen Groningen The Netherlands
| | - Mark Weatherall
- Capital and Coast District Health Board Wellington New Zealand
- University of Otago Wellington Wellington New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand Wellington New Zealand
- Victoria University of Wellington Wellington New Zealand
- Capital and Coast District Health Board Wellington New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand Wellington New Zealand
- Victoria University of Wellington Wellington New Zealand
- Capital and Coast District Health Board Wellington New Zealand
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643
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Suri TM, Esquinas A, Hadda V, Mohan A. HVNI vs NIPPV in the treatment of acute decompensated heart failure: Is acute stabilization enough? Am J Emerg Med 2019; 37:1588-1589. [PMID: 31085011 DOI: 10.1016/j.ajem.2019.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/07/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tejas Menon Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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644
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Sklar MC, Patel BK, Beitler JR, Piraino T, Goligher EC. Optimal Ventilator Strategies in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med 2019; 40:81-93. [PMID: 31060090 PMCID: PMC7117088 DOI: 10.1055/s-0039-1683896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mechanical ventilation practices in patients with acute respiratory distress syndrome (ARDS) have progressed with a growing understanding of the disease pathophysiology. Paramount to the care of affected patients is the delivery of lung-protective mechanical ventilation which prioritizes tidal volume and plateau pressure limitation. Lung protection can probably be further enhanced by scaling target tidal volumes to the specific respiratory mechanics of individual patients. The best procedure for selecting optimal positive end-expiratory pressure (PEEP) in ARDS remains uncertain; several relevant issues must be considered when selecting PEEP, particularly lung recruitability. Noninvasive ventilation must be used with caution in ARDS as excessively high respiratory drive can further exacerbate lung injury; newer modes of delivery offer promising approaches in hypoxemic respiratory failure. Airway pressure release ventilation offers an alternative approach to maximize lung recruitment and oxygenation, but clinical trials have not demonstrated a survival benefit of this mode over conventional ventilation strategies. Rescue therapy with high-frequency oscillatory ventilation is an important option in refractory hypoxemia. Despite a disappointing lack of benefit (and possible harm) in patients with moderate or severe ARDS, possibly due to lung hyperdistention and right ventricular dysfunction, high-frequency oscillation may improve outcome in patients with very severe hypoxemia.
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Affiliation(s)
- Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York, New York
| | - Thomas Piraino
- Keenan Centre for Biomedical Research, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Critical Care, Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Department of Respiratory Therapy, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada.,Department of Medicine, Division of Respirology, University Health Network, Toronto, Ontario, Canada
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645
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Zayed Y, Banifadel M, Barbarawi M, Kheiri B, Chahine A, Rashdan L, Haykal T, Samji V, Armstrong E, Bachuwa G, Al-Sanouri I, Seedahmed E, Hernandez DA. Noninvasive Oxygenation Strategies in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials. J Intensive Care Med 2019; 35:1216-1225. [PMID: 31046545 DOI: 10.1177/0885066619844713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Acute hypoxemic respiratory failure (AHRF) is a leading cause of intensive care unit (ICU) admission among immunocompromised patients. Invasive mechanical ventilation is associated with increased morbidity and mortality. OBJECTIVE To evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in immunocompromised patients with AHRF. METHODS Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to December 2018. We included all randomized controlled trials (RCTs) comparing different modalities of initial oxygenation strategies in immunocompromised patients with AHRF. Our primary outcome was the need for intubation and invasive mechanical ventilation while secondary outcomes were ICU acquired infections and short- and long-term mortality. Data were extracted separately and independently by 2 reviewers. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrIs). RESULTS Nine RCTs were included (1570 patients, mean age 61.1 ± 13.8 years with 64% male). Noninvasive ventilation was associated with a significantly reduced intubation rate compared with standard oxygen therapy (OR: 0.53; 95% CrI: 0.26-0.91). There were no significant reductions of intubation between NIV versus HFNC (OR: 0.83; 95% CrI: 0.35-2.11) or HFNC versus standard oxygen therapy (OR: 0.65; 95% CrI: 0.26-1.24). There were no significant differences between all groups regarding short-term (28-day or ICU) mortality or long-term (90-day or hospital) mortality or ICU-acquired infections (P > 0.05). CONCLUSION Among immunocompromised patients with AHRF, NIV was associated with a significant reduction of intubation compared with standard oxygen therapy. There were no significant differences among all oxygenation strategies regarding mortality and ICU-acquired infections.
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Affiliation(s)
- Yazan Zayed
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Momen Banifadel
- Internal Medicine Department, 89021University of Toledo, Toledo, OH, USA
| | - Mahmoud Barbarawi
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Babikir Kheiri
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Adam Chahine
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Laith Rashdan
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Tarek Haykal
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Varun Samji
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Emily Armstrong
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ghassan Bachuwa
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ibrahim Al-Sanouri
- Pulmonary and Critical Care Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Elfateh Seedahmed
- Pulmonary and Critical Care Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Dawn-Alita Hernandez
- Pulmonary and Critical Care Department, 89021University of Toledo, Toledo, OH, USA
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646
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Abstract
Non-invasive ventilation (NIV) given to the right patient, in the right setting, in the right way and at the right time improves outcomes. However, national audits reveal poor practice in patient selection, clinical judgement, treatment initiation and availability of trained staff. NIV is indicated for persistent acute hypercapnic respiratory failure (AHRF) with acidosis after usual medical management in chronic obstructive pulmonary disease (COPD) exacerbation and even without acidosis in neuromuscular disorders or other restrictive conditions eg obesity hypoventilation or kyphoscoliosis. Having trained staff in a suitable environment with adequate equipment are keys to its success, along with close monitoring. A plan should be put in place at the time of initiating NIV about the ceiling of care, eg escalation to intubation or palliation, if the patient is not improving with NIV. Early NIV failure is most likely due to technical issues, such as inadequate pressures or mask leak, while late failure is usually the consequence of advanced disease. Any presentation with AHRF is a poor prognostic indicator and outpatient respiratory follow-up is indicated following discharge. For selected patients with COPD who remain hypercapnic 2 weeks after an exacerbation, domiciliary NIV can reduce admissions and improve survival. For patients with neuromuscular disorders or kyphoscoliosis a presentation with AHRF almost always indicates the need for domiciliary NIV.
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647
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Catalanotti V, Pisani L, Betti S, Bensai S, Prediletto I, Fasano L, Nava S. Noninvasive ventilation and renal replacement therapy in do-not-intubate order critically ill patients: A brief report. CLINICAL RESPIRATORY JOURNAL 2019; 13:400-403. [PMID: 30942944 DOI: 10.1111/crj.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/19/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Multiple organ failure has been considered a contraindication for noninvasive ventilation (NIV). MATERIALS AND METHODS We described the outcome of Do-not-Intubate (DNI) patients with acute respiratory failure, treated with NIV and, subsequently, necessitating renal replacement therapy (RRT). RESULTS AND DISCUSSION Seven patients admitted to our Respiratory Intensive Care Unit, developed Acute Kidney Injury (AKI) during NIV treatment and received RRT for 12.8 ± 8 days together with NIV. All the patients but one, discontinued renal support because they regained a satisfactory urinary output; nevertheless mortality rate was high (71%). CONCLUSION Our data suggest that RRT could be feasible together with NIV. RRT was associated with an acute improvement in renal function but did not modify the mortality rate.
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Affiliation(s)
| | - Lara Pisani
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Sara Betti
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Serena Bensai
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Fasano
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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648
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Trethewey SP, Edgar RG, Morlet J, Mukherjee R, Turner AM. Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV. Respir Med 2019; 151:128-132. [PMID: 31047109 DOI: 10.1016/j.rmed.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) refractory to medical management in patients with COPD. This study investigated the relationship between time from hospital presentation to diagnosis of AHRF and in-hospital mortality. METHODS Retrospective analysis of hospitalised COPD patients treated with a first episode of ward-based NIV for AHRF at a large UK teaching hospital between 2004 and 2017. Data collected prospectively as part of NIV service evaluation. Multivariable logistic regression performed to identify predictors of in-hospital mortality. RESULTS In total, 547 unique patients were studied comprising 245 males (44.8%), median age 70.6 years, median FEV1% predicted 34%. Overall in-hospital mortality was 19% (n = 104); median survival was 1.7 years. In univariate analysis, a longer time between hospital presentation to diagnosis of AHRF was associated with in-hospital mortality (median [IQR]: 8.7 [0.7-75.8] hours vs. 1.9 [0.3-13.6] hours, p < 0.0001). In multivariable logistic regression, significant predictors of in-hospital mortality were AHRF >24 h after hospital presentation (odds ratio [95% CI]: 2.29 [1.33-3.95], p = 0.003), pneumonia on admission (1.81 [1.07-3.08], p = 0.027), increased age (1.10 [1.07-1.14], p < 0.001) and NIV as ceiling of treatment (5.86 [2.87-11.94], p < 0.001). CONCLUSIONS Hospitalised COPD patients with late presentation of AHRF, requiring acute ward-based NIV, may have increased in-hospital mortality. These patients may benefit from closer monitoring and earlier specialist respiratory review.
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Affiliation(s)
- Samuel P Trethewey
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ross G Edgar
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julien Morlet
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rahul Mukherjee
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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649
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Hui DS, Chow BK, Lo T, Tsang OTY, Ko FW, Ng SS, Gin T, Chan MTV. Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. Eur Respir J 2019; 53:13993003.02339-2018. [PMID: 30705129 DOI: 10.1183/13993003.02339-2018] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) is an emerging therapy for respiratory failure but the extent of exhaled air dispersion during treatment is unknown. We examined exhaled air dispersion during HFNC therapy versus continuous positive airway pressure (CPAP) on a human patient simulator (HPS) in an isolation room with 16 air changes·h-1. METHODS The HPS was programmed to represent different severity of lung injury. CPAP was delivered at 5-20 cmH2O via nasal pillows (Respironics Nuance Pro Gel or ResMed Swift FX) or an oronasal mask (ResMed Quattro Air). HFNC, humidified to 37°C, was delivered at 10-60 L·min-1 to the HPS. Exhaled airflow was marked with intrapulmonary smoke for visualisation and revealed by laser light-sheet. Normalised exhaled air concentration was estimated from the light scattered by the smoke particles. Significant exposure was defined when there was ≥20% normalised smoke concentration. RESULTS In the normal lung condition, mean±sd exhaled air dispersion, along the sagittal plane, increased from 186±34 to 264±27 mm and from 207±11 to 332±34 mm when CPAP was increased from 5 to 20 cmH2O via Respironics and ResMed nasal pillows, respectively. Leakage from the oronasal mask was negligible. Mean±sd exhaled air distances increased from 65±15 to 172±33 mm when HFNC was increased from 10 to 60 L·min-1. Air leakage to 620 mm occurred laterally when HFNC and the interface tube became loose. CONCLUSION Exhaled air dispersion during HFNC and CPAP via different interfaces is limited provided there is good mask interface fitting.
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Affiliation(s)
- David S Hui
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Benny K Chow
- Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Lo
- Dept of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Owen T Y Tsang
- Dept of Medicine, Princess Margaret Hospital, Hong Kong, Hong Kong SAR, China
| | - Fanny W Ko
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Susanna S Ng
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tony Gin
- Dept of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Matthew T V Chan
- Dept of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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650
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Huseini T, Manners D, Jones S, Piccolo F. External validation of the SAPS3-CNIV score to predict hospital mortality following noninvasive ventilation: a retrospective single-centre study. ERJ Open Res 2019; 5:00232-2018. [PMID: 30972348 PMCID: PMC6452042 DOI: 10.1183/23120541.00232-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
Prognostication tools are developed to assist clinical decision making and provide valid diagnostic and prognostic outcomes including mortality. Given significant disease and demographic heterogeneity, these tools have to be generally applicable to different patient populations. Therefore, once a model is developed it is internally and externally validated with subsequent clinical impact analyses after which its performance is evaluated and that particular model is then established. A retrospective single-centre study suggesting that patients with higher SAPS3-CNIV scores may be monitored in an ICU setting in order to reduce adverse patient events and optimal utilisation of resourceshttp://ow.ly/F5qp30o2OT7
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Affiliation(s)
- Taha Huseini
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - David Manners
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia.,Curtin Medical School, Curtin University, Bentley, Australia
| | - Simon Jones
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - Francesco Piccolo
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
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