651
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Grieco DL, Menga LS, Eleuteri D, Antonelli M. Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. Minerva Anestesiol 2019; 85:1014-1023. [PMID: 30871304 DOI: 10.23736/s0375-9393.19.13418-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. Experimental data suggest that not all subjects are exposed to the development of P-SILI: patients with a PaO2/FiO2 ratio below 200 mmHg may represent the most at risk population. For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation.
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Affiliation(s)
- Domenico L Grieco
- Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy - .,Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy -
| | - Luca S Menga
- Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy.,Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Davide Eleuteri
- Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy.,Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
| | - Massimo Antonelli
- Institute of Anesthesiology and Resuscitation, Sacred Heart Catholic University, Rome, Italy.,Department of Emergency, Anesthesiology and Resuscitation Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Rome, Italy
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652
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Fisser C, Spoletini G, Soe AK, Livesey A, Schreiber A, Swingwood E, Bos LD, Dreher M, Schultz MJ, Heunks L, Scala R. European Respiratory Society International Congress 2018: highlights from Assembly 2 on respiratory intensive care. ERJ Open Res 2019; 5:00198-2018. [PMID: 30847349 PMCID: PMC6397914 DOI: 10.1183/23120541.00198-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions held at the International Congress in Paris in 2018. For the highly esteemed reader who may have missed the Congress, a concise review was written on three topics: the state-of-the-art session on respiratory critical care, hot topics in weaning and the best abstracts in noninvasive ventilation. The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions from the 2018 #ERSCongress in Parishttp://ow.ly/6Du830nFESK
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Affiliation(s)
- Christoph Fisser
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Dept of Pneumology, Hospital Donaustauf, Donaustauf, Germany
| | - Giulia Spoletini
- Respiratory Dept, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Aung Kyaw Soe
- Dept of Hospital Therapy, Pediatric Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alana Livesey
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Annia Schreiber
- Dept of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
| | - Ema Swingwood
- Physiotherapy Dept - Adult Therapy Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lieuwe D Bos
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Michael Dreher
- Dept of Pneumology and Intensive Care Medicine, University Hospital Aachen, Germany
| | - Marcus J Schultz
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Leo Heunks
- Dept of Intensive Care, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
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653
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Nam H, Cho JH, Choi EY, Chang Y, Choi WI, Hwang JJ, Moon JY, Lee K, Kim SW, Kang HK, Sim YS, Park TS, Park SY, Park S. Current Status of Noninvasive Ventilation Use in Korean Intensive Care Units: A Prospective Multicenter Observational Study. Tuberc Respir Dis (Seoul) 2019; 82:242-250. [PMID: 30841017 PMCID: PMC6609522 DOI: 10.4046/trd.2018.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/29/2018] [Accepted: 11/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results A total of 156 patients treated with NIV were enrolled (mean age, 71.9±11.6 years). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.
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Affiliation(s)
- Hyunseung Nam
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Hwa Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Pulmonary and Critical Care Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Youjin Chang
- Department of Pulmonary and Critical Care Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Won Il Choi
- Department of Internal Medicine, Kyeimyung University Dongsan Hospital, Daegu, Korea
| | - Jae Joon Hwang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Young Moon
- Department of Pulmonary and Critical Care Medicine, Chungnam University Hospital, Daejeon, Korea
| | - Kwangha Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sei Won Kim
- Department of Pulmonary, Critical Care and Sleep Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yun Su Sim
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Seung Yong Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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654
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Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients? Expert Rev Respir Med 2019; 13:407-415. [PMID: 30704303 DOI: 10.1080/17476348.2019.1577732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The role of noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) in the home-setting remains controversial. Despite studies suggesting potential benefits, there is an apparent underutilization of such therapy in patients with stable COPD in a domiciliary setting. Areas covered: The reasons for underutilization in the home-setting are multifactorial, and we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed underutilization. In this article, we will discuss continuous PAP, bilevel PAP, and non-invasive positive pressure ventilation using a home ventilator (NIPPV). Expert commentary: Many patients with stable COPD and chronic respiratory failure do not receive NIPPV therapy at home despite supportive scientific evidence. Such underutilization suggests that there are barriers to implementation that include provider knowledge, health services, and payor policies. For patients with stable COPD without chronic respiratory failure, there is inadequate scientific evidence to support domiciliary NIPPV or CPAP therapy. In patients with stable COPD without chronic respiratory failure, studies aimed at identifying patient characteristics that determine the effectiveness of domiciliary NIPPV therapy needs further study. Future implementation and health-policy research with appropriate stakeholders are direly needed to help improve patient outcomes.
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655
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Thille AW, Joly F, Marjanovic N, Frat JP. High-flow oxygen therapy for the management of patients with acute exacerbation of cystic fibrosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S113. [PMID: 30740434 DOI: 10.21037/atm.2018.11.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Arnaud W Thille
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM CIC 1402 - ALIVE, Université de Poitiers, faculté de Médecine et Pharmacie, Poitiers, France
| | - Florent Joly
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM CIC 1402 - ALIVE, Université de Poitiers, faculté de Médecine et Pharmacie, Poitiers, France
| | - Nicolas Marjanovic
- INSERM CIC 1402 - ALIVE, Université de Poitiers, faculté de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Service d'Accueil des Urgences, Poitiers, France
| | - Jean-Pierre Frat
- CHU de Poitiers, Réanimation Médicale, Poitiers, France.,INSERM CIC 1402 - ALIVE, Université de Poitiers, faculté de Médecine et Pharmacie, Poitiers, France
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656
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Azoulay E, Mokart D, Kouatchet A, Demoule A, Lemiale V. Acute respiratory failure in immunocompromised adults. THE LANCET. RESPIRATORY MEDICINE 2019; 7:173-186. [PMID: 30529232 PMCID: PMC7185453 DOI: 10.1016/s2213-2600(18)30345-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undetermined cause, a standardised diagnostic investigation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.
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Affiliation(s)
- Elie Azoulay
- Assistance Publique Hôpitaux de Paris, Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Paris, France; ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut national de la santé et de la recherche médicale, Paris Diderot Sorbonne University, Paris, France.
| | - Djamel Mokart
- Medical Surgical Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Centre hospitalier universitaire d'Angers, Angers, France
| | - Alexandre Demoule
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Institut national de la santé et de la recherche médicale, Sorbonne Universités, Paris, France
| | - Virginie Lemiale
- Assistance Publique Hôpitaux de Paris, Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Paris, France; ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut national de la santé et de la recherche médicale, Paris Diderot Sorbonne University, Paris, France
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657
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Reychler G, Michotte JB. Development challenges and opportunities in aerosol drug delivery systems in non-invasive ventilation in adults. Expert Opin Drug Deliv 2019; 16:153-162. [DOI: 10.1080/17425247.2019.1572111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Jean-Bernard Michotte
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium
- Filière Physiothérapie, School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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658
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Hedsund C, Ankjærgaard KL, Rasmussen DB, Schwaner SH, Andreassen HF, Hansen EF, Wilcke JT. NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection. Eur Clin Respir J 2019; 6:1571332. [PMID: 30728926 PMCID: PMC6352931 DOI: 10.1080/20018525.2019.1571332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/07/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction: Hospital mortality among chronic obstructive pulmonary disease (COPD) patients receiving NIV for acute respiratory failure has shown to be significantly higher in clinical settings than in the randomized trials (RCTs) which clinical guidelines are based on. This may be due to the quality of care of NIV or patient selection. In daily clinical practice, we include patients with terminal pulmonary disease with a do-not-intubate (DNI) or a do-not-resuscitate (DNR) order with a high mortality risk compared to highly selected patients in RCTs. The aim of this study was to determine the role of patient selection for in-hospital mortality among patients receiving NIV for acute respiratory failure of COPD. Methods: We conducted a retrospective study including all patients receiving acute NIV due to acute respiratory failure at the respiratory wards in 2012–2013 at two hospitals in Greater Copenhagen. Results: Overall in-hospital mortality rate was 30%. In patients with a DNI/DNR order, mortality was 59% and in patients with no limitations in treatment 2%. Patients who fulfilled the exclusion criteria of the RCT by Plant et al. had a mortality of 41% compared to 25% in the remaining population. Conclusions: High overall in-hospital mortality reflects that patient selection in clinical practice is very different from RCT. Quality of acute NIV treatment seems acceptable in clinical practice for patients with less severe COPD and no limitations in treatment. Higher mortality in patients with DNI/DNR order may be due to inefficient NIV treatment for these patients with more severe COPD.
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Affiliation(s)
- Caroline Hedsund
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
| | | | - Daniel Bech Rasmussen
- Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Helle Frost Andreassen
- Department of Respiratory Medicine, University Hospital of Copenhagen, Bispebjerg Bakke, Denmark
| | | | - Jon Torgny Wilcke
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
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659
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Chalmers JD, Kolb M. The evolution of the European Respiratory Journal: volume 2. Eur Respir J 2019; 53:53/1/1802459. [PMID: 30655453 DOI: 10.1183/13993003.02459-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 11/05/2022]
Affiliation(s)
- James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Martin Kolb
- Firestone Institute for Respiratory Health St Joseph's Healthcare, Hamilton, ON, Canada
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660
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Comellini V, Pacilli AMG, Nava S. Benefits of non-invasive ventilation in acute hypercapnic respiratory failure. Respirology 2019; 24:308-317. [PMID: 30636373 DOI: 10.1111/resp.13469] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023]
Abstract
Non-invasive ventilation (NIV) with bilevel positive airway pressure is a non-invasive technique, which refers to the provision of ventilatory support through the patient's upper airway using a mask or similar device. This technique is successful in correcting hypoventilation. It has become widely accepted as the standard treatment for patients with hypercapnic respiratory failure (HRF). Since the 1980s, NIV has been used in intensive care units and, after initial anecdotal reports and larger series, a number of randomized trials have been conducted. Data from these trials have shown that NIV is a valuable treatment for HRF. This review aims to explore the principal areas in which NIV can be useful, focusing particularly on patients with acute HRF (AHRF). We will update the evidence base with the goal of supporting clinical practice. We provide a practical description of the main indications for NIV in AHRF and identify the group of patients with hypercapnic failure who will benefit most from the application of NIV.
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Affiliation(s)
- Vittoria Comellini
- Respiratory and Critical Care Unit, University Hospital St Orsola-Malpighi, Bologna, Italy
| | - Angela Maria Grazia Pacilli
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, University Hospital St Orsola-Malpighi, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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661
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Duca A, Rosti V, Brambilla AM, Cosentini R. Non-invasive ventilation in COPD exacerbation: how and why. Intern Emerg Med 2019; 14:139-142. [PMID: 30368718 DOI: 10.1007/s11739-018-1974-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Andrea Duca
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Rosti
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cosentini
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy.
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662
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Ventilación mecánica no invasiva versus presión continua positiva en la vía aérea en el edema agudo de pulmón cardiogénico en una unidad de cuidados intensivos. Arch Bronconeumol 2019; 55:63-64. [DOI: 10.1016/j.arbres.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022]
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663
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Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2019; 23:414-422. [PMID: 31645827 PMCID: PMC6775721 DOI: 10.5005/jp-journals-10071-23236] [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] [Indexed: 11/23/2022] Open
Abstract
Background Role of noninvasive ventilation (NIV) following extubation in patients with acute respiratory failure is debatable. NIV may provide benefit in post surgical patients, but its role in nonsurgical patients is controversial. Materials and methods PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials, where postextubation NIV has been compared with standard oxygen therapy in adult patients with acute respiratory failure. Results Data of 1525 patients from 11 randomized trials have been included in this meta-analysis. Two trials used NIV to manage post-extubation respiratory failure. Pooled analysis found that mortality rate at longest available follow-up [OR (95% CI) 0.84 (0.50, 1.42); p = 0.52] and reintubation rate [OR (95% CI) 0.75 (0.51, 1.09); p = 0.13] were similar between NIV and standard oxygen therapy. NIV did not decrease intubation rate when used as preventive modality [OR (95% CI) 0.65 (0.40, 1.06); p = 0.08]. Duration of ICU stay was also similar in the two groups [MD (95% CI) 0.46 (-0.43, 1.36) days; p = 0.3]. Conclusion Post extubation NIV in non- surgical patients with acute respiratory failure does not provide any benefit over conventional oxygen therapy. How to cite this article Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2019;23(9):414-422.
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Affiliation(s)
- Souvik Maitra
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Departmentof Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anirban Som
- Department of Anesthetics, Bradford Teaching Hospital, Bradfordshire, United Kingdom
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664
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Seyfi S, Amri P, Mouodi S. New modalities for non-invasive positive pressure ventilation: A review article. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:1-6. [PMID: 30858934 PMCID: PMC6386330 DOI: 10.22088/cjim.10.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/20/2018] [Accepted: 05/28/2018] [Indexed: 01/21/2023]
Abstract
Efficiency of non-invasive positive pressure ventilation in the treatment of respiratory failure has been shown in many published studies. In this review article, we introduced new modalities of non-invasive ventilation (NIV), clinical settings in which NIV can be used and a practical summary of the latest official guidelines published by the European Respiratory Clinical Practice. Clinical trials and review articles in four databases up to 25 February 2018 about new modalities of non-invasive positive pressure ventilation were reviewed. Commonly used modalities for treatment of respiratory failure include: CPAP (continuous positive airway pressure) and BiPAP (bilevel positive airway pressure) or NIPSV (noninvasive pressure support ventilation). The limitations of the BiPAP method are the trigger and cycle asynchrony, inadequate volume delivery and increased respiratory rate. Newer methods, such as adaptive servo-ventilation, have been developed to treat central and complex sleep apnea and the NAVA (neutrally adjusted ventilatory assist) to improve the trigger and cycle asynchrony. In the proportional assist ventilation, unlike the pressure support ventilation, with increased patient effort (flow) the tidal volume increases and it prevents the increase in the respiratory rate and respiratory distress. High-flow nasal cannula is a non-invasive technique that does not provide respiratory support, but provides a mixture of oxygen to the patient. The use of non-invasive pursed-lip breathing ventilation in chronic obstructive pulmonary disease (COPD) patients reduces dyspnea (decreases respiratory rate) and increases blood oxygen saturation. New modalities of NIV improve patient comfort and patient-ventilator interactions, and are recommended in patients with respiratory failure.
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Affiliation(s)
- Shahram Seyfi
- Clinical Research Development Unit of Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Parviz Amri
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Simin Mouodi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babal, Iran
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665
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Aliberti S, Rosti VD, Travierso C, Brambilla AM, Piffer F, Petrelli G, Minelli C, Camisa D, Voza A, Guiotto G, Cosentini R. A real life evaluation of non invasive ventilation in acute cardiogenic pulmonary edema: a multicenter, perspective, observational study for the ACPE SIMEU study group. BMC Emerg Med 2018; 18:61. [PMID: 30594135 PMCID: PMC6310941 DOI: 10.1186/s12873-018-0216-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND During the past three decades conflicting evidences have been published on the use of non-invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). The aim of this study is to describe the management of acute respiratory failure (ARF) due to ACPE in twelve Italian emergency departments (EDs). We evaluated prevalence, characteristics and outcomes of ACPE patients treated with oxygen therapy, continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (BiPAP) on admission to the EDs. METHODS In this multicenter, prospective, observational study, consecutive adult patients with ACPE were enrolled in 12 EDs in Italy from May 2009 to December 2013. Three study groups were identified according to the initial respiratory treatment: patients receiving oxygen therapy, those treated with CPAP and those treated with BiPAP. Treatment failure was evaluated as study outcome. RESULTS We enrolled 1293 patients with acute cardiogenic pulmonary edema. 273 (21%) began with oxygen, 788 (61%) with CPAP and 232 (18%) with BiPAP. One out of four patient who began with oxygen was subsequently switched to NIV and initial treatment with oxygen therapy had an odds ratio for treatment failure of 3.65 (95% CI: 2.55-5.23, p < 0.001). CONCLUSIONS NIV seems to be the first choice for treatment of ARF due to ACPE, showing high clinical effectiveness and representing a rescue option for patients not improving with conventional oxygen therapy.
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Affiliation(s)
- Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Cardio-Thoracic Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Travierso
- Respiratory Unit, ASST Rhodense Ospedale Salvini, Viale Forlanini 95, 20024 Garbagnate Milanese, Italy
| | - Anna Maria Brambilla
- Emergency Department, IRCCS Fondazione Ospedale Maggiore Policlinico Ca’ Granda, Milan, Italy
| | - Federico Piffer
- Department of Pulmonology, Hospital of Arco, APSS, Trento, Italy
| | - Giuseppina Petrelli
- Emergency Department, Presidio Ospedaliero Madonna del Soccorso, San Benedetto del Tronto, Ascoli Piceno, Italy
| | | | - Daniele Camisa
- Emergency Department, Vizzolo Predabissi Hospital, AO Melegnano, Milan, Italy
| | - Antonio Voza
- Emergency Department, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | | | - Roberto Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XIII, Bergamo, Italy
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666
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Cortegiani A, Crimi C, Sanfilippo F, Noto A, Di Falco D, Grasselli G, Gregoretti C, Giarratano A. High flow nasal therapy in immunocompromised patients with acute respiratory failure: A systematic review and meta-analysis. J Crit Care 2018; 50:250-256. [PMID: 30622042 DOI: 10.1016/j.jcrc.2018.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The role of high-flow nasal therapy (HFNT) as compared to conventional oxygen therapy (COT) in immunocompromised patients admitted to intensive care unit (ICU) with acute respiratory failure (ARF) remains unclear. We conducted a systematic review and meta-analysis in order to address this issue. METHODS We searched PubMed, Medline and Embase until November 7th, 2018. Randomized controlled trials (RCTs), non-randomized prospective and retrospective evidence were selected. Observational studies were considered for sensitivity analysis. Primary outcome was mortality rate; intubation rate was a secondary outcome. RESULTS We included four studies in the primary analysis: one RCT, two RCT's post-hoc analyses and one retrospective study. We found no significant difference in short-term mortality comparing HFNT vs. COT: 1) ICU: n = 872 patients, odds ratio (OR) = 0.80 [0.44,1.45], p = 0.46, I2 = 30%, p = 0.24; 2) 28-day: n = 996 patients, OR = 0.79 [0.45,1.38], p = 0.40, I2 = 52%, p = 0.12). Conversely, we found a reduction of intubation rate in the HFNT group (n = 1052 patients, OR = 0.74 [0.55,0.98], p = 0.03, I2 = 7%, p = 0.36). The inclusion of one observational study for sensitivity analysis did not grossly change results. CONCLUSIONS We found no benefit of HFNT over COT on mortality in immunocompromised patients with ARF. However, HFNT was associated with a lower intubation rate warranting further research.
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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, Palermo, Italy.
| | - Claudia Crimi
- Respiratory Medicine Unit, AOU "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Alberto Noto
- Anesthesia and Intensive Care Unit, AOU Policinico "G. Martino", Messina, Italy
| | - Davide Di Falco
- Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Festa del Perdono 1, 20122, Milan, 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, Palermo, 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, Palermo, Italy
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667
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Criner GJ, Jacobs MR, Zhao H, Marchetti N. Effects of Roflumilast on Rehospitalization and Mortality in Patients. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2018; 6:74-85. [PMID: 30775426 PMCID: PMC6373589 DOI: 10.15326/jcopdf.6.1.2018.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation portends the greatest risk of rehospitalization and mortality. Treatments that prevent hospitalizations could significantly lessen COPD morbidity and mortality. Methods: We performed a prospective, randomized, double-blind, placebo-controlled study of roflumilast 500 ug daily versus placebo in patients hospitalized for acute COPD exacerbation. Primary outcome was time to all-cause mortality or non-elective rehospitalization at 180 days post-randomization. Secondary outcomes were death or hospitalization from a respiratory cause, quality of life, change in health status, forced expiratory volume in 1 second (FEV1) and roflumilast tolerance. Results: A total of 64 patients with moderate to severe COPD (FEV1, 37.6 ± 16.4% predicted; 61% female, 61.6 ± 7.9 years old) were assigned to roflumilast or placebo. No deaths occurred in the follow-up period. There was no difference in the time to first readmission between the roflumilast and placebo groups (46.1 days versus 47.3 days respectively, p=0.93). There were 29 and 30 readmissions in the roflumilast and placebo groups, respectively (p=0.47). The St George's Respiratory Questionnaire (SGRQ) decreased 10.8 points and 7.8 points in the roflumilast and placebo groups, respectively and were not different. EuroQuality of Life Five Dimension scale (EQ5D) scores improved, but not significantly in either group. Weight loss and nausea were more common with roflumilast but not different from placebo. Change in glycosylated hemoglobin percentage (HgbA1C%) was not different between groups. Sub-analysis for the impact of chronic bronchitis did not affect outcomes. Conclusion: In this pilot study conducted in patients hospitalized with an exacerbation of COPD, roflumilast did not affect time to all-cause rehospitalization, quality of life, FEV1 or any other measured parameter.
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Affiliation(s)
- Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Michael R. Jacobs
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine and Temple School of Pharmacy, Temple University, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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668
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Vaschetto R, Longhini F, Persona P, Ori C, Stefani G, Liu S, Yi Y, Lu W, Yu T, Luo X, Tang R, Li M, Li J, Cammarota G, Bruni A, Garofalo E, Jin Z, Yan J, Zheng R, Yin J, Guido S, Della Corte F, Fontana T, Gregoretti C, Cortegiani A, Giarratano A, Montagnini C, Cavuto S, Qiu H, Navalesi P. Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Med 2018; 45:62-71. [PMID: 30535516 DOI: 10.1007/s00134-018-5478-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. METHODS Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. RESULTS We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0-7.0) vs. 5.5 (4.0-9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0-12.0) vs. 9.0 (6.5-12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13-32) vs. 27(18-39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. CONCLUSIONS In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.
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Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
- Università del Piemonte Orientale, via Solaroli 17, Novara, Italy
| | - Federico Longhini
- Ospedale Sant'Andrea, Anestesia e Rianimazione, Corso Abbiate 21, Vercelli, Italy
| | - Paolo Persona
- Emergency Department, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padua, Italy
| | - Carlo Ori
- Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Giulia Stefani
- Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Songqiao Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yang Yi
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Weihua Lu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Tao Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Xiaoming Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Rui Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Maoqin Li
- Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Jiaqiong Li
- Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Andrea Bruni
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Eugenio Garofalo
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Zhaochen Jin
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, 212002, Jiangsu, China
| | - Jun Yan
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, 212002, Jiangsu, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225000, Jiangsu, China
| | - Jingjing Yin
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225000, Jiangsu, China
| | - Stefania Guido
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
- Università del Piemonte Orientale, via Solaroli 17, Novara, Italy
| | - Tiziano Fontana
- Azienda Sanitaria Locale del Verbano Cusio Ossola, Anestesia e Rianimazione, Piazza Vittime dei Lager Nazifascisti 1, Domodossola, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Claudia Montagnini
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Silvio Cavuto
- Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, S.C. Infrastruttura Ricerca e Statistica, Via Amendola 2, Reggio Emilia, Italy
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Paolo Navalesi
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy.
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Ward-Based Non-Invasive Ventilation in Acute Exacerbations of COPD: A Narrative Review of Current Practice and Outcomes in the UK. Healthcare (Basel) 2018; 6:healthcare6040145. [PMID: 30544857 PMCID: PMC6315392 DOI: 10.3390/healthcare6040145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/30/2022] Open
Abstract
Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK.
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670
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Piper A, Chu CM. Non-invasive ventilation: Inspiring clinical practice. Respirology 2018; 24:306-307. [PMID: 30508875 DOI: 10.1111/resp.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chung-Ming Chu
- Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, SAR, People's Republic of China
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671
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Yeung J, Couper K, Ryan EG, Gates S, Hart N, Perkins GD. Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis. Intensive Care Med 2018; 44:2192-2204. [PMID: 30382306 PMCID: PMC6280833 DOI: 10.1007/s00134-018-5434-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE A systematic review and meta-analysis was conducted to answer the question 'In adults with respiratory failure requiring invasive ventilation for more than 24 h, does a weaning strategy with early extubation to non-invasive ventilation (NIV) compared to invasive ventilation weaning reduce all-cause hospital mortality?' METHODS We included randomised and quasi-randomised controlled trials that evaluated the use of non-invasive ventilation, compared to invasive ventilation, as a weaning strategy in adults mechanically ventilated for at least 24 h. The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) bibliographic databases were searched from inception to February 2018. Bayesian hierarchical models were used to perform the meta-analysis. The primary outcome was mortality at hospital discharge. Secondary outcomes included mortality (30, 60, 90 and 180 days), quality of life, duration of invasive ventilation, weaning failure, length of stay [intensive care unit (ICU) and hospital] and adverse events. RESULTS Twenty-five relevant studies involving 1609 patients were included in the quantitative analysis. Studies had moderate to high risk of bias due to risk of performance and detection bias. Mortality at hospital discharge was lower in the NIV weaning group compared to the invasive weaning group [pooled odds ratio (OR) 0.58, 95% highest density interval (HDI) 0.29-0.89]. Subgroup analyses showed lower pooled mortality at hospital discharge rates in NIV weaning than those in the control group in chronic obstructive pulmonary disease (COPD) patients (pooled OR 0.43, 95% HDI 0.13-0.81) and the effect is less certain in the mixed ICU population (pooled OR 0.88, 95% HDI 0.25-1.48). NIV weaning reduced the duration of invasive ventilation in patients [standardised mean difference (SMD) - 1.34, 95% HDI - 1.92 to - 0.77] and ICU length of stay (SMD - 0.70, 95% HDI - 0.94 to - 0.46). Reported rates of ventilator associated pneumonia (VAP) were lower in the NIV group. NIV weaning did not reduce overall hospital length of stay or long-term mortality. There were insufficient data to compare other adverse events and health-related quality of life. CONCLUSIONS The use of NIV in weaning from mechanical ventilation decreases hospital mortality, the incidence of VAP and ICU length of stay. NIV as a weaning strategy appears to be most beneficial in patients with COPD.
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Affiliation(s)
- Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
- Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth G Ryan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nick Hart
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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672
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Pharmacological Therapy of COPD. Chest 2018; 154:1404-1415. [DOI: 10.1016/j.chest.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
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673
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Hilbert G, Vargas F. My paper 20 years later: NIV in immunocompromized patients. Intensive Care Med 2018; 44:2225-2228. [DOI: 10.1007/s00134-018-5155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/28/2018] [Indexed: 11/30/2022]
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674
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Bourke SC, Piraino T, Pisani L, Brochard L, Elliott MW. Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice. THE LANCET RESPIRATORY MEDICINE 2018; 6:935-947. [DOI: 10.1016/s2213-2600(18)30388-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/31/2022]
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675
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Bräunlich J, Wirtz H. Nasal high-flow in acute hypercapnic exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3895-3897. [PMID: 30555226 PMCID: PMC6280891 DOI: 10.2147/copd.s185001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jens Bräunlich
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany,
| | - Hubert Wirtz
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany,
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676
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Dugan KC, Hall JB, Patel BK. High-Flow Nasal Oxygen-The Pendulum Continues to Swing in the Assessment of Critical Care Technology. JAMA 2018; 320:2083-2084. [PMID: 30357275 DOI: 10.1001/jama.2018.14287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Karen C Dugan
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
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677
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Elliott MW. Non-invasive ventilation: Essential requirements and clinical skills for successful practice. Respirology 2018; 24:1156-1164. [PMID: 30468277 DOI: 10.1111/resp.13445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
Audits and case reviews of the acute delivery of non-invasive ventilation (NIV) have shown that the results achieved in real life often fall short of those achieved in research trials. Factors include inappropriate selection of patients for NIV and failure to apply NIV correctly. This highlights the need for proper training of all involved individuals. This article addresses the different skills needed in a team to provide an effective NIV service. Some detail is given in each of the key areas but it is not comprehensive and should stimulate further learning (reading, attendance on courses, e-learning, etc.), determined by the needs of the individual.
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Affiliation(s)
- Mark W Elliott
- Department of Respiratory Medicine, St James's University Hospital, Leeds, UK
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678
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Cortegiani A, Accurso G, Mercadante S, Giarratano A, Gregoretti C. High flow nasal therapy in perioperative medicine: from operating room to general ward. BMC Anesthesiol 2018; 18:166. [PMID: 30414608 PMCID: PMC6230300 DOI: 10.1186/s12871-018-0623-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High flow nasal therapy (HFNT) is a technique in which humidified and heated gas is delivered to the airways through the nose via small nasal prongs at flows that are higher than the rates generally applied during conventional oxygen therapy. The delivered high flow rates combine mixtures of air and oxygen and enable different inspired oxygen fractions ranging from 0.21 to 1. HFNT is increasingly used in critically ill adult patients, especially hypoxemic patients in different clinical settings. MAIN BODY Noninvasive ventilation delivers positive pressure (end-expiratory and inspiratory pressures or continuous positive airway pressure) via different external interfaces. In contrast, HFNT produces different physiological effects that are only partially linked to the generation of expiratory positive airway pressure. HFNT and noninvasive ventilation (NIV) are interesting non-invasive supports in perioperative medicine. HFNT exhibits some advantages compared to NIV because HFNT is easier to apply and requires a lower nursing workload. Tolerance of HFNT remains a matter of intense debate, and it may be related to selected parameters. Patients receiving HFNT and their respiratory patterns should be closely monitored to avoid delays in intubation despite correct oxygenation parameters. CONCLUSION HFNT seems to be an interesting noninvasive support in perioperative medicine. The present review provides anesthesiologists with an overview of current evidence and practical advice on the application of HFNT in perioperative medicine in adult patients.
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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
| | - Giuseppe Accurso
- 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
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, 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
| | - 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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679
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Frat JP, Coudroy R, Thille AW. Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other? Respirology 2018; 24:724-731. [PMID: 30406954 DOI: 10.1111/resp.13435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a first-line strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in post-operative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.
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Affiliation(s)
- Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
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680
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Adler D, Dupuis-Lozeron E, Janssens JP, Soccal PM, Lador F, Brochard L, Pépin JL. Obstructive sleep apnea in patients surviving acute hypercapnic respiratory failure is best predicted by static hyperinflation. PLoS One 2018; 13:e0205669. [PMID: 30359410 PMCID: PMC6201889 DOI: 10.1371/journal.pone.0205669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022] Open
Abstract
Rationale Acute hypercapnic respiratory failure (AHRF) treated with non-invasive ventilation in the ICU is frequently caused by chronic obstructive pulmonary disease (COPD) exacerbations and obesity-hypoventilation syndrome, the latter being most often associated with obstructive sleep apnea. Overlap syndrome (a combination of COPD and obstructive sleep apnea) may represent a major burden in this population, and specific diagnostic pathways are needed to improve its detection early after ICU discharge. Objectives To evaluate whether pulmonary function tests can identify a high probability of obstructive sleep apnea in AHRF survivors and outperform common screening questionnaires to identify the disorder. Methods Fifty-three patients surviving AHRF (31 males; median age 67 years (interquartile range: 62–74) participated in the study. Anthropometric data were recorded and body plethysmography was performed 15 days after ICU discharge. A sleep study was performed 3 months after ICU discharge. Results The apnea-hypopnea index was negatively associated with static hyperinflation as measured by the residual volume to total lung capacity ratio in the % of predicted (coefficient = -0.64; standard error 0.17; 95% CI -0.97 to -0.31; p<0.001). A similar association was observed in COPD patients only: coefficient = -0.65; standard error 0.19; 95% CI -1.03 to -0.26; p = 0.002. Multivariate analysis with penalized maximum likelihood confirmed that the residual volume to total lung capacity ratio was the main contributor for apnea-hypopnea index variance in addition to classic predictors. Screening questionnaires to select patients at risk for sleep-disordered breathing did not perform well. Conclusions In AHRF survivors, static hyperinflation is negatively associated with the apnea-hypopnea index in both COPD and non-COPD patients. Measuring static hyperinflation in addition to classic predictors may help to increase the recognition of obstructive sleep apnea as common screening tools are of limited value in this specific population.
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Affiliation(s)
- Dan Adler
- Service de Pneumologie, Département des spécialités de médecine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
- * E-mail:
| | - Elise Dupuis-Lozeron
- Division d’épidémiologie clinique, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Paul Janssens
- Service de Pneumologie, Département des spécialités de médecine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Paola M. Soccal
- Service de Pneumologie, Département des spécialités de médecine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Frédéric Lador
- Service de Pneumologie, Département des spécialités de médecine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Laurent Brochard
- Keenan Research Center and Li Ka Shing Knowledge Institute, Department of Critical Care, St Michael’s Hospital, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Jean-Louis Pépin
- Service de Pneumologie, Département des spécialités de médecine, Geneva University Hospitals, Geneva, Switzerland
- Laboratoire HP2, Inserm 1042, Université Grenoble Alpes, Grenoble, France
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681
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David-João PG, Guedes MH, Réa-Neto Á, Chaiben VBDO, Baena CP. Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis. J Crit Care 2018; 49:84-91. [PMID: 30388493 DOI: 10.1016/j.jcrc.2018.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Evaluate current recommendation for the use of noninvasive ventilation (Bi-level positive airway pressure- BiPAP modality) in hypoxemic acute respiratory failure, excluding chronic obstructive pulmonary disease. METHODS Electronic searches in MEDLINE, Web of Science, Clinical Trials, and The Cochrane Central Register of Controlled Clinical Trials. We searched for randomized controlled trials comparing BiPAP to a control group in patients with hypoxemic acute respiratory failure. Endotracheal intubation and death were the assessed outcomes. RESULTS Of the 563 studies found, nine met the inclusion criteria for this systematic review. The pooled RR (95% CI) for intubation in patients with acute pulmonary edema (APE)/community acquired pneumonia (CAP) and in immunosuppressed patients (cancer and transplants) were 0.61 (0.39-0.84) and 0.77 (0.60-0.93), respectively. For Intensive Care Units (ICU) mortality, the RR (95% CI) in patients with APE/CAP was 0.51 (0.22-0.79). The heterogeneity was low in all comparisons. CONCLUSIONS NIV showed a significant protective effect for intubation in immunosuppressed patients (cancer and transplants) and in patients with APE/CAP. However, the benefits of NIV for other etiologies are not clear and more trials are needed to prove these effects.
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Affiliation(s)
| | - Murilo H Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | | | - Cristina P Baena
- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; CEPI - Centro de Ensino Pesquisa e Inovação, Hospital Marcelino Champagnat, Curitiba, Brazil.
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682
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Spoletini G, Mega C, Pisani L, Alotaibi M, Khoja A, Price LL, Blasi F, Nava S, Hill NS. High-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial. J Crit Care 2018; 48:418-425. [PMID: 30321833 DOI: 10.1016/j.jcrc.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV). METHODS Multicenter trial including patients (n = 54) anticipated to receive NIV for ≥24 h due to acute or acute-on-chronic respiratory failure. Subjects were randomized (1:1) to SO or HFNT during breaks off NIV. Primary outcome was total time on and off NIV. Secondary outcomes were comfort and dyspnea, respiratory rate (RR), oxygen saturation (SpO2), tolerance and side effects. RESULTS Total time per patient on NIV (1315 vs 1441 min) and breaks (1362 vs 1196 min), and mean duration of each break (520 vs 370 min) were similar in the HFNT and SO arms (p > .05). Comfort score was higher on HFNT than on SO (8.3 ± 2.7 vs 6.9 ± 2.3, p = .001). Dyspnea, RR and SpO2 were similar in the two arms, but the increase in RR and dyspnea seen with SO during breaks did not occur with HFNT. CONCLUSION Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.
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Affiliation(s)
- Giulia Spoletini
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Chiara Mega
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Lara Pisani
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Mona Alotaibi
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Alia Khoja
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA; The Institute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston, MA, USA
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Ca' Granda, Milan, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, Ospedale Sant'Orsola Malpighi, Alma Mater University, Bologna, Italy
| | - Nicholas S Hill
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA.
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683
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Crisafulli E, Barbeta E, Ielpo A, Torres A. Management of severe acute exacerbations of COPD: an updated narrative review. Multidiscip Respir Med 2018; 13:36. [PMID: 30302247 PMCID: PMC6167788 DOI: 10.1186/s40248-018-0149-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
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Affiliation(s)
- Ernesto Crisafulli
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enric Barbeta
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonella Ielpo
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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684
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Singha S, BaHammam A, Esquinas AM. Non-invasive ventilation in low- and low-middle income countries: Insights for real-world analysis. J Crit Care 2018; 47:352. [DOI: 10.1016/j.jcrc.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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685
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Management of Dyspnea in the Terminally Ill. Chest 2018; 154:925-934. [DOI: 10.1016/j.chest.2018.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 11/21/2022] Open
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686
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Gershon AS, Jafarzadeh SR, Wilson KC, Walkey AJ. Clinical Knowledge from Observational Studies. Everything You Wanted to Know but Were Afraid to Ask. Am J Respir Crit Care Med 2018; 198:859-867. [DOI: 10.1164/rccm.201801-0118pp] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Kevin C. Wilson
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Allan J. Walkey
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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687
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Skoczyński S, Scala R, Navalesi P. Survey on accessibility and real-life application of noninvasive ventilation. ERJ Open Res 2018; 4:00062-2018. [PMID: 30402452 PMCID: PMC6213288 DOI: 10.1183/23120541.00062-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/07/2018] [Indexed: 11/05/2022] Open
Abstract
Noninvasive mechanical ventilation (NIV) is an accepted method of respiratory failure treatment; however, at present, little is known about the global factors limiting NIV application. A survey designed to determine NIV accessibility and limiting factors in world economies and regions was developed. The questionnaire was sent to members of the European Respiratory Society (ERS) Respiratory Intensive Care Assembly and all ERS National Delegates. Replies to the survey were collected from 161 respondents from 46 countries. NIV was found to be provided most frequently by pulmonologists and intensivists. In high-income economies (HIEs), NIV reimbursement in chronic respiratory failure treatment was found to be independent of the underlying disease and supplementary insurance (p<0.0001), whereas in upper-middle-income economies (UMIEs) it was found to be dependent on the underlying disease (p<0.0001). In chronic respiratory failure, NIV was not reimbursed in lower-middle-income economies (LMIEs) (p<0.0001). In LMIEs and UMIEs, the lack of financial resources was the main limiting factor in acute (p=0.007) and chronic respiratory failure (p<0.0001). In the income-level-based assessment, financing was recognised as relevant in LMIEs and UMIEs (p<0.0001), equipment in LMIEs and UMIEs (p=0.03), medical staff in all economies (p=0.02), and legal regulations in LMIEs (p=0.0005). It was confirmed that NIV in acute and chronic respiratory failure is reimbursed based on government regulations in UMIEs and HIEs (p<0.0001), and is not reimbursed and probably will not be reimbursed in the near future in LMIEs (p<0.0001). We conclude that financial constraints are still considered a major limiting factor for NIV use.
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Affiliation(s)
- Szymon Skoczyński
- Dept of Pulmonology, School of Medicine in Katowice, The Medical University of Silesia, Katowice, Poland
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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688
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Oxygenation/non-invasive ventilation strategy and risk for intubation in immunocompromised patients with hypoxemic acute respiratory failure. Oncotarget 2018; 9:33682-33693. [PMID: 30263094 PMCID: PMC6154743 DOI: 10.18632/oncotarget.26069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023] Open
Abstract
We investigated how the initial ventilation/oxygenation management may influence the need for intubation on the coming day in a cohort of immunocompromised patients with acute hypoxemic respiratory failure (ARF). Data from 847 immunocompromised patients with ARF were used to estimate the probability of intubation at day+1 within the first 3 days of ICU admission, according to oxygenation management. First, noninvasive ventilation (NIV) was compared to oxygen therapy whatever the administration device; then standard oxygen was compared to High Flow Nasal Cannula therapy alone (HFNC), NIV alone or NIV+HFNC. To take into account the oxygenation regimens over time and to handle confounders, propensity score weighting models were used. In the original sample, the probability of intubation at day+1 was higher in the NIV group vs oxygenation therapy (OR = 1.64, 95CI, 1.09–2.48) or vs the standard oxygen group (OR = 2.05, 95CI: 1.29–3.29); it was also increased in the HFNC group compared to standard oxygen (OR = 2.85, 95CI: 1.37–5.67). However, all these differences disappeared by handling confounding-by-indication in the weighted samples, as well as in the pooled model. Note that adjusted OR for day-28 mortality increased with the day of intubation. In this large cohort of immunocompromised patients, ventilation/oxygenation management had no impact on the probability of intubation on the coming day.
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689
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Abstract
Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.
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Affiliation(s)
- Brian O'Gara
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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690
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Schreiber A, Fusar Poli B, Bos LD, Nenna R. Noninvasive ventilation in hypercapnic respiratory failure: from rocking beds to fancy masks. Breathe (Sheff) 2018; 14:235-237. [PMID: 30186523 PMCID: PMC6118891 DOI: 10.1183/20734735.018918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Significant developments have occurred in noninvasive ventilation (NIV) over the past two to three decades, such that it is now one of the most evidence-based areas of respiratory medicine. NIV is now part of the standard of care for a variety of conditions such as hypercapnic respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary oedema [1, 2] and it has gained prominence in other settings such as in weaning from invasive mechanical ventilation (IMV), in the postoperative period and in palliative care [3]. Indications for the use of NIV continue to expand. A chronological account of some of the significant research into the application of NIV in acute hypercapnic respiratory failure over recent decadeshttp://ow.ly/L5bZ30ktEG6
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Affiliation(s)
- Annia Schreiber
- Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Barbara Fusar Poli
- Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Lieuwe D Bos
- Academic Medical Center, University of Amsterdam, Dept of Respiratory Medicine and Dept of Intensive Care, Amsterdam, The Netherlands
| | - Raffaella Nenna
- Dept of Paediatrics; "Sapienza" University of Rome, Rome, Italy
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691
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Thille AW, Muller G, Gacouin A, Coudroy R, Demoule A, 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, Picard W, Bourenne J, Pradel G, Bailly P, Terzi N, Buscot M, Lacave G, Danin PE, Nanadoumgar H, Gibelin A, Zanre L, Deye N, Ragot S, Frat JP. High-flow nasal cannula oxygen therapy alone or with non-invasive ventilation during the weaning period after extubation in ICU: the prospective randomised controlled HIGH-WEAN protocol. BMJ Open 2018; 8:e023772. [PMID: 30185583 PMCID: PMC6129104 DOI: 10.1136/bmjopen-2018-023772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk. Whereas HFNC may be considered as an optimal therapy during the postextubation period, HFNC associated with NIV could be an additional means of preventing postextubation respiratory failure. We are hypothesising that treatment associating NIV with HFNC between NIV sessions may be more effective than HFNC alone and may reduce the reintubation rate in patients at high risk. METHODS AND ANALYSIS This study is an investigator-initiated, multicentre randomised controlled trial comparing HFNC alone or with NIV sessions during the postextubation period in patients at high risk of extubation failure in the ICU. Six hundred patients will be randomised with a 1:1 ratio in two groups according to the strategy of oxygenation after extubation. The primary outcome is the reintubation rate within the 7 days following planned extubation. Secondary outcomes include the number of patients who meet the criteria for moderate/severe respiratory failure, ICU length of stay and mortality up to day 90. 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 NCT03121482.
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Affiliation(s)
- Arnaud W Thille
- Department of Réanimation Médicale, CHU de Poitiers, Poitiers, France
- Université de Poitiers, INSERM CIC 1402 ALIVE, Poitiers, France
| | - Grégoire Muller
- Médecine Intensive Réanimation, Groupe Hospitalier Régional d'Orléans, Orléans, France
| | - Arnaud Gacouin
- Service des Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Hôpital Ponchaillou, Rennes, France
| | - Rémi Coudroy
- Department of Réanimation Médicale, CHU de Poitiers, Poitiers, France
- Université de Poitiers, INSERM CIC 1402 ALIVE, Poitiers, France
| | - Alexandre Demoule
- Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Romain Sonneville
- Hôpital Bichat - Claude Bernard, Médecine Intensive Réanimation, AP-HP, Université Paris Diderot, Paris, France
| | - François Beloncle
- Département de Médecine Intensive - Réanimation, Université d'Angers, CHU d'Angers, Angers, France
| | - Christophe Girault
- Département de Réanimation Médicale, Normandie Université, UNIROUEN, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), CHU de Rouen, Hôpital Charles Nicolle, Rouen, France
| | - Laurence Dangers
- Service de Réanimation Polyvalente, CHU Félix Guyon, Saint Denis de la Réunion, France
| | - Alexandre Lautrette
- Service de Réanimation Médicale, CHU de Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Séverin Cabasson
- Service de Réanimation, Centre hospitalier de la Rochelle, La Rochelle, Nouvelle-Aquitaine, France
| | - Anahita Rouzé
- Centre de Réanimation, Université de Lille, CHU de Lille, Lille, France
| | - Emmanuel Vivier
- Reanimation Polyvalente, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Anthony Le Meur
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Jean-Damien Ricard
- Réanimation Médico-Chirurgicale, AP-HP, INSERM, Université Paris Diderot, UMR IAME 1137, Sorbonne Paris Cité, Hopital Louis-Mourier, Colombes, France
| | - Keyvan Razazi
- Service de Réanimation Médicale DHU A-TVB, AP-HP, Hopitaux Universitaires Henri Mondor, Creteil, Île-de-France, France
| | - Guillaume Barberet
- Service de Réanimation Médicale, Groupe Hospitalier Régional Mulhouse Sud Alsace, Site Emile Muller, Mulhouse, France
| | - Christine Lebert
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Stephan Ehrmann
- CHU de Tours, Médecin Intensive Réanimation, CIC 1415, CRICS-TriggerSEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Walter Picard
- Service de Réanimation, Centre Hospitalier de Pau, Pau, France
| | - Jeremy Bourenne
- CHU La Timone 2, Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, Marseille, France
| | - Gael Pradel
- Service de Réanimation, Centre Hospitalier Henri Mondor d'Aurillac, Aurillac, France
| | - Pierre Bailly
- Médecine Intensive Réanimation, CHU de Brest, Brest, France
| | - Nicolas Terzi
- Médecine Intensive Réanimation, INSERM, Université Grenoble-Alpes, U1042, HP2, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Matthieu Buscot
- Réanimation Médicale Archet 1, Université Cote d'Azur, CHU de Nice, Nice, France
| | - Guillaume Lacave
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Pierre-Eric Danin
- Réanimation Médico-Chirurgicale Archet 2, INSERM U 1065, CHU de Nice, Nice, France
| | | | - Aude Gibelin
- Réanimation et USC médico-chirurgicale, CARMAS, AP-HP, Faculté de Médecine Sorbonne Université, Collegium Galilée, Hopital Tenon, Paris, France
| | - Lassane Zanre
- Service de Réanimation, Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Nicolas Deye
- Réanimation Médicale et Toxicologique, AP-HP, INSERM UMR-S 942, Hopital Lariboisiere, Paris, France
| | - Stéphanie Ragot
- Université de Poitiers, INSERM CIC 1402 ALIVE, Poitiers, France
| | - Jean-Pierre Frat
- Department of Réanimation Médicale, CHU de Poitiers, Poitiers, France
- Université de Poitiers, INSERM CIC 1402 ALIVE, Poitiers, France
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692
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Zerman A, Aydogdu M, Gursel G. Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients: reply. Intern Emerg Med 2018; 13:977-978. [PMID: 29774492 DOI: 10.1007/s11739-018-1862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Avsar Zerman
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Muge Aydogdu
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Gul Gursel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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693
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Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:355. [PMID: 30370282 DOI: 10.21037/atm.2018.04.39] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiogenic pulmonary edema (CPE) is among the most common causes of acute respiratory failure (ARF) in the acute care setting and often requires ventilatory assistance. In patients with ARF due to CPE, use of non-invasive positive airway pressure can decrease the systemic venous return and the left ventricular (LV) afterload, thus reducing LV filling pressure and limiting pulmonary edema. In these patients, either non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) can improve vital signs and physiological parameters, decreasing the need for endotracheal intubation (ETI) and hospital mortality when compared to conventional oxygen therapy. Results on the use of NIV or CPAP in patients with CPE prior to hospitalization are not homogeneous among studies, hampering any conclusive recommendation regarding their role in the pre-hospital setting.
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Affiliation(s)
- Giuseppe Bello
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo De Santis
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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694
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Peñuelas Ó, Esteban A. Noninvasive ventilation for acute respiratory failure: the next step is to know when to stop. Eur Respir J 2018; 52:52/2/1801185. [PMID: 30093558 DOI: 10.1183/13993003.01185-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Óscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Spain
| | - Andrés Esteban
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Spain
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695
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Di Mussi R, Spadaro S, Stripoli T, Volta CA, Trerotoli P, Pierucci P, Staffieri F, Bruno F, Camporota L, Grasso S. High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:180. [PMID: 30071876 PMCID: PMC6091018 DOI: 10.1186/s13054-018-2107-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. METHODS This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88-92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. RESULTS EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). CONCLUSIONS In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O2 therapy.
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Affiliation(s)
- Rosa Di Mussi
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Tania Stripoli
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Paolo Trerotoli
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Cattedra di Statistica Medica, Università degli Studi Aldo Moro, Bari, Italy
| | - Paola Pierucci
- Dipartimento di Medicina Respiratoria e del Sonno, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Staffieri
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Chirurgia Veterinaria, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Bruno
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, and Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Salvatore Grasso
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy.
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696
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Segovia B, Velasco D, Jaureguizar Oriol A, Díaz Lobato S. Combination Therapy in Patients with Acute Respiratory Failure: High-Flow Nasal Cannula and Non-Invasive Mechanical Ventilation. Arch Bronconeumol 2018; 55:166-167. [PMID: 30017253 DOI: 10.1016/j.arbres.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Bárbara Segovia
- Sanatorio Colegiales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Diurbis Velasco
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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697
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Scala R, Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success? Eur Respir Rev 2018; 27:27/149/180029. [DOI: 10.1183/16000617.0029-2018] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best “ingredients” for a “successful recipe” (i.e.patient selection, interface, ventilator, interface,etc.) and to avoid a delayed intubation if the ventilation attempt fails.
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698
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Grensemann J, Fuhrmann V, Kluge S. Oxygen Treatment in Intensive Care and Emergency Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:455-462. [PMID: 30064624 PMCID: PMC6111205 DOI: 10.3238/arztebl.2018.0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/02/2017] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oxygen treatment is often life-saving, but multiple studies in recent years have yielded evidence that the indiscriminate administration of oxygen to patients in the intensive care unit and emergency room can cause hyperoxia and thereby elevate mortality. METHODS This review is based on prospective, randomized trials concerning the optimum use of oxygen in adult medicine, which were retrieved by a selective search in PubMed, as well as on pertinent retrospective studies and guideline recommendations. RESULTS 13 prospective, randomized trials involving a total of 17 213 patients were analyzed. In patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and in ventilated intensive-care patients, normoxia was associated with a lower mortality than hyperoxia (2% vs. 9%). In patients with myocardial infarction, restrictive oxygen administration was associated with a smaller infarct size on cardiac MRI at 6 months compared to oxygen administration at 8 L/min (13.1 g vs. 20.3 g). For patients with stroke, the currently available data do not reveal any benefit or harm from oxygen administration. None of the trials showed any benefit from the administration of oxygen to non-hypoxemic patients; in fact, this was generally associated with increased morbidity or mortality. CONCLUSION Hypoxemia should certainly be avoided, but the fact that the liberal administration of oxygen to patients in intensive care units and emergency rooms tends to increase morbidity and mortality implies the advisability of a conservative, normoxic oxygenation strategy.
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Affiliation(s)
- Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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699
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Raurell-Torredà M, Argilaga-Molero E, Colomer-Plana M, Ródenas-Francisco A, Garcia-Olm M. Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences. ENFERMERIA INTENSIVA 2018; 30:21-32. [PMID: 29954679 DOI: 10.1016/j.enfi.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences. METHOD Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]). RESULTS Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment. CONCLUSIONS There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.
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Affiliation(s)
- M Raurell-Torredà
- Escuela de Enfermería, Facultad Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
| | - E Argilaga-Molero
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - M Colomer-Plana
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, España
| | | | - M Garcia-Olm
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, España
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700
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Davies MG, Juniper MC. Lessons learnt from the National Confidential Enquiry into Patient Outcome and Death: Acute non-invasive ventilation. Thorax 2018. [DOI: 10.1136/thoraxjnl-2018-211901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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