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Pettenuzzo T, Boscolo A, Pistollato E, Pretto C, Giacon TA, Frasson S, Carbotti FM, Medici F, Pettenon G, Carofiglio G, Nardelli M, Cucci N, Tuccio CL, Gagliardi V, Schiavolin C, Simoni C, Congedi S, Monteleone F, Zarantonello F, Sella N, De Cassai A, Navalesi P. Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis. Crit Care 2024; 28:152. [PMID: 38720332 PMCID: PMC11077852 DOI: 10.1186/s13054-024-04924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. METHODS A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. RESULTS Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. CONCLUSIONS In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Elisa Pistollato
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Pretto
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Sara Frasson
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Francesca Medici
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giovanni Pettenon
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giuliana Carofiglio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Marco Nardelli
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Nicolas Cucci
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Clara Letizia Tuccio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Veronica Gagliardi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Schiavolin
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Sabrina Congedi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Monteleone
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Zarantonello
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy.
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Misseri G, Frassanito L, Simonte R, Rosà T, Grieco DL, Piersanti A, De Robertis E, Gregoretti C. Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives. J Pers Med 2023; 14:56. [PMID: 38248757 PMCID: PMC10817439 DOI: 10.3390/jpm14010056] [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: 11/27/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. Objectives: This narrative review provides an overview on the perioperative use of NRS. Preoperative, intraoperative, and postoperative respiratory support is discussed, along with potential future areas of research. Results: During induction of anesthesia, in selected patients at high risk of difficult intubation, NIV is associated with improved gas exchange and reduced risk of postoperative respiratory complications. HFNOT demonstrated an improvement in oxygenation. Evidence on the intraoperative use of NRS is limited. Compared with conventional oxygenation, HFNOT is associated with a reduced risk of hypoxemia during procedural sedation, and recent data indicate a possible role for HFNOT for intraoperative apneic oxygenation in specific surgical contexts. After extubation, "preemptive" NIV and HFNOT in unselected cohorts do not affect clinical outcome. Postoperative "curative" NIV in high-risk patients and among those exhibiting signs of respiratory failure can reduce reintubation rate, especially after abdominal surgery. Data on postoperative "curative" HFNOT are limited. Conclusions: There is increasing evidence on the perioperative use of NRS. Use of NRS should be tailored based on the patient's specific characteristics and type of surgery, aimed at a personalized cost-effective approach.
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Affiliation(s)
- Giovanni Misseri
- Fondazione Istituto “G. Giglio” Cefalù, 90015 Palermo, Italy; (G.M.); (C.G.)
| | - Luciano Frassanito
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy; (L.F.); (T.R.); (D.L.G.); (A.P.)
| | - Rachele Simonte
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Tommaso Rosà
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy; (L.F.); (T.R.); (D.L.G.); (A.P.)
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00165 Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy; (L.F.); (T.R.); (D.L.G.); (A.P.)
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00165 Rome, Italy
| | - Alessandra Piersanti
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy; (L.F.); (T.R.); (D.L.G.); (A.P.)
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Cesare Gregoretti
- Fondazione Istituto “G. Giglio” Cefalù, 90015 Palermo, Italy; (G.M.); (C.G.)
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
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3
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Suleiman A, Azizi BA, Munoz-Acuna R, Ahrens E, Tartler TM, Wachtendorf LJ, Linhardt FC, Santer P, Chen G, Wilson JL, Gangadharan SP, Schaefer MS. Intensity of one-lung ventilation and postoperative respiratory failure: A hospital registry study. Anaesth Crit Care Pain Med 2023; 42:101250. [PMID: 37236317 DOI: 10.1016/j.accpm.2023.101250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Studies linked a high intensity of mechanical ventilation, measured as high mechanical power (MP) to postoperative respiratory failure (PRF) in the setting of two-lung ventilation. We investigated whether a higher MP during one-lung ventilation (OLV) is associated with PRF. METHODS In this registry-based study, adult patients who underwent general anesthesia with OLV for thoracic surgeries between 2006 and 2020 at a New England tertiary healthcare network were included. The association between MP during OLV and PRF (emergency non-invasive ventilation or reintubation within seven days) was assessed in a cohort weighted through a generalized propensity score conditional on a priori defined preoperative and intraoperative factors. Dominance of components of MP and intensity of OLV versus two-lung ventilation in predicting PRF was investigated. RESULTS Out of 878 included patients, 106 (12.1%) developed PRF. The median (IQR) MP during OLV was 9.8 J/min (7.5-11.8) and 8.3 J/min (6.6-10.2) in patients with and without PRF respectively. A higher MP during OLV was associated with PRF (ORadj 1.22 per 1 J/min increase; 95%CI 1.13-1.31; p < 0.001) and characterized by a U-shaped dose-response curve, with the lowest probability of PRF (7.5%) at 6.4 J/min. Dominance analysis of PRF predictors showed a stronger contribution of driving pressure over respiratory rate and tidal volume, the dynamic over the static component of MP, and MP during OLV over two-lung ventilation (contribution to Pseudo-R2: 0.017, 0.021, and 0.036, respectively). CONCLUSION A higher intensity of OLV, mainly driven by driving pressure, is dose-dependently associated with PRF and might constitute a target for mechanical ventilation.
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Affiliation(s)
- Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Basit A Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim M Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix C Linhardt
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Santer
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer L Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
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4
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Moury PH, Pasquier V, Greco F, Arvieux JL, Alves-Macedo S, Richard M, Casez-Brasseur M, Skaare K, Jacon P, Durand M, Bedague D, Jaber S, Bosson JL, Albaladejo P. A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory. Can J Anaesth 2023; 70:1182-1193. [PMID: 37268802 DOI: 10.1007/s12630-023-02495-2] [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: 07/26/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The efficacy of noninvasive ventilation (NIV) during procedures that require sedation and analgesia has not been established. We evaluated whether NIV reduces the incidence of respiratory events. METHODS In this randomized controlled trial, we included 195 patients with an American Society of Anesthesiologists Physical Status of III or IV during electrophysiology laboratory procedures. We compared NIV with face mask oxygen therapy for patients under sedation. The primary outcome was the incidence of respiratory events determined by a computer-driven blinded analysis and defined by hypoxemia (peripheral oxygen saturation < 90%) or apnea/hypopnea (absence of breathing for 20 sec on capnography). Secondary outcomes included hemodynamic variables, sedation, patient safety (composite scores of major or minor adverse events), and adverse outcomes at day 7. RESULTS A respiratory event occurred in 89/98 (95%) patients in the NIV group and in 69/97 (73%) patients with face masks (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.13 to 1.47; P < 0.001). Hypoxemia occurred in 40 (42%) patients in the NIV group and in 33 (34%) patients with face masks (RR, 1.21; 95% CI, 0.84 to 1.74; P = 0.30). Apnea/hypopnea occurred in 83 patients (92%) in the NIV group vs 65 patients (70%) with face masks (RR, 1.32; 95% CI, 1.14 to 1.53; P < 0.001). Hemodynamic variables, sedation, major or minor safety events, and patient outcomes were not different between the groups. CONCLUSIONS Respiratory events were more frequent among patients receiving NIV without any safety or outcome impairment. These results do not support the routine use of NIV intraoperatively. STUDY REGISTRATION ClinicalTrials.gov (NCT02779998); registered 4 November 2015.
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Affiliation(s)
- Pierre-Henri Moury
- HP2 Laboratory, U1042, Grenoble Alpes University, Grenoble, France.
- Pôle Anesthésie-Réanimation, Réanimation Cardiovasculaire et Thoracique, CHU Grenoble Alpes, CS 10217, Grenoble Cedex 9, France.
| | | | - Flora Greco
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | | | - Marion Richard
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | - Kristina Skaare
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Peggy Jacon
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Damien Bedague
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Samir Jaber
- Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Jean-Luc Bosson
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
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Barbagallo M, Schiappa E. Noninvasive Positive Pressure Ventilation in Patients Undergoing Lung Resection Surgery. NONINVASIVE MECHANICAL VENTILATION 2023:645-654. [DOI: 10.1007/978-3-031-28963-7_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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[Efficacy Analysis of High-flow Nasal Oxygen Therapy in Patients
Accepting Single-port Video-assisted Thoracoscopic Lobectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:642-650. [PMID: 36172728 PMCID: PMC9549426 DOI: 10.3779/j.issn.1009-3419.2022.102.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients who underwent lobectomy resection are prone to hypoxemia, and the vast majority present with type I respiratory failure. Thus, improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients. In this study, the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy (HFNO), noninvasive mechanical ventilation (NIMV) and nasal oxygen breath (NOB) in patients with hypoxemia after single-port video-assisted thoracoscopic (VATS) lobectomy, and the clinical efficacy of HFNO in these patients was further investigated. METHODS A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups (n=60), which were treated with HFNO, NIMV and NOB, respectively. The results of arterial blood gas analysis, patient's comfort score and incidence of complications were observed before, 1 h, 6 h-12 h and after use. Statistical analyses were conducted using statistical program for social sciences 25.0 (SPSS 25.0), and P<0.05 was considered as statistical significance. RESULTS For patients with hypoxemia after accepting single-port VATS lobectomy, HFNO was no less effective than NIMV (P=0.333), and both of whom could fast increase patients' partial pressure of oxygen/fraction of inspiration O₂ (PaO₂/FiO₂) compared to NOB (P<0.001). Besides, HFNO shows a great advantage in comfort degree and stay length (P<0.001, P=0.004), and incidence of complications were slightly lower than other groups (P=0.232). But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide (PaCO₂). CONCLUSIONS For patients with hypoxemia who accepting single-port VATS lobectomy, HFNO can be used as the first choice. However, for patients with postoperative hypoxemia accompanied by elevated PaCO₂, NIMV is still recommended to improve oxygenation.
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Ohchi Y, Kuribayashi Y, Makino T, Yasuda N, Kitano T. Nasal pillow noninvasive ventilation versus high-flow nasal therapy after extubation in surgical intensive care patients: A propensity-matched cohort study. J Int Med Res 2022; 50:3000605221112777. [PMID: 35866425 PMCID: PMC9310252 DOI: 10.1177/03000605221112777] [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] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the tolerability and efficacy of nasal pillow-noninvasive ventilation (NP-NIV) compared with high-flow nasal therapy (HFNT) in postsurgical patients. Methods This propensity score-matched retrospective study enrolled postoperative patients that received NP-NIV (NP-NIV group) or HFNT (HFNT group) in the intensive care unit. Data were collected from their medical records and the tolerability and respiratory status before and after extubation were compared between the two groups. Results The study enrolled 83 patients in the NP-NIV group and 27 patients in the HFNT group. After propensity score matching, there were 19 patients in each group. After matching, there were no significant differences in the baseline demographic and clinical characteristics before extubation. The tolerability was similar in both groups. When the NP-NIV group was compared with the HFNT group, the respiratory rate was significantly lower (median 16 [interquartile range, 14–17] versus median 19 [interquartile range, 18–26], respectively) and the partial pressure of arterial oxygen/fraction of inspired oxygen ratio was significantly higher (median 205 [174–256] versus median 155 [130–192], respectively) at 1 h after extubation. Conclusion NP-NIV was equally well tolerated and provided better respiratory support than HFNT in postsurgical patients.
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Affiliation(s)
- Yoshifumi Ohchi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yoshihide Kuribayashi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takenori Makino
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Norihisa Yasuda
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takaaki Kitano
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
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Arrivé F, Rodriguez M, Frat JP, Thille A. Place de l’oxygénothérapie à haut débit en post-extubation. Rev Mal Respir 2022; 39:469-476. [DOI: 10.1016/j.rmr.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
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Verma A, Tran Z, Sakowitz S, Hadaya J, Lee C, Madrigal J, Revels S, Benharash P. Hospital variation in the development of respiratory failure after pulmonary lobectomy: A national analysis. Surgery 2022; 172:379-384. [DOI: 10.1016/j.surg.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
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10
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Cammarota G, Simonte R, De Robertis E. Comfort During Non-invasive Ventilation. Front Med (Lausanne) 2022; 9:874250. [PMID: 35402465 PMCID: PMC8988041 DOI: 10.3389/fmed.2022.874250] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 01/03/2023] Open
Abstract
Non-invasive ventilation (NIV) has been shown to be effective in avoiding intubation and improving survival in patients with acute hypoxemic respiratory failure (ARF) when compared to conventional oxygen therapy. However, NIV is associated with high failure rates due, in most cases, to patient discomfort. Therefore, increasing attention has been paid to all those interventions aimed at enhancing patient's tolerance to NIV. Several practical aspects have been considered to improve patient adaptation. In particular, the choice of the interface and the ventilatory setting adopted for NIV play a key role in the success of respiratory assistance. Among the different NIV interfaces, tolerance is poorest for the nasal and oronasal masks, while helmet appears to be better tolerated, resulting in longer use and lower NIV failure rates. The choice of fixing system also significantly affects patient comfort due to pain and possible pressure ulcers related to the device. The ventilatory setting adopted for NIV is associated with varying degrees of patient comfort: patients are more comfortable with pressure-support ventilation (PSV) than controlled ventilation. Furthermore, the use of electrical activity of the diaphragm (EADi)-driven ventilation has been demonstrated to improve patient comfort when compared to PSV, while reducing neural drive and effort. If non-pharmacological remedies fail, sedation can be employed to improve patient's tolerance to NIV. Sedation facilitates ventilation, reduces anxiety, promotes sleep, and modulates physiological responses to stress. Judicious use of sedation may be an option to increase the chances of success in some patients at risk for intubation because of NIV intolerance consequent to pain, discomfort, claustrophobia, or agitation. During the Coronavirus Disease-19 (COVID-19) pandemic, NIV has been extensively employed to face off the massive request for ventilatory assistance. Prone positioning in non-intubated awake COVID-19 patients may improve oxygenation, reduce work of breathing, and, possibly, prevent intubation. Despite these advantages, maintaining prone position can be particularly challenging because poor comfort has been described as the main cause of prone position discontinuation. In conclusion, comfort is one of the major determinants of NIV success. All the strategies aimed to increase comfort during NIV should be pursued.
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11
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Park S. Treatment of acute respiratory failure: noninvasive mechanical ventilation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.3.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) has been an important strategy to support patients with respiratory failure, while preventing complications assorted with invasive mechanical ventilation. Physicians need to be aware of the various roles of NIV and the challenges encountered in clinical practice.Current Concepts: Traditionally, the application of NIV has been well-known to be associated with reduced mortality in patients with chronic obstructive pulmonary disease (COPD) or acute pulmonary edema and those suffering from acute respiratory failure. However, despite some positive results of NIV treatment in patients with de novo hypoxemic respiratory failure such as acute pneumonia or acute respiratory distress syndrome, NIV failure (or delayed intubation) can have deleterious effects on patients outcomes. Besides, the aggravation of lung injury should also be taken into consideration when applied to patients exhibiting high respiratory drive. Nonetheless, NIV has potential for wide applications in various clinical situations such as facilitation of ventilator weaning, post-operative respiratory failure, or palliative treatment.Discussion and Conclusion: In addition to the strong evidence in patients with acute respiratory failure due to COPD or acute pulmonary edema, the NIV treatment can be potentially used for various clinical conditions. However, compared to European countries, the prevalence of NIV use continues to remain lower in South Korea. Nevertheless, when applied in appropriately selected patients in a timely manner, NIV treatment can be associated with improved patient outcomes.
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Lagier D, Zeng C, Fernandez-Bustamante A, Melo MFV. Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Anesthesiology 2022; 136:206-236. [PMID: 34710217 PMCID: PMC9885487 DOI: 10.1097/aln.0000000000004009] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient's safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.
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Affiliation(s)
- David Lagier
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Congli Zeng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Marcos F. Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Thille AW, Wairy M, Pape SL, Frat JP. Oxygenation strategies after extubation of critically ill and postoperative patients. JOURNAL OF INTENSIVE MEDICINE 2021; 1:65-70. [PMID: 36788799 PMCID: PMC9923965 DOI: 10.1016/j.jointm.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
In intensive care units (ICUs), the decision to extubate is a critical one because mortality is particularly high in case of reintubation. Around 15% of patients ready to be weaned off a ventilator experience extubation failure leading to reintubation. The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation. High-flow nasal oxygen and non-invasive ventilation, may be used to prevent reintubation in patients with low (e.g., patients without comorbidities and with short durations of mechanical ventilation) and high risk (e.g., patients >65 years and those with underlying cardiac disease, chronic respiratory disorders, and/or hypercapnia at the time of extubation) of reintubation, respectively. However, non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation, and should therefore be used very carefully in this setting. The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs. Standard oxygen after a surgical procedure is adequate, even following major abdominal or cardiothoracic surgery, but should probably be switched to high-flow nasal oxygen in patients with hypoxemic. Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects, it may actually improve the outcomes in postoperative patients with respiratory failure. This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.
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Affiliation(s)
- Arnaud W. Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France,ALIVE Research group, INSERM CIC 1402, University of Poitiers, Poitiers 86021, France,Corresponding author: Arnaud W. Thille, Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue la Milétrie, Poitiers Cedex 86021, France.
| | - Mathilde Wairy
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France,ALIVE Research group, INSERM CIC 1402, University of Poitiers, Poitiers 86021, France
| | - Sylvain Le Pape
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France,ALIVE Research group, INSERM CIC 1402, University of Poitiers, Poitiers 86021, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France,ALIVE Research group, INSERM CIC 1402, University of Poitiers, Poitiers 86021, France
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14
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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15
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El-Goly AMM. Lines of Treatment of COVID-19 Infection. COVID-19 INFECTIONS AND PREGNANCY 2021. [PMCID: PMC8298380 DOI: 10.1016/b978-0-323-90595-4.00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care. Perioper Med (Lond) 2020; 9:31. [PMID: 33106758 PMCID: PMC7582032 DOI: 10.1186/s13741-020-00159-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padova, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Al-Iede MM, Al-Zayadneh E, Bridge C, Alqutawneh B, Waters K. Risk factors for postoperative pulmonary complications in children with severely compromised pulmonary function secondary to severe scoliosis. Pediatr Pulmonol 2020; 55:2782-2790. [PMID: 32729967 DOI: 10.1002/ppul.24997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES After corrective surgery for scoliosis, postoperative pulmonary complications lead to increases in morbidity, length of hospital stay (LOS) and mortality. This study aimed to identify associations with such respiratory complications, and to assess the utility of noninvasive ventilation (NIV) in children with severe scoliosis METHODS: This retrospective cohort study included all children aged ≤17 years who underwent spinal surgery for scoliosis between January 2009 and January 2012 at a quaternary pediatric hospital. Data were collated regarding polysomnography (PSG) and NIV use, before and after corrective surgery. Factors associated with severely compromised pulmonary function (SCPF) were established and correlations with the occurrence of postoperative pulmonary complications and LOS were identified. RESULTS Altogether, 133 children had corrective surgery for scoliosis, aged 12.7 (range: 2-17) years at operation. Scoliosis causes were identified as: idiopathic (39.8%), neuromuscular disease (32.2%), syndrome (15.7%), and congenital (12%). Correlates with SCPF (forced vital capacity [FVC] <40% predicted, n = 10) included markers of sleep hypoventilation, including serum bicarbonate ≥29 mmol/L, morning pCO2 > 50mm Hg (P = .003), and overnight, episodic CO2 retention of >7 mm Hg. Using these parameters an additional eight children with SCPF were identified making a total of 18 out of 133 (13.5%) of the patients. Postoperative pulmonary complications were seen in 24 children (18%) and their occurrence correlated with higher Cobb angle (>90°), lower pulmonary function (FVC), higher serum bicarbonate and underlying neuromuscular disease. Amongst the 18 children with SCPF, regular use of NIV preoperatively was associated with reduced rate of postoperative pulmonary complications (P = .02) and reduced LOS by 6.4 days (P = .01). CONCLUSION Nocturnal hypoventilation on PSG identifies children with SCPF. Use of NIV in children with SCPF was linked to fewer postoperative pulmonary complications and reduced duration of hospital stay.
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Affiliation(s)
| | - Enas Al-Zayadneh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Corinne Bridge
- Department of Orthopaedics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Basim Alqutawneh
- Radiology Department, Blacktown-Mount Druitt Hospital, Sydney, Australia
| | - Karen Waters
- Discipline of Paediatrics & Child Health, University of Sydney, New South Wales, Australia.,Sleep Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Bolourani S, Wang P, Patel VM, Manetta F, Lee PC. Predicting respiratory failure after pulmonary lobectomy using machine learning techniques. Surgery 2020; 168:743-752. [DOI: 10.1016/j.surg.2020.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
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19
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Algahtani R, Merenda A. Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications. Neurocrit Care 2020; 34:1047-1061. [PMID: 32794145 PMCID: PMC7426068 DOI: 10.1007/s12028-020-01072-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022]
Abstract
With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient’s deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra- and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.
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Affiliation(s)
- Rami Algahtani
- Department of Neurology, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Amedeo Merenda
- Department of Neurology, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA. .,Department of Neurosurgery, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA.
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Sharma R, Suri JC, Ramakrishnan N, Mani RK, Khilnani GC, Sidhu US. Guidelines for noninvasive ventilation in acute respiratory failure. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Zayed Y, Kheiri B, Barbarawi M, Rashdan L, Gakhal I, Ismail E, Kerbage J, Rizk F, Shafi S, Bala A, Sidahmed S, Bachuwa G, Seedahmed E. Effect of oxygenation modalities among patients with postoperative respiratory failure: a pairwise and network meta-analysis of randomized controlled trials. J Intensive Care 2020; 8:51. [PMID: 32690993 PMCID: PMC7366473 DOI: 10.1186/s40560-020-00468-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background Postoperative respiratory failure is associated with increased perioperative complications. Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure. Methods Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to September 2019. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. We performed a Bayesian network meta-analysis to calculate the odds ratio (OR) and Bayesian 95% credible intervals (CrIs). Results Nine RCTs representing 1865 patients were included (the mean age was 61.6 ± 10.2 and 64.4% were males). In comparison with standard oxygen, NIV was associated with a significant reduction in intubation rate (OR 0.23; 95% Cr.I. 0.10–0.46), mortality (OR 0.45; 95% Cr.I. 0.27–0.71), and intensive care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25–0.70). Compared to standard oxygen, HFNC was associated with a significant reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08–0.76) and ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20–0.80), but not mortality (OR 0.58; 95% Cr.I. 0.26–1.22). There were no significant differences between HFNC and NIV regarding different outcomes. In a subgroup analysis, we observed a mortality benefit with NIV over standard oxygen in patients undergoing cardiothoracic surgeries but not in abdominal surgeries. Furthermore, in comparison with standard oxygen, NIV and HFNC were associated with lower intubation rates following cardiothoracic surgeries while only NIV reduced the intubation rates following abdominal surgeries. Conclusions Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. Moreover, NIV was associated with reduced mortality in comparison with standard oxygen.
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Affiliation(s)
- Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon USA
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Laith Rashdan
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Inderdeep Gakhal
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Esra'a Ismail
- College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Josiane Kerbage
- Department of Anesthesia, Lebanese University, Beirut, Lebanon
| | - Fatima Rizk
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI USA
| | - Saadia Shafi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Areeg Bala
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Shima Sidahmed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Elfateh Seedahmed
- Department of Pulmonary and Critical Care, Hurley Medical Center/Michigan State University, Flint, MI USA
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Nam H, Cho JH, Park TS, Kim SW, Kang HK, Shin YM, Hwang JJ, Lee K, Ha JH, Lee YS, Chang Y, Park S. Non-invasive ventilation for acute respiratory failure: pressure support ventilation vs. pressure-controlled ventilation. J Thorac Dis 2020; 12:2553-2562. [PMID: 32642163 PMCID: PMC7330335 DOI: 10.21037/jtd.2020.03.27] [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] [Indexed: 12/04/2022]
Abstract
Background The best ventilator mode for patients receiving non-invasive ventilation (NIV) has not been clarified. This study compared the effectiveness of two pressure-targeted modes, i.e., pressure support ventilation (PSV) and pressure-controlled ventilation (PCV), in patients receiving NIV. Methods This was a prospective multicentre observational study of NIV use for acute respiratory failure (ARF) in adult patients. We compared the two pressure-targeted modes in terms of NIV success and complication rates. Results Among 176 patients receiving NIV, 88 patients were included in the study (PCV mode, n=29; PSV mode, n=59). The study population had a median age of 73.0 years and median body mass index of 20.8 kg/m2. The applied inspiratory positive airway pressure (IPAP) was higher in patients with PCV than in those with PSV [18.0 cmH2O (15.0–20.5 cmH2O) vs. 15.0 cmH2O (12.0–17.0 cmH2O), respectively, P=0.001]. More patients with PCV received sedatives and experienced dry mouth than those with PSV; however, the incidences of large leaks were low in both groups (n=5 vs. n=2, respectively). With regard to NIV outcomes, 24 (27.2%) patients experienced NIV failure and 13 (14.8%) died in hospital. PSV mode was a significant factor for NIV success [odds ratio (OR), 2.303; 95% confidence interval (CI), 1.216 to 4.360] in multivariate analyses and this association remained significant in a 1:1 matched cohort (n=29 per group). Conclusions In contrast to PCV mode, PSV mode was significantly associated with NIV success in the intensive care unit setting, particularly when large leaks were not a major concern. Nevertheless, further well-designed multicenter, protocol-driven randomized controlled trials are warranted.
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Affiliation(s)
- Hyunseung Nam
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Hwa Cho
- Department Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sei Won Kim
- Department of Pulmonary, Critical Care and Sleep Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yoon Mi Shin
- Department of Pulmonary and Critical Care Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Joon Hwang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kwangha Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jick Hwan Ha
- Department of Pulmonary and Critical Care Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Inchoen, Korea
| | - Young Seok Lee
- Department of Pulmonary and Critical Care Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Youjin Chang
- Department of Pulmonary and Critical Care Medicine, Inje University Paik Hospital, Seoul, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline. Intensive Care Med 2020; 46:697-713. [PMID: 32157356 PMCID: PMC7223056 DOI: 10.1007/s00134-020-05948-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
Abstract
Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure at risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula, noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that: in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately post-extubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery.
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Acute respiratory failure in randomized trials of noninvasive respiratory support: A systematic review of definitions, patient characteristics, and criteria for intubation. J Crit Care 2020; 57:141-147. [PMID: 32145657 DOI: 10.1016/j.jcrc.2020.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To examine the definitions of acute respiratory failure, the characteristics of recruited patients, and the criteria for intubation used in randomized trials. METHODS We searched MEDLINE for randomized trials of noninvasive respiratory support modalities in patients with de novo respiratory failure. We included trials from 1995 to 2017 that enrolled 40 or more patients and used intubation as an outcome. RESULTS We examined the reports of 53 trials that enrolled 7225 patients. There was wide variation in the use of variables for defining acute respiratory failure. Dyspnea was rarely measured and the increase in breathing effort was poorly defined. The characteristics of patients enrolled in trials changed over time and differed by the cause of respiratory failure. Intubation was poorly characterized. The criteria for intubation had more variables than the criteria for respiratory failure. CONCLUSIONS We identified deficiencies in the design and reporting of randomized trials, some of which can be remedied by investigators. We also found that patient characteristics differ by the type of respiratory failure. This knowledge can help clinician identify patients at the right moment to benefit from the tested interventions and investigators in developing criteria for enrollment in future trials.
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Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, Khatib KI, Jagiasi BG, Chanchalani G, Mishra RC, Samavedam S, Govil D, Gupta S, Prayag S, Ramasubban S, Dobariya J, Marwah V, Sehgal I, Jog SA, Kulkarni AP. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med 2020; 24:S61-S81. [PMID: 32205957 PMCID: PMC7085817 DOI: 10.5005/jp-journals-10071-g23186] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A. ACUTE HYPERCAPNIC RESPIRATORY FAILURE A1. Acute Exacerbation of COPD: Recommendations: NIV should be used in management of acute exacerbation of COPD in patients with acute or acute-on-chronic respiratory acidosis (pH = 7.25-7.35). (1A) NIV should be attempted in patients with acute exacerbation of COPD (pH <7.25 & PaCO2 ≥ 45) before initiating invasive mechanical ventilation (IMV) except in patients requiring immediate intubation. (2A). Lower the pH higher the chance of failure of NIV. (2B) NIV should not to be used routinely in normo- or mildly hyper-capneic patients with acute exacerbation of COPD, without acidosis (pH > 7.35). (2B) A2. NIV in ARF due to Chest wall deformities/Neuromuscular diseases: Recommendations: NIV may be used in patients of ARF due to chest wall deformity/Neuromuscular diseases. (PaCO2 ≥ 45) (UPP) A3. NIV in ARF due to Obesity hypoventilation syndrome (OHS): Recommendations: NIV may be used in AHRF in OHS patients when they present with acute hypercapnic or acute on chronic respiratory failure (pH 45). (3B) NIV/CPAP may be used in obese, hypercapnic patients with OHS and/or right heart failure in the absence of acidosis. (UPP) B. NIV IN ACUTE HYPOXEMIC RESPIRATORY FAILURE B1. NIV in Acute Cardiogenic Pulmonary Oedema: Recommendations: NIV is recommended in hospital patients with ARF, due to Cardiogenic pulmonary edema. (1A). NIV should be used in patients with acute heart failure/ cardiogenic pulmonary edema, right from emergency department itself. (1B) Both CPAP and BiPAP modes are safe and effective in patients with cardiogenic pulmonary edema. (1A). However, BPAP (NIV-PS) should be preferred in cardiogenic pulmonary edema with hypercapnia. (3A) B2. NIV in acute hypoxemic respiratory failure: Recommendations: NIV may be used over conventional oxygen therapy in mild early acute hypoxemic respiratory failure (P/F ratio <300 and >200 mmHg), under close supervision. (2B) We strongly recommend against a trial of NIV in patients with acute hypoxemic failure with P/F ratio <150. (2A) B3. NIV in ARF due to Chest Trauma: Recommendations: NIV may be used in traumatic flail chest along with adequate pain relief. (3B) B4. NIV in Immunocompromised Host: Recommendations: In Immunocompromised patients with early ARF, we may consider NIV over conventional oxygen. (2B). B5. NIV in Palliative Care: Recommendations: We strongly recommend use of NIV for reducing dyspnea in palliative care setting. (2A) B6. NIV in post-operative cases: Recommendations: NIV should be used in patients with post-operative acute respiratory failure. (2A) B6a. NIV in abdominal surgery: Recommendations: NIV may be used in patients with ARF following abdominal surgeries. (2A) B6b. NIV in bariatric surgery: Recommendations: NIV may be used in post-bariatric surgery patients with pre-existent OSA or OHS. (3A) B6c. NIV in Thoracic surgery: Recommendations: In cardiothoracic surgeries, use of NIV is recommended post operatively for acute respiratory failure to improve oxygenation and reduce chance of reintubation. (2A) NIV should not be used in patients undergoing esophageal surgery. (UPP) B6d. NIV in post lung transplant: Recommendations: NIV may be used for shortening weaning time and to avoid re-intubation following lung transplantation. (2B) B7. NIV during Procedures (ETI/Bronchoscopy/TEE/Endoscopy): Recommendations: NIV may be used for pre-oxygenation before intubation. (2B) NIV with appropriate interface may be used in patients of ARF during Bronchoscopy/Endoscopy to improve oxygenation. (3B) B8. NIV in Viral Pneumonitis ARDS: Recommendations: NIV cannot be considered as a treatment of choice for patients with acute respiratory failure with H1N1 pneumonia. However, it may be reasonable to use NIV in selected patients with single organ involvement, in a strictly controlled environment with close monitoring. (2B) B9. NIV and Acute exacerbation of Pulmonary Tuberculosis: Recommendations: Careful use of NIV in patients with acute Tuberculosis may be considered, with effective infection control precautions to prevent air-borne transmission. (3B) B10. NIV after planned extubation in high risk patients: Recommendation: We recommend that NIV may be used to wean high risk patients from invasive mechanical ventilation as it reduces re-intubation rate. (2B) B11. NIV for respiratory distress post extubation: Recommendations: We recommend that NIV therapy should not be used to manage respiratory distress post-extubation in high risk patients. (2B) C. APPLICATION OF NIV Recommendation: Choice of mode should be mainly decided by factors like disease etiology and severity, the breathing effort by the patient and the operator familiarity and experience. (UPP) We suggest using flow trigger over pressure triggering in assisted modes, as it provides better patient ventilator synchrony. Especially in COPD patients, flow triggering has been found to benefit auto PEEP. (3B) D. MANAGEMENT OF PATIENT ON NIV D1. Sedation: Recommendations: A non-pharmacological approach to calm the patient (Reassuring the patient, proper environment) should always be tried before administrating sedatives. (UPP) In patients on NIV, sedation may be used with extremely close monitoring and only in an ICU setting with lookout for signs of NIV failure. (UPP) E. EQUIPMENT Recommendations: We recommend that portable bilevel ventilators or specifically designed ICU ventilators with non-invasive mode should be used for delivering Non-invasive ventilation in critically ill patients. (UPP) Both critical care ventilators with leak compensation and bi-level ventilators have been equally effective in decreasing the WOB, RR, and PaCO2. (3B) Currently, Oronasal mask is the most preferred interface for non-invasive ventilation for acute respiratory failure. (3B) F. WEANING Recommendations: We recommend that weaning from NIV may be done by a standardized protocol driven approach of the unit. (2B) How to cite this article: Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med 2020;24(Suppl 1):S61-S81.
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Affiliation(s)
- Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India, , e-mail:
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , 020-25531539 / 25539538, e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India, , e-mail:
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India, , e-mail:
| | - G C Khilnani
- Department of PSRI Institute of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India, , e-mail:
| | - Yatin Mehta
- Department of Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon-122001, Haryana, India, Extn. 3335, e-mail:
| | - Khalid Ismail Khatib
- Department of Medicine, SKN Medical College, Pune, Maharashtra, India, , e-mail:
| | - Bharat G Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India, , e-mail:
| | - Gunjan Chanchalani
- Department of Critical Care Medicine, Bhatia Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India, , e-mail:
| | - Shirish Prayag
- Department of Critical Care, Prayag Hospital, Pune, Maharashtra, India, , e-mail:
| | - Suresh Ramasubban
- Department of Critical Care, Apollo Gleneagles Hospital Limited, Kolkata, India, , e-mail:
| | - Jayesh Dobariya
- Department of critical care, Synergy Hospital Rajkot, Rajkot, Gujarat, India, , e-mail:
| | - Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India, , e-mail:
| | - Inder Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India, , e-mail:
| | - Sameer Arvind Jog
- Department of Critical Care, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India, , 91-9823018178, e-mail:
| | - Atul Prabhakar Kulkarni
- Department of Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India, , e-mail:
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Dos Santos EDC, da Silva JDS, de Assis Filho MTT, Vidal MB, Monte MDC, Lunardi AC. Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial. J Physiother 2020; 66:19-26. [PMID: 31843426 DOI: 10.1016/j.jphys.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
QUESTIONS In patients with a collection of fluid in the pleural space, do mobilisation and respiratory techniques: shorten the drainage period and length of hospital stay; improve respiratory function and oxygenation; and prevent pulmonary complications? Does the addition of positive airway pressure to this regimen further improve the effects? DESIGN Randomised controlled trial with three intervention arms, concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS One hundred and fifty-six inpatients with a fluid collection in the pleural space and with chest drainage in situ. INTERVENTION Participants received usual care and were randomly assigned to: a control group that also received sham positive airway pressure (4 cmH2O) only (Con); an experimental group that received incentive spirometry, airway clearance, mobilisation and the same sham positive pressure (Exp1); or an experimental group that received the Exp1 regimen except that the positive airway pressure was 15 cmH2O (Exp2). Treatments were provided three times per day for 7 days. OUTCOME MEASURES Days of chest tube drainage, length of hospital stay, pulmonary complications and adverse events were recorded until hospital discharge. Costs in each group were estimated. RESULTS The Exp2 group had shorter duration of chest tube drainage and length of hospital stay compared with the Exp1 and Con groups. In addition, the Exp2 group had less antibiotic use (18% versus 43% versus 55%) and pneumonia incidence (0% versus 16% versus 20%) compared with the Exp1 and Con groups (all p < 0.01). The groups had similar rates of adverse events (10% versus 2% versus 6%, p > 0.05). Total treatment costs were lower in the Exp2 group than in the Exp1 and Con groups. CONCLUSIONS In patients with a fluid collection in the pleural space, the addition of positive pressure to mobilisation and respiratory techniques decreased the duration of thoracic drainage, length of hospital stay, pulmonary complications, antibiotic use and treatment costs. REGISTRATION ClinicalTrials.govNCT02246946.
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Affiliation(s)
- Elinaldo da Conceição Dos Santos
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | | | - Marcela Brito Vidal
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | - Adriana Cláudia Lunardi
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Physical Therapy, School of Medicine, Universidade de São Paulo, São Paulo, Brazil.
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Nong L, Liang W, Yu Y, Xi Y, Liu D, Zhang J, Zhou J, Yang C, He W, Liu X, Li Y, Chen R. Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia. J Crit Care 2019; 56:12-17. [PMID: 31785505 PMCID: PMC7126932 DOI: 10.1016/j.jcrc.2019.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/10/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022]
Abstract
Purpose This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure. Materials and methods This was a single-center prospective randomized study. All patients undergoing FOB-guided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. The NIV group were intubated through a sealed hole in a specially designed face mask during continuous NIV support with 100% oxygen. Control patients were intubated with removal of the mask and no ventilatory support. Results We enrolled 106 patients, including 53 in each group. Pulse oxygen saturation (SpO2) after preoxygenation (99% (96%–100%) vs. 96% (90%–99%), p = .001) and minimum SpO2 during intubation (95% (87%–100%) vs. 83% (74%–91%), p < .01) were both significantly higher in the NIV compared with the control group. Severe hypoxemic events (SpO2 < 80%) occurred less frequently in the NIV group than in controls (7.4% vs. 37.7%, respectively; p < .01). Conclusions Continuous NIV support during FOB-guided nasal intubation can prevent severe desaturation during intubation in critically ill patients with respiratory failure. Trial registration: ClinicalTrials.gov, NCT02462668. Registered on 25 May 2015, https://www.clinicaltrials.gov/ct2/results?term=NCT02462668. Our study is the first to evaluate NIV during FOB-guided nasotracheal intubation. NIV support during FOB-guided nasotracheal intubation was effectively prevented severe desaturation during intubation. We used a specially-designed intubation face mask to ensure that there was no interruption of NIV support during intubation.
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Affiliation(s)
- Lingbo Nong
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weibo Liang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuheng Yu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yin Xi
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongdong Liu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Zhou
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun Yang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Lab of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Abstract
PURPOSE OF REVIEW Noninvasive ventilation (NIV) is widely used in ICU patients to treat or to prevent acute respiratory failure. Whereas its physiological effects are clearly beneficial in hypercapnic patients, it could be deleterious in hypoxemic patients without hypercapnia. RECENT FINDINGS NIV should be cautiously used in patients with de-novo respiratory failure, the vast majority of whom meet the criteria for acute respiratory distress syndrome. Spontaneous breathing with high tidal volumes may worsen lung injury in these patients, and recent findings suggest that NIV may increase the risk of mortality. Even though high-flow oxygen therapy is increasingly applied in this context, NIV remains recommended for management of immunocompromised patients with acute respiratory failure. NIV should be the first-line oxygenation strategy in patients with acute hypercapnic respiratory failure when pH is equal to or below 7.35. Prophylactic NIV prevents respiratory failure after extubation of patients at high risk of reintubation. SUMMARY Most previous studies have compared NIV with standard oxygen, and recent recommendations have been established from these findings. Given the growing use of high-flow oxygen therapy, new studies are needed to compare NIV versus high-flow oxygen therapy so as to better define the appropriate indications for each treatment.
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Maggiore SM, Battilana M, Serano L, Petrini F. Ventilatory support after extubation in critically ill patients. THE LANCET RESPIRATORY MEDICINE 2019; 6:948-962. [PMID: 30629933 DOI: 10.1016/s2213-2600(18)30375-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/29/2022]
Abstract
The periextubation period represents a crucial moment in the management of critically ill patients. Extubation failure, defined as the need for reintubation within 2-7 days after a planned extubation, is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia, longer intensive care unit and hospital stays, and increased mortality. Conventional oxygen therapy is commonly used after extubation. Additional methods of non-invasive respiratory support, such as non-invasive ventilation and high-flow nasal therapy, can be used to avoid reintubation. The aim of this Review is to describe the pathophysiological mechanisms of postextubation respiratory failure and the available techniques and strategies of respiratory support to avoid reintubation. We summarise and discuss the available evidence supporting the use of these strategies to achieve a tailored therapy for an individual patient at the bedside.
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Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.
| | - Mariangela Battilana
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Luca Serano
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Petrini
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy
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Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep 2019; 9:9539. [PMID: 31266972 PMCID: PMC6606632 DOI: 10.1038/s41598-019-45881-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/11/2019] [Indexed: 01/15/2023] Open
Abstract
This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.
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Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure. Curr Opin Anaesthesiol 2019; 32:150-155. [PMID: 30817387 DOI: 10.1097/aco.0000000000000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. SUMMARY Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment.
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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Laverdure F, Genty T, Rezaiguia-Delclaux S, Herve P, Stephan F. Ultrasound Assessment of Respiratory Workload With High-Flow Nasal Oxygen Versus Other Noninvasive Methods After Chest Surgery. J Cardiothorac Vasc Anesth 2019; 33:3042-3047. [PMID: 31201041 DOI: 10.1053/j.jvca.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the respiratory workload using the diaphragm thickening fraction (DTf) determined by sonography during high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel positive airway pressure support (BIPAP) in patients with acute respiratory failure (ARF) after cardiothoracic surgery. DESIGN Prospective controlled clinical trial. SETTING A French 23-bed cardiothoracic surgical intensive care unit. PARTICIPANTS Nonintubated patients with ARF after cardiothoracic surgery or while awaiting lung transplantation. INTERVENTIONS HFNO (50 L/min), SOT via a standard facemask, and BIPAP (pressure support, 4 cmH2O; positive end-expiratory pressure [PEEP], 4 cmH2O), with FIO2 kept constant were successively applied and compared. With BIPAP, pressure support or PEEP increments up to 8 cmH2O were compared with baseline settings. Each measurement was made after stable breathing for 5 minutes. MEASUREMENTS AND MAIN RESULTS Fifty patients aged 60.0 ± 12.2 years were enrolled, including 14 (28%) with obesity. Mean PaO2/FIO2 was 153 ± 55 mmHg. DTf was lower with HFNO and BIPAP than with SOT (respectively 21.2% ± 15.1% v 30.9% ± 21.1% and 17.8% ± 19.1% v 30.9% ± 21.1%, p < 0.001) and was not different with HFNO versus BIPAP (p = 0.22). With BIPAP, increasing pressure support to 8 cmH2O decreased DTf (21.0% ± 14.3% v 28.8% ± 19.8%, p = 0.009), whereas increasing PEEP to 8 cmH2O did not (25.2% ± 17.2% v 28.8% ± 19.8%, p = 0.79). Tidal volume increased to 10.6 ± 3.4 mL/kg with 8 cmH2O pressure support v 8.8 ± 2.7 mL/kg with 4 cmH2O pressure support (p < 0.001). CONCLUSION HFNO provides a comparable respiratory workload decrease compared with BIPAP at lower levels of pressure support and PEEP compared with SOT. Increasing BIPAP pressure support may provide higher levels of assistance but carries a risk of overdistension.
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Affiliation(s)
- Florent Laverdure
- Department of Anesthesiology, Marie Lannelongue Hospital, Le Plessis Robinson, France; Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
| | - Thibaut Genty
- Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | | | - Philippe Herve
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Stephan
- Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Torres MFS, Porfírio GJM, Carvalho APV, Riera R. Non-invasive positive pressure ventilation for prevention of complications after pulmonary resection in lung cancer patients. Cochrane Database Syst Rev 2019; 3:CD010355. [PMID: 30840317 PMCID: PMC6402531 DOI: 10.1002/14651858.cd010355.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary complications are often seen during the postoperative period following lung resection for patients with lung cancer. Some situations such as intubation, a long stay in the intensive care unit, the high cost of antibiotics and mortality may be avoided with the prevention of postoperative pulmonary complications. Non-invasive positive pressure ventilation (NIPPV) is widely used in hospitals, and is thought to reduce the number of pulmonary complications and mortality after this type of surgery. Therefore, a systematic review is needed to critically assess the benefits and harms of NIPPV for patients undergoing lung resection. This is an update of a Cochrane review first published in 2015. OBJECTIVES To assess the effectiveness and safety of NIPPV for preventing complications in patients following pulmonary resection for lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS and PEDro until 21 December 2018, to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. We also searched the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. SELECTION CRITERIA We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative period after pulmonary resection with no intervention or conventional respiratory therapy. DATA COLLECTION AND ANALYSIS Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis), but where this was not possible we tabulated or presented the data in the main text (qualitative synthesis). Where substantial heterogeneity existed, we applied a random-effects model. MAIN RESULTS Of the 190 references retrieved from the searches, 7 randomised clinical trials (RCTs) (1 identified with the new search) and 1 quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 486 patients. Five studies described quantitative measures of pulmonary complications, with pooled data showing no difference between NIPPV compared with no intervention (RR 1.03; 95% CI 0.72 to 1.47). Three studies reported intubation rates and there was no significant difference between the intervention and control groups (RR 0.55; 95% CI 0.25 to 1.20). Five studies reported measures of mortality on completion of the intervention period. There was no statistical difference between the groups for this outcome (RR 0.60; 95% CI 0.24 to 1.53). Similar results were observed in the subgroup analysis considering ventilatory mode (bi-level versus continuous positive airway pressure (CPAP). No study evaluated the postoperative use of antibiotics. Two studies reported the length of intensive care unit stay and there was no significant difference between the intervention and control groups (MD -0.75; 95% CI -3.93 to 2.43). Four studies reported the length of hospital stay and there was no significant difference between the intervention and control groups (MD -0.12; 95% CI -6.15 to 5.90). None of the studies described any complications related to NIPPV. Of the seven included studies, four studies were considered as 'low risk of bias' in all domains, two studies were considered 'high risk of bias' for the allocation concealment domain, and one of these was also considered 'high risk of bias' for random sequence generation. One other study was considered 'high risk of bias' for including participants with more severe disease. The new study identified could not be included in the meta-analysis as its intervention differed from the other studies (use of pre and postoperative NIPPV in the same population). AUTHORS' CONCLUSIONS This review demonstrated that there was no additional benefit of using NIPPV in the postoperative period after pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is 'very low', 'low' and 'moderate' since there were few studies, with small sample size and low frequency of outcomes. New well-designed and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.
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Affiliation(s)
- Maria FS Torres
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeBrazilian Cochrane CentreRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Gustavo JM Porfírio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Alan PV Carvalho
- Universidade Federal de São PauloUrgency MedicineRua Pedro de Toledo, 598São PauloSão PauloBrazil04039‐001
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
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Pennisi MA, Bello G, Congedo MT, Montini L, Nachira D, Ferretti GM, Meacci E, Gualtieri E, De Pascale G, Grieco DL, Margaritora S, Antonelli M. Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: a randomized trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:68. [PMID: 30819227 PMCID: PMC6396480 DOI: 10.1186/s13054-019-2361-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/17/2019] [Indexed: 02/08/2023]
Abstract
Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi mask oxygen therapy. Methods In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO2 (PaO2/FiO2) lower than 300 mmHg) within four postoperative days. Results Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41–3] (p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60–3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51–3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11–4.18]). Post hoc analyses revealed that PaO2/FiO2 during the study was not different between groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5–3.4] (p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06–0.54], p = 0.002). Conclusions When compared to Venturi mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. Trial registration ClinicalTrials.gov, NCT02544477. Registered 9 September 2015. Electronic supplementary material The online version of this article (10.1186/s13054-019-2361-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariano Alberto Pennisi
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Bello
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Teresa Congedo
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Montini
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Maria Ferretti
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Gualtieri
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
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Bajaj A, Kumar S, Inamdar AH, Agrawal L. Noninvasive ventilation in acute hypoxic respiratory failure in medical intensive care unit: A study in rural medical college. Int J Crit Illn Inj Sci 2019; 9:36-42. [PMID: 30989067 PMCID: PMC6423923 DOI: 10.4103/ijciis.ijciis_40_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Noninvasive ventilation (NIV) has emerged as an important tool for the management of acute hypoxic respiratory failure (AHRF) and has been the area of research in the last two decades. In this study, we have tried to find out the outcome of NIV in patients with AHRF. Materials and Methods: In this prospective, observational study, all the patients of AHRF requiring NIV were enrolled, and heart rate (HR), respiratory rate (RR), arterial blood gas parameters, and NIV settings at baseline, 1 h, and 4 h were collected. The patients were classified as AHRF with acute respiratory distress syndrome (ARDS) and AHRF without ARDS, which were further classified according to the outcome. Results: Among 200 patients admitted in medical intensive care unit (ICU), 50 patients (27 with ARDS and 23 without ARDS) were put on NIV. There was a significant improvement in HR, RR, PaO
2, and inspiratory positive airway pressure after 1 and 4 h and significant improvement at 4 h in expiratory positive airway pressure in all the groups on NIV. Length of ICU stay and hospital stay was less in the nonintubated group. Mortality rate was 25.92% in the intubated group, while it was nil in the nonintubated group. Conclusion: NIV found to reduce the endotracheal intubation and mortality, by improving the outcome of the patient.
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Affiliation(s)
- Aditya Bajaj
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Anil H Inamdar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Laxmi Agrawal
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
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Bourke SC, Piraino T, Pisani L, Brochard L, Elliott MW. Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice. THE LANCET RESPIRATORY MEDICINE 2018; 6:935-947. [DOI: 10.1016/s2213-2600(18)30388-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/31/2022]
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Boet S, Etherington C, Nicola D, Beck A, Bragg S, Carrigan ID, Larrigan S, Mendonca CT, Miao I, Postonogova T, Walker B, De Wit J, Mohamed K, Balaa N, Lalu MM, McIsaac DI, Moher D, Stevens A, Miller D. Anesthesia interventions that alter perioperative mortality: a scoping review. Syst Rev 2018; 7:218. [PMID: 30497505 PMCID: PMC6267894 DOI: 10.1186/s13643-018-0863-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice. METHODS Searches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically. RESULTS Among the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1). CONCLUSIONS By mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - David Nicola
- Family Medicine, McGill University, Montreal, Canada
| | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Susan Bragg
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Ian D Carrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarah Larrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Cassandra T Mendonca
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Isaac Miao
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Benjamin Walker
- Department of Anesthesia, University of Utah, Salt Lake City, UT, 84132, USA
| | - José De Wit
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Karim Mohamed
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Nadia Balaa
- Department of Family Medicine, Montfort Hospital, University of Ottawa, Ottawa, Canada
| | - Manoj Mathew Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Adrienne Stevens
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Donald Miller
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
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Frat JP, Coudroy R, Thille AW. Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other? Respirology 2018; 24:724-731. [PMID: 30406954 DOI: 10.1111/resp.13435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a first-line strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in post-operative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.
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Affiliation(s)
- Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
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Blanc K, Dechartres A, Zaimi R, Lefebvre A, Janet-Vendroux A, Fournel L, Dermine H, Lorut C, Becanne X, Hamelin-Canny E, Bobbio A, Roche N, Regnard JF, Alifano M, Rabbat A. Patients experiencing early acute respiratory failure have high postoperative mortality after pneumonectomy. J Thorac Cardiovasc Surg 2018; 156:2368-2376. [PMID: 30449587 DOI: 10.1016/j.jtcvs.2018.08.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Post-pneumonectomy acute respiratory failure leading to invasive mechanical ventilation carries a severe prognosis especially when acute respiratory distress syndrome occurs. The aim of this study was to describe risk factors and outcome of acute respiratory failure. METHODS We retrospectively reviewed clinical files of all patients who underwent pneumonectomy in a single center between 2005 and 2015. Risk factors and outcome of acute respiratory failure were assessed in univariate and multivariate analysis. RESULTS Among the 543 patients who underwent pneumonectomy in the period of study, 89 (16.4%) needed reintubation within the 30th postoperative day and 60 of these (11% of all pneumonectomies) developed acute respiratory distress syndrome. In multivariate analysis, right-side of pneumonectomy (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.24-4.22), chronic cardiac disease (OR, 2.15; 95% CI, 1.08-4.25), Charlson Comorbidity Index (OR, 1.35; 95% CI, 1.14-1.61), carinal resection (OR, 3.23; 95% CI, 1.26-8.29), and extrapleural pneumonectomy (OR, 8.36; 95% CI, 3.31-21.11) were identified as independent risk factors of reintubation. Thirty-day mortality was 7.7% for all pneumonectomies, 41.6% (37/89) in the invasive ventilation group, and 53.3% (32/60) in patients with acute respiratory distress syndrome. In non-reintubated patients, 30-day mortality was 1.1% (5/454). In reintubated patients, 5-year survival was 27.1% (95% CI, 17.8-41.4). CONCLUSIONS Early acute respiratory failure requiring reintubation remains a severe complication of pneumonectomy with a poor outcome.
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Affiliation(s)
- Kim Blanc
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Agnès Dechartres
- Department of Clinic Epidemiology Center, Hôtel Dieu, HUPC, APHP, Paris Descartes University, Paris, France
| | - Rym Zaimi
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Lefebvre
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Janet-Vendroux
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Hervé Dermine
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Christine Lorut
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Xavier Becanne
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Emelyne Hamelin-Canny
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Nicolas Roche
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Jean-François Regnard
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France.
| | - Antoine Rabbat
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
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41
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Shoji CY, Figuereido LCD, Calixtre EM, Rodrigues CDA, Falcão ALE, Martins PP, Anjos APRD, Dragosavac D. Reintubation of patients submitted to cardiac surgery: a retrospective analysis. Rev Bras Ter Intensiva 2018; 29:180-187. [PMID: 28977259 PMCID: PMC5496752 DOI: 10.5935/0103-507x.20170028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/11/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores. METHODS Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015. RESULTS The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points). CONCLUSION The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.
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Affiliation(s)
- Cíntia Yukie Shoji
- Departamento de Cirurgia, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | | | | | | | | | - Pedro Paulo Martins
- Departamento de Cirurgia, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | | | - Desanka Dragosavac
- Departamento de Cirurgia, Universidade Estadual de Campinas - Campinas (SP), Brasil
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42
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D’Journo XB, Falcoz PE, Alifano M, Le Rochais JP, D’Annoville T, Massard G, Regnard JF, Icard P, Marty-Ane C, Trousse D, Doddoli C, Orsini B, Edouard S, Million M, Lesavre N, Loundou A, Baumstarck K, Peyron F, Honoré S, Dizier S, Charvet A, Leone M, Raoult D, Papazian L, Thomas PA. Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial. Intensive Care Med 2018; 44:578-587. [DOI: 10.1007/s00134-018-5156-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022]
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43
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Ergan B, Nasiłowski J, Winck JC. How should we monitor patients with acute respiratory failure treated with noninvasive ventilation? Eur Respir Rev 2018; 27:27/148/170101. [PMID: 29653949 DOI: 10.1183/16000617.0101-2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022] Open
Abstract
Noninvasive ventilation (NIV) is currently one of the most commonly used support methods in hypoxaemic and hypercapnic acute respiratory failure (ARF). With advancing technology and increasing experience, not only are indications for NIV getting broader, but more severe patients are treated with NIV. Depending on disease type and clinical status, NIV can be applied both in the general ward and in high-dependency/intensive care unit settings with different environmental opportunities. However, it is important to remember that patients with ARF are always very fragile with possible high mortality risk. The delay in recognition of unresponsiveness to NIV, progression of respiratory failure or new-onset complications may result in devastating and fatal outcomes. Therefore, it is crucial to understand that timely action taken according to monitoring variables is one of the key elements for NIV success. The purpose of this review is to outline basic and advanced monitoring techniques for NIV during an ARF episode.
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Affiliation(s)
- Begum Ergan
- Division of Intensive Care, Dept of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey .,Both authors contributed equally
| | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.,Both authors contributed equally
| | - João Carlos Winck
- Northern Rehabilitation Centre Cardio-Pulmonary Group, Vila Nova de Gaia, Respiratory Medicine Units of Trofa-Saúde Alfena Hospital and Braga-Centro Hospital and Faculty of Medicine University of Porto, Porto, Portugal
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44
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Effect of preoxygenation using non-invasive ventilation before intubation on subsequent organ failures in hypoxaemic patients: a randomised clinical trial. Br J Anaesth 2018; 120:361-367. [DOI: 10.1016/j.bja.2017.11.067] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/26/2017] [Accepted: 11/15/2017] [Indexed: 01/31/2023] Open
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45
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Kuckelman J, Cuadrado DG. Care of the Postoperative Pulmonary Resection Patient. SURGICAL CRITICAL CARE THERAPY 2018. [PMCID: PMC7120963 DOI: 10.1007/978-3-319-71712-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patients undergoing pulmonary resection all exhibit, to some degree, a level of pulmonary dysfunction. This is due to the physiologic stress of the procedure performed, the patient’s comorbidities, and preexisting cardiopulmonary reserve. Although prognostic factors for intensive care requirement exist, to date, there is no consensus for postoperative admission. Institutional practices vary across the country, with patients often admitted to intensive care for surveillance. Guidelines published from the American Thoracic Society in 1999 emphasize that admission to the ICU be reserved for those patients requiring care and monitoring for severe physiologic instability. Admissions following pulmonary resection are typically due to respiratory complications and are an independent predictor of mortality. The following chapter will review the indications for admission to the ICU and common issues encountered following pulmonary resection and conclude with a discussion of the management of patients undergoing pulmonary transplantation.
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46
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Admon AJ, Hyzy RC. New Guidelines on Noninvasive Ventilation. A Few Answers, and Several More Questions. Am J Respir Crit Care Med 2017; 196:811-813. [DOI: 10.1164/rccm.201707-1378ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew J. Admon
- Department of Internal MedicineUniversity of MichiganAnn Arbor, Michigan
| | - Robert C. Hyzy
- Department of Internal MedicineUniversity of MichiganAnn Arbor, Michigan
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47
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Quintard H, l’Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C, Guitton C, Hamonic Y, Maury E, Mekontso-Dessap A, Michel F, Nolent P, Perbet S, Prat G, Roquilly A, Tazarourte K, Terzi N, Thille A, Alves M, Gayat E, Donetti L. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med 2017; 36:327-341. [DOI: 10.1016/j.accpm.2017.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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48
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Esquinas AM, Benhamou MO, Glossop AJ, Mina B. Noninvasive Mechanical Ventilation in Acute Ventilatory Failure: Rationale and Current Applications. Sleep Med Clin 2017; 12:597-606. [PMID: 29108614 DOI: 10.1016/j.jsmc.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Noninvasive ventilation plays a pivotal role in acute ventilator failure and has been shown, in certain disease processes such as acute exacerbation of chronic obstructive pulmonary disease, to prevent and shorten the duration of invasive mechanical ventilation, reducing the risks and complications associated with it. The application of noninvasive ventilation is relatively simple and well tolerated by patients and in the right setting can change the course of their illness.
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Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Non-invasive Ventilatory Unit, Hospital Morales Meseguer, Avenida Marques Velez, Murcia 30008, Spain.
| | - Maly Oron Benhamou
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
| | - Alastair J Glossop
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2HE, UK
| | - Bushra Mina
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
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49
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Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017. [PMID: 28860265 DOI: 10.1183/13993003.02426–2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material.This guideline committee developed recommendations for 11 actionable questions in a PICO (population-intervention-comparison-outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders.
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Affiliation(s)
- Bram Rochwerg
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Mark W Elliott
- Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - Dean Hess
- Respiratory Care Dept, Massachusetts General Hospital and Dept of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Stefano Nava
- Dept of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Massimo Antonelli
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Jan Brozek
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Giorgio Conti
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Miquel Ferrer
- Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Kalpalatha Guntupalli
- Depts of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samir Jaber
- Dept of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, Montpellier, France
| | - Sean Keenan
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.,Dept of Critical Care Medicine, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | - Sangeeta Mehta
- Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Suhail Raoof
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
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50
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Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50:50/2/1602426. [PMID: 28860265 DOI: 10.1183/13993003.02426-2016] [Citation(s) in RCA: 720] [Impact Index Per Article: 102.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Abstract
Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material.This guideline committee developed recommendations for 11 actionable questions in a PICO (population-intervention-comparison-outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders.
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Affiliation(s)
- Bram Rochwerg
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Mark W Elliott
- Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - Dean Hess
- Respiratory Care Dept, Massachusetts General Hospital and Dept of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Stefano Nava
- Dept of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Massimo Antonelli
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Jan Brozek
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Giorgio Conti
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Miquel Ferrer
- Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Kalpalatha Guntupalli
- Depts of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samir Jaber
- Dept of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, Montpellier, France
| | - Sean Keenan
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.,Dept of Critical Care Medicine, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | - Sangeeta Mehta
- Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Suhail Raoof
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
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