1
|
Morin F, Polard L, Fresnel E, Richard M, Schmit H, Martin-Houitte C, Cordioli RL, Lebret M, Mercat A, Beloncle F, Savary D, Richard JC, Lesimple A. A new physiological manikin to test and compare ventilation devices during cardiopulmonary resuscitation. Resusc Plus 2024; 19:100663. [PMID: 38827273 PMCID: PMC11143906 DOI: 10.1016/j.resplu.2024.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Background There is a lack of bench systems permitting to evaluate ventilation devices in the specific context of cardiac arrest. Objectives The objective of the study is to assess if a new physiological manikin may permit to evaluate the performances of medical devices dedicated to ventilation during cardiopulmonary resuscitation (CPR). Methods Specific CPR-related features required to reproduce realistic ventilation were implemented into the SAM (Sarthe Anjou Mayenne) manikin. In the first place, the manikin ability to mimic ventilation during CPR was assessed and compared to real-life tracings of airway pressure, flow and capnogram from three out of hospital cardiac arrest (OHCA) patients. In addition, to illustrate the interest of this manikin, ventilation was evaluated during mechanical continuous chest compressions with two devices dedicated to CPR: the Boussignac cardiac arrest device (B-card - Vygon; Ecouen France) and the Impedance Threshold Device (ITD - Zoll; Chelmsford, MA). Results The SAM manikin enabled precise replication of ventilation tracings as observed in three OHCA patients during CPR, and it allowed for comparison between two distinct ventilation devices. B-card generated a mean, maximum and minimum intrathoracic pressure of 6.3 (±0.1) cmH2O, 18.9 (±1.1) cmH2O and -0.3 (±0.2) cmH2O respectively; while ITD generated a mean, maximum and minimum intrathoracic pressure of -1.6 (±0.0) cmH2O, 5.7 (±0.1) cmH2O and -4.8 (±0.1) cmH2O respectively during CPR. B-card allowed to increase passive ventilation compared to the ITD which resulted in a dramatic limitation of passive ventilation. Conclusion The SAM manikin is an innovative model integrating specific physiological features that permit to accurately evaluate and compare ventilation devices during CPR.
Collapse
Affiliation(s)
- François Morin
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- Vent’Lab, University Hospital of Angers, Angers, France
| | - Laura Polard
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
| | | | | | - Hugo Schmit
- Department of Emergency Medicine, Annecy Genevois Hospital, Annecy, France
| | | | | | - Marius Lebret
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
- Kernel Biomedical, Bois-Guillaume, France
- Université Paris-Saclay, UVSQ, Erphan Paris-Saclay University, Versailles, France
| | - Alain Mercat
- Vent’Lab, University Hospital of Angers, Angers, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - François Beloncle
- Vent’Lab, University Hospital of Angers, Angers, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - Dominique Savary
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- Vent’Lab, University Hospital of Angers, Angers, France
| | - Jean-Christophe Richard
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - Arnaud Lesimple
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
| |
Collapse
|
2
|
Luján M, Cinesi Gómez C, Peñuelas O, Ferrando C, Heili-Frades SB, Carratalá Perales JM, Mas A, Sayas Catalán J, Mediano O, Roca O, García Fernández J, González Varela A, Sempere Montes G, Rialp Cervera G, Hernández G, Millán T, Ferrer Monreal M, Egea Santaolalla C. Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient. Arch Bronconeumol 2024; 60:285-295. [PMID: 38521646 DOI: 10.1016/j.arbres.2024.02.017] [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: 02/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation. Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered. While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.
Collapse
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Anesthesia and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Sarah Béatrice Heili-Frades
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
| | | | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | - Olga Mediano
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
| | - Oriol Roca
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier García Fernández
- Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
| | | | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Teresa Millán
- Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
| | - Miquel Ferrer Monreal
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
3
|
Rodrigues de Moraes L, Robba C, Battaglini D, Pelosi P, Rocco PRM, Silva PL. New and personalized ventilatory strategies in patients with COVID-19. Front Med (Lausanne) 2023; 10:1194773. [PMID: 37332761 PMCID: PMC10273276 DOI: 10.3389/fmed.2023.1194773] [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: 03/27/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus and may lead to severe respiratory failure and the need for mechanical ventilation (MV). At hospital admission, patients can present with severe hypoxemia and dyspnea requiring increasingly aggressive MV strategies according to the clinical severity: noninvasive respiratory support (NRS), MV, and the use of rescue strategies such as extracorporeal membrane oxygenation (ECMO). Among NRS strategies, new tools have been adopted for critically ill patients, with advantages and disadvantages that need to be further elucidated. Advances in the field of lung imaging have allowed better understanding of the disease, not only the pathophysiology of COVID-19 but also the consequences of ventilatory strategies. In cases of refractory hypoxemia, the use of ECMO has been advocated and knowledge on handling and how to personalize strategies have increased during the pandemic. The aims of the present review are to: (1) discuss the evidence on different devices and strategies under NRS; (2) discuss new and personalized management under MV based on the pathophysiology of COVID-19; and (3) contextualize the use of rescue strategies such as ECMO in critically ill patients with COVID-19.
Collapse
Affiliation(s)
- Lucas Rodrigues de Moraes
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chiara Robba
- Unit of Anaesthesia and Intensive Care, San Martino Hospital (IRCCS), Genoa, Italy
| | - Denise Battaglini
- Unit of Anaesthesia and Intensive Care, San Martino Hospital (IRCCS), Genoa, Italy
| | - Paolo Pelosi
- Unit of Anaesthesia and Intensive Care, San Martino Hospital (IRCCS), Genoa, Italy
| | - Patricia R. M. Rocco
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Hess DR. Respiratory Care Management of COPD Exacerbations. Respir Care 2023; 68:821-837. [PMID: 37225653 PMCID: PMC10208989 DOI: 10.4187/respcare.11069] [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: 05/26/2023]
Abstract
A COPD exacerbation is characterized by an increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks. Exacerbations are common. Respiratory therapists and physicians in an acute care setting often treat these patients. Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92%. Arterial blood gases remain the standard approach to assessing gas exchange in patients with COPD exacerbation. The limitations of arterial blood gas surrogates (pulse oximetry, capnography, transcutaneous monitoring, peripheral venous blood gases) should be appreciated so that they can be used wisely. Inhaled short-acting bronchodilators can be provided by nebulizer (jet or mesh), pressurized metered-dose inhaler (pMDI), pMDI with spacer or valved holding chamber, soft mist inhaler, or dry powder inhaler. The available evidence for the use of heliox for COPD exacerbation is weak. Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines. Robust high-level evidence with patient important outcomes is lacking for the use of high-flow nasal cannula in patients with COPD exacerbation. Management of auto-PEEP is the priority in mechanically ventilated patients with COPD. This is achieved by reducing airway resistance and decreasing minute ventilation. Trigger asynchrony and cycle asynchrony are addressed to improve patient-ventilator interaction. Patients with COPD should be extubated to NIV. Additional high-level evidence is needed before widespread use of extracorporeal CO2 removal. Care coordination can improve the effectiveness of care for patients with COPD exacerbation. Evidence-based practices improve outcomes in patients with COPD exacerbation.
Collapse
Affiliation(s)
- Dean R Hess
- Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts; and Northeastern University, Boston, Massachusetts.
| |
Collapse
|
5
|
Luján M, Flórez P, Pomares X. What Circuits, Masks and Filters Should Be Used in Home Non-Invasive Mechanical Ventilation. J Clin Med 2023; 12:jcm12072692. [PMID: 37048774 PMCID: PMC10094856 DOI: 10.3390/jcm12072692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Most of the published reviews about non-invasive home ventilation mainly reflect the technical aspects of ventilators. There is much less information about the consumables most used at home. However, the choice of a good interface or tubing system can lead to physiological changes in the patient–ventilator interaction that the clinician should be aware of. These physiological changes may affect the performance of the ventilator itself, the reliability of monitoring and, of course, the comfort of the patient. The use of different circuits, masks or filters is therefore related to the concepts of rebreathing, compressible volume, instrumental dead space or leak estimation and tidal volume. Through certain bench experiments, it is possible to determine the implications that each of these elements may have in clinical practice.
Collapse
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigacion Biomédica en Red (CIBERES), 28029 Madrid, Spain
| | - Pablo Flórez
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
| | - Xavier Pomares
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Branson RD, Rodriquez D. COVID-19 Lessons Learned: Response to the Anticipated Ventilator Shortage. Respir Care 2023; 68:129-150. [PMID: 36566030 PMCID: PMC9993519 DOI: 10.4187/respcare.10676] [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: 12/26/2022]
Abstract
Early in the COVID-19 pandemic predictions of a worldwide ventilator shortage prompted a worldwide search for solutions. The impetus for the scramble for ventilators was spurred on by inaccurate and often unrealistic predictions of ventilator requirements. Initial efforts looked simply at acquiring as many ventilators as possible from national and international sources. Ventilators from the Strategic National Stockpile were distributed to early hotspots in the Northeast and Northwest United States. In a triumph of emotion over logic, well-intended experts from other industries turned their time, talent, and treasure toward making a ventilator for the first time. Interest in shared ventilation (more than one patient per ventilator) was ignited by an ill-advised video on social media that ignored the principles of gas delivery in deference to social media notoriety. With shared ventilation, a number of groups mistook a physiologic problem for a plumbing problem. The United States government invoked the Defense Production Act to push automotive manufacturers to partner with existing ventilator manufacturers to speed production. The FDA granted emergency use authorization for "splitters" to allow shared ventilation as well as for ventilators and ancillary equipment. Rationing of ventilators was discussed in the lay press and medical literature but was never necessary in the US. Finally, planners realized that staff with expertise in providing mechanical ventilation were the most important shortage. Over 200,000 ventilators were purchased by the United States government, states, cities, health systems, and individuals. Most had little value in caring for patients with COVID-19 ARDS. This paper attempts to look at where miscalculations were made, with an eye toward what we can do better in the future.
Collapse
Affiliation(s)
- Richard D Branson
- Division of Trauma/Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Dario Rodriquez
- Division of Trauma/Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, Ohio; and Airman Biosciences Division, Airman Systems Directorate, Wright-Patterson Air Force Base, Dayton, Ohio
| |
Collapse
|
8
|
Ferrone G, Spinazzola G, Costa R, Piastra M, Maresca G, Antonelli M, Conti G. Influence of total face masks design and circuit on synchrony and performance during pressure support ventilation: A bench study. Respir Med Res 2022; 82:100963. [DOI: 10.1016/j.resmer.2022.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
|
9
|
Tolson J, Hone R, Bandiera C, Rautela L, Churchward TJ, Ridgers A, Howard ME, Worsnop CJ. Filters Alter the Performance of Noninvasive Ventilators. Respir Care 2022; 67:795-800. [PMID: 35610028 PMCID: PMC9994091 DOI: 10.4187/respcare.09365] [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: 11/05/2022]
Abstract
BACKGROUND Noninvasive ventilation is recommended in hypercapnic respiratory failure secondary to ventilatory failure. Noninvasive ventilation may contribute to aerosol dispersion, which may increase the risk of transmission of COVID 2019. The addition of filters to the ventilator circuit has been recommended to reduce this risk. The aim of this benchtop study was to investigate the impact of adding filters to a ventilator circuit. METHODS In this benchtop study, a breathing simulator was used with 4 commonly used ventilators. Ventilators were set to approximate the typical settings that are used for patients on long-term noninvasive ventilation. Ventilator performance was then evaluated with 3 circuit configurations in place: circuit A: no filter in situ; circuit B: 1 filter at the simulator end of the circuit; and circuit C: 1 filter at the simulator end of the circuit and a second filter at the ventilator end of the circuit. RESULTS Ventilator variables were impacted by the addition of filters. Measurements of peak pressure (P < .001), tidal volume (P < .001), and peak flow (P < .001) decreased between circuit A and circuit C in all ventilators that were tested. Ventilator triggering was less sensitive in 3 of the 4 ventilators and the fourth ventilator did not trigger under the same simulator settings. CONCLUSIONS This study demonstrated that ventilator settings established with filters in situ are not applicable if the ventilator is used without the filters. This is an important clinical consideration for patients who are hospitalized and require noninvasive ventilation in the COVID 2019 era.
Collapse
Affiliation(s)
- Julie Tolson
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney Hone
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | | | - Linda Rautela
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Thomas J Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Anna Ridgers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Christopher J Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| |
Collapse
|
10
|
Stieglitz S, Mandal M, Bhakta P, Esquinas AM. Balancing the risks and benefits is essential for reaping the success of adding in-circuit bacterial filters. Eur Respir J 2022; 59:59/5/2200562. [PMID: 35589116 DOI: 10.1183/13993003.00562-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Sven Stieglitz
- Dept of Pneumology, Allergy, Sleep, and Intensive Care Medicine, Petrus Hospital Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Mohanchandra Mandal
- Dept of Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Pradipta Bhakta
- Dept of Anaesthesiology and Intensive Care, University Hospital Waterford, Waterford, Ireland
| | | |
Collapse
|
11
|
Khonsari RH, Oranger M, François PM, Mendoza-Ruiz A, Leroux K, Boussaid G, Prieur D, Hodge JP, Belle A, Midler V, Morelot-Panzini C, Patout M, Gonzalez-Bermejo J. Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic? PLoS One 2022; 17:e0263808. [PMID: 35446853 PMCID: PMC9022824 DOI: 10.1371/journal.pone.0263808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis. MATERIAL AND METHODS Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices. RESULTS Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months. CONCLUSIONS 3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics.
Collapse
Affiliation(s)
- Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Mathilde Oranger
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | | | | | - Ghilas Boussaid
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Delphine Prieur
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Antoine Belle
- Service de Pneumologie, Centre Hospitalier Intercommunal de Compiègne-Noyon, Compiègne, France
| | - Vincent Midler
- Département de la Maîtrise d’Ouvrage et de la Politique Technique – DEFIP, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Capucine Morelot-Panzini
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
| | - Maxime Patout
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
- Service des Pathologies du Sommeil (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jésus Gonzalez-Bermejo
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
| |
Collapse
|
12
|
Higher mortality and intubation rate in COVID-19 patients treated with noninvasive ventilation compared with high-flow oxygen or CPAP. Sci Rep 2022; 12:6527. [PMID: 35444251 PMCID: PMC9020755 DOI: 10.1038/s41598-022-10475-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
The effectiveness of noninvasive respiratory support in severe COVID-19 patients is still controversial. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. We recruited 367 consecutive patients aged ≥ 18 years who were treated with HFNC (155, 42.2%), CPAP (133, 36.2%) or NIV (79, 21.5%). The main outcome was intubation or death at 28 days after respiratory support initiation. After adjusting for relevant covariates and taking patients treated with HFNC as reference, treatment with NIV showed a higher risk of intubation or death (hazard ratio 2.01; 95% confidence interval 1.32–3.08), while treatment with CPAP did not show differences (0.97; 0.63–1.50). In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28 days than high-flow oxygen or CPAP. This finding may help physicians to choose the best noninvasive respiratory support treatment in these patients. Clinicaltrials.gov identifier: NCT04668196.
Collapse
|
13
|
Rabec C, Fresnel E, Rétory Y, Zhu K, Joly K, Kerfourn A, Dudoignon B, Mendoza A, Cuvelier A, Muir JF, Melloni B, Chabot JF, Gonzalez-Bermejo J, Patout M. Addition of bacterial filter alters positive airway pressure and non-invasive ventilation performances. Eur Respir J 2022; 59:13993003.02636-2021. [PMID: 35086835 PMCID: PMC9030068 DOI: 10.1183/13993003.02636-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
Recently, one manufacturer of home ventilators issued an alert regarding the potential risk of serious injury related to the use of some of their positive airway pressure (PAP) and non-invasive ventilation (NIV) devices [1]. The risk is caused by the polyurethane foam used in their ventilators. In some cases, the foam broke into the blower and could have been inhaled by patients. The manufacturer and some healthcare regulatory agencies advocated, as a temporary solution, to modify PAP and NIV circuits by adding an inline bacterial filter in order to reduce the risk of inhalation [2]. However, changing ventilator circuits can alter ventilator performances during PAP and NIV [3]. The recommendation to add a bacterial filter on home positive pressure devices has significant negative impact on their performances and precludes auto-titrating positive airway pressure to function. These data suggest to not follow such recommendation.https://bit.ly/31YrWyo
Collapse
Affiliation(s)
- Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France.,Fédération ANTADIR, Paris, France.,Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | | | - Yann Rétory
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
| | - Kaixian Zhu
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
| | | | | | - Benjamin Dudoignon
- 6AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
| | - Alexis Mendoza
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | - Antoine Cuvelier
- Normandie Univ, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | | | - Boris Melloni
- Fédération ANTADIR, Paris, France.,Pulmonary department, University Hospital Limoges, Limoges France
| | - Jean-François Chabot
- Fédération ANTADIR, Paris, France.,Département de Pneumologie, Université de Lorraine, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Jésus Gonzalez-Bermejo
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Maxime Patout
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France .,6AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| |
Collapse
|
14
|
Rolland-Debord C, D'Haenens A, Mendiluce L, Spurr L, Konda S, Cherneva R, Lhuillier E, Heunks L, Patout M. ERS International Congress 2020 Virtual: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2021; 7:00214-2021. [PMID: 34790814 PMCID: PMC8591268 DOI: 10.1183/23120541.00214-2021] [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: 03/25/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022] Open
Abstract
During the virtual European Respiratory Society Congress 2020, early career members summarised the sessions organised by the Respiratory Intensive Care Assembly. The topics covered included diagnostic strategies in patients admitted to the intensive care unit with acute respiratory failure, with a focus on patients with interstitial lung disease and for obvious reasons, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These sessions are summarised in this article, with take-home messages highlighted. Updates from #ERSCongress 2020 on diagnostic strategies in patients admitted to the ICU with acute respiratory failure and on the management of #SARSCoV2 infectionhttps://bit.ly/38cx0Pi
Collapse
Affiliation(s)
- Camille Rolland-Debord
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service des Explorations Fonctionnelles de la Respiration de l'Exercice et de la Dyspnée, Hôpital Tenon, Paris, France
| | | | - Leire Mendiluce
- Ventilation Unit and Respiratory Semi-Critical Care Unit, Dept of Respiratory Medicine, University Hospital Germans Trias i Pujol, Universitat de Barcelona, Barcelona, Spain
| | - Lydia Spurr
- Academic and Clinical Dept of Sleep and Breathing, Royal Brompton and Harefield Hospitals, London, UK
| | - Shruthi Konda
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Radostina Cherneva
- Medical University, Sofia, Dept of Respiratory Diseases, University Hospital 'St Sophia', Sofia, Bulgaria
| | - Elodie Lhuillier
- Unité de recherche clinique, Centre Henri Becquerel, Rouen, France
| | - Leo Heunks
- Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| |
Collapse
|
15
|
Masa JF, Patout M, Scala R, Winck JC. Reorganizing the respiratory high dependency unit for pandemics. Expert Rev Respir Med 2021; 15:1505-1515. [PMID: 34720022 DOI: 10.1080/17476348.2021.1997596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Respiratory high dependency units (RHDUs) set up in European countries in the last decade are based on being a transitional step between the intensive care units (ICUs) and the conventional hospital ward in terms of staffing, level of monitoring, and patients' severity. In the pre-COVID-19 era, its main use has been the treatment of hypercapnic acute-on-chronic respiratory failure with noninvasive respiratory support, and more recently, for hypoxemic acute respiratory failure. AREAS COVERED We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, limited to the terms: COVID-19 and RHDU, Respiratory Intermediate care Unit, acute respiratory distress syndrome (ARDS), noninvasive ventilation (NIV), high flow nasal cannula (HFNC), prone position, and monitoring. In this review, we summarize RHDU´s dual purpose: on the one hand, to decrease the number of admissions into ICU, and on the other hand, early discharges of patients from ICU with prolonged admissions due to the need of care or laborious weaning from invasive mechanical ventilation. Although this dual purpose of RHDUs has contributed to decrease the overload of the ICUs during the pandemic, the hundreds of patients admitted in hospitals, with approximately 20%-30% needing critical care, has exceeded the forecasts of many hospitals. EXPERT OPINION It seems clear that a reorganization and optimization of the care of patients with severe COVID-19 is necessary, minimizing admissions to the ICU and facilitating an early discharge. During the pandemic, several hospitals have spontaneously created new RHDUs or extended preexisting RHDUs or up-graded respiratory wards in order to receive less sick patients requiring lower levels of monitoring and nurse-to-patient ratios. This article reviews under a European expert perspective this topic and proposes an adaptation and optimization of the RHDUs to meet the emergent needs caused by the pandemic emphasizing the role of the expert application of noninvasive respiratory therapies in preventing intubation and ICU access.
Collapse
Affiliation(s)
- Juan Fernando Masa
- San Pedro De Alcantara Hospital, Cáceres, Spain.,Ciber De Enfermedades Respiratorias (Ciberes), Madrid, Spain.,Instituto Universitario De Investigación Biosanitaria De Extremadura (Inube), Spain
| | - Maxime Patout
- 1. Ap-hp, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service Des Pathologies Du Sommeil (Département R3S), Paris, France.,Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit. Cardiovascular-thoracic-metabolic Department. Usl Toscana Sudest. San Donato Hospital, Arezzo, Italy
| | - Joao Carlos Winck
- Faculdade De Medicina Da Universidade Do Porto, Centro De Reabilitação Do Norte (Chvng), Vila Nova De Gaia, Portugal
| |
Collapse
|
16
|
Coppadoro A, Zago E, Pavan F, Foti G, Bellani G. The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:327. [PMID: 34496927 PMCID: PMC8424168 DOI: 10.1186/s13054-021-03746-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022]
Abstract
A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO2 rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.
Collapse
Affiliation(s)
| | - Elisabetta Zago
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Fabio Pavan
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giacomo Bellani
- ASST Monza, San Gerardo Hospital, Monza, Italy. .,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy.
| |
Collapse
|
17
|
Winck JC. Circuit Set-ups to Reduce Virus Aerosolization During Noninvasive Positive Pressure Ventilation: Dancing in the Dark. Chest 2021; 160:13-14. [PMID: 34246362 PMCID: PMC8261020 DOI: 10.1016/j.chest.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
|
18
|
Helgeson SA, Lim KG, Patel NM, Lee AS, Niven AS, Cheung J. Particle generation during positive airway pressure therapy. Sleep Med 2021; 84:82-85. [PMID: 34126400 PMCID: PMC8130584 DOI: 10.1016/j.sleep.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/08/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Scott A Helgeson
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Neal M Patel
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Augustine S Lee
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Cheung
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|