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Helms J, Catoire P, Abensur Vuillaume L, Bannelier H, Douillet D, Dupuis C, Federici L, Jezequel M, Jozwiak M, Kuteifan K, Labro G, Latournerie G, Michelet F, Monnet X, Persichini R, Polge F, Savary D, Vromant A, Adda I, Hraiech S. Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference. Ann Intensive Care 2024; 14:140. [PMID: 39235690 PMCID: PMC11377397 DOI: 10.1186/s13613-024-01367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023. METHODS A committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. RESULTS The jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made? CONCLUSION These recommendations should optimize the use of oxygen during ARF.
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Affiliation(s)
- Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.
- UMR 1260, Regenerative Nanomedicine (RNM), FMTS, INSERM (French National Institute of Health and Medical Research), Strasbourg, France.
| | - Pierre Catoire
- Emergency Medicine Department, University Hospital of Bordeaux, 1 Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Laure Abensur Vuillaume
- SAMU57, Service d'Accueil des Urgences, Centre Hospitalier Régional Metz-Thionville, 57530, Ars-Laquenexy, France
| | - Héloise Bannelier
- Service d'Accueil des Urgences - SMUR Hôpital Pitié Salpêtrière Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Delphine Douillet
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Réanimation Médicale, Clermont-Ferrand, France
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRAe, CRNH Auvergne, 63000, Clermont-Ferrand, France
| | - Laura Federici
- Service d'Anesthésie Réanimation, Centre Hospitalier D'Ajaccio, Ajaccio, France
| | - Melissa Jezequel
- Unité de Soins Intensifs Cardiologiques, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, CHU de Nice, 151 Route Saint Antoine de Ginestière, 06200, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | | | - Guylaine Labro
- Service de Réanimation Médicale GHRMSA, 68100, Mulhouse, France
| | - Gwendoline Latournerie
- Pole de Médecine d'Urgence- CHU Toulouse, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Fabrice Michelet
- Service de Réanimation, Hôpital de Saint Brieuc, Saint-Brieuc, France
| | - Xavier Monnet
- AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Romain Persichini
- Service de Réanimation et Soins Continus, CH de Saintes, Saintes, France
| | - Fabien Polge
- Hôpitaux Universitaires de Paris Centre Site Cochin APHP, Paris, France
| | - Dominique Savary
- Département de Médecine d'Urgences, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
- IRSET Institut de Recherche en Santé, Environnement et Travail/Inserm EHESP - UMR_S1085, CAPTV CDC, 49000, Angers, France
| | - Amélie Vromant
- Service d'Accueil des Urgences, Hôpital La Pitié Salpetrière, Paris, France
| | - Imane Adda
- Department of Research, One Clinic, Paris, France
- PointGyn, Paris, France
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de Médecine, Centre d'Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
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Crescioli E, Nielsen FM, Bunzel AM, Eriksen ASB, Siegemund M, Poulsen LM, Andreasen AS, Bestle MH, Iversen SA, Brøchner AC, Grøfte T, Hildebrandt T, Laake JH, Kjær MBN, Lange T, Perner A, Klitgaard TL, Schjørring OL, Rasmussen BS. Long-term mortality and health-related quality of life with lower versus higher oxygenation targets in intensive care unit patients with COVID-19 and severe hypoxaemia. Intensive Care Med 2024:10.1007/s00134-024-07613-2. [PMID: 39235624 DOI: 10.1007/s00134-024-07613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE The aim of this study was to evaluate one-year outcomes of lower versus higher oxygenation targets in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. METHODS We conducted pre-planned analyses of one-year mortality and health-related quality of life (HRQoL) in the Handling Oxygenation Targets in COVID-19 trial. The trial randomised 726 ICU patients with COVID-19 and hypoxaemia to partial pressure of arterial oxygen targets of 8 kPa (60 mmHg) versus 12 kPa (90 mmHg) during ICU stay up to 90 days, including readmissions. HRQoL was assessed using EuroQol visual analogue scale (EQ-VAS) and 5-level 5-dimension questionnaire (EQ-5D-5L). Outcomes were analysed in the intention-to-treat population. Non-survivors were assigned the worst possible score (zero), and multiple imputation was applied for missing EQ-VAS values. RESULTS We obtained one-year vital status for 691/726 (95.2%) of patients and HRQoL data for 642/726 (88.4%). At one year, 117/348 (33.6%) of patients in the lower-oxygenation group had died compared to 134/343 (39.1%) in the higher-oxygenation group (adjusted risk ratio: 0.85; 98.6% confidence interval (CI) 0.66-1.09; p = 0.11). Median EQ-VAS was 50 (interquartile range, 0-80) versus 40 (0-75) (adjusted mean difference: 4.8; 98.6% CI - 2.2 to 11.9; p = 0.09) and EQ-5D-5L index values were 0.61 (0-0.81) in the lower-oxygenation group versus 0.43 (0-0.79) (p = 0.20) in the higher-oxygenation group, respectively. CONCLUSION Among adult ICU patients with COVID-19 and severe hypoxaemia, one-year mortality results were most compatible with benefit of the lower oxygenation target, which did not appear to result in more survivors with poor quality of life.
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Affiliation(s)
- Elena Crescioli
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Frederik Mølgaard Nielsen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Marie Bunzel
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Anne Sofie Broberg Eriksen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Martin Siegemund
- Department of Intensive Care, Acute Medicine, Basel University Hospital, Basel, Switzerland
| | | | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Herlev, Copenhagen, Denmark
| | - Morten Heiberg Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Andi Iversen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | | | - Thorbjørn Grøfte
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Jon Henrik Laake
- Department of Anaesthesia and Intensive Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Maj-Brit Nørregaard Kjær
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Thomas Lass Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Olav Lilleholt Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Lee KG, Roca O, Casey JD, Semler MW, Roman-Sarita G, Yarnell CJ, Goligher EC. When to intubate in acute hypoxaemic respiratory failure? Options and opportunities for evidence-informed decision making in the intensive care unit. THE LANCET. RESPIRATORY MEDICINE 2024; 12:642-654. [PMID: 38801827 DOI: 10.1016/s2213-2600(24)00118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 05/29/2024]
Abstract
The optimal timing of intubation in acute hypoxaemic respiratory failure is uncertain and became a point of controversy during the COVID-19 pandemic. Invasive mechanical ventilation is a potentially life-saving intervention but carries substantial risks, including injury to the lungs and diaphragm, pneumonia, intensive care unit-acquired muscle weakness, and haemodynamic impairment. In deciding when to intubate, clinicians must balance premature exposure to the risks of ventilation with the potential harms of unassisted breathing, including disease progression and worsening multiorgan failure. Currently, the optimal timing of intubation is unclear. In this Personal View, we examine a range of parameters that could serve as triggers to initiate invasive mechanical ventilation. The utility of a parameter (eg, the ratio of arterial oxygen tension to fraction of inspired oxygen) to predict the likelihood of a patient undergoing intubation does not necessarily mean that basing the timing of intubation on that parameter will improve therapeutic outcomes. We examine options for clinical investigation to make progress on establishing the optimal timing of intubation.
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Affiliation(s)
- Kevin G Lee
- Department of Physiology, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Jonathan D Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Christopher J Yarnell
- Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, ON, Canada; Scarborough Health Network, Department of Critical Care Medicine, Toronto, ON, Canada; Scarborough Health Network Research Institute, Toronto, ON, Canada.
| | - Ewan C Goligher
- Department of Physiology, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada
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Goury A, Houlla Z, Jozwiak M, Urbina T, Turpin M, Lavalard A, Laghlam D, Voicu S, Rosman J, Coutureau C, Mourvillier B. Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis. Respir Res 2024; 25:279. [PMID: 39010097 PMCID: PMC11251296 DOI: 10.1186/s12931-024-02873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia. METHODS In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality. RESULTS We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25.4%) int the NIV group compared with 59/233 (25.3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0.82 [95%CI, 0.50-1.35] (p = 0.434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10.0 days [IQR, 7.0-19.8] versus 18.0 days [IQR,11.0-31.0] with a propensity score weighted HR of 1.77 [95%CI, 1.29-2.43] (p < 0.001). A subgroup analysis showed a significant increase in mortality rate for intubated patients in the NIV group with 56/122 (45.9%), compared to 59/233 (25.3%) for patients in the straight intubation group (p < 0.001). CONCLUSIONS In severely hypoxemic COVID-19 patients, no significant differences were observed on 90-day mortality between patients receiving straight intubation and those receiving NIV after HFNO failure. NIV strategy was associated with a significant reduction in ICU length of stay, despite an increase in mortality in the subgroup of patients finally intubated.
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Affiliation(s)
- Antoine Goury
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France.
| | - Zeyneb Houlla
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Turpin
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandra Lavalard
- Unité de Réanimation Polyvalente, Centre Hospitalier de Troyes, Troyes, France
| | - Driss Laghlam
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jeremy Rosman
- Unité de Soins Intensifs et Réanimation, Groupe Hospitalier de Territoire Nord-Ardennes, Charleville-Mézières, France
| | - Claire Coutureau
- Université de Reims Champagne-Ardenne, VieFra, Reims, F-51100, France
- Unité d'Aide Méthodologique, CHU Reims, Reims, F-51100, France
| | - Bruno Mourvillier
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
- Université de Reims Champagne-Ardenne, EA-4684 CardioVir, Reims, F-51100, France
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Seow D, Khor YH, Khung SW, Smallwood DM, Ng Y, Pascoe A, Smallwood N. High-flow nasal oxygen therapy compared with conventional oxygen therapy in hospitalised patients with respiratory illness: a systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e002342. [PMID: 39009460 PMCID: PMC11268052 DOI: 10.1136/bmjresp-2024-002342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND High-flow nasal oxygen therapy (HFNO) is used in diverse hospital settings to treat patients with acute respiratory failure (ARF). This systematic review aims to summarise the evidence regarding any benefits HFNO therapy has compared with conventional oxygen therapy (COT) for patients with ARF. METHODS Three databases (Embase, Medline and CENTRAL) were searched on 22 March 2023 for studies evaluating HFNO compared with COT for the treatment of ARF, with the primary outcome being hospital mortality and secondary outcomes including (but not limited to) escalation to invasive mechanical ventilation (IMV) or non-invasive ventilation (NIV). Risk of bias was assessed using the Cochrane risk-of-bias tool (randomised controlled trials (RCTs)), ROBINS-I (non-randomised trials) or Newcastle-Ottawa Scale (observational studies). RCTs and observational studies were pooled together for primary analyses, and secondary analyses used RCT data only. Treatment effects were pooled using the random effects model. RESULTS 63 studies (26 RCTs, 13 cross-over and 24 observational studies) were included, with 10 230 participants. There was no significant difference in the primary outcome of hospital mortality (risk ratio, RR 1.08, 95% CI 0.93 to 1.26; p=0.29; 17 studies, n=5887) between HFNO and COT for all causes ARF. However, compared with COT, HFNO significantly reduced the overall need for escalation to IMV (RR 0.85, 95% CI 0.76 to 0.95 p=0.003; 39 studies, n=8932); and overall need for escalation to NIV (RR 0.70, 95% CI 0.50 to 0.98; p=0.04; 16 studies, n=3076). In subgroup analyses, when considering patients by illness types, those with acute-on-chronic respiratory failure who received HFNO compared with COT had a significant reduction in-hospital mortality (RR 0.58, 95% CI 0.37 to 0.91; p=0.02). DISCUSSION HFNO was superior to COT in reducing the need for escalation to both IMV and NIV but had no impact on the primary outcome of hospital mortality. These findings support recommendations that HFNO may be considered as first-line therapy for ARF. PROSPERO REGISTRATION NUMBER CRD42021264837.
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Affiliation(s)
- Daniel Seow
- Department of Internal Medicine, Sengkang General Hospital, Singapore
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Su-Wei Khung
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - David M Smallwood
- Department of Respiratory Medicine, Western Health, Footscray, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Yvonne Ng
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Amy Pascoe
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Koyama H, Sakai K, Fukaguchi K, Hadano H, Aida Y, Kamio T, Abe T, Nishii M, Takeuchi I. A comparison study of temporal trends of SARS-CoV2 RNAemia and biomarkers to predict success and failure of high flow oxygen therapy among patients with moderate to severe COVID-19. PLoS One 2024; 19:e0305077. [PMID: 38985808 PMCID: PMC11236165 DOI: 10.1371/journal.pone.0305077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Optimal timing for intubating patients with coronavirus disease 2019 (COVID-19) has been debated throughout the pandemic. Early use of high-flow nasal cannula (HFNC) can help reduce the need for intubation, but delay can result in poorer outcomes. This study examines trends in laboratory parameters and serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA levels of patients with COVID-19 in relation to HFNC failure. Patients requiring HFNC within three days of hospitalization between July 1 and September 30, 2021 were enrolled. The primary outcome was HFNC failure (early failure ≤Day 3; late failure ≥Day 4), defined as transfer to intensive care just before/after intubation or in-hospital death. We examined changes in laboratory markers and SARS-CoV2-RNAemia on Days 1, 4, and 7, together with demographic data, oxygenation status, and therapeutic agents. We conducted a univariate logistic regression with the explanatory variables defined as 10% change rate in each laboratory marker from Day 1 to 4. We utilized the log-rank test to assess the differences in HFNC failure rates, stratified based on the presence of SARS-CoV2 RNAemia. Among 122 patients, 17 (13.9%) experienced HFNC failure (early: n = 6, late: n = 11). Seventy-five patients (61.5%) showed an initial SpO2/FiO2 ratio ≤243, equivalent to PaO2/FiO2 ratio ≤200, and the initial SpO2/FiO2 ratio was significantly lower in the failure group (184 vs. 218, p = 0.018). Among the laboratory markers, a 10% increase from Day 1 to 4 of lactate dehydrogenase (LDH) and interleukin (IL)-6 was associated with late failure (Odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.09-1.89 and OR: 1.04, 95%CI: 1.00-1.19, respectively). Furthermore, in patients with persistent RNAemia on Day 4 or 7, the risk of late HFNC failure was significantly higher (Log-rank test, p<0.01). In conclusion, upward trends in LDH and IL-6 levels and the persistent RNAemia even after treatment were associated with HFNC failure.
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Affiliation(s)
- Hiroshi Koyama
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kiyomitsu Fukaguchi
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
- Center for Acute and General Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroki Hadano
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yoshihisa Aida
- Center for Acute and General Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tadashi Kamio
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Mototsugu Nishii
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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7
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Pereira AB, Pizzol FD, Veiga VC, Taniguchi LU, Misquita AF, Carvalho GAC, Silva LMCJ, Dadam MM, Fernandes RP, Maia IS, Zandonai CL, Cavalcanti AB, Romano MLP, Westphal GA. The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen. CRITICAL CARE SCIENCE 2024; 36:e20240203en. [PMID: 38958373 PMCID: PMC11208043 DOI: 10.62675/2965-2774.20240203-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/05/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019. METHODS This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula. RESULTS A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27). CONCLUSION The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.
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Affiliation(s)
- Aline Braz Pereira
- Centro Hospitalar UnimedIntensive Care UnitJoinvilleSCBrazilIntensive Care Unit, Centro Hospitalar Unimed - Joinville (SC), Brazil.
| | - Felipe Dal Pizzol
- Universidade do Extremo Sul CatarinensePostgraduate Program in Health SciencesCriciúmaSCBrazilPostgraduate Program in Health Sciences, Universidade do Extremo Sul Catarinense - Criciúma (SC), Brazil.
| | - Viviane Cordeiro Veiga
- BP - A Beneficência Portuguesa de São PauloIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Leandro Utino Taniguchi
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaSão PauloSPBrazilIntensive Care Unit, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Aline Finoti Misquita
- BP - A Beneficência Portuguesa de São PauloIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Gustavo Augusto Couto Carvalho
- BP - A Beneficência Portuguesa de São PauloIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Ligia Maria Coscrato Junqueira Silva
- BP - A Beneficência Portuguesa de São PauloIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Michelli Marcela Dadam
- Hospital Municipal São JoséIntensive Care UnitJoinvilleSCBrazilIntensive Care Unit, Hospital Municipal São José - Joinville (SC), Brazil.
| | - Ruthy Perotto Fernandes
- Centro Hospitalar UnimedIntensive Care UnitJoinvilleSCBrazilIntensive Care Unit, Centro Hospitalar Unimed - Joinville (SC), Brazil.
| | - Israel Silva Maia
- Hospital Nereu RamosIntensive Care UnitFlorianópolisSCBrazilIntensive Care Unit, Hospital Nereu Ramos - Florianópolis, Santa Catarina (SC), Brazil.
| | - Cassio Luis Zandonai
- Hospital Nereu RamosIntensive Care UnitFlorianópolisSCBrazilIntensive Care Unit, Hospital Nereu Ramos - Florianópolis, Santa Catarina (SC), Brazil.
| | - Alexandre Biasi Cavalcanti
- Hcor-Hospital do CoraçãoIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, Hcor-Hospital do Coração, Associação Beneficente Síria - São Paulo (SP), Brazil.
| | - Marcelo Luz Pereira Romano
- Hcor-Hospital do CoraçãoIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, Hcor-Hospital do Coração, Associação Beneficente Síria - São Paulo (SP), Brazil.
| | - Glauco Adrieno Westphal
- Centro Hospitalar UnimedIntensive Care UnitJoinvilleSCBrazilIntensive Care Unit, Centro Hospitalar Unimed - Joinville (SC), Brazil.
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8
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Kwizera A, Kabatoro D, Owachi D, Kansiime J, Kateregga G, Nanyunja D, Sendagire C, Nyakato D, Olaro C, Audureau E, Mekontso Dessap A. Respiratory support with standard low-flow oxygen therapy, high-flow oxygen therapy or continuous positive airway pressure in adults with acute hypoxaemic respiratory failure in a resource-limited setting: protocol for a randomised, open-label, clinical trial - the Acute Respiratory Intervention StudiEs in Africa (ARISE-AFRICA) study. BMJ Open 2024; 14:e082223. [PMID: 38951007 PMCID: PMC11218023 DOI: 10.1136/bmjopen-2023-082223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/19/2024] [Indexed: 07/03/2024] Open
Abstract
RATIONALE Acute hypoxaemic respiratory failure (AHRF) is associated with high mortality in sub-Saharan Africa. This is at least in part due to critical care-related resource constraints including limited access to invasive mechanical ventilation and/or highly skilled acute care workers. Continuous positive airway pressure (CPAP) and high-flow oxygen by nasal cannula (HFNC) may prove useful to reduce intubation, and therefore, improve survival outcomes among critically ill patients, particularly in resource-limited settings, but data in such settings are lacking. The aim of this study is to determine whether CPAP or HFNC as compared with standard oxygen therapy, could reduce mortality among adults presenting with AHRF in a resource-limited setting. METHODS This is a prospective, multicentre, randomised, controlled, stepped wedge trial, in which patients presenting with AHRF in Uganda will be randomly assigned to standard oxygen therapy delivered through a face mask, HFNC oxygen or CPAP. The primary outcome is all-cause mortality at 28 days. Secondary outcomes include the number of patients with criteria for intubation at day 7, the number of patients intubated at day 28, ventilator-free days at day 28 and tolerance of each respiratory support. ETHICS AND DISSEMINATION The study has obtained ethical approval from the Research and Ethics Committee, School of Biomedical Sciences, College of Health Sciences, Makerere University as well as the Uganda National Council for Science and Technology. Patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04693403. PROTOCOL VERSION 8 September 2023; version 5.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daphne Kabatoro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- Department of Emergency Medicine, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Jackson Kansiime
- Department of Internal Medicine, St Mary's Hospital, Gulu, Uganda
| | - George Kateregga
- Department of Anaesthesia and Intensive Care, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doreen Nanyunja
- Department of Internal Medicine, China-Uganda Friendship Hospital Naguru, Kampala, Uganda
| | | | | | | | - Etienne Audureau
- CEPIA EA7376, Universite Paris-Est Creteil Val de Marne, Creteil, France
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9
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Arias-Sanchez PP, Wendel-Garcia PD, Tirapé-Castro HA, Cobos J, Jaramillo-Aguilar SX, Peñaloza-Tinoco AM, Jaramillo-Aguilar DS, Martinez A, Holguín-Carvajal JP, Cabrera E, Roche-Campo F, Aguirre-Bermeo H. Use of a gas-operated ventilator as a noninvasive bridging respiratory therapy in critically Ill COVID-19 patients in a middle-income country. Intern Emerg Med 2024:10.1007/s11739-024-03681-w. [PMID: 38940989 DOI: 10.1007/s11739-024-03681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
During the COVID-19 pandemic, there was a notable undersupply of respiratory support devices, especially in low- and middle-income countries. As a result, many hospitals turned to alternative respiratory therapies, including the use of gas-operated ventilators (GOV). The aim of this study was to describe the use of GOV as a noninvasive bridging respiratory therapy in critically ill COVID-19 patients and to compare clinical outcomes achieved with this device to conventional respiratory therapies. Retrospective cohort analysis of critically ill COVID-19 patients during the first local wave of the pandemic. The final analysis included 204 patients grouped according to the type of respiratory therapy received in the first 24 h, as follows: conventional oxygen therapy (COT), n = 28 (14%); GOV, n = 72 (35%); noninvasive ventilation (NIV), n = 49 (24%); invasive mechanical ventilation (IMV), n = 55 (27%). In 72, GOV served as noninvasive bridging respiratory therapy in 42 (58%) of these patients. In the other 30 patients (42%), 20 (28%) presented clinical improvement and were discharged; 10 (14%) died. In the COT and GOV groups, 68% and 39%, respectively, progressed to intubation (P ≤ 0.001). Clinical outcomes in the GOV and NIV groups were similar (no statistically significant differences). GOV was successfully used as a noninvasive bridging respiratory therapy in more than half of patients. Clinical outcomes in the GOV group were comparable to those of the NIV group. These findings support the use of GOV as an emergency, noninvasive bridging respiratory therapy in medical crises when alternative approaches to the standard of care may be justifiable.
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Affiliation(s)
- Pedro P Arias-Sanchez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Intensive Care Unit, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | | | - Johanna Cobos
- Intensive Care Unit, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | | | | | | | - Alberto Martinez
- Emergency Department, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | | | - Enrique Cabrera
- Intensive Care Unit, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Ferran Roche-Campo
- Intensive Care Unit, Hospital Verge de la Cinta de Tortosa, Tarragona, Spain
- The Pere Virgili Institute for Health Research (IISPV), Tarragona, Spain
| | - Hernan Aguirre-Bermeo
- Intensive Care Unit, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
- Faculty of Medicine, Universidad de Cuenca, Cuenca, Ecuador.
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10
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Schortgen F, Tabra Osorio C, Demiri S, Dzogang C, Jung C, Lavenu A, Lecarpentier E. Management of pregnant women in tertiary maternity hospitals in the Paris area referred to the intensive care unit for acute hypoxaemic respiratory failure related to SARS-CoV-2: which practices for which outcomes? Ann Intensive Care 2024; 14:94. [PMID: 38890164 PMCID: PMC11189363 DOI: 10.1186/s13613-024-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence for the management of pregnant women with acute hypoxaemic respiratory failure (AHRF) is currently lacking. The likelihood of avoiding intubation and the risks of continuing the pregnancy under invasive ventilation remain undetermined. We report the management and outcome of pregnant women with pneumonia related to SARS-CoV-2 admitted to the ICU of tertiary maternity hospitals of the Paris area. METHODS We studied a retrospective cohort of pregnant women admitted to 15 ICUs with AHRF related to SARS-CoV-2 defined by the need for O2 ≥ 6 L/min, high-flow nasal oxygen (HFNO), non-invasive or invasive ventilation. Trajectories were assessed to determine the need for intubation and the possibility of continuing the pregnancy on invasive ventilation. RESULTS One hundred and seven pregnant women, 34 (IQR: 30-38) years old, at a gestational age of 27 (IQR: 25-30) weeks were included. Obesity was present in 37/107. Intubation was required in 47/107 (44%). Intubation rate according to respiratory support was 14/19 (74%) for standard O2, 17/36 (47%) for non-invasive ventilation and 16/52 (31%) for HFNO. Factors significantly associated with intubation were pulmonary co-infection: adjusted OR: 3.38 (95% CI 1.31-9.21), HFNO: 0.11 (0.02-0.41) and non-invasive ventilation: 0.20 (0.04-0.80). Forty-six (43%) women were delivered during ICU stay, 39/46 (85%) for maternal pulmonary worsening, 41/46 (89%) at a preterm stage. Fourteen non-intubated women were delivered under regional anaesthesia; 9/14 ultimately required emergency intubation. Four different trajectories were identified: 19 women were delivered within 2 days after ICU admission while not intubated (12 required prolonged intubation), 23 women were delivered within 2 days after intubation, in 11 intubated women pregnancy was continued allowing delivery after ICU discharge in 8/11, 54 women were never intubated (53 were delivered after discharge). Timing of delivery after intubation was mainly dictated by gestational age. One maternal death and one foetal death were recorded. CONCLUSION In pregnant women with AHRF related to SARS-CoV-2, HFNO and non-invasive mechanical ventilation were associated with a reduced rate of intubation, while pulmonary co-infection was associated with an increased rate. Pregnancy was continued on invasive mechanical ventilation in one-third of intubated women. Study registration retrospectively registered in ClinicalTrials (NCT05193526).
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Affiliation(s)
- Frédérique Schortgen
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France.
| | - Cecilia Tabra Osorio
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Suela Demiri
- Department of Adult Intensive Care, Service de médecine intensive réanimation, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Cléo Dzogang
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Camille Jung
- Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est Créteil (UPEC), Créteil, France
| | - Audrey Lavenu
- IRMAR, Mathematical Research Institute, University of Rennes, Rennes, France
- Clinical Investigation Centre, INSERM CIC 1414, University of Rennes, Rennes, France
| | - Edouard Lecarpentier
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est Créteil (UPEC), Créteil, France
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11
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Nadem Boueini N, Haage P, Abanador-Kamper N, Kamper L. [Correlation between comorbidities and thoracic CT manifestations of COVID-19 pneumonia]. Med Klin Intensivmed Notfmed 2024; 119:384-390. [PMID: 37747481 PMCID: PMC11130017 DOI: 10.1007/s00063-023-01062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Pulmonary manifestation of coronavirus disease 2019 (COVID-19) is described using standardized computed tomography (CT) morphologic criteria. In this study, we investigated possible associations between thoracic CT manifestations in COVID-19 pneumonia and typical comorbidities, as well as clinical course. METHODS We analyzed clinical data and pulmonary imaging of 61 patients with positive PCR test. Pulmonary changes were categorized and reviewed for associations with pre-existing comorbidities and clinical course. RESULTS Compared to patients with atypical infiltrate patterns (2/19, 10.5%), 25 patients with typical infiltrate patterns (25/42, 59.5%) were significantly more likely to receive intensive care (p<0.001). In addition, patients with typical infiltrate patterns were more likely to receive non-invasive ventilation (12/42, 28.6%, p=0.040) and high-flow therapy (8/42, 19%, p=0.041) compared to patients with atypical infiltrate patterns. Mortality was also higher in patients with typical infiltrate patterns, with 15 patients (15/42, 35.7%) dying during follow-up compared to only 1 patient with atypical infiltrate pattern (1/19, 10.5%, p=0.012). No significant association between specific comorbidities and the resulting infiltrate pattern could be demonstrated. CONCLUSIONS Patients with a typical COVID-19 infiltrate pattern are more likely to receive intensive care and show higher mortality rates. Further analysis with larger patient collectives is needed to identify specific risk factors for typical COVID-19 pneumonia.
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Affiliation(s)
- Nima Nadem Boueini
- Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
- Diagnostische und interventionelle Radiologie, HELIOS Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland.
| | - Patrick Haage
- Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
- Diagnostische und interventionelle Radiologie, HELIOS Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
| | - Nadine Abanador-Kamper
- Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
- Abteilung für Kardiologie, HELIOS Klinikum Elberfeld, Arrenberger Str. 20, 42117, Wuppertal, Deutschland
| | - Lars Kamper
- Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
- Diagnostische und interventionelle Radiologie, HELIOS Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
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12
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Demoule A, Baptiste A, Thille AW, Similowski T, Ragot S, Prat G, Mercat A, Girault C, Carteaux G, Boulain T, Perbet S, Decavèle M, Belin L, Frat JP. Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure. Crit Care 2024; 28:174. [PMID: 38783367 PMCID: PMC11118550 DOI: 10.1186/s13054-024-04903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population. METHODS This was a secondary analysis of a multicenter, randomized, controlled trial. Dyspnea was quantified by a visual analog scale (dyspnea-VAS) from zero to 100 mm. Dyspnea was measured in 259 of the 310 patients included. Factors associated with intubation were assessed with a competing risks model taking into account ICU discharge. The Cox model was used to evaluate factors associated with 90-day mortality. RESULTS At baseline (randomization in the parent trial), median dyspnea-VAS was 46 (interquartile range, 16-65) mm and was ≥ 40 mm in 146 patients (56%). The intubation rate was 45%. Baseline variables independently associated with intubation were moderate (dyspnea-VAS 40-64 mm) and severe (dyspnea-VAS ≥ 65 mm) dyspnea at baseline (sHR 1.96 and 2.61, p = 0.023), systolic arterial pressure (sHR 2.56, p < 0.001), heart rate (sHR 1.94, p = 0.02) and PaO2/FiO2 (sHR 0.34, p = 0.028). 90-day mortality was 20%. The cumulative probability of survival was lower in patients with baseline dyspnea-VAS ≥ 40 mm (logrank test, p = 0.049). Variables independently associated with mortality were SAPS 2 ≥ 25 (p < 0.001), moderate-to-severe dyspnea at baseline (p = 0.073), PaO2/FiO2 (p = 0.118), and treatment arm (p = 0.046). CONCLUSIONS In patients admitted to the ICU for de novo acute hypoxemic respiratory failure, dyspnea is associated with a higher risk of intubation and with a higher mortality. TRIAL REGISTRATION clinicaltrials.gov Identifier # NCT01320384.
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Affiliation(s)
- Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France.
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.
| | - Amandine Baptiste
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Unité de Recherche Clinique, AP-HP, Paris, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département R3S, AP-HP, 75013, Paris, France
| | - Stephanie Ragot
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Gwénael Prat
- Service de Médecine Intensive et Réanimation, CHU de Brest, Brest, France
| | - Alain Mercat
- Service de Réanimation médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
| | - Christophe Girault
- UNIROUEN, UR 3830, Medical Intensive Care Unit, Rouen University Hospital, Normandie University, Rouen, France
| | - Guillaume Carteaux
- Hôpitaux Universitaires Henri Mondor, Service de Médecine Intensive Réanimation, Université Paris Est Créteil, Groupe de Recherche Clinique CARMAS, AP-HP, Créteil, France
| | - Thierry Boulain
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France
| | - Sébastien Perbet
- Réanimation Médico-Chirurgicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- GReD, UMR/CNRS 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Lisa Belin
- Site Pitié-Salpêtrière, Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, APHP-Sorbonne Université, Paris, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
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Pisciotta W, Passannante A, Arina P, Alotaibi K, Ambler G, Arulkumaran N. High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:936-944. [PMID: 38307776 PMCID: PMC11103093 DOI: 10.1016/j.bja.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Noninvasive methods of respiratory support, including noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO), are potential strategies to prevent progression to requirement for invasive mechanical ventilation in acute hypoxaemic respiratory failure. The COVID-19 pandemic provided an opportunity to understand the utility of noninvasive respiratory support among a homogeneous cohort of patients with contemporary management of acute respiratory distress syndrome. We performed a network meta-analysis of studies evaluating the efficacy of NIV (including CPAP) and HFNO, compared with conventional oxygen therapy (COT), in patients with COVID-19. METHODS PubMed, Embase, and the Cochrane library were searched in May 2023. Standard random-effects meta-analysis was used first to estimate all direct pairwise associations and the results from all studies were combined using frequentist network meta-analysis. Primary outcome was treatment failure, defined as discontinuation of HFNO, NIV, or COT despite progressive disease. Secondary outcome was mortality. RESULTS We included data from eight RCTs with 2302 patients, (756 [33%] assigned to COT, 371 [16%] to NIV, and 1175 [51%] to HFNO). The odds of treatment failure were similar for NIV (P=0.33) and HFNO (P=0.25), and both were similar to that for COT (reference category). The odds of mortality were similar for all three treatments (odds ratio for NIV vs COT: 1.06 [0.46-2.44] and HFNO vs COT: 0.97 [0.57-1.65]). CONCLUSIONS Noninvasive ventilation, high-flow nasal oxygen, and conventional oxygen therapy are comparable with regards to treatment failure and mortality in COVID-19-associated acute respiratory failure. PROSPERO REGISTRATION CRD42023426495.
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Affiliation(s)
- Walter Pisciotta
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Alberto Passannante
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Khalid Alotaibi
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
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14
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Nielsen FM, Klitgaard TL, Siegemund M, Laake JH, Thormar KM, Cole JM, Aagaard SR, Bunzel AMG, Vestergaard SR, Langhoff PK, Pedersen CH, Hejlesen JØ, Abdelhamid S, Dietz A, Gebhard CE, Zellweger N, Hollinger A, Poulsen LM, Weihe S, Andersen-Ranberg NC, Pedersen UG, Mathiesen O, Andreasen AS, Brix H, Thomsen JJ, Petersen CH, Bestle MH, Wichmann S, Lund MS, Mortensen KM, Brand BA, Haase N, Iversen SA, Marcussen KV, Brøchner AC, Borup M, Grøfte T, Hildebrandt T, Kjær MBN, Engstrøm J, Lange T, Perner A, Schjørring OL, Rasmussen BS. Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. JAMA 2024; 331:1185-1194. [PMID: 38501214 PMCID: PMC10951852 DOI: 10.1001/jama.2024.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
Importance Supplemental oxygen is ubiquitously used in patients with COVID-19 and severe hypoxemia, but a lower dose may be beneficial. Objective To assess the effects of targeting a Pao2 of 60 mm Hg vs 90 mm Hg in patients with COVID-19 and severe hypoxemia in the intensive care unit (ICU). Design, Setting, and Participants Multicenter randomized clinical trial including 726 adults with COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. The trial was prematurely stopped prior to outcome assessment due to slow enrollment. End of 90-day follow-up was June 1, 2023. Interventions Patients were randomized 1:1 to a Pao2 of 60 mm Hg (lower oxygenation group; n = 365) or 90 mm Hg (higher oxygenation group; n = 361) for up to 90 days in the ICU. Main Outcomes and Measures The primary outcome was the number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes included mortality, proportion of patients with serious adverse events, and number of days alive and out of hospital, all at 90 days. Results Of 726 randomized patients, primary outcome data were available for 697 (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 495 patients (68%) were male. At 90 days, the median number of days alive without life support was 80.0 days (IQR, 9.0-89.0 days) in the lower oxygenation group and 72.0 days (IQR, 2.0-88.0 days) in the higher oxygenation group (P = .009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days [95% CI, 0.2-11.5 days]; P = .04). Mortality at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group (risk ratio, 0.86 [98.6% CI, 0.66-1.13]; P = .18). There were no statistically significant differences in proportion of patients with serious adverse events or in number of days alive and out of hospital. Conclusion and Relevance In adult ICU patients with COVID-19 and severe hypoxemia, targeting a Pao2 of 60 mm Hg resulted in more days alive without life support in 90 days than targeting a Pao2 of 90 mm Hg. Trial Registration ClinicalTrials.gov Identifier: NCT04425031.
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Affiliation(s)
- Frederik M. Nielsen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Siegemund
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Jon H. Laake
- Department of Anaesthesia and Intensive Care, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Katrin M. Thormar
- Department of Anesthesia and Intensive Care, Landspitali, University Hospital of Reykjavik, Reykjavik, Iceland
| | - Jade M. Cole
- Department of Intensive Care, Cardiff University Hospital of Wales, Cardiff, Wales
| | - Søren R. Aagaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Marie G. Bunzel
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Stine R. Vestergaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Peter K. Langhoff
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Caroline H. Pedersen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Josefine Ø. Hejlesen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Salim Abdelhamid
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Anna Dietz
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Caroline E. Gebhard
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Nuria Zellweger
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Alexa Hollinger
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Lone M. Poulsen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Sarah Weihe
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | | | - Ulf G. Pedersen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Helene Brix
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Jonas J. Thomsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Christina H. Petersen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Martin S. Lund
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Karoline M. Mortensen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Björn A. Brand
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne A. Iversen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Klaus V. Marcussen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Anne C. Brøchner
- Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Morten Borup
- Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Maj-Brit N. Kjær
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Janus Engstrøm
- Copenhagen Trial Unit, Centre for Clinical Intervention, Capital Region, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav L. Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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15
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Yang P, Sjoding MW. Acute Respiratory Distress Syndrome: Definition, Diagnosis, and Routine Management. Crit Care Clin 2024; 40:309-327. [PMID: 38432698 DOI: 10.1016/j.ccc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury characterized by severe hypoxemic respiratory failure, bilateral opacities on chest imaging, and low lung compliance. ARDS is a heterogeneous syndrome that is the common end point of a wide variety of predisposing conditions, with complex pathophysiology and underlying mechanisms. Routine management of ARDS is centered on lung-protective ventilation strategies such as low tidal volume ventilation and targeting low airway pressures to avoid exacerbation of lung injury, as well as a conservative fluid management strategy.
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Affiliation(s)
- Philip Yang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, 6335 Hospital Parkway, Physicians Plaza Suite 310, Johns Creek, GA 30097, USA.
| | - Michael W Sjoding
- Division of Pulmonary and Critical Care Medicine, University of Michigan, 2800 Plymouth Road, NCRC, Building 16, G027W, Ann Arbor, MI 48109, USA
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16
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Mosier JM, Tidswell M, Wang HE. Noninvasive respiratory support in the emergency department: Controversies and state-of-the-art recommendations. J Am Coll Emerg Physicians Open 2024; 5:e13118. [PMID: 38464331 PMCID: PMC10920951 DOI: 10.1002/emp2.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 03/12/2024] Open
Abstract
Acute respiratory failure is a common reason for emergency department visits and hospital admissions. Diverse underlying physiologic abnormalities lead to unique aspects about the most common causes of acute respiratory failure: acute decompensated heart failure, acute exacerbation of chronic obstructive pulmonary disease, and acute de novo hypoxemic respiratory failure. Noninvasive respiratory support strategies are increasingly used methods to support work of breathing and improve gas exchange abnormalities to improve outcomes relative to conventional oxygen therapy or invasive mechanical ventilation. Noninvasive respiratory support includes noninvasive positive pressure ventilation and nasal high flow, each with unique physiologic mechanisms. This paper will review the physiology of respiratory failure and noninvasive respiratory support modalities and offer data and guideline-driven recommendations in the context of key clinical controversies.
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Affiliation(s)
- Jarrod M. Mosier
- Department of Emergency MedicineThe University of Arizona College of MedicineTucsonArizonaUSA
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of MedicineThe University of Arizona College of MedicineTucsonArizonaUSA
| | - Mark Tidswell
- Division of Pulmonary and Critical Care, Department of MedicineUniversity of Massachusetts Chan Medical School – Baystate Medical CenterSpringfieldMassachusettsUSA
| | - Henry E. Wang
- Department of Emergency MedicineThe Ohio State UniversityColumbusOhioUSA
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17
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Salluh JIF, Póvoa P, Beane A, Kalil A, Sendagire C, Sweeney DA, Pilcher D, Polverino E, Tacconelli E, Estenssoro E, Frat JP, Ramirez J, Reyes LF, Roca O, Nseir S, Nobre V, Lisboa T, Martin-Loeches I. Challenges for a broad international implementation of the current severe community-acquired pneumonia guidelines. Intensive Care Med 2024; 50:526-538. [PMID: 38546855 DOI: 10.1007/s00134-024-07381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024]
Abstract
Severe community-acquired pneumonia (sCAP) remains one of the leading causes of admission to the intensive care unit, thus consuming a large share of resources and is associated with high mortality rates worldwide. The evidence generated by clinical studies in the last decade was translated into recommendations according to the first published guidelines focusing on severe community-acquired pneumonia. Despite the advances proposed by the present guidelines, several challenges preclude the prompt implementation of these diagnostic and therapeutic measures. The present article discusses the challenges for the broad implementation of the sCAP guidelines and proposes solutions when applicable.
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Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil.
| | - Pedro Póvoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark Centre for Clinical Epidemiology, Odense, Denmark
- Department of Intensive Care, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Abi Beane
- Pandemic Science Hub and Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- NICS-MORU, Colombo, Sri Lanka
| | - Andre Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cornelius Sendagire
- Anesthesia and Critical Care, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road3004, Prahran, VIC, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, Servicio de Terapia Intensiva, Buenos Aires, Argentina
| | - Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM, CIC-1402, IS-ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
- University of Louisville, Louisville, KY, USA
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí - I3PT, Parc del Taulí 1, 08028, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, 59000, Lille, France
- Team Fungal Associated Invasive and Inflammatory Diseases, Lille Inflammation Research International Center, Université de Lille, INSERM U995, Lille, France
| | - Vandack Nobre
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Lisboa
- Critical Care Department, Programa de Pós-Graduação em Ciencias Pneumologicas, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
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18
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Freitas DHM, Costa ELV, Zimmermann NA, Gois LSO, Anjos MVA, Lima FG, Andrade PS, Joelsons D, Ho Y, Sales FCS, Sabino EC, Carvalho CRR, Ferreira JC. Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves. PLoS One 2024; 19:e0299607. [PMID: 38452031 PMCID: PMC10919739 DOI: 10.1371/journal.pone.0299607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. METHODS This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). RESULTS We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12). CONCLUSIONS In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.
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Affiliation(s)
- Daniela Helena Machado Freitas
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Leite Vieira Costa
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Alcantara Zimmermann
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Larissa Santos Oliveira Gois
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mirella Vittig Alves Anjos
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Felipe Gallego Lima
- Divisao de Cardiologia, Faculdade de Medicina, Instituto Do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pâmela Santos Andrade
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Joelsons
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Yeh‐Li Ho
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flávia Cristina Silva Sales
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ester Cerdeira Sabino
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Juliana Carvalho Ferreira
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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19
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Hyun DG, Lee SY, Ahn JH, Hong SB, Lim CM, Koh Y, Huh JW. Prognosis of mechanically ventilated patients with COVID-19 after failure of high-flow nasal cannula: a retrospective cohort study. Respir Res 2024; 25:109. [PMID: 38429645 PMCID: PMC10905875 DOI: 10.1186/s12931-024-02671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND There is an argument whether the delayed intubation aggravate the respiratory failure in Acute respiratory distress syndrome (ARDS) patients with coronavirus disease 2019 (COVID-19). We aimed to investigate the effect of high-flow nasal cannula (HFNC) failure before mechanical ventilation on clinical outcomes in mechanically ventilated patients with COVID-19. METHODS This retrospective cohort study included mechanically ventilated patients who were diagnosed with COVID-19 and admitted to the intensive care unit (ICU) between February 2020 and December 2021 at Asan Medical Center. The patients were divided into HFNC failure (HFNC-F) and mechanical ventilation (MV) groups according to the use of HFNC before MV. The primary outcome of this study was to compare the worst values of ventilator parameters from day 1 to day 3 after mechanical ventilation between the two groups. RESULTS Overall, 158 mechanically ventilated patients with COVID-19 were included in this study: 107 patients (67.7%) in the HFNC-F group and 51 (32.3%) in the MV group. The two groups had similar profiles of ventilator parameter from day 1 to day 3 after mechanical ventilation, except of dynamic compliance on day 3 (28.38 mL/cmH2O in MV vs. 30.67 mL/H2O in HFNC-F, p = 0.032). In addition, the HFNC-F group (5.6%) had a lower rate of ECMO at 28 days than the MV group (17.6%), even after adjustment (adjusted hazard ratio, 0.30; 95% confidence interval, 0.11-0.83; p = 0.045). CONCLUSIONS Among mechanically ventilated COVID-19 patients, HFNC failure before mechanical ventilation was not associated with deterioration of respiratory failure.
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Affiliation(s)
- Dong-Gon Hyun
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jee Hwan Ahn
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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20
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Fisher JM, Subbian V, Essay P, Pungitore S, Bedrick EJ, Mosier JM. Acute Respiratory Failure From Early Pandemic COVID-19: Noninvasive Respiratory Support vs Mechanical Ventilation. CHEST CRITICAL CARE 2024; 2:100030. [PMID: 38645483 PMCID: PMC11027508 DOI: 10.1016/j.chstcc.2023.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND The optimal strategy for initial respiratory support in patients with respiratory failure associated with COVID-19 is unclear, and the initial strategy may affect outcomes. RESEARCH QUESTION Which initial respiratory support strategy is associated with improved outcomes in patients with COVID-19 with acute respiratory failure? STUDY DESIGN AND METHODS All patients with COVID-19 requiring respiratory support and admitted to a large health care network were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (NIRS; noninvasive positive pressure ventilation by facemask or high-flow nasal oxygen) with patients treated initially with invasive mechanical ventilation (IMV). The primary outcome was time to in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths of stay (ICU and hospital), and time to intubation. RESULTS Nearly one-half of the 2,354 patients (47%) who met inclusion criteria received IMV first, and 53% received initial NIRS. Overall, in-hospital mortality was 38% (37% for IMV and 39% for NIRS). Initial NIRS was associated with an increased hazard of death compared with initial IMV (hazard ratio, 1.42; 95% CI, 1.03-1.94), but also an increased hazard of leaving the hospital sooner that waned with time (noninvasive support by time interaction: hazard ratio, 0.97; 95% CI, 0.95-0.98). INTERPRETATION Patients with COVID-19 with acute hypoxemic respiratory failure initially treated with NIRS showed an increased hazard of in-hospital death.
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Affiliation(s)
- Julia M Fisher
- Statistics Consulting Laboratory, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, The University of Arizona College of Medicine, Tucson, AZ; Department of Biomedical Engineering, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Patrick Essay
- Department of Systems and Industrial Engineering, The University of Arizona College of Medicine, Tucson, AZ
| | - Sarah Pungitore
- Program in Applied Mathematics, The University of Arizona College of Medicine, Tucson, AZ
| | - Edward J Bedrick
- Statistics Consulting Laboratory, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Jarrod M Mosier
- The University of Arizona, the Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ; Division of Pulmonary, Allergy, Critical Care, and Sleep, The University of Arizona College of Medicine, Tucson, AZ; Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ
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Aarab Y, Debourdeau T, Garnier F, Capdevila M, Monet C, De Jong A, Capdevila X, Charbit J, Dagod G, Pensier J, Jaber S. Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study. Anaesth Crit Care Pain Med 2024; 43:101321. [PMID: 37944861 DOI: 10.1016/j.accpm.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic abruptly increased the inflow of patients requiring intensive care units (ICU). French health institutions responded by a twofold capacity increase with temporary upgraded beds, supplemental beds in pre-existing ICUs, or newly created units (New-ICU). We aimed to compare outcomes according to admission in expert pre-existing ICUs or in New-ICU. METHODS This multicenter retrospective observational study was conducted in two 20-bed expert ICUs of a University Hospital (Expert-ICU) and in one 16-bed New-ICU in a private clinic managed respectively by 3 and 2 physicians during daytime and by one physician during the night shift. All consecutive adult patients with COVID-19-related acute hypoxemic respiratory failure admitted after centralized regional management by a dedicated crisis cell were included. The primary outcome was 180-day mortality. Propensity score matching and restricted cubic spline for predicted mortality over time were performed. RESULTS During the study period, 165 and 176 patients were enrolled in Expert-ICU and New-ICU respectively, 162 (98%) and 157 (89%) patients were analyzed. The unadjusted 180-day mortality was 30.8% in Expert-ICU and 28.7% in New-ICU, (log-rank test, p = 0.7). After propensity score matching, 123 pairs (76 and 78%) of patients were matched, with no significant difference in mortality (32% vs. 32%, OR 1.00 [0.89; 1.12], p = 1). Adjusted predicted mortality decreased over time (p < 0.01) in both Expert-ICU and New-ICU. CONCLUSIONS In COVID-19 patients with acute hypoxemic respiratory failure, hospitalization in a new ICU was not associated with mortality at day 180.
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Affiliation(s)
- Yassir Aarab
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France; Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France.
| | - Theodore Debourdeau
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Fanny Garnier
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Mathieu Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Clément Monet
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Audrey De Jong
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Jonathan Charbit
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Geoffrey Dagod
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Joris Pensier
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
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22
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Statlender L, Shvartser L, Teppler S, Bendavid I, Kushinir S, Azullay R, Singer P. Predicting invasive mechanical ventilation in COVID 19 patients: A validation study. PLoS One 2024; 19:e0296386. [PMID: 38166095 PMCID: PMC10760863 DOI: 10.1371/journal.pone.0296386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The decision to intubate and ventilate a patient is mainly clinical. Both delaying intubation (when needed) and unnecessarily invasively ventilating (when it can be avoided) are harmful. We recently developed an algorithm predicting respiratory failure and invasive mechanical ventilation in COVID-19 patients. This is an internal validation study of this model, which also suggests a categorized "time-weighted" model. METHODS We used a dataset of COVID-19 patients who were admitted to Rabin Medical Center after the algorithm was developed. We evaluated model performance in predicting ventilation, regarding the actual endpoint of each patient. We further categorized each patient into one of four categories, based on the strength of the prediction of ventilation over time. We evaluated this categorized model performance regarding the actual endpoint of each patient. RESULTS 881 patients were included in the study; 96 of them were ventilated. AUC of the original algorithm is 0.87-0.94. The AUC of the categorized model is 0.95. CONCLUSIONS A minor degradation in the algorithm accuracy was noted in the internal validation, however, its accuracy remained high. The categorized model allows accurate prediction over time, with very high negative predictive value.
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Affiliation(s)
- Liran Statlender
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | | | - Itai Bendavid
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shiri Kushinir
- Rabin Medical Center Research Authority, Beilinson Hospital, Petah Tikva, Israel
| | - Roy Azullay
- TSG IT Advanced Systems Ltd., Or Yehuda, Israel
| | - Pierre Singer
- Department of Gefneral Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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23
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Wang JC, Peng Y, Dai B, Hou HJ, Zhao HW, Wang W, Tan W. Comparison between high-flow nasal cannula and conventional oxygen therapy in COVID-19 patients: a systematic review and meta-analysis. Ther Adv Respir Dis 2024; 18:17534666231225323. [PMID: 38230522 PMCID: PMC10798115 DOI: 10.1177/17534666231225323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) are important respiratory support strategies for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the results are conflicting for the risk of intubation with HFNC as compared to COT. OBJECTIVES We systematically synthesized the outcomes of HFNC relative to COT in COVID-19 patients with AHRF and evaluated these outcomes in relevant subpopulations. DESIGN This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES AND METHODS We searched PubMed, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, medRxiv, BioRxiv, and the Cochrane Central Register of Controlled Trials for randomized controlled trials and observational studies that compared the efficacy of HFNC with COT in patients with COVID-19-related AHRF. Primary outcomes were intubation rate and mortality rate. Secondary outcomes were the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), respiratory rate, hospital length of stay, intensive care unit (ICU) length of stay, and days free from invasive mechanical ventilation. RESULTS In total, 20 studies with 5732 patients were included. We found a decreased risk of requiring intubation in HFNC compared to COT [odds ratio (OR) = 0.61, 95% confidence interval (CI): 0.46-0.82, p = 0.0009, I2 = 75%]. Similarly, we found HFNC was associated with lower risk of intubation rate compared to COT in the subgroup of patients with baseline PaO2/FiO2 < 200 mmHg (OR = 0.69, 95% CI: 0.55-0.86, p = 0.0007, I2 = 45%), and who were in ICU settings at enrollment (OR = 0.57, 95% CI: 0.38-0.85, p = 0.005, I2 = 80%). HFNC was associated with an improvement of PaO2/FiO2 and respiratory rate compared to COT. The use of HFNC compared to COT did not reduce the mortality rate, days free from invasive mechanical ventilation, hospital length of stay, or ICU length of stay. CONCLUSION Compared to COT, HFNC may decrease the need for tracheal intubation in patients with COVID-19-related AHRF, particularly among patients with baseline PaO2/FiO2 < 200 mmHg and those in ICU settings. TRIAL REGISTRATION This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022339072).
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Affiliation(s)
- Jian-chao Wang
- Department of Neurosurgery, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yun Peng
- Department of Intensive Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Heping District, Shenyang, China
| | - Hai-jia Hou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Heping District, Shenyang, China
| | - Hong-wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Heping District, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Heping District, Shenyang, China
| | - Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang 110001, China
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24
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Manole C, Dediu-Anghel M, Baroiu L, Ștefanopol IA, Nechifor A, Niculet E, Mihailov R, Moroianu LA, Voinescu DC, Firescu D. Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19. J Int Med Res 2024; 52:3000605231222151. [PMID: 38194495 PMCID: PMC10777799 DOI: 10.1177/03000605231222151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Critically ill patients with COVID-19 develop acute respiratory distress syndrome characterized by relatively well-preserved pulmonary compliance but severe hypoxemia. The challenge in managing such patients lies in optimizing oxygenation, which can be achieved through either high oxygen flow or noninvasive mechanical ventilation. This study was performed to compare the efficiency of two methods of noninvasive oxygen therapy: continuous positive airway pressure (CPAP) and high-flow nasal oxygen therapy (HFNO). METHODS This retrospective cohort study involved 668 patients hospitalized in the intensive care unit (ICU) of the "Sf. Apostol Andrei" Emergency Clinical Hospital, Galati, Romania from 1 April 2020 to 31 March 2021 (CPAP, n = 108; HFNO, n = 108). RESULTS Mortality was significantly lower in the CPAP and HFNO groups than in the group of patients who underwent intubation and mechanical ventilation after ICU admission. Mortality in the ICU was not significantly different between the CPAP and HFNO groups. CONCLUSIONS HFNO and CPAP represent efficient alternative therapies for patients with severe COVID-19 whose respiratory treatment has failed. Studies involving larger groups of patients are necessary to establish a personalized, more complex management modality for critically ill patients with COVID-19.
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Affiliation(s)
- Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Mihaela Dediu-Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Infectious Diseases Department, “Sf. Cuv. Parascheva” Infectious Diseases Clinical Hospital, Galati, Romania
| | - Ioana Anca Ștefanopol
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MIC-DIR), “Dunărea de Jos” University of Galat,i, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Pathology Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Raul Mihailov
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Lavinia Alexandra Moroianu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Psychiatry Department, “Elisabeta Doamna” Psychiatric Clinical Hospital, Galati, Romania
| | - Doina Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Medical Department, “Sfantul Apostol Andrei” Emergency County Clinical Hospital, Galati, Romania
| | - Dorel Firescu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
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25
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Janssen ML, Türk Y, Baart SJ, Hanselaar W, Aga Y, van der Steen-Dieperink M, van der Wal FJ, Versluijs VJ, Hoek RAS, Endeman H, Boer DP, Hoiting O, Hoelters J, Achterberg S, Stads S, Heller-Baan R, Dubois AVF, Elderman JH, Wils EJ. Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19. Crit Care Med 2024; 52:31-43. [PMID: 37855812 PMCID: PMC10715700 DOI: 10.1097/ccm.0000000000006068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use. We aimed to assess the safety and clinical outcomes of initiation of HFNO therapy in COVID-19 on non-ICU wards. DESIGN Prospective observational multicenter pragmatic study. SETTING Respiratory wards and ICUs of 10 hospitals in The Netherlands. PATIENTS Adult patients treated with HFNO for COVID-19-associated hypoxemia between December 2020 and July 2021 were included. Patients with treatment limitations were excluded from this analysis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Outcomes included intubation and mortality rate, duration of hospital and ICU stay, severity of respiratory failure, and complications. Using propensity-matched analysis, we compared patients who initiated HFNO on the wards versus those in ICU. Six hundred eight patients were included, of whom 379 started HFNO on the ward and 229 in the ICU. The intubation rate in the matched cohort ( n = 214 patients) was 53% and 60% in ward and ICU starters, respectively ( p = 0.41). Mortality rates were comparable between groups (28-d [8% vs 13%], p = 0.28). ICU-free days were significantly higher in ward starters (21 vs 17 d, p < 0.001). No patient died before endotracheal intubation, and the severity of respiratory failure surrounding invasive ventilation and clinical outcomes did not differ between intubated ward and ICU starters (respiratory rate-oxygenation index 3.20 vs 3.38; Pa o2 :F io2 ratio 65 vs 64 mm Hg; prone positioning after intubation 81 vs 78%; mortality rate 17 vs 25% and ventilator-free days at 28 d 15 vs 13 d, all p values > 0.05). CONCLUSIONS In this large cohort of hypoxemic patients with COVID-19, initiation of HFNO outside the ICU was safe, and clinical outcomes were similar to initiation in the ICU. Furthermore, the initiation of HFNO on wards saved time in ICU without excess mortality or complicated course. Our results indicate that HFNO initiation outside ICU should be further explored in other hypoxemic diseases and clinical settings aiming to preserve ICU capacity and healthcare costs.
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Affiliation(s)
- Matthijs L Janssen
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
- Department of Intensive Care, Maasstad Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
- Department of Respiratory Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
- Department of Intensive Care, Haaglanden Medisch Centrum, Den Haag, The Netherlands
- Department of Intensive Care, Ikazia Ziekenhuis, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
- Department of Intensive Care, IJsselland Ziekenhuis, Capelle aan den Ijssel, The Netherlands
| | - Yasemin Türk
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Wessel Hanselaar
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | - Yaar Aga
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | | | | | - Vera J Versluijs
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Rogier A S Hoek
- Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk P Boer
- Department of Intensive Care, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Jürgen Hoelters
- Department of Respiratory Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Sefanja Achterberg
- Department of Intensive Care, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | - Susanne Stads
- Department of Intensive Care, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Roxane Heller-Baan
- Department of Respiratory Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Alain V F Dubois
- Department of Respiratory Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Jan H Elderman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, IJsselland Ziekenhuis, Capelle aan den Ijssel, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
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26
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Le Pape S, Savart S, Arrivé F, Frat JP, Ragot S, Coudroy R, Thille AW. High-flow nasal cannula oxygen versus conventional oxygen therapy for acute respiratory failure due to COVID-19: a systematic review and meta-analysis. Ann Intensive Care 2023; 13:114. [PMID: 37994981 PMCID: PMC10667189 DOI: 10.1186/s13613-023-01208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The effectiveness of high-flow nasal cannula oxygen therapy (HFNC) in patients with acute respiratory failure due to COVID-19 remains uncertain. We aimed at assessing whether HFNC is associated with reduced risk of intubation or mortality in patients with acute respiratory failure due to COVID-19 compared with conventional oxygen therapy (COT). METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, and CENTRAL databases for randomized controlled trials (RCTs) and observational studies comparing HFNC vs. COT in patients with acute respiratory failure due to COVID-19, published in English from inception to December 2022. Pediatric studies, studies that compared HFNC with a noninvasive respiratory support other than COT and those in which intubation or mortality were not reported were excluded. Two authors independently screened and selected articles for inclusion, extracted data, and assessed the risk of bias. Fixed-effects or random-effects meta-analysis were performed according to statistical heterogeneity. Primary outcomes were risk of intubation and mortality across RCTs. Effect estimates were calculated as risk ratios and 95% confidence interval (RR; 95% CI). Observational studies were used for sensitivity analyses. RESULTS Twenty studies were analyzed, accounting for 8383 patients, including 6 RCTs (2509 patients) and 14 observational studies (5874 patients). By pooling the 6 RCTs, HFNC compared with COT significantly reduced the risk of intubation (RR 0.89, 95% CI 0.80 to 0.98; p = 0.02) and reduced length of stay in hospital. HFNC did not significantly reduce the risk of mortality (RR 0.93, 95% CI 0.77 to 1.11; p = 0.40). CONCLUSIONS In patients with acute respiratory failure due to COVID-19, HFNC reduced the need for intubation and shortened length of stay in hospital without significant decreased risk of mortality. Trial registration The study was registered on the International prospective register of systematic reviews (PROSPERO) at https://www.crd.york.ac.uk/prospero/ with the trial registration number CRD42022340035 (06/20/2022).
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Affiliation(s)
- Sylvain Le Pape
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France.
- INSERM CIC 1402, IS-ALIVE Research group, University of Poitiers, Poitiers, France.
| | - Sigourney Savart
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France
| | - François Arrivé
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France
- INSERM CIC 1402, IS-ALIVE Research group, University of Poitiers, Poitiers, France
| | - Stéphanie Ragot
- INSERM CIC 1402, IS-ALIVE Research group, University of Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France
- INSERM CIC 1402, IS-ALIVE Research group, University of Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, 86021, Poitiers Cedex, France
- INSERM CIC 1402, IS-ALIVE Research group, University of Poitiers, Poitiers, France
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27
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Meersseman C, Grolleau E, Freymond N, Wallet F, Gilbert T, Locatelli-Sanchez M, Gérinière L, Perrot E, Souquet PJ, Fontaine-Delaruelle C, David JS, Couraud S. High flow nasal oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation. Respir Med Res 2023; 84:101026. [PMID: 37717386 PMCID: PMC10195878 DOI: 10.1016/j.resmer.2023.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND In COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment. HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure. METHODS We conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale. RESULTS Fifty-six patients were included. Median age was 83 years [76.3-87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital. HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p = 0.001). CONCLUSIONS We suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.
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Affiliation(s)
- Corentin Meersseman
- Lyon-Est Medical School, Claude Bernard Lyon 1 University, Villeurbanne, France; Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France.
| | - Emmanuel Grolleau
- Lyon-Est Medical School, Claude Bernard Lyon 1 University, Villeurbanne, France; Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Nathalie Freymond
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Florent Wallet
- Anesthesia and Critical Care Medicine Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Thomas Gilbert
- Department of Geriatric Medicine, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Myriam Locatelli-Sanchez
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Laurence Gérinière
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Emilie Perrot
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Pierre-Jean Souquet
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Clara Fontaine-Delaruelle
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Stéphane David
- Anesthesia and Critical Care Medicine Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Sébastien Couraud
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France; Lyon Center for Innovation in Cancerology, Lyon-Sud Medical School, Claude Bernard Lyon 1 University, Oullins, France
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Artaud-Macari E, Le Bouar G, Maris J, Dantoing E, Vatignez T, Girault C. [Ventilatory management of SARS-CoV-2 acute respiratory failure]. Rev Mal Respir 2023; 40:751-767. [PMID: 37865564 DOI: 10.1016/j.rmr.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023]
Abstract
COVID-19 pneumonia presents several particularities in its clinical presentation (cytokine storm, silent hypoxemia, thrombo-embolic risk) and may lead to a number of acute respiratory distress syndrome (ARDS) phenotypes. While the optimal oxygenation strategy in cases of hypoxemic acute respiratory failure (ARF) is still under debate, ventilatory management of COVID-19-related ARF has confirmed the efficacy of high-flow oxygen therapy and restored interest in other ventilatory approaches such as continuous positive airway pressure (CPAP) and noninvasive ventilation involving a helmet, which due to patient overflow are sometimes implemented outside of critical care units. However, further studies are still needed to determine which patients should be given which oxygenation technique, and under which conditions they require invasive mechanical ventilation, given that delayed initiation potentially burdens prognosis. During invasive mechanical ventilation, ventral decubitus and extracorporeal membrane oxygenation have become increasingly prevalent. While innovative therapies such as awake prone position or lung transplantation have likewise been developed, their indications, modalities and efficacy remain to be determined.
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Affiliation(s)
- E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France; UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France.
| | - G Le Bouar
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - J Maris
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - E Dantoing
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - T Vatignez
- Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
| | - C Girault
- UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France; Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
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Ferreyro BL, Gorman EA, Angriman F. Noninvasive Respiratory Support in Adult Patients With COVID-19: Current Role and Research Challenges. Crit Care Med 2023; 51:1602-1607. [PMID: 37902347 DOI: 10.1097/ccm.0000000000005986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - Ellen A Gorman
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Federico Angriman
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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de Carvalho VCP, da Silva Guimarães BL, Fujihara MTF, Ceotto VF, Turon R, Lugon JR, Gismondi RAOC. Daily ROX index can predict transitioning to mechanical ventilation within the next 24 h in COVID-19 patients on HFNC. Am J Emerg Med 2023; 73:160-165. [PMID: 37688983 DOI: 10.1016/j.ajem.2023.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate‑oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements. METHODS A retrospective cross-sectional study was performed using a database that included adult patients with COVID-19 pneumonia treated in the ICU. Patients were followed from ICU admission and ROX index was calculated daily on HFNC. Receiver operating characteristics curves (ROCs) were performed. RESULTS Two hundred forty-nine patients were enrolled, 48% of whom require mechanical ventilation (MV). The area under the ROC of the pooled 4-day values of the ROX index as a predictor of transition from HFNC to MV within 24 h of measurements was 0.86 (95%CI 0.83 to 0.88, P < 0.001) with a cutoff point of 4.06. CONCLUSION In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.
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Affiliation(s)
| | | | | | | | - Ricardo Turon
- Intensive Care Unit, Hospital Niteroi D'Or, Niteroi, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Department of Medicine, Medical School, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
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Prada SI, Garcia-Garcia MP, Ospina-Tascón GA, Rosselli D. Cost Analysis of High-Flow Oxygen Therapy Compared with Conventional Oxygen Therapy in Severe COVID-19 in Colombia: Data from a Randomized Clinical Trial. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:733-738. [PMID: 37822790 PMCID: PMC10564115 DOI: 10.2147/ceor.s412087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/30/2023] [Indexed: 10/13/2023] Open
Abstract
Background A randomized clinical trial (HiFlo-COVID-19 Trial) showed that among patients with severe COVID-19, treatment with high-flow oxygen therapy (HFOT) significantly reduced the need for invasive mechanical ventilation support and time for clinical recovery compared with conventional oxygen therapy (COT). However, the cost of this strategy is unknown. Objective We examined total cost of HFOT treatment compared with COT in real-world setting. Methods We conducted a post-trial-based cost analysis from the perspective of a managed competition healthcare system, using actual records of billed costs. Cost categories include general ward, intensive care unit, procedures, imaging, laboratories, medications, supplies, and others. Results A total of 188 participants (mean age 60, 33% female) were included. Average costs (and standard deviation) in the HFOT group were USD $7992 (7394) and in the COT group USD $ 10,190 (9402). Differences, however, did not reach statistical significance (P=0.093). However, resource use was always less costly for the HNFO group, with an overall percentage decrease of 27%. Two categories make up 72% of all savings: medications (41%) and intensive care unit (31%). Conclusion For patients in ICU with severe COVID-19 the cost of treatment with HFOT as compared to COT is likely to be cost-saving due to less use of medications and length of stay in ICU.
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Affiliation(s)
- Sergio I Prada
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
- Universidad Icesi, Centro PROESA, Cali, Colombia
| | | | - Gustavo A Ospina-Tascón
- Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia
- Translational Medicine Laboratory in Critical Care (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogota, Colombia
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Obradović D, Milovančev A, Plećaš Đurić A, Sovilj-Gmizić S, Đurović V, Šović J, Đurđević M, Tubić S, Bulajić J, Mišić M, Jojić J, Pušara M, Lazić I, Đurković M, Bek Pupovac R, Vulić A, Jozing M. High-Flow Nasal Cannula oxygen therapy in COVID-19: retrospective analysis of clinical outcomes - single center experience. Front Med (Lausanne) 2023; 10:1244650. [PMID: 37849487 PMCID: PMC10577378 DOI: 10.3389/fmed.2023.1244650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background High-Flow Nasal Cannula (HFNC) oxygen therapy emerged as the therapy of choice in COVID-19-related pneumonia and moderate to severe acute hypoxemic respiratory failure (AHRF). HFNC oxygen therapy in COVID-19 has been recommended based its use to treat AHRF of other etiologies, and studies on assessing outcomes in COVID-19 patients are highly needed. This study aimed to examine outcomes in COVID-19 patients with pneumonia and severe AHRF treated with HFNC. Materials and methods The study included 235 COVID-19 patients with pneumonia treated with HFNC. Data extracted from medical records included demographic characteristics, comorbidities, laboratory parameters, clinical and oxygenation status, clinical complications, as well as the length of hospital stay. Patients were segregated into two groups based on their oxygen therapy needs: HDU group, those who exclusively required HFNC and ICU group, those whose oxygen therapy needed to be escalated at some point of hospital stay. The primary outcome was the need for respiratory support escalation (noninvasive or invasive mechanical ventilation) and the secondary outcome was the in-hospital all-cause mortality. Results The primary outcome was met in 113 (48%) of patients. The overall mortality was 70%, significantly higher in the ICU group [102 (90.2%) vs. 62 (50.1%), p < 0.001]. The rate of intrahospital infections was significantly higher in the ICU group while there were no significant differences in the length of hospital stay between the groups. The ICU group exhibited significant increases in D-dimer, NLR, and NEWS values, accompanied by a significant decrease in the SaO2/FiO2 ratio. The multivariable COX proportional regression analysis identified malignancy, higher levels of 4C Mortality Score and NEWS2 as significant predictors of mortality. Conclusion High-Flow Nasal Cannula oxygen therapy is a safe type of respiratory support in patients with COVID-19 pneumonia and acute hypoxemic respiratory failure with significantly less possibility for emergence of intrahospital infections. In 52% of patients, HFNC was successful in treating AHRF in COVID-19 patients. Overall, mortality in COVID-19 pneumonia with AHRF is still very high, especially in patients treated with noninvasive/invasive mechanical ventilation.
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Affiliation(s)
- Dušanka Obradović
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Plećaš Đurić
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Clinic of Anesthesiology, Intensive Care and Pain Therapy, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | | | - Vladimir Đurović
- Clinic of Nephrology and Clinical Immunology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Jovica Šović
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Miloš Đurđević
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Stevan Tubić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Jelena Bulajić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Milena Mišić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Jovana Jojić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Miroslava Pušara
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Ivana Lazić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mladen Đurković
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Renata Bek Pupovac
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Vulić
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Marija Jozing
- Urgent Care Center, University Clinical Center of Vojvodina, Novi Sad, Serbia
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Thille AW, Marie D, Reynaud F, Barrau S, Beuvon C, Bironneau V, Jutant EM, Coudroy R, Frat JP, Rault C, Drouot X. Sleep Assessment in Critically Ill Patients With Acute Hypoxemic Respiratory Failure. Respir Care 2023; 68:1417-1425. [PMID: 37253613 PMCID: PMC10506642 DOI: 10.4187/respcare.10844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Sleep deprivation alters respiratory muscle performance and may precipitate respiratory failure. This study aimed to assess sleep in subjects admitted to ICU for acute hypoxemic respiratory failure and its role in the risk of intubation. METHODS This was a prospective observational single-center cohort study including subjects admitted to ICU for de novo acute hypoxemic respiratory failure defined as breathing frequency ≥ 25 breaths/min or clinical signs of respiratory distress and PaO2 /FIO2 < 300 mm Hg while receiving high-flow nasal oxygen. Subjects with altered consciousness, central nervous or psychiatric disorders, continuous sedation or neuroleptic medication, or were uncooperative were excluded. Sleep was assessed by complete polysomnography (PSG) the night following ICU admission. The main outcome was to assess sleep among subjects with acute hypoxemic respiratory failure and to compare sleep between subjects who eventually required intubation to those who did not. RESULTS Over a 24-month inclusion period, 34 subjects had complete PSG, among whom 5 (15%) required intubation in the ICU. Total sleep time was 4.2 h in median (interquartile range 2.9-6.8); deep-sleep duration was 70 min (34-127), and rapid eye movement (REM) sleep duration was 9 min (0-28). Among them, 13 subjects (38%) had no REM sleep. Total sleep time and duration of deep and REM sleep stages did not differ between subjects who required intubation and those successfully treated with high-flow nasal oxygen. CONCLUSIONS Whereas total sleep time remained relatively preserved in critically ill subjects with acute hypoxemic respiratory failure, REM sleep time was uncommon or completely absent in a large number of subjects. Sleep did not differ between subjects who required intubation and those who did not. However, given a trend toward an increased risk of intubation in subjects with a complete absence of REM sleep, further studies are needed to better explore the impact of REM sleep on the risk of intubation.
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Affiliation(s)
- Arnaud W Thille
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
| | - Damien Marie
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Faustine Reynaud
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Stéphanie Barrau
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Clément Beuvon
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Vanessa Bironneau
- INSERM CIC 1402, ALIVE Research group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Pneumologie, Poitiers, France
| | - Etienne-Marie Jutant
- INSERM CIC 1402, ALIVE Research group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Pneumologie, Poitiers, France
| | - Rémi Coudroy
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Jean-Pierre Frat
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Christophe Rault
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Neurophysiologie clinique et Explorations fonctionnelles, Poitiers, France
| | - Xavier Drouot
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Neurophysiologie clinique et Explorations fonctionnelles, Poitiers, France
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Pitre T, Zeraatkar D, Kachkovski GV, Leung G, Shligold E, Dowhanik S, Angriman F, Ferreyro BL, Scales DC, Rochwerg B. Noninvasive Oxygenation Strategies in Adult Patients With Acute Hypoxemic Respiratory Failure: A Systematic Review and Network Meta-Analysis. Chest 2023; 164:913-928. [PMID: 37085046 DOI: 10.1016/j.chest.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Several recently published randomized controlled trials have evaluated various noninvasive oxygenation strategies for the treatment of acute hypoxemic respiratory failure. RESEARCH QUESTION Which available noninvasive oxygen strategies are effective for acute hypoxic respiratory failure? STUDY DESIGN AND METHODS A systematic review of Medline, Embase, Cochrane CENTRAL, CINAHL, Web of Science, MedRxiv, and Research Square was conducted from inception to October 1, 2022. A random effects frequentist network meta-analysis was performed, and the results are presented using absolute risk difference per 1,000 patients. The Grading of Recommendations, Assessment, Development and Evaluation framework was used to rate the certainty of the evidence. Mortality, invasive mechanical ventilation, duration of hospitalization and ICU stay, ventilator-free days, and level of comfort are reported. RESULTS Thirty-six trials (7,046 patients) were included. It was found that helmet CPAP probably reduces mortality compared with standard oxygen therapy (SOT) (231 fewer deaths per 1,000; 95% CI, 126-273 fewer) (moderate certainty). A high-flow nasal cannula (HFNC) probably reduces the need for invasive mechanical ventilation (103.5 fewer events per 1,000; 95% CI, 40.5-157.5 fewer) (moderate certainty). All noninvasive oxygenation strategies may reduce the duration of hospitalization as compared with SOT (low certainty). Helmet bilevel ventilation (4.84 days fewer; 95% CI, 2.33-7.36 days fewer) and helmet CPAP (1.74 days fewer; 95% CI, 4.49 fewer-1.01 more) may reduce the duration of ICU stay as compared with SOT (both low certainty). SOT may be more comfortable than face mask noninvasive ventilation and no different in comfort compared with an HFNC (both low certainty). INTERPRETATION A helmet interface for noninvasive ventilation probably reduces mortality and the risk of mechanical ventilation, as well as the duration of hospital and ICU stay. An HFNC probably reduces the risk of invasive mechanical ventilation and may be as comfortable as SOT. Further research is necessary to understand the role of these interfaces in acute hypoxemic respiratory failure.
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Affiliation(s)
- Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesiology, McMaster University, Hamilton, ON, Canada
| | - George V Kachkovski
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Gareth Leung
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erica Shligold
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sebastian Dowhanik
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Federico Angriman
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health. University of Toronto, Toronto, ON, Canada
| | - Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health. University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Fuset-Cabanes MP, Hernández-Platero LL, Sabater-Riera J, Gordillo-Benitez M, Di Paolo F, Cárdenas-Campos P, Maisterra-Santos K, Pons-Serra M, Sastre-Pérez P, García-Zaloña A, Puentes-Yañez J, Pérez-Fernández X. Days spent on non-invasive ventilation support: can it determine when to initiate VV- ECMO? Observational study in a cohort of Covid-19 patients. BMC Pulm Med 2023; 23:310. [PMID: 37626354 PMCID: PMC10464376 DOI: 10.1186/s12890-023-02605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). METHODS Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. RESULTS Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 patients (48%) had died and 37 patients (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p = 0.02), lactate (p = 0.001), and days from initiation of NIV support to starting VV-ECMO (p = 0.04) were all associated with day-90 mortality. CONCLUSIONS In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appeared to be a better predictor of mortality than the time between intubation and VV-ECMO.
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Affiliation(s)
| | - LLuisa Hernández-Platero
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pediatric Intensive Care Unit, SJD Barcelona Hospital, Barcelona, Spain
| | - Joan Sabater-Riera
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Fabio Di Paolo
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - María Pons-Serra
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Paola Sastre-Pérez
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
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Phan AMV, Hoang HYT, Truong Do TS, Hoang TQ, Phan TV, Huynh NAP, Minh Le K. High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience. J Int Med Res 2023; 51:3000605231193580. [PMID: 37607569 PMCID: PMC10467390 DOI: 10.1177/03000605231193580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE This study was performed to determine the outcomes of patients with coronavirus disease 2019 (COVID-19) who developed hypoxemic respiratory failure necessitating high-flow nasal cannula (HFNC) therapy and to identify the predictors of HFNC therapy success. METHODS This retrospective observational study involved all patients treated with HFNC therapy at a center for COVID-19 in Viet Nam from August to October 2021. RESULTS The study recruited 302 patients. Of these 302 patients, 171 (56.6%) underwent successful HFNC therapy, and the all-cause mortality rate was 33.44%. Non-critical COVID-19 and a higher respiratory rate-oxygenation (ROX) index at 48 hours after initiating HFNC therapy were independently correlated with HFNC therapy success. The statistically significant predictors of HFNC therapy success were younger age, non-critical COVID-19, a higher platelet count when starting HFNC therapy, and a higher ROX index at 24, 36, and 48 hours after HFNC therapy initiation. CONCLUSIONS HFNC therapy appears to be effective in patients with COVID-19 who develop respiratory failure requiring respiratory support. Non-critical COVID-19 and a higher ROX index measured 48 hours after HFNC therapy initiation might serve as predictive factors for the success of HFNC therapy.
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Affiliation(s)
- Anh-Minh Vu Phan
- Intensive Care Unit, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Hai-Yen Thi Hoang
- Intensive Care Unit, University Medical Center, Ho Chi Minh City, Viet Nam
| | | | - Trung Quoc Hoang
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Thuan Van Phan
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Nguyet-Anh Phuong Huynh
- Department of Trauma and Plastic Surgery, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Khoi Minh Le
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
- Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Santus P, Radovanovic D, Saad M, Zilianti C, Coppola S, Chiumello DA, Pecchiari M. Acute dyspnea in the emergency department: a clinical review. Intern Emerg Med 2023; 18:1491-1507. [PMID: 37266791 PMCID: PMC10235852 DOI: 10.1007/s11739-023-03322-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
Acute dyspnea represents one of the most frequent symptoms leading to emergency room evaluation. Its significant prognostic value warrants a careful evaluation. The differential diagnosis of dyspnea is complex due to the lack of specificity and the loose association between its intensity and the severity of the underlying pathological condition. The initial assessment of dyspnea calls for prompt diagnostic evaluation and identification of optimal monitoring strategy and provides information useful to allocate the patient to the most appropriate setting of care. In recent years, accumulating evidence indicated that lung ultrasound, along with echocardiography, represents the first rapid and non-invasive line of assessment that accurately differentiates heart, lung or extra-pulmonary involvement in patients with dyspnea. Moreover, non-invasive respiratory support modalities such as high-flow nasal oxygen and continuous positive airway pressure have aroused major clinical interest, in light of their efficacy and practicality to treat patients with dyspnea requiring ventilatory support, without using invasive mechanical ventilation. This clinical review is focused on the pathophysiology of acute dyspnea, on its clinical presentation and evaluation, including ultrasound-based diagnostic workup, and on available non-invasive modalities of respiratory support that may be required in patients with acute dyspnea secondary or associated with respiratory failure.
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Affiliation(s)
- Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy.
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, Milan, Italy.
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, Milan, Italy
| | - Marina Saad
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Camilla Zilianti
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo E Carlo, Ospedale Universitario San Paolo, Milan, Italy
| | - Davide Alberto Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo E Carlo, Ospedale Universitario San Paolo, Milan, Italy
- Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
- Coordinated Research Center On Respiratory Failure, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Pecchiari
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
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Grasselli G, Calfee CS, Camporota L, Poole D, Amato MBP, Antonelli M, Arabi YM, Baroncelli F, Beitler JR, Bellani G, Bellingan G, Blackwood B, Bos LDJ, Brochard L, Brodie D, Burns KEA, Combes A, D'Arrigo S, De Backer D, Demoule A, Einav S, Fan E, Ferguson ND, Frat JP, Gattinoni L, Guérin C, Herridge MS, Hodgson C, Hough CL, Jaber S, Juffermans NP, Karagiannidis C, Kesecioglu J, Kwizera A, Laffey JG, Mancebo J, Matthay MA, McAuley DF, Mercat A, Meyer NJ, Moss M, Munshi L, Myatra SN, Ng Gong M, Papazian L, Patel BK, Pellegrini M, Perner A, Pesenti A, Piquilloud L, Qiu H, Ranieri MV, Riviello E, Slutsky AS, Stapleton RD, Summers C, Thompson TB, Valente Barbas CS, Villar J, Ware LB, Weiss B, Zampieri FG, Azoulay E, Cecconi M. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med 2023; 49:727-759. [PMID: 37326646 PMCID: PMC10354163 DOI: 10.1007/s00134-023-07050-7] [Citation(s) in RCA: 198] [Impact Index Per Article: 198.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.
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Affiliation(s)
- Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Daniele Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy
| | | | - Massimo Antonelli
- Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Francesca Baroncelli
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, NY, USA
| | - Giacomo Bellani
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Geoff Bellingan
- Intensive Care Medicine, University College London, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurent Brochard
- Keenan Research Center, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Daniel Brodie
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Critical Care, Unity Health Toronto - Saint Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Sonia D'Arrigo
- Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - Sharon Einav
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Niall D Ferguson
- Department of Medicine, Division of Respirology and Critical Care, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
- Departments of Medicine and Physiology, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jean-Pierre Frat
- CHU De Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM, CIC-1402, IS-ALIVE, Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Claude Guérin
- University of Lyon, Lyon, France
- Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS 7200, Créteil, France
| | - Margaret S Herridge
- Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Carol Hodgson
- The Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Catherine L Hough
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Samir Jaber
- Anesthesia and Critical Care Department (DAR-B), Saint Eloi Teaching Hospital, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, 34295, Montpellier, France
| | - Nicole P Juffermans
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur Kwizera
- Makerere University College of Health Sciences, School of Medicine, Department of Anesthesia and Intensive Care, Kampala, Uganda
| | - John G Laffey
- Anesthesia and Intensive Care Medicine, School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Anesthesia and Intensive Care Medicine, Galway University Hospitals, Saolta University Hospitals Groups, Galway, Ireland
| | - Jordi Mancebo
- Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Alain Mercat
- Département de Médecine Intensive Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Nuala J Meyer
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Canada
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Michelle Ng Gong
- Division of Pulmonary and Critical Care Medicine, Montefiore Medical Center, Bronx, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Laurent Papazian
- Bastia General Hospital Intensive Care Unit, Bastia, France
- Aix-Marseille University, Faculté de Médecine, Marseille, France
| | - Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mariangela Pellegrini
- Anesthesia and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Marco V Ranieri
- Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Elisabeth Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Charlotte Summers
- Department of Medicine, University of Cambridge Medical School, Cambridge, UK
| | - Taylor B Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carmen S Valente Barbas
- University of São Paulo Medical School, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jesús Villar
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Lorraine B Ware
- Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Björn Weiss
- Department of Anesthesiology and Intensive Care Medicine (CCM CVK), Charitè - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando G Zampieri
- Academic Research Organization, Albert Einstein Hospital, São Paulo, Brazil
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Grieco DL, Munshi L, Piquilloud L. Personalized noninvasive respiratory support for acute hypoxemic respiratory failure. Intensive Care Med 2023; 49:840-843. [PMID: 37115260 PMCID: PMC10140708 DOI: 10.1007/s00134-023-07048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione 'Policlinico Universitario A. Gemelli' IRCCS, L.Go F. Vito, 00168, Rome, Italy.
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Respirology, University Health Network/Sinai Health System, Toronto, Canada
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
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Maggiore SM, Grieco DL, Lemiale V. The use of high-flow nasal oxygen. Intensive Care Med 2023; 49:673-676. [PMID: 37079086 PMCID: PMC10117236 DOI: 10.1007/s00134-023-07067-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
- Department of Anesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of The Sacred Heart, Rome, Italy
| | - Virginie Lemiale
- Medical ICU, University Hospital Saint Louis, APHP, Paris, France
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Jalil Y, Ferioli M, Dres M. The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support. J Clin Med 2023; 12:jcm12103486. [PMID: 37240592 DOI: 10.3390/jcm12103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population.
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Affiliation(s)
- Yorschua Jalil
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Martina Ferioli
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Martin Dres
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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He Y, Zhuang X, Liu H, Ma W. Comparison of the efficacy and comfort of high-flow nasal cannula with different initial flow settings in patients with acute hypoxemic respiratory failure: a systematic review and network meta-analysis. J Intensive Care 2023; 11:18. [PMID: 37165464 PMCID: PMC10171174 DOI: 10.1186/s40560-023-00667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) has been proven effective in improving patients with acute hypoxemic respiratory failure (AHRF), but a discussion of its use for initial flow settings still need to be provided. We aimed to compare the effectiveness and comfort evaluation of HFNC with different initial flow settings in patients with AHRF. METHODS Studies published by October 10, 2022, were searched exhaustively in PubMed, Embase, Web of Science, Cochrane Library (CENTRAL), and the China National Knowledge Infrastructure (CNKI) database. Network meta-analysis (NMA) was performed with STATA 17.0 and R software (version 4.2.1). A Bayesian framework was applied for this NMA. Comparisons of competing models based on the deviance information criterion (DIC) were used to select the best model for NMA. The primary outcome is the intubation at day 28. Secondary outcomes included short-term and long-term mortality, comfort score, length of ICU or hospital stay, and 24-h PaO2/FiO2. RESULTS This NMA included 23 randomized controlled trials (RCTs) with 5774 patients. With NIV as the control, the HFNC_high group was significantly associated with lower intubation rates (odds ratio [OR] 0.72 95% credible interval [CrI] 0.56 to 0.93; moderate quality evidence) and short-term mortality (OR 0.81 95% CrI 0.69 to 0.96; moderate quality evidence). Using HFNC_Moderate (Mod) group (mean difference [MD] - 1.98 95% CrI -3.98 to 0.01; very low quality evidence) as a comparator, the HFNC_Low group had a slight advantage in comfort scores but no statistically significant difference. Of all possible interventions, the HFNC_High group had the highest probability of being the best in reducing intubation rates (73.04%), short-term (82.74%) and long-term mortality (67.08%). While surface under the cumulative ranking curve value (SUCRA) indicated that the HFNC_Low group had the highest probability of being the best in terms of comfort scores. CONCLUSIONS The high initial flow settings (50-60 L/min) performed better in decreasing the occurrence of intubation and mortality, albeit with poor comfort scores. Treatment of HFNC for AHRF patients ought to be initiated from moderate flow rates (30-40 L/min), and individualized flow settings can make HFNC more sensible in clinical practice.
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Affiliation(s)
- Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China
| | - Xuhui Zhuang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China.
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Beloncle FM. Is COVID-19 different from other causes of acute respiratory distress syndrome? JOURNAL OF INTENSIVE MEDICINE 2023:S2667-100X(23)00008-7. [PMID: 37362866 PMCID: PMC10085872 DOI: 10.1016/j.jointm.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia can lead to acute hypoxemic respiratory failure. When mechanical ventilation is needed, almost all patients with COVID-19 pneumonia meet the criteria for acute respiratory distress syndrome (ARDS). The question of the specificities of COVID-19-associated ARDS compared to other causes of ARDS is of utmost importance, as it may justify changes in ventilatory strategies. This review aims to describe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategies are required in these patients.
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Affiliation(s)
- François M Beloncle
- Medical ICU, University Hospital of Angers, Vent'Lab, University of Angers, Angers 49033, France
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Crimi C, Cortegiani A. High-Flow Nasal Therapy in Acute and Chronic Respiratory Failure: Past, Present, and Future. J Clin Med 2023; 12:jcm12072666. [PMID: 37048749 PMCID: PMC10095482 DOI: 10.3390/jcm12072666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
High-flow nasal therapy (HFNT) was introduced into clinical practice in the early 2000s as a form of noninvasive respiratory support (NIRS) [...]
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, 95123 Catania, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
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Thille AW, Frat JP. High-flow nasal oxygen: benefits are hard to show in COVID-19 patients with mild hypoxaemia. Thorax 2023; 78:321-322. [PMID: 36598078 DOI: 10.1136/thorax-2022-219156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France .,INSERM CIC 1402, IS-ALIVE research group, Université de Poitiers UFR Médecine et Pharmacie, Poitiers, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,INSERM CIC 1402, IS-ALIVE research group, Université de Poitiers UFR Médecine et Pharmacie, Poitiers, France
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46
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Pereira LF, Dallagnol CA, Moulepes TH, Hirota CY, Kutsmi P, dos Santos LV, Pirich CL, Picheth GF. Oxygen therapy alternatives in COVID-19: From classical to nanomedicine. Heliyon 2023; 9:e15500. [PMID: 37089325 PMCID: PMC10106793 DOI: 10.1016/j.heliyon.2023.e15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Around 10-15% of COVID-19 patients affected by the Delta and the Omicron variants exhibit acute respiratory insufficiency and require intensive care unit admission to receive advanced respiratory support. However, the current ventilation methods display several limitations, including lung injury, dysphagia, respiratory muscle atrophy, and hemorrhage. Furthermore, most of the ventilatory techniques currently offered require highly trained professionals and oxygen cylinders, which may attain short supply owing to the high demand and misuse. Therefore, the search for new alternatives for oxygen therapeutics has become extremely important for maintaining gas exchange in patients affected by COVID-19. This review highlights and suggest new alternatives based on micro and nanostructures capable of supplying oxygen and/or enabling hematosis during moderate or acute COVID-19 cases.
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Affiliation(s)
- Luis F.T. Pereira
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Camila A. Dallagnol
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Tassiana H. Moulepes
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Clara Y. Hirota
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Pedro Kutsmi
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Lucas V. dos Santos
- Department of Biochemistry, Federal University of Paraná, Curitiba, PR, Brazil
| | - Cleverton L. Pirich
- Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, PR, Brazil
| | - Guilherme F. Picheth
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
- Department of Biochemistry, Federal University of Paraná, Curitiba, PR, Brazil
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Crimi C, Murphy P, Patout M, Sayas J, Winck JC. Lessons from COVID-19 in the management of acute respiratory failure. Breathe (Sheff) 2023; 19:230035. [PMID: 37378059 PMCID: PMC10292773 DOI: 10.1183/20734735.0035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Patrick Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
| | - Joao Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Centro De Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal
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Kasarabada A, Barker K, Ganoe T, Clevenger L, Visco C, Gibson J, Karimi R, Naderi N, Lam B, Stepanova M, Henry L, King C, Desai M. How long is too long: A retrospective study evaluating the impact of the duration of noninvasive oxygenation support strategies (high flow nasal cannula & BiPAP) on mortality in invasive mechanically ventilated patients with COVID-19. PLoS One 2023; 18:e0281859. [PMID: 36795723 PMCID: PMC9934441 DOI: 10.1371/journal.pone.0281859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND/AIM We investigated the association of noninvasive oxygenation support [high flow nasal cannula (HFNC) and BiPAP], timing of invasive mechanical ventilation (IMV), and inpatient mortality among patients hospitalized with COVID-19. METHODS Retrospective chart review study of patients hospitalized with COVID-19 (ICD-10 code U07.1) and received IMV from March 2020-October 2021. Charlson comorbidity index (CCI) was calculated; Obesity defined as body mass index (BMI) ≥ 30 kg/m2; morbid obesity was BMI ≥ 40 kg/m2. Clinical parameters/vital signs recorded at time of admission. RESULTS 709 COVID-19 patients underwent IMV, predominantly admitted from March-May 2020 (45%), average age 62±15 years, 67% male, 37% Hispanic, and 9% from group living settings. 44% had obesity, 11% had morbid obesity, 55% had type II diabetes, 75% had hypertension, and average CCI was 3.65 (SD = 3.11). Crude mortality rate was 56%. Close linear association of age with inpatient-mortality risk was found [OR (95% CI) = 1.35 (1.27-1.44) per 5 years, p<0.0001)]. Patients who died after IMV received noninvasive oxygenation support significantly longer: 5.3 (8.0) vs. 2.7 (SD 4.6) days; longer use was also independently associated with a higher risk of inpatient-mortality: OR = 3.1 (1.8-5.4) for 3-7 days, 7.2 (3.8-13.7) for ≥8 days (reference: 1-2 days) (p<0.0001). The association magnitude varied between age groups: 3-7 days duration (ref: 1-2 days), OR = 4.8 (1.9-12.1) in ≥65 years old vs. 2.1 (1.0-4.6) in <65 years old. Higher mortality risk was associated with higher CCI in patients ≥65 (P = 0.0082); among younger patients, obesity (OR = 1.8 (1.0-3.2) or morbid obesity (OR = 2.8;1.4-5.9) (p<0.05) were associated. No mortality association was found for sex or race. CONCLUSION Time spent on noninvasive oxygenation support [as defined by high flow nasal cannula (HFNC) and BiPAP] prior to IMV increased mortality risk. Research for the generalizability of our findings to other respiratory failure patient populations is needed.
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Affiliation(s)
- Aditya Kasarabada
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Kimberly Barker
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Theresa Ganoe
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Lindsay Clevenger
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Cristina Visco
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Jessica Gibson
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Rahim Karimi
- Medicine Service Line, Inova Health Systems, Falls Church, Virginia, United States of America
| | - Negar Naderi
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Brian Lam
- Medicine Service Line, Inova Health Systems, Falls Church, Virginia, United States of America
| | - Maria Stepanova
- Medicine Service Line, Inova Health Systems, Falls Church, Virginia, United States of America
| | - Linda Henry
- Medicine Service Line, Inova Health Systems, Falls Church, Virginia, United States of America
| | - Christopher King
- Department of Advanced Lung Disease and Transplant, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Mehul Desai
- Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
- Medicine Service Line, Inova Health Systems, Falls Church, Virginia, United States of America
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Newly Proposed Diagnostic Criteria for Acute Respiratory Distress Syndrome: Does Inclusion of High Flow Nasal Cannula Solve the Problem? J Clin Med 2023; 12:jcm12031043. [PMID: 36769691 PMCID: PMC9917973 DOI: 10.3390/jcm12031043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a common life-threatening clinical syndrome which accounts for 10% of intensive care unit admissions. Since the Berlin definition was developed, the clinical diagnosis and therapy have changed dramatically by adding a minimum positive end-expiratory pressure (PEEP) to the assessment of hypoxemia compared to the American-European Consensus Conference (AECC) definition in 1994. High-flow nasal cannulas (HFNC) have become widely used as an effective respiratory support for hypoxemia to the extent that their use was proposed in the expansion of the ARDS criteria. However, there would be problems if the diagnosis of a specific disease or clinical syndrome occurred, based on therapeutic strategies.
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Bongiovanni F, Michi T, Natalini D, Grieco DL, Antonelli M. Advantages and drawbacks of helmet noninvasive support in acute respiratory failure. Expert Rev Respir Med 2023; 17:27-39. [PMID: 36710082 DOI: 10.1080/17476348.2023.2174974] [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: 01/31/2023]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) represents an effective strategy for managing acute respiratory failure. Facemask NIV is strongly recommended in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnia and acute cardiogenic pulmonary edema (ACPE). Its role in managing acute hypoxemic respiratory failure (AHRF) remains a debated issue. NIV and continuous positive airway pressure (CPAP) delivered through the helmet are recently receiving growing interest for AHRF management. AREAS COVERED In this narrative review, we discuss the clinical applications of helmet support compared to the other available noninvasive strategies in the different phenotypes of acute respiratory failure. EXPERT OPINION Helmets enable the use of high positive end-expiratory pressure, which may protect from self-inflicted lung injury: in AHRF, the possible superiority of helmet support over other noninvasive strategies in terms of clinical outcome has been hypothesized in a network metanalysis and a randomized trial, but has not been confirmed by other investigations and warrants confirmation. In AECOPD patients, helmet efficacy may be inferior to that of face masks, and its use prompts caution due to the risk of CO2 rebreathing. Helmet support can be safely applied in hypoxemic patients with ACPE, with no advantages over facemasks.
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Affiliation(s)
- Filippo Bongiovanni
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Teresa Michi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Daniele Natalini
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Domenico L Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
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