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Marjanovic N, Piton M, Lamarre J, Alleyrat C, Couvreur R, Guenezan J, Mimoz O, Frat JP. High-flow nasal cannula oxygen versus noninvasive ventilation for the management of acute cardiogenic pulmonary edema: a randomized controlled pilot study. Eur J Emerg Med 2024; 31:267-275. [PMID: 38364020 DOI: 10.1097/mej.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Whether high-flow nasal oxygen can improve clinical signs of acute respiratory failure in acute heart failure (AHF) is uncertain. OBJECTIVE To compare the effect of high-flow oxygen with noninvasive ventilation (NIV) on respiratory rate in patients admitted to an emergency department (ED) for AHF-related acute respiratory failure. DESIGN, SETTINGS AND PARTICIPANTS Multicenter, randomized pilot study in three French EDs. Adult patients with acute respiratory failure due to suspected AHF were included. Key exclusion criteria were urgent need for intubation, Glasgow Coma Scale <13 points or hemodynamic instability. INTERVENTION Patients were randomly assigned to receive high-flow oxygen (minimum 50 l/min) or noninvasive bilevel positive pressure ventilation. OUTCOMES MEASURE The primary outcome was change in respiratory rate within the first hour of treatment and was analyzed with a linear mixed model. Secondary outcomes included changes in pulse oximetry, heart rate, blood pressure, blood gas samples, comfort, treatment failure and mortality. MAIN RESULTS Among the 145 eligible patients in the three participating centers, 60 patients were included in the analysis [median age 86 (interquartile range (IQR), 90; 92) years]. There was a median respiratory rate of 30.5 (IQR, 28; 33) and 29.5 (IQR, 27; 35) breaths/min in the high-flow oxygen and NIV groups respectively, with a median change of -10 (IQR, -12; -8) with high-flow nasal oxygen and -7 (IQR, -11; -5) breaths/min with NIV [estimated difference -2.6 breaths/min (95% confidence interval (CI), -0.5-5.7), P = 0.052] at 60 min. There was a median SpO 2 of 95 (IQR, 92; 97) and 96 (IQR, 93; 97) in the high-flow oxygen and NIV groups respectively, with a median change at 60 min of 2 (IQR, 0; 5) with high-flow nasal oxygen and 2 (IQR, -1; 5) % with NIV [estimated difference 0.8% (95% CI, -1.1-2.8), P = 0.60]. PaO 2 , PaCO 2 and pH did not differ at 1 h between groups, nor did treatment failure, intubation and mortality rates. CONCLUSION In this pilot study, we did not observe a statistically significant difference in changes in respiratory rate among patients with acute respiratory failure due to AHF and managed with high-flow oxygen or NIV. However, the point estimate and its large confidence interval may suggest a benefit of high-flow oxygen. TRIAL REGISTRATION NCT04971213 ( https://clinicaltrials.gov ).
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Affiliation(s)
- Nicolas Marjanovic
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
- INSERM, CIC-1402, IS-ALIVE
- Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers
| | - Melyne Piton
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
| | | | | | | | | | - Olivier Mimoz
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
| | - Jean-Pierre Frat
- INSERM, CIC-1402, IS-ALIVE
- Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
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Demoule A, Fossé Q, Mercat A, Bergum D, Virolle S, Bureau C, Mellemseter M, Guichou R, Similowski T, Dres M, Mortaza S. Operator independent continuous ultrasound monitoring of diaphragm excursion predicts successful weaning from mechanical ventilation: a prospective observational study. Crit Care 2024; 28:245. [PMID: 39014512 PMCID: PMC11253384 DOI: 10.1186/s13054-024-05003-0] [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: 03/27/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi). METHODS In 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously. RESULTS The agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7-0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 - 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 - 0.20). Similar results were observed with PCVdi. CONCLUSIONS Operator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm. Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).
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Affiliation(s)
- Alexandre Demoule
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France.
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.
| | - Quentin Fossé
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Alain Mercat
- Service de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
| | - Daniel Bergum
- Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Sara Virolle
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
| | - Côme Bureau
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | | | | | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
- Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Martin Dres
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Satar Mortaza
- Service de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
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Shastri L, Thomsen LP, Toftegaard M, Tygesen GB, Weinreich UM, Rychwicka-Kielek BA, Davies MG, Ekström M, Rittger H, Kelly AM, Kristensen SR, Kjærgaard S, Kamperidis P, Manuel A, Damgaard KA, Andreassen S, Rees SE. The use of venous blood gas in assessing arterial acid-base and oxygenation status - an analysis of aggregated data from multiple studies evaluating the venous to arterial conversion (v-TAC) method. Expert Rev Respir Med 2024:1-7. [PMID: 38973767 DOI: 10.1080/17476348.2024.2378021] [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: 04/25/2024] [Accepted: 07/05/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Several methods exist to reduce the number of arterial blood gases (ABGs). One method, Roche v-TAC, has been evaluated in different patient groups. This paper aggregates data from these studies, in different patient categories using common analysis criteria. RESEARCH DESIGN AND METHODS We included studies evaluating v-TAC based on paired arterial and peripheral venous blood samples. Bland-Altman analysis compared measured and calculated arterial values of pH, PCO2, and PO2. Subgroup analyses were performed for normal, chronic hypercapnia and chronic base excess, acute hyper- and hypocapnia, and acute and chronic base deficits. RESULTS 811 samples from 12 studies were included. Bias and limits of agreement for measured and calculated values: pH 0.001 (-0.029 to 0.031), PCO2 -0.08 (-0.65 to 0.49) kPa, and PO2 0.04 (-1.71 to 1.78) kPa, with similar values for all sub-group analyses. CONCLUSION These data suggest that v-TAC analysis may have a role in replacing ABGs, avoiding arterial puncture. Substantial data exist in patients with chronic hypercapnia and chronic base excess, acute hyper- and hypocapnia, and in patients with relatively normal acid-base status, with similar bias and precision across groups and across study data. Limited data exist for patients with acute and chronic base deficits.
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Affiliation(s)
- Lisha Shastri
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Gitte Boier Tygesen
- Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Møller Weinreich
- Department of Lung Medicine, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Beate Agnieszka Rychwicka-Kielek
- The Clinical Institute, Aalborg University, Aalborg, Denmark
- Bronchoskopic Diagnostics Department, Mazowieckie Centrum Leczenia Chorób Płuc i Gruźlicy, Otwock, Poland
| | - Michael Gordon Davies
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Magnus Ekström
- Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Harald Rittger
- Klinikum Fürth, Department of Cardiology, Fürth, Germany
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine hospital, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Søren Risom Kristensen
- The Clinical Institute, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kjærgaard
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital North, Aalborg, Denmark
| | | | - Ari Manuel
- Sleep and Respiratory Department, University Hospital Aintree, Liverpool, UK
| | | | - Steen Andreassen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen Edward Rees
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2024; 78:453-514. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
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Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
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Botsch AA, Oravec MJ, Rapier BT, Goff LM, Desmett AL. Noninvasive Ventilation for Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19. Am J Crit Care 2024; 33:260-269. [PMID: 38945818 DOI: 10.4037/ajcc2024663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes and worldwide resource strain. OBJECTIVES To determine associations between use of noninvasive ventilation in adult patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia, progression to intubation, and hospital mortality. METHODS This retrospective cohort study included patients in an institutional COVID-19 registry. Adult patients were included if they were admitted for COVID-19 between March 1, 2020, and March 31, 2022, and developed moderate to severe ARDS. Primary outcomes were progression to intubation and hospital mortality in patients who received noninvasive ventilation or mechanical ventilation. A secondary outcome was successful treatment with noninvasive ventilation without intubation. RESULTS Of 823 patients who met inclusion criteria, 454 (55.2%) did not receive noninvasive ventilation and 369 (44.8%) received noninvasive ventilation. Patients receiving noninvasive ventilation were more likely to require mechanical ventilation than were patients not receiving noninvasive ventilation. Among patients requiring endotracheal intubation, those receiving noninvasive ventilation had a higher likelihood of mortality. Patients receiving noninvasive ventilation had lower severity-adjusted odds of survival to discharge without intubation than did patients not receiving noninvasive ventilation. CONCLUSION Patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia treated with noninvasive ventilation had increased likelihood of progression to endotracheal intubation and hospital mortality.
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Affiliation(s)
- Alexander A Botsch
- Alexander A. Botsch is lead nurse practitioner, Division of Critical Care, Department of Medicine, Summa Health, Akron, Ohio
| | - Michael J Oravec
- Michael J. Oravec is research program director, Department of Medicine, Summa Health, Akron
| | - Brandon T Rapier
- Brandon T. Rapier is a critical care fellow, Department of Medicine, Summa Health, Akron
| | - Laine M Goff
- Laine M. Goff is a medical student, Northeast Ohio Medical University, Rootstown, Ohio
| | - Ashley L Desmett
- Ashley L. Desmett is an attending physician and program director, Pulmonary Disease and Critical Care Medicine Fellowship, Division of Critical Care, Department of Medicine, Summa Health, Akron
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Dunbar PJ, Peterson R, McGrath M, Pomponio R, Kiser TH, Ho PM, Vandivier RW, Burnham EL, Moss M, Sottile PD. Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure. Crit Care Med 2024; 52:1043-1053. [PMID: 38506571 DOI: 10.1097/ccm.0000000000006253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death. DESIGN A retrospective multicenter cohort study. SETTING A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States. PATIENTS Adult (≥ 18 yr) patients admitted to U.S. hospitals requiring NIV for ARF. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified 433,357 patients on NIV of whom (26.7% [95% CI] 26.3%-27.0%) received sedation or analgesia. A total of 50,589 patients (11.7%) received opioids only, 40,646 (9.4%) received benzodiazepines only, 20,146 (4.6%) received opioids and benzodiazepines, 1.573 (0.4%) received dexmedetomidine only, and 2,639 (0.6%) received dexmedetomidine in addition to opioid and/or benzodiazepine. Of 433,357 patients receiving NIV, 50,413 (11.6%; 95% CI, 11.5-11.7%) patients underwent invasive mechanical ventilation on hospital days 2-5 or died on hospital days 2-30. Intubation was used in 32,301 patients (7.4%; 95% CI, 7.3-7.6%). Further, death occurred in 24,140 (5.6%; 95% CI, 5.5-5.7%). In multivariable analysis adjusting for relevant covariates, receipt of any medication studied was associated with increased odds of intubation or death. In inverse probability weighting, receipt of any study medication was also associated with increased odds of intubation or death (average treatment effect odds ratio 1.38; 95% CI, 1.35-1.40). CONCLUSIONS The use of sedation and analgesia during NIV is common. Medication exposure was associated with increased odds of intubation or death. Further investigation is needed to confirm this finding and determine whether any subpopulations are especially harmed by this practice.
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Affiliation(s)
- Peter J Dunbar
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Ryan Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Max McGrath
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Raymond Pomponio
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - P Michael Ho
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - R William Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Peter D Sottile
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO
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Kwizera A, Kabatoro D, Owachi D, Kansiime J, Kateregga G, Nanyunja D, Sendagire C, Nyakato D, Olaro C, Audureau E, Mekontso Dessap A. Respiratory support with standard low-flow oxygen therapy, high-flow oxygen therapy or continuous positive airway pressure in adults with acute hypoxaemic respiratory failure in a resource-limited setting: protocol for a randomised, open-label, clinical trial - the Acute Respiratory Intervention StudiEs in Africa (ARISE-AFRICA) study. BMJ Open 2024; 14:e082223. [PMID: 38951007 PMCID: PMC11218023 DOI: 10.1136/bmjopen-2023-082223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/19/2024] [Indexed: 07/03/2024] Open
Abstract
RATIONALE Acute hypoxaemic respiratory failure (AHRF) is associated with high mortality in sub-Saharan Africa. This is at least in part due to critical care-related resource constraints including limited access to invasive mechanical ventilation and/or highly skilled acute care workers. Continuous positive airway pressure (CPAP) and high-flow oxygen by nasal cannula (HFNC) may prove useful to reduce intubation, and therefore, improve survival outcomes among critically ill patients, particularly in resource-limited settings, but data in such settings are lacking. The aim of this study is to determine whether CPAP or HFNC as compared with standard oxygen therapy, could reduce mortality among adults presenting with AHRF in a resource-limited setting. METHODS This is a prospective, multicentre, randomised, controlled, stepped wedge trial, in which patients presenting with AHRF in Uganda will be randomly assigned to standard oxygen therapy delivered through a face mask, HFNC oxygen or CPAP. The primary outcome is all-cause mortality at 28 days. Secondary outcomes include the number of patients with criteria for intubation at day 7, the number of patients intubated at day 28, ventilator-free days at day 28 and tolerance of each respiratory support. ETHICS AND DISSEMINATION The study has obtained ethical approval from the Research and Ethics Committee, School of Biomedical Sciences, College of Health Sciences, Makerere University as well as the Uganda National Council for Science and Technology. Patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04693403. PROTOCOL VERSION 8 September 2023; version 5.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daphne Kabatoro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- Department of Emergency Medicine, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Jackson Kansiime
- Department of Internal Medicine, St Mary's Hospital, Gulu, Uganda
| | - George Kateregga
- Department of Anaesthesia and Intensive Care, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doreen Nanyunja
- Department of Internal Medicine, China-Uganda Friendship Hospital Naguru, Kampala, Uganda
| | | | | | | | - Etienne Audureau
- CEPIA EA7376, Universite Paris-Est Creteil Val de Marne, Creteil, France
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8
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Girault C, Artaud-Macari E, Jolly G, Carpentier D, Cuvelier A, Béduneau G. [High-flow nasal oxygen therapy and hypercapnic acute respiratory failure]. Rev Mal Respir 2024:S0761-8425(24)00228-6. [PMID: 38926023 DOI: 10.1016/j.rmr.2024.06.002] [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: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Humidified high-flow nasal oxygen therapy (HFNO) has, in recent years, come to assume a key role in the management of hypoxemic acute respiratory failure (ARF). While non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, the operating principles and physiological effects of HFNO could be interesting and useful in the initial management of hypercapnic ARF and/or after extubation, particularly in acute exacerbations of chronic obstructive pulmonary disease. Under these conditions, HFNO could be used either alone continuously or in combination with NIV during breaks in spontaneous breathing, depending on the severity and etiology of the underlying hypercapnic ARF.
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Affiliation(s)
- C Girault
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France.
| | - E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Jolly
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - D Carpentier
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Béduneau
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
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9
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Colaianni-Alfonso N, Castro I, Cáceres V, Montiel G, Maggiore SM, Vetrugno L. Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:37. [PMID: 38915126 PMCID: PMC11197175 DOI: 10.1186/s44158-024-00173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is widely employed as the initial treatment for patients with chronic acute exacerbation of obstructive pulmonary disease (AECOPD). Nevertheless, high-flow nasal cannula (HFNC) has been increasingly utilized and investigated to mitigate the issues associated with NIV. Flow rate may play a significant role in diaphragmatic function among subjects recovering from AECOPD. Based on these observations, we conducted a physiological study to assess the impact of HFNC therapy on diaphragmatic function, as measured by US, respiratory rate (RR), gas exchange, and patient comfort at various flow rates. METHODS A prospective physiological pilot study enrolled subjects with a diagnosis of AECOPD who required NIV for more than 24 h. After stabilization, these subjects underwent a 30-min trial using NIV and HFNC at different sequential flow rates (30-60 L/min). At the end of each trial, diaphragmatic displacement (DD, cm) and diaphragmatic thickness fraction (DTF, %) were measured using ultrasound. Additionally, other physiological variables, such as RR, gas exchange, and patient comfort, were recorded. RESULTS A total of 20 patients were included in the study. DD was no different among trials (p = 0.753). DTF (%) was significantly lower with HFNC-30 L/min compared to HFNC-50 and 60 L/min (p < 0.001 for all comparisons). No significant differences were found in arterial pH and PaCO2 at discontinuation of NIV and at the end of HFNC trials (p > 0.050). During HFNC trials, RR remained unchanged without statistically significant differences (p = 0.611). However, we observed that HFNC improved comfort compared to NIV (p < 0.001 for all comparisons). Interestingly, HFNC at 30 and 40 L/min showed greater comfort during trials. CONCLUSIONS In subjects recovering from AECOPD and receiving HFNC, flows above 40 L/min may not offer additional benefits in terms of comfort and decreased respiratory effort. HFNC could be a suitable alternative to COT during breaks off NIV.
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Affiliation(s)
- Nicolás Colaianni-Alfonso
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina.
| | - Iván Castro
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Vanesa Cáceres
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Guillermo Montiel
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of G. d' Annunzio, Chieti-Pescara, Italy
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10
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Weimar Z, Smallwood N, Shao J, Chen XE, Moran TP, Khor YH. Arterial blood gas analysis or venous blood gas analysis for adult hospitalised patients with respiratory presentations: a systematic review. Intern Med J 2024. [PMID: 38856155 DOI: 10.1111/imj.16438] [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: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Identification of hypoxaemia and hypercapnia is essential for the diagnosis and treatment of acute respiratory failure. While arterial blood gas (ABG) analysis is standard for PO2 and PCO2 measurement, venous blood gas (VBG) analysis is increasingly used as an alternative. Previous systematic reviews established that VBG reporting of PO2 and PCO2 is less accurate, but the impacts on clinical management and patient outcomes are unknown. AIMS This study aimed to systematically review available evidence of the clinical impacts of using ABGs or VBGs and examine the arteriovenous difference in blood gas parameters. METHODS A comprehensive search of the MEDLINE, Embase and Cochrane Library databases since inception was conducted. Included studies were prospective or cross-sectional studies comparing peripheral ABG to peripheral VBG in adult non-critical care inpatients presenting with respiratory symptoms. RESULTS Of 15 119 articles screened, 15 were included. No studies were found that examined clinical impacts resulting from using VBG compared to ABG. Included studies focused on the agreement between ABG and VBG measurements of pH, PO2, PCO2 and HCO3 -. Due to the heterogeneity of the included studies, qualitative evidence synthesis was performed. While the arteriovenous difference in pH and HCO3 - was generally predictable, the difference in PO2 and PCO2 was more significant and less predictable. CONCLUSIONS Our study reinforces the notion that VBG is not comparable to ABG for physiological measurements. However, a key revelation from our research is the significant lack of data regarding the clinical implications of using VBG instead of ABG, a common scenario in clinical practice. This highlights a critical knowledge gap.
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Affiliation(s)
- Zoe Weimar
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory & Sleep Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Shao
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xinye E Chen
- Department of General Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Thomas P Moran
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yet H Khor
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Cristo-Ropero MJ, Garcia-Rubira JC, Rivera-Rabanal FJ, Seoane-García T, Madrona-Jiménez L, Izquierdo-Bajo Á, Hernández-Meneses B, Vilches-Arenas A, Hidalgo-Urbano R. N-terminal pro-B-type natriuretic peptide and pulmonary echography are predictors of acute heart failure needing early mechanical ventilation in acute coronary syndrome. Coron Artery Dis 2024:00019501-990000000-00238. [PMID: 38828510 DOI: 10.1097/mca.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The aim of this study was to determine the best clinical predictors of acute heart failure needing mechanical ventilation (MV) in the first 48 h of evolution of patients admitted because of acute coronary syndrome (ACS). METHODS We analyzed a cohort of patients admitted for ACS between February 2017 and February 2018. A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. It was compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak troponin T-us value GRACE (Global Registry of Acute Coronary Events), CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology and American Heart Association guidelines - Bleeding Score), CACS (Canada Acute Coronary Syndrome risk score), and HAMIOT (Heart Failure after Acute Myocardial Infarction with Optimal Treatment score) scores, shock index, ejection fraction, chest X-ray, and Killip class at admission as predictors of MV in the first 48 h of admission. RESULTS A total of 119 patients were included: 54.6% with ST elevation and 45.4% without ST elevation. Twelve patients (10.1%) required MV in the first 48 h of evolution. The sensitivity of PE+ was 100% (73.5-100%), specificity 91.6% (84.6-96.1%), and area under the curve was 0.96 (0.93-0.96). The sensitivity of an NT-proBNP value more than 3647 was 88.9% (51.9-99.7%), specificity 92.1% (84.5-96.8%), and area under the curve was 0.905 (0.793-1). The κ statistic between both predictors was 0.579. All the other scores were significantly worse than PE + . CONCLUSION Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS. The agreement between both tests was only moderate.
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Affiliation(s)
- María J Cristo-Ropero
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
| | - Juan C Garcia-Rubira
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
| | | | - Tania Seoane-García
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
| | - Luis Madrona-Jiménez
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
| | - Álvaro Izquierdo-Bajo
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
| | | | - Angel Vilches-Arenas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain
| | - Rafael Hidalgo-Urbano
- Cardiovascular Department, Servicio de Cardiología, Hospital Universitario Virgen Macarena
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12
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Kaminska M, Adam V, Orr JE. Home Noninvasive Ventilation in COPD. Chest 2024; 165:1372-1379. [PMID: 38301744 PMCID: PMC11177097 DOI: 10.1016/j.chest.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Evidence is increasing that long-term noninvasive ventilation (LTNIV) can improve outcomes in individuals with severe, hypercapnic COPD. Although the evidence remains unclear in some aspects, LTNIV seems to be able to improve patient-related and physiologic outcomes like dyspnea, FEV1 and partial pressure of carbon dioxide (Pco2) and also to reduce rehospitalizations and mortality. Efficacy generally is associated with reduction in Pco2. To achieve this, an adequate interface (mask) is essential, as are appropriate ventilation settings that target the specific respiratory physiologic features of COPD. This will ensure comfort, synchrony, and adherence that will result in physiologic improvements. This article briefly reviews the newest evidence and current guidelines on LTNIV in severe COPD. It describes an actual patient who benefitted from the therapy. Finally, it provides strategies for initiating and optimizing this LTNIV in COPD, discussing high-pressure noninvasive ventilation, optimization of triggering, and control of inspiratory time. As demand increases, clinicians will need to be familiar with this therapy to reap its benefits, because inadequately adjusted LTNIV will not be tolerated or effective.
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Affiliation(s)
- Marta Kaminska
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
| | - Veronique Adam
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, San Diego, La Jolla, CA
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13
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Farmer MJS, Callahan CD, Hughes AM, Riska KL, Hill NS. Applying Noninvasive Ventilation in Treatment of Acute Exacerbation of COPD Using Evidence-Based Interprofessional Clinical Practice. Chest 2024; 165:1469-1480. [PMID: 38417700 PMCID: PMC11177098 DOI: 10.1016/j.chest.2024.02.040] [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: 03/30/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024] Open
Abstract
When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse, and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of COPD that incorporates the necessary interprofessional collaboration among physicians, nurses, and respiratory therapists caring for these patients.
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Affiliation(s)
- Mary Jo S Farmer
- Department of Medicine, Pulmonary & Critical Care Division, UMASS Chan Medical School-Baystate, Springfield, MA.
| | | | - Ashley M Hughes
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL; Center for Innovation in Chronic, Complex Healthcare (CINCCH), Edward Hines JR VA Hospital, Hines, IL
| | | | - Nicholas S Hill
- Division of Pulmonary, Critical Care & Sleep Medicine, Tufts University School of Medicine, Boston, MA
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14
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Ferreyro BL, De Jong A, Grieco DL. How to use facemask noninvasive ventilation. Intensive Care Med 2024:10.1007/s00134-024-07471-y. [PMID: 38801519 DOI: 10.1007/s00134-024-07471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhymedexpUniversité de Montpellier, InsermCNRSCHRU de Montpellier, Montpellier, France
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, L.Go F. Vito, 00168, Rome, Italy.
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15
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Bruni A, Battaglia C, Bosco V, Pelaia C, Neri G, Biamonte E, Manti F, Mollace A, Boscolo A, Morelli M, Navalesi P, Laganà D, Garofalo E, Longhini F. Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome. J Clin Med 2024; 13:2871. [PMID: 38792413 PMCID: PMC11122218 DOI: 10.3390/jcm13102871] [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: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.
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Affiliation(s)
- Andrea Bruni
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Caterina Battaglia
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Eugenio Biamonte
- Institute of Anesthesia and Intensive Care, Dulbecco Hospital, 88100 Catanzaro, Italy;
| | - Francesco Manti
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Annachiara Mollace
- Radiodiagnostic Institute, Dulbecco Hospital, 88100 Catanzaro, Italy; (C.B.); (F.M.); (A.M.)
| | - Annalisa Boscolo
- Department of Medicine (DIMED), University of Padua, 35131 Padua, Italy; (A.B.); (P.N.)
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35122 Padova, Italy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35122 Padova, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynecology, “Annunziata” Hospital, 87100 Cosenza, Italy;
| | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padua, 35131 Padua, Italy; (A.B.); (P.N.)
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35122 Padova, Italy
| | - Domenico Laganà
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.B.); (V.B.); (C.P.); (G.N.); (D.L.); (F.L.)
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16
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Keskinidou C, Vassiliou AG, Papoutsi E, Jahaj E, Dimopoulou I, Siempos I, Kotanidou A. Dysregulated Coagulation and Fibrinolysis Are Present in Patients Admitted to the Emergency Department with Acute Hypoxemic Respiratory Failure: A Prospective Study. Biomedicines 2024; 12:1081. [PMID: 38791043 PMCID: PMC11118913 DOI: 10.3390/biomedicines12051081] [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: 03/29/2024] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Acute hypoxemic respiratory failure (AHRF) is defined as acute and progressive, and patients are at a greater risk of developing acute respiratory distress syndrome (ARDS). Until now, most studies have focused on prognostic and diagnostic biomarkers in ARDS. Since there is evidence supporting a connection between dysregulated coagulant and fibrinolytic pathways in ARDS progression, it is plausible that this dysregulation also exists in AHRF. The aim of this study was to explore whether levels of soluble endothelial protein C receptor (sEPCR) and plasminogen differentiate patients admitted to the emergency department (ED) with AHRF. sEPCR and plasminogen levels were measured in 130 AHRF patients upon ED presentation by ELISA. Our results demonstrated that patients presenting to the ED with AHRF had elevated levels of sEPCR and plasminogen. It seems that dysregulation of coagulation and fibrinolysis occur in the early stages of respiratory failure requiring hospitalisation. Further research is needed to fully comprehend the contribution of sEPCR and plasminogen in AHRF.
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Affiliation(s)
| | - Alice Georgia Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (C.K.); (E.P.); (E.J.); (I.D.); (I.S.)
| | | | | | | | | | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (C.K.); (E.P.); (E.J.); (I.D.); (I.S.)
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17
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Pepe F, Fabiani G, Cogozzo C, Mazzilli V, Villanti M, Pini R, Innocenti F. HACOR score to predict NIV failure in patients with COVID-related hypoxemic respiratory failure managed in the ordinary ward and in the critical care setting. Intern Emerg Med 2024:10.1007/s11739-024-03628-1. [PMID: 38739206 DOI: 10.1007/s11739-024-03628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
We evaluated the prevalence of non-invasive ventilation (NIV) failure among patients with COVID-19-related pneumonia, managed in the ordinary ward and in the HDU/ICU and we tested the prognostic role of the HACOR score in those different settings. This is a retrospective study, conducted in the University-Hospital Careggi. We included all subjects with COVID-19 and ARF requiring NIV between March 2020 and May 2021, respectively managed in the ordinary ward (G1) and in the critical care setting (G2). Clinical parameters, HACOR and SOFA score were evaluated at Day 0 and after 1, 2 and 5 days of treatment. The primary outcome was NIV failure. 13% G1 patients and 40% G2 patients underwent endotracheal intubation (ETI). NIV was successful in 60% G1 AND 43% G2 patients (p < 0.001). In G1, compared to those with successful NIV, patients who underwent ETI, had a higher HACOR since the baseline evaluation (T0: 6 [5-6] vs 5 [3-6]; T1: 6 [5-6] vs 5 [3-6], all p < 0.05). An HACOR score > 5 was associated with an increased prevalence of ETI independent to an advanced age and a SOFA score > 5 both in G1 (T1: RR 4.87, 95% CI 1.462-16.275; T5: 3.630, 95% CI 0.979-13.462) and G2 (T0: 1.76, 95% CI 0.906-3.422; T1: 3.38, 95% CI 1.386-8.265). Among patients with COVID-related-ARF, NIV could be managed in the ordinary ward in a consistent proportion of patients and, among them, an HACOR score > 5 was independently associated with increased NIV failure from the earliest evaluations.
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Affiliation(s)
- Francesco Pepe
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Ginevra Fabiani
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Carolina Cogozzo
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Valerio Mazzilli
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Maurizio Villanti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
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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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Yang J, Chen L, Yu H, Hu J, Qiu F. Effects of high-flow nasal cannula oxygen therapy in bronchiectasis and hypercapnia: a retrospective observational study. BMC Pulm Med 2024; 24:217. [PMID: 38698379 PMCID: PMC11067275 DOI: 10.1186/s12890-024-03037-2] [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: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The effectiveness of high-flow nasal cannula (HFNC) therapy in patients with bronchiectasis experiencing hypercapnia remains unclear. Our aim was to retrospectively analyze the short-term outcomes of HFNC therapy in such patients, and to further explore the predictors of HFNC treatment failure in this particular patient population. METHODS A retrospective review was conducted on patients with bronchiectasis who received HFNC (n = 70) for hypercapnia (arterial partial pressure of carbon dioxide, PaCO2 ≥ 45 mmHg) between September 2019 and September 2023. RESULTS In the study population, 30% of patients presented with acidemia (arterial pH < 7.35) at baseline. Within 24 h of HFNC treatment, there was a significant reduction in PaCO2 levels by a mean of 4.0 ± 12.7 mmHg (95% CI -7.0 to -1.0 mmHg). Concurrently, arterial pH showed a statistically significant increase with a mean change of 0.03 ± 0.06 (95% CI 0.01 to 0.04). The overall hospital mortality rate in our study was 17.5%. The median length of hospital stay was 11.0 days (interquartile range [IQR] 8.0 to 16.0 days). Sub-analysis revealed no statistically significant differences in hospital mortality (19.0% vs. 20.4%, p = 0.896), length of hospital stay (median 14.0 days [IQR 9.0 to 18.0 days] vs. 10.0 days [IQR 7.0 to 16.0 days], p = 0.117) and duration of HFNC application (median 5.0 days [IQR 2.0 to 8.5 days] vs. 6.0 days [IQR 4.9 to 9.5 days], p = 0.076) between the acidemia group and the non-acidemia group (arterial pH ≥ 7.35). However, more patients in the non-acidemia group had do-not-intubate orders. The overall treatment failure rate for HFNC was 28.6%. Logistic regression analysis identified the APACHE II score (OR 1.24 per point) as the independent predictor of HFNC failure. CONCLUSIONS In patients with bronchiectasis and hypercapnia, HFNC as an initial respiratory support can effectively reduce PaCO2 level within 24 h of treatment. A high APACHE II score has emerged as a prognostic indicator for HFNC treatment failure. These observations highlight randomized controlled trials to meticulously evaluate the efficacy of HFNC in this specific population.
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Affiliation(s)
- Jing Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China.
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Jingjing Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
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20
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Munroe ES, Prevalska I, Hyer M, Meurer WJ, Mosier JM, Tidswell MA, Prescott HC, Wei L, Wang H, Fung CM. High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study. Crit Care Explor 2024; 6:e1092. [PMID: 38725442 PMCID: PMC11081605 DOI: 10.1097/cce.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
IMPORTANCE Patients presenting to the emergency department (ED) with hypoxemia often have mixed or uncertain causes of respiratory failure. The optimal treatment for such patients is unclear. Both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are used. OBJECTIVES We sought to compare the effectiveness of initial treatment with HFNC versus NIV for acute hypoxemic respiratory failure. DESIGN SETTING AND PARTICIPANTS We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with HFNC or NIV within 24 hours of arrival to the University of Michigan adult ED from January 2018 to December 2022. We matched patients 1:1 using a propensity score for odds of receiving NIV. MAIN OUTCOMES AND MEASURES The primary outcome was major adverse pulmonary events (28-d mortality, ventilator-free days, noninvasive respiratory support hours) calculated using a win ratio. RESULTS A total of 1154 patients were included. Seven hundred twenty-six (62.9%) received HFNC and 428 (37.1%) received NIV. We propensity score matched 668 of 1154 (57.9%) patients. Patients on NIV versus HFNC had lower 28-day mortality (16.5% vs. 23.4%, p = 0.033) and required noninvasive treatment for fewer hours (median 7.5 vs. 13.5, p < 0.001), but had no difference in ventilator-free days (median [interquartile range]: 28 [26, 28] vs. 28 [10.5, 28], p = 0.199). Win ratio for composite major adverse pulmonary events favored NIV (1.38; 95% CI, 1.15-1.65; p < 0.001). CONCLUSIONS AND RELEVANCE In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with NIV compared with HFNC was associated with lower mortality and fewer composite major pulmonary adverse events calculated using a win ratio. These findings underscore the need for randomized controlled trials to further understand the impact of noninvasive respiratory support strategies.
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Affiliation(s)
- Elizabeth S Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Ina Prevalska
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Madison Hyer
- Center for Biostatistics, Ohio State University, Columbus, OH
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Mark A Tidswell
- Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School-Baystate Medical Center, Springfield, MA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Lai Wei
- Center for Biostatistics, Ohio State University, Columbus, OH
| | - Henry Wang
- Department of Emergency Medicine, Ohio State University, Columbus, OH
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21
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Mayaux J, Decavele M, Dres M, Lecronier M, Demoule A. [Non-invasive ventilation in acute respiratory failure of oncology-hematology patients: What are its current benefits and limitations?]. Rev Mal Respir 2024; 41:382-389. [PMID: 38609766 DOI: 10.1016/j.rmr.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/04/2023] [Indexed: 04/14/2024]
Abstract
Acute respiratory failure (ARF) is a leading cause, along with sepsis, of admission to the intensive care unit (ICU) of patients with active cancer. Presenting variable clinical severity, ARF in onco-hematological patients has differing etiologies, primarily represented by possibly opportunistic acute infectious pneumonia (de novo hypoxemic ARF), and decompensation in chronic cardiac or respiratory diseases (e.g., acute pulmonary edema or exacerbated chronic obstructive pulmonary disease). In these patients, orotracheal intubation is associated with a doubled risk of in-hospital mortality. Consequently, over the last three decades, numerous researchers have attempted to demonstrate and pinpoint the precise role of non-invasive ventilation (NIV) in the specific context of ARF in onco-hematological patients. While the benefits of NIV in the management of acute pulmonary edema or alveolar hypoventilation (hypercapnic ARF) are well-demonstrated, its positioning in de novo hypoxemic ARF is debatable, and has recently been called into question. In the early 2000s, based on randomized controlled trials, NIV was recommended as first-line treatment, one reason being that it allowed significantly reduced use of orotracheal intubation. In the latest randomized studies, however, the benefits of NIV in terms of survival orotracheal intubation have not been observed; as a result, it is no longer recommended in the management of de novo hypoxemic ARF in onco-haematological patients.
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Affiliation(s)
- J Mayaux
- Service de médecine intensive et réanimation, département R3S - DMU APPROCHES, hôpital universitaire Pitié-Salpêtrière - Sorbonne université médecine, Paris, France.
| | - M Decavele
- Service de médecine intensive et réanimation, département R3S - DMU APPROCHES, hôpital universitaire Pitié-Salpêtrière - Sorbonne université médecine, Paris, France
| | - M Dres
- Service de médecine intensive et réanimation, département R3S - DMU APPROCHES, hôpital universitaire Pitié-Salpêtrière - Sorbonne université médecine, Paris, France
| | - M Lecronier
- Service de médecine intensive et réanimation, département R3S - DMU APPROCHES, hôpital universitaire Pitié-Salpêtrière - Sorbonne université médecine, Paris, France
| | - A Demoule
- Service de médecine intensive et réanimation, département R3S - DMU APPROCHES, hôpital universitaire Pitié-Salpêtrière - Sorbonne université médecine, Paris, France
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22
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Bello AR, Tralhão A. Non-invasive ventilation for cardiogenic shock associated respiratory failure - Striking the perfect balance between risk and benefit. Rev Port Cardiol 2024; 43:275-277. [PMID: 37931851 DOI: 10.1016/j.repc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Ana Rita Bello
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - António Tralhão
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
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23
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Reta-Pérez O, Colmenero-Ruiz M, Hernández-Socorro CR, Saavedra P, Maichle SF, Portugal E, Cerezo-Arias M, Sánchez Alés L, Martínez-Carmona JF, Mateu-Campos L, Lorencio-Cárdenas C, García-Miguélez A, Sosa-Durr M, San Martín-Bragado M, Ruiz-Santana S. Trophic Nutrition in ICU Patients Undergoing High-Flow Oxygen Therapy and/or Noninvasive Mechanical Ventilation: The Nutri-Trophic Study. Nutrients 2024; 16:1366. [PMID: 38732612 PMCID: PMC11085204 DOI: 10.3390/nu16091366] [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: 03/30/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Enteral nutrition (EN) therapy in ICU patients requiring oxygen therapy with high-flow nasal cannula (HFNC) and/or noninvasive mechanical ventilation (NIMV) is controversial. A prospective, cohort, observational, and multicenter study was conducted in 10 ICUs in Spain to analyze the 90-day mortality, tolerance, side effects, and infectious complications of trophic EN in patients requiring HFNC therapy and/or NIVM. A total of 149 patients were enrolled. The mean age, severity scores, tracheobronchitis, bacteremia, and antimicrobial therapy were significantly higher in deceased than in living patients (p < 0.05), and the mortality rate was 14.8%. A total of 110 patients received oral trophic feedings, 36 patients received nasogastric tube feedings (NGFs), and 3 received mixed feedings. Trophic EN was discontinued in only ten (14.9%) patients because of feeding-related complications. The variables selected for the multivariate logistic regression on feeding discontinuation were SOFA upon admission (OR per unit = 1.461) and urea (OR per mg/dL = 1.029). There were no significant differences in the development of new infections according to the route of EN administration. Early trophic feeding administered to patients with acute respiratory failure requiring noninvasive ventilation is safe and feasible, and is associated with few dietary and infectious complications in a mortality, setting comparable to similar studies.
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Affiliation(s)
- Olivia Reta-Pérez
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - Manuel Colmenero-Ruiz
- Department of Intensive Care, Hospital Universitario San Cecilio, A. del Conocimiento s/n, 18016 Granada, Spain;
| | - Carmen Rosa Hernández-Socorro
- Department of Radiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Pedro Saavedra
- Department of Mathematics, Universidad de Las Palmas de Gran Canaria (ULPGC), 35010 Las Palmas de Gran Canaria, Spain;
| | - Silmary F. Maichle
- Department of Intensive Care, Hospital Clínico Universitario San Carlos, Calle del Prof. Martín Lagos s/n, 28040 Madrid, Spain;
| | - Esther Portugal
- Department of Intensive Care, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain;
| | - Mariola Cerezo-Arias
- Department of Intensive Care, Hospital Universitario de Badajoz, Av.de Elvas s/n, 06080 Badajoz, Spain;
| | - Laura Sánchez Alés
- Department of Intensive Care, Hospital Universitari de Terrassa: CST, Carr. De Torrebonica s/n, 08227 Terrassa, Spain;
| | - Juan F. Martínez-Carmona
- Department of Intensive Care, Hospital Regional Universitario de Málaga, Av. De Carlos Haya 84, 29010 Málaga, Spain;
| | - Lidon Mateu-Campos
- Department of Intensive Care, Hospital General Universitario de Castellón, Avinguda de Benicàssim 128, 12004 Castelló de la Plana, Spain;
| | - Carol Lorencio-Cárdenas
- Department of Intensive Care, Hospital Universitari Dr Josep Trueta, Avinguda de França, s/n, 17007 Girona, Spain;
| | - Ana García-Miguélez
- Department of Intensive Care, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla s/n, 39008 Santander, Spain;
| | - María Sosa-Durr
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - María San Martín-Bragado
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
| | - Sergio Ruiz-Santana
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria (ULPGC), Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain; (O.R.-P.); (M.S.-D.); (M.S.M.-B.)
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24
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Acet-Öztürk NA, Aydin-Güçlü Ö, Yildiz MN, Demirdöğen E, Görek Dilektaşli A, Coşkun F, Uzaslan E, Ursavaş A, Karadağ M. Comparison of BAP65, DECAF, PEARL, and MEWS Scores in Predicting Respiratory Support Need in Hospitalized Exacerbation of Chronic Obstructive Lung Disease Patients. Med Princ Pract 2024; 33:1-9. [PMID: 38626747 PMCID: PMC11250507 DOI: 10.1159/000538812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models. SUBJECTS AND METHODS We compared the prognostic performance of the BAP65 score, DECAF score, PEARL score, and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need. RESULTS This cross-sectional study consisted of 139 patients. Patients in need of noninvasive or invasive mechanical ventilation support are grouped as ventilatory support groups (n = 54). Comparison between receiver operating characteristic curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cutoff value of 1 presented the highest sensitivity and BAP65 score with a cutoff value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed that gender played a significant role in COPD exacerbation outcome, and arterial pCO2 and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One-point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed a correlation with age, comorbidity index, and dyspnea. BAP65 and DECAF scores also showed a correlation with length of stay. CONCLUSION Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.
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Affiliation(s)
| | - Özge Aydin-Güçlü
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Merve Nur Yildiz
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ezgi Demirdöğen
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | | | - Funda Coşkun
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Esra Uzaslan
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ahmet Ursavaş
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Mehmet Karadağ
- Department of Pulmonology, Uludağ University Faculty of Medicine, Bursa, Turkey
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25
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Nielsen FM, Klitgaard TL, Siegemund M, Laake JH, Thormar KM, Cole JM, Aagaard SR, Bunzel AMG, Vestergaard SR, Langhoff PK, Pedersen CH, Hejlesen JØ, Abdelhamid S, Dietz A, Gebhard CE, Zellweger N, Hollinger A, Poulsen LM, Weihe S, Andersen-Ranberg NC, Pedersen UG, Mathiesen O, Andreasen AS, Brix H, Thomsen JJ, Petersen CH, Bestle MH, Wichmann S, Lund MS, Mortensen KM, Brand BA, Haase N, Iversen SA, Marcussen KV, Brøchner AC, Borup M, Grøfte T, Hildebrandt T, Kjær MBN, Engstrøm J, Lange T, Perner A, Schjørring OL, Rasmussen BS. Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. JAMA 2024; 331:1185-1194. [PMID: 38501214 PMCID: PMC10951852 DOI: 10.1001/jama.2024.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
Importance Supplemental oxygen is ubiquitously used in patients with COVID-19 and severe hypoxemia, but a lower dose may be beneficial. Objective To assess the effects of targeting a Pao2 of 60 mm Hg vs 90 mm Hg in patients with COVID-19 and severe hypoxemia in the intensive care unit (ICU). Design, Setting, and Participants Multicenter randomized clinical trial including 726 adults with COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. The trial was prematurely stopped prior to outcome assessment due to slow enrollment. End of 90-day follow-up was June 1, 2023. Interventions Patients were randomized 1:1 to a Pao2 of 60 mm Hg (lower oxygenation group; n = 365) or 90 mm Hg (higher oxygenation group; n = 361) for up to 90 days in the ICU. Main Outcomes and Measures The primary outcome was the number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes included mortality, proportion of patients with serious adverse events, and number of days alive and out of hospital, all at 90 days. Results Of 726 randomized patients, primary outcome data were available for 697 (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 495 patients (68%) were male. At 90 days, the median number of days alive without life support was 80.0 days (IQR, 9.0-89.0 days) in the lower oxygenation group and 72.0 days (IQR, 2.0-88.0 days) in the higher oxygenation group (P = .009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days [95% CI, 0.2-11.5 days]; P = .04). Mortality at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group (risk ratio, 0.86 [98.6% CI, 0.66-1.13]; P = .18). There were no statistically significant differences in proportion of patients with serious adverse events or in number of days alive and out of hospital. Conclusion and Relevance In adult ICU patients with COVID-19 and severe hypoxemia, targeting a Pao2 of 60 mm Hg resulted in more days alive without life support in 90 days than targeting a Pao2 of 90 mm Hg. Trial Registration ClinicalTrials.gov Identifier: NCT04425031.
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Affiliation(s)
- Frederik M. Nielsen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Siegemund
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Jon H. Laake
- Department of Anaesthesia and Intensive Care, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Katrin M. Thormar
- Department of Anesthesia and Intensive Care, Landspitali, University Hospital of Reykjavik, Reykjavik, Iceland
| | - Jade M. Cole
- Department of Intensive Care, Cardiff University Hospital of Wales, Cardiff, Wales
| | - Søren R. Aagaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Marie G. Bunzel
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Stine R. Vestergaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Peter K. Langhoff
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Caroline H. Pedersen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Josefine Ø. Hejlesen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Salim Abdelhamid
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Anna Dietz
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Caroline E. Gebhard
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Nuria Zellweger
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Alexa Hollinger
- Department of Intensive Care and Department of Clinical Research, Basel University Hospital, Basel, Switzerland
| | - Lone M. Poulsen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Sarah Weihe
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | | | - Ulf G. Pedersen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Helene Brix
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Jonas J. Thomsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Christina H. Petersen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Herlev, Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Martin S. Lund
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Karoline M. Mortensen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Björn A. Brand
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne A. Iversen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Klaus V. Marcussen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Anne C. Brøchner
- Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Morten Borup
- Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Maj-Brit N. Kjær
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Janus Engstrøm
- Copenhagen Trial Unit, Centre for Clinical Intervention, Capital Region, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav L. Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ferrer M, De Pascale G, Tanzarella ES, Antonelli M. Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT. Semin Respir Crit Care Med 2024; 45:169-186. [PMID: 38604188 DOI: 10.1055/s-0043-1778140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Severe acute respiratory failure (ARF) is a major issue in patients with severe community-acquired pneumonia (CAP). Standard oxygen therapy is the first-line therapy for ARF in the less severe cases. However, respiratory supports may be delivered in more severe clinical condition. In cases with life-threatening ARF, invasive mechanical ventilation (IMV) will be required. Noninvasive strategies such as high-flow nasal therapy (HFNT) or noninvasive ventilation (NIV) by either face mask or helmet might cover the gap between standard oxygen and IMV. The objective of all the supporting measures for ARF is to gain time for the antimicrobial treatment to cure the pneumonia. There is uncertainty regarding which patients with severe CAP are most likely to benefit from each noninvasive support strategy. HFNT may be the first-line approach in the majority of patients. While NIV may be relatively contraindicated in patients with excessive secretions, facial hair/structure resulting in air leaks or poor compliance, NIV may be preferable in those with increased work of breathing, respiratory muscle fatigue, and congestive heart failure, in which the positive pressure of NIV may positively impact hemodynamics. A trial of NIV might be considered for select patients with hypoxemic ARF if there are no contraindications, with close monitoring by an experienced clinical team who can intubate patients promptly if they deteriorate. In such cases, individual clinician judgement is key to choose NIV, interface, and settings. Due to the paucity of studies addressing IMV in this population, the protective mechanical ventilation strategies recommended by guidelines for acute respiratory distress syndrome can be reasonably applied in patients with severe CAP.
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Affiliation(s)
- Miquel Ferrer
- Unitat de Vigilancia Intensiva Respiratoria, Servei de Pneumologia, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CIBERES-CB060628), Barcelona, Spain
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eloisa S Tanzarella
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Yang T, Ma Y, Chen X, Yang Q, Pei J, Zhang Z, Qian X, Wang Y, Fan X, Han L. Effect of different noninvasive ventilation interfaces on the prevention of facial pressure injury: A network meta-analysis. Intensive Crit Care Nurs 2024; 81:103585. [PMID: 37977002 DOI: 10.1016/j.iccn.2023.103585] [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: 07/27/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the effect of different noninvasive ventilation interfaces on preventing the facial pressure injury. METHODS This network meta-analysis was conducted following the PRISMA reporting guidelines. Seven electronic databases were systematically searched for randomised controlled trials about the comparative effectiveness of different interfaces in preventing facial pressure injury with noninvasive ventilation in adults and newborns from inception to June 2023. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias assessment tool was used to assess the methodological quality. RESULTS A total of 78 randomised controlled trials involving 7,291 patients were included. The results of network meta-analysis showed that the effectiveness of the eight noninvasive ventilation interfaces on the prevention of facial pressure injury was in the order of: nasal cannula > full-face mask > rotation of nasal mask with nasal prongs > helmet > nasal mask > oronasal mask > nasal prongs > face mask. The use of full-face mask in adults and nasal cannula in newborns had the best effect on preventing the incidence of facial pressure injury. CONCLUSIONS The use of full-face mask in adults and nasal cannula in newborns had the most clinical advantage in preventing the incidence of facial pressure injury and were worthy promoting in clinical practice. IMPLICATIONS FOR CLINICAL PRACTICE This study provides a certain theoretical basis for the selection of appropriate interface for patients with noninvasive ventilation. Clinical practitioners should choose the appropriate interfaces based on the patient's specific condition to reduce the incidence of facial pressure injury, enhance patient comfort, and improve the effectiveness of respiratory therapy.
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Affiliation(s)
- Tingting Yang
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoli Chen
- Department of Pediatrics, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qiuxia Yang
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Juhong Pei
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyao Zhang
- School of Foreign Languages, Lanzhou University of Arts and Science, Lanzhou, Gansu, China
| | - Xiaoling Qian
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yunyun Wang
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiangping Fan
- Department of Nursing, The Third People's Hospital of Lanzhou, Lanzhou, Gansu, China
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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Mosier JM, Tidswell M, Wang HE. Noninvasive respiratory support in the emergency department: Controversies and state-of-the-art recommendations. J Am Coll Emerg Physicians Open 2024; 5:e13118. [PMID: 38464331 PMCID: PMC10920951 DOI: 10.1002/emp2.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 03/12/2024] Open
Abstract
Acute respiratory failure is a common reason for emergency department visits and hospital admissions. Diverse underlying physiologic abnormalities lead to unique aspects about the most common causes of acute respiratory failure: acute decompensated heart failure, acute exacerbation of chronic obstructive pulmonary disease, and acute de novo hypoxemic respiratory failure. Noninvasive respiratory support strategies are increasingly used methods to support work of breathing and improve gas exchange abnormalities to improve outcomes relative to conventional oxygen therapy or invasive mechanical ventilation. Noninvasive respiratory support includes noninvasive positive pressure ventilation and nasal high flow, each with unique physiologic mechanisms. This paper will review the physiology of respiratory failure and noninvasive respiratory support modalities and offer data and guideline-driven recommendations in the context of key clinical controversies.
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Affiliation(s)
- Jarrod M. Mosier
- Department of Emergency MedicineThe University of Arizona College of MedicineTucsonArizonaUSA
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of MedicineThe University of Arizona College of MedicineTucsonArizonaUSA
| | - Mark Tidswell
- Division of Pulmonary and Critical Care, Department of MedicineUniversity of Massachusetts Chan Medical School – Baystate Medical CenterSpringfieldMassachusettsUSA
| | - Henry E. Wang
- Department of Emergency MedicineThe Ohio State UniversityColumbusOhioUSA
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29
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Younan R, Augy JL, Hermann B, Guidet B, Aegerter P, Guerot E, Novara A, Hauw-Berlemont C, Hamdan A, Bailleul C, Santi F, Diehl JL, Peron N, Aissaoui N. Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area. JOURNAL OF INTENSIVE MEDICINE 2024; 4:209-215. [PMID: 38681794 PMCID: PMC11043637 DOI: 10.1016/j.jointm.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 05/01/2024]
Abstract
Background Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area. Methods In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality. Results A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (n=2841) between 1997 and 2001, 1.76% (n=1717) between 2002 and 2006, 1.05% (n=965) between 2007 and 2011, and 1.05% (n=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32-59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13-28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV. Conclusion ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.
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Affiliation(s)
- Romy Younan
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Jean Loup Augy
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Bertrand Hermann
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, AP-HP, Saint Antoine Hospital, Universités de Sorbonne, Université Pierre et Marie Curie, Paris, France
- INSERM U1136, Paris, France
| | - Philippe Aegerter
- Versailles Saint-Quentin-en-Yvelines University, INSERM U1018, Groupe Interrégional de Recherche Clinique et d'Innovation, Île-de-France, France
| | - Emmanuel Guerot
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Ana Novara
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Caroline Hauw-Berlemont
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Amer Hamdan
- Respiratory Medicine Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Clotilde Bailleul
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Francesca Santi
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Jean-Luc Diehl
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Innovative Therapies in Hemostasis, INSERM UMR-S1140, Université de Paris, Paris, France
- Intensive Care Unit and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Nicolas Peron
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Nadia Aissaoui
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
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Wu P, Huo W, Zhao H, Lv J, Lv S, An Y. Risk factors and predictive model for mortality in patients undergoing allogeneic hematopoietic stem cell transplantation admitted to the intensive care unit. Exp Ther Med 2024; 27:168. [PMID: 38476903 PMCID: PMC10928819 DOI: 10.3892/etm.2024.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/26/2024] [Indexed: 03/14/2024] Open
Abstract
Hematological malignant tumors represent a group of major diseases carrying a substantial risk to the lives of affected patients. Risk factors for mortality in critically ill patients have garnered substantial attention in recent research endeavors. The present research aimed to identify factors predicting intensive care unit (ICU) mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Furthermore, the present study analyzed and compared the mortality rate between patients undergoing haploidentical hematopoietic stem cell transplantation (Haplo-SCT) and those undergoing identical sibling donor (ISD) transplantation. A total of 108 patients were included in the present research, 83 (76.9%) of whom underwent Haplo-SCT. ICU mortality was reported in 58 (53.7%) patients, with the values of 55.4 and 48.0% associated with Haplo-SCT and ISD, respectively (P=0.514). The mortality rate of patients undergoing Haplo-SCT was comparable to that of patients undergoing ISD transplantation. The present study found that reduced hemoglobin, elevated total bilirubin, elevated brain natriuretic peptide, elevated fibrinogen degradation products, need for vasoactive drugs at ICU admission, need for invasive mechanical ventilation and elevated APACHE II scores were independent risk factors for ICU mortality. Among patients presenting with 5-7 risk factors, the ICU mortality reached 100%, significantly exceeding that of other patients. The present research revealed that ICU mortality rates remain elevated among patients who underwent allo-HSCT, especially those presenting multiple risk factors. However, the outcome of patients undergoing Haplo-SCT were comparable to those of patients undergoing ISD transplants.
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Affiliation(s)
- Peihua Wu
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Wenxuan Huo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Huiying Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Jie Lv
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Shan Lv
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, P.R. China
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31
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Salluh JIF, Póvoa P, Beane A, Kalil A, Sendagire C, Sweeney DA, Pilcher D, Polverino E, Tacconelli E, Estenssoro E, Frat JP, Ramirez J, Reyes LF, Roca O, Nseir S, Nobre V, Lisboa T, Martin-Loeches I. Challenges for a broad international implementation of the current severe community-acquired pneumonia guidelines. Intensive Care Med 2024; 50:526-538. [PMID: 38546855 DOI: 10.1007/s00134-024-07381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024]
Abstract
Severe community-acquired pneumonia (sCAP) remains one of the leading causes of admission to the intensive care unit, thus consuming a large share of resources and is associated with high mortality rates worldwide. The evidence generated by clinical studies in the last decade was translated into recommendations according to the first published guidelines focusing on severe community-acquired pneumonia. Despite the advances proposed by the present guidelines, several challenges preclude the prompt implementation of these diagnostic and therapeutic measures. The present article discusses the challenges for the broad implementation of the sCAP guidelines and proposes solutions when applicable.
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Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil.
| | - Pedro Póvoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark Centre for Clinical Epidemiology, Odense, Denmark
- Department of Intensive Care, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Abi Beane
- Pandemic Science Hub and Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- NICS-MORU, Colombo, Sri Lanka
| | - Andre Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cornelius Sendagire
- Anesthesia and Critical Care, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road3004, Prahran, VIC, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, Servicio de Terapia Intensiva, Buenos Aires, Argentina
| | - Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM, CIC-1402, IS-ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
- University of Louisville, Louisville, KY, USA
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí - I3PT, Parc del Taulí 1, 08028, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, 59000, Lille, France
- Team Fungal Associated Invasive and Inflammatory Diseases, Lille Inflammation Research International Center, Université de Lille, INSERM U995, Lille, France
| | - Vandack Nobre
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Lisboa
- Critical Care Department, Programa de Pós-Graduação em Ciencias Pneumologicas, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
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Parrilla-Gómez FJ, Marin-Corral J, Castellví-Font A, Pérez-Terán P, Picazo L, Ravelo-Barba J, Campano-García M, Festa O, Restrepo M, Masclans JR. Switches in non-invasive respiratory support strategies during acute hypoxemic respiratory failure: Need to monitoring from a retrospective observational study. Med Intensiva 2024; 48:200-210. [PMID: 37985338 DOI: 10.1016/j.medine.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To explore combined non-invasive-respiratory-support (NIRS) patterns, reasons for NIRS switching, and their potential impact on clinical outcomes in acute-hypoxemic-respiratory-failure (AHRF) patients. DESIGN Retrospective, single-center observational study. SETTING Intensive Care Medicine. PATIENTS AHRF patients (cardiac origin and respiratory acidosis excluded) underwent combined NIRS therapies such as non-invasive-ventilation (NIV) and High-Flow-Nasal-Cannula (HFNC). INTERVENTIONS Patients were classified based on the first NIRS switch performed (HFNC-to-NIV or NIV-to-HFNC), and further specific NIRS switching strategies (NIV trial-like vs. Non-NIV trial-like and single vs. multiples switches) were independently evaluated. MAIN VARIABLES OF INTEREST Reasons for switching, NIRS failure and mortality rates. RESULTS A total of 63 patients with AHRF were included, receiving combined NIRS, 58.7% classified in the HFNC-to-NIV group and 41.3% in the NIV-to-HFNC group. Reason for switching from HFNC to NIV was AHRF worsening (100%), while from NIV to HFNC was respiratory improvement (76.9%). NIRS failure rates were higher in the HFNC-to-NIV than in NIV-to-HFNC group (81% vs. 35%, p < 0.001). Among HFNC-to-NIV patients, there was no difference in the failure rate between the NIV trial-like and non-NIV trial-like groups (86% vs. 78%, p = 0.575) but the mortality rate was significantly lower in NIV trial-like group (14% vs. 52%, p = 0.02). Among NIV to HFNC patients, NIV failure was lower in the single switch group compared to the multiple switches group (15% vs. 53%, p = 0.039), with a shorter length of stay (5 [2-8] vs. 12 [8-30] days, p = 0.001). CONCLUSIONS NIRS combination is used in real life and both switches' strategies, HFNC to NIV and NIV to HFNC, are common in AHRF management. Transitioning from HFNC to NIV is suggested as a therapeutic escalation and in this context performance of a NIV-trial could be beneficial. Conversely, switching from NIV to HFNC is suggested as a de-escalation strategy that is deemed safe if there is no NIRS failure.
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Affiliation(s)
- Francisco José Parrilla-Gómez
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM); Department of Medicine and Life Sciences (MELIS), UPF, Barcelona, Spain.
| | - Judith Marin-Corral
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM); Division of Pulmonary & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, San Antonio, TX, USA
| | - Andrea Castellví-Font
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM)
| | - Purificación Pérez-Terán
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM); Department of Medicine and Life Sciences (MELIS), UPF, Barcelona, Spain
| | - Lucía Picazo
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM)
| | - Jorge Ravelo-Barba
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM)
| | - Marta Campano-García
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM)
| | - Olimpia Festa
- Anaesthesia and Reanimation Department, Hospital General de Sant Boi, Barcelona, Spain
| | - Marcos Restrepo
- Division of Pulmonary & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, San Antonio, TX, USA; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Joan Ramón Masclans
- Critical Care Department, Hospital del Mar de Barcelona. Critical illness research group (GREPAC), Hospital del Mar Research Institute (IMIM); Department of Medicine and Life Sciences (MELIS), UPF, Barcelona, Spain
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Padte S, Samala Venkata V, Mehta P, Tawfeeq S, Kashyap R, Surani S. 21st century critical care medicine: An overview. World J Crit Care Med 2024; 13:90176. [PMID: 38633477 PMCID: PMC11019625 DOI: 10.5492/wjccm.v13.i1.90176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units (ICUs). This abstract provides a concise summary of the latest developments in critical care, highlighting key areas of innovation. Recent advancements in critical care include Precision Medicine: Tailoring treatments based on individual patient characteristics, genomics, and biomarkers to enhance the effectiveness of therapies. The objective is to describe the recent advancements in Critical Care Medicine. Telemedicine: The integration of telehealth technologies for remote patient monitoring and consultation, facilitating timely interventions. Artificial intelligence (AI): AI-driven tools for early disease detection, predictive analytics, and treatment optimization, enhancing clinical decision-making. Organ Support: Advanced life support systems, such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support. Infection Control: Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections. Ventilation Strategies: Precision ventilation modes and lung-protective strategies to minimize ventilator-induced lung injury. Sepsis Management: Early recognition and aggressive management of sepsis with tailored interventions. Patient-Centered Care: A shift towards patient-centered care focusing on psychological and emotional well-being in addition to medical needs. We conducted a thorough literature search on PubMed, EMBASE, and Scopus using our tailored strategy, incorporating keywords such as critical care, telemedicine, and sepsis management. A total of 125 articles meeting our criteria were included for qualitative synthesis. To ensure reliability, we focused only on articles published in the English language within the last two decades, excluding animal studies, in vitro/molecular studies, and non-original data like editorials, letters, protocols, and conference abstracts. These advancements reflect a dynamic landscape in critical care medicine, where technology, research, and patient-centered approaches converge to improve the quality of care and save lives in ICUs. The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.
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Affiliation(s)
- Smitesh Padte
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | | | - Priyal Mehta
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Sawsan Tawfeeq
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Rahul Kashyap
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
- Department of Research, WellSpan Health, York, PA 17403, United States
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Salim Surani
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
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Greco E, Segre E, Melchio M, Labarile G, Lison D, Morello F, Lupia E. Incidence and management of agitation during non-invasive mechanical ventilation outside intensive care units: an observational cohort study in a high dependency unit. Panminerva Med 2024; 66:75-77. [PMID: 37733013 DOI: 10.23736/s0031-0808.23.04958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Elisabetta Greco
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy -
| | - Elisabetta Segre
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Monica Melchio
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giulia Labarile
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Davide Lison
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fulvio Morello
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Lupia
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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V S, Marwah V, Jyothis MC. Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation. Indian J Crit Care Med 2024; 28:309-310. [PMID: 38477005 PMCID: PMC10926043 DOI: 10.5005/jp-journals-10071-24642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Shrinath V, Marwah V, Jyothis MC. Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation. Indian J Crit Care Med 2024;28(3):309-310.
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Affiliation(s)
- Shrinath V
- Department of Respiratory Medicine, INHS Asvini, Mumbai, Maharashtra, India
| | - Vikas Marwah
- Department of Respiratory Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - MC Jyothis
- Department of Respiratory Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
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Duggal A, Conrad SA, Barrett NA, Saad M, Cheema T, Pannu S, Romero RS, Brochard L, Nava S, Ranieri VM, May A, Brodie D, Hill NS. Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial. Am J Respir Crit Care Med 2024; 209:529-542. [PMID: 38261630 DOI: 10.1164/rccm.202311-2060oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 01/25/2024] Open
Abstract
Rationale: It is unclear whether extracorporeal CO2 removal (ECCO2R) can reduce the rate of intubation or the total time on invasive mechanical ventilation (IMV) in adults experiencing an exacerbation of chronic obstructive pulmonary disease (COPD). Objectives: To determine whether ECCO2R increases the number of ventilator-free days within the first 5 days postrandomization (VFD-5) in exacerbation of COPD in patients who are either failing noninvasive ventilation (NIV) or who are failing to wean from IMV. Methods: This randomized clinical trial was conducted in 41 U.S. institutions (2018-2022) (ClinicalTrials.gov ID: NCT03255057). Subjects were randomized to receive either standard care with venovenous ECCO2R (NIV stratum: n = 26; IMV stratum: n = 32) or standard care alone (NIV stratum: n = 22; IMV stratum: n = 33). Measurements and Main Results: The trial was stopped early because of slow enrollment and enrolled 113 subjects of the planned sample size of 180. There was no significant difference in the median VFD-5 between the arms controlled by strata (P = 0.36). In the NIV stratum, the median VFD-5 for both arms was 5 days (median shift = 0.0; 95% confidence interval [CI]: 0.0-0.0). In the IMV stratum, the median VFD-5 in the standard care and ECCO2R arms were 0.25 and 2 days, respectively; median shift = 0.00 (95% confidence interval: 0.00-1.25). In the NIV stratum, all-cause in-hospital mortality was significantly higher in the ECCO2R arm (22% vs. 0%, P = 0.02) with no difference in the IMV stratum (17% vs. 15%, P = 0.73). Conclusions: In subjects with exacerbation of COPD, the use of ECCO2R compared with standard care did not improve VFD-5. Clinical trial registered with www.clinicaltrials.gov (NCT03255057).
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Affiliation(s)
- Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Nicholas A Barrett
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mohamed Saad
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Tariq Cheema
- Division of Pulmonary Critical Care, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Sonal Pannu
- Division of Pulmonary Critical Care and Sleep, Department of Medicine, Ohio State University, Columbus, Ohio
| | - Ramiro Saavedra Romero
- Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy
| | - Alexandra May
- ALung Technologies, LivaNova PLC, Pittsburgh, Pennsylvania
| | - Daniel Brodie
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
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Bianquis C, Leiva Agüero S, Cantero C, Golfe Bonmatí A, González J, Hu X, Lacoste-Palasset T, Livesey A, Guillamat Prats R, Salai G, Sykes DL, Toland S, van Zeller C, Viegas P, Vieira AL, Zaneli S, Karagiannidis C, Fisser C. ERS International Congress 2023: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2024; 10:00886-2023. [PMID: 38651090 PMCID: PMC11033729 DOI: 10.1183/23120541.00886-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 04/25/2024] Open
Abstract
Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.
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Affiliation(s)
- Clara Bianquis
- Sorbonne Université, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sebastian Leiva Agüero
- Academic unit of the University Institute of Health Science H.A. Barceló Foundation, La Rioja, Argentina
| | - Chloé Cantero
- APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | | | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Xinxin Hu
- St Vincent's Health Network Sydney, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Thomas Lacoste-Palasset
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris–Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Alana Livesey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Grgur Salai
- Department of Pulmonology, University Hospital Dubrava, Zagreb, Croatia
| | | | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Donegal, Ireland
| | - Cristiano van Zeller
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro Viegas
- Departamento de Pneumonologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal
| | | | - Stavroula Zaneli
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, Athens, Greece
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
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Kumari N, Kumari B, Kumar S, Arun N, Kumari R. Effectiveness of high flow nasal cannula (HFNC) versus bilevel positive airway pressure (BiPAP) in preventing tracheal reintubation in patients with high risk of extubation failure in intensive care unit - A randomised comparative trial. Indian J Anaesth 2024; 68:246-253. [PMID: 38476546 PMCID: PMC10926337 DOI: 10.4103/ija.ija_620_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 03/14/2024] Open
Abstract
Background and Aims The incidence of tracheal extubation failure in high-risk patients is higher, and non-invasive ventilation is suggested to avoid tracheal reintubation. This study compares the effectiveness of bilevel positive airway pressure (BiPAP) and high flow nasal cannula (HFNC) to reduce the rate of reintubation in intensive care unit (ICU) patients with increased risk of extubation failure. Methods This randomised comparative trial was conducted on 60 high-risk patients on mechanical ventilators admitted to the ICU, ready for weaning after a spontaneous breathing trial. They were randomised to Group H for HFNC and Group B for BiPAP therapy. Designated therapy was administered in these high-risk patients for up to 48 hours after tracheal extubation. Haemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), a saturation of peripheral oxygen (SpO2), electrocardiogram (ECG)], arterial blood gas analysis (ABG) parameter [potential of hydrogen (pH), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen/fraction of inspired oxygen (paO2/FiO2) ratio], the effectiveness of cough, comfort level was recorded and continuous monitoring for signs of respiratory distress and failure was done. Results Most of the patients were obese and had more than two risk factors for extubation failure. Several patients in Group B have significantly higher successful extubation than in Group H (P = 0.044). Most of the reintubation took place within 24 hours. The HFNC therapy was more comfortable and acceptable to patients. Conclusion BiPAP therapy was more efficient than HFNC in preventing tracheal reintubation among patients with a high risk of extubation failure.
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Affiliation(s)
- Nisha Kumari
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibha Kumari
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nidhi Arun
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ritu Kumari
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Gunenc FS, Seyidova İ, Ozbilgin S, Ur K, Hanci V. Comparison of pressure controlled, volume controlled, and volume guaranteed pressure controlled modes in prone position in patients operated for lumbar disc herniation: A randomized trial. Medicine (Baltimore) 2024; 103:e37227. [PMID: 38335373 PMCID: PMC10861017 DOI: 10.1097/md.0000000000037227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND To compare pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes in patients undergoing spinal surgery in the prone position under general anesthesia. METHODS The study included 78 patients aged 20 to 80 years, American Society of Anesthesiologists 1-2, scheduled for lumbar spinal surgery. Patients included in the study were randomly divided into 3 groups Group-VCV; Group-PCV; Group-PCV-VG. Standard anesthesia protocol was applied. In addition to routine monitoring, train of four and BIS monitoring were performed. All ventilation modes were set with a target tidal volume of 6 to 8 mL/kg, FiO2: 0.40-0.45 and a respiratory rate of normocarbia. Positive end-expiratory pressure: 5 cm H2O, inspiration/expiration ratio = 1:2, and the maximum airway pressure:40 cm H2O. Hemodynamic, respiratory variables and arterial blood gases was measured, 15 minutes after induction of anesthesia in the supine position (T1), after prone position 15 minutes (T2), 30 minutes (T3), 45 minutes (T4), 60 minutes (T5), 75 minutes (T6), 90 minutes (T7). RESULTS There was no significant difference between the groups in patient characteristics. SAP, DAP, mean arterial pressure, and heart rate decreased after being placed in the prone position in all groups. Hemodynamic variables did not differ significantly between the groups. partial arterial oxygen pressure and arterial oxygen saturation levels in blood gas were found to be significantly higher in Group-PCV-VG compared to Group-PCV and Group-VCV in both the supine and prone positions. Ppeak and plateau airway pressure (Pplato) values increased and dynamic lung compliance (Cdyn) values decreased after placing the patients in the prone position in all groups. Lower Ppeak and Pplato values and higher Cdyn values were observed in both the supine and prone positions in the Group-PCV-VG group compared to the Group-PCV and Group-VCV groups. CONCLUSION PCV-VG provides lower Ppeak and Pplato values, as well as better Cdyn, oxygenation values compared to PCV and VCV. So that PCV-VG may be an effective alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery.
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Affiliation(s)
- Ferim Sakize Gunenc
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Intensive Care, Izmir, Turkey
| | - İlkana Seyidova
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Intensive Care, Izmir, Turkey
| | - Sule Ozbilgin
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Intensive Care, Izmir, Turkey
| | - Koray Ur
- Dokuz Eylul University, School of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Volkan Hanci
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Intensive Care, Izmir, Turkey
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Gayen S, Dachert S, Lashari BH, Gordon M, Desai P, Criner GJ, Cardet JC, Shenoy K. Critical Care Management of Severe Asthma Exacerbations. J Clin Med 2024; 13:859. [PMID: 38337552 PMCID: PMC10856115 DOI: 10.3390/jcm13030859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients.
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Affiliation(s)
- Shameek Gayen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Stephen Dachert
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Bilal H. Lashari
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Parag Desai
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL 33602, USA;
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
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Ha TS, Oh DK, Lee HJ, Chang Y, Jeong IS, Sim YS, Hong SK, Park S, Suh GY, Park SY. Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. Acute Crit Care 2024; 39:1-23. [PMID: 38476061 PMCID: PMC11002621 DOI: 10.4266/acc.2024.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator. METHODS Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations. RESULTS Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. CONCLUSIONS We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.
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Affiliation(s)
- Tae Sun Ha
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong Kyu Oh
- Department of Pulmonology, Dongkang Medical Center, Ulsan, Korea
| | - Hak-Jae Lee
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youjin Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Su Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Suk-Kyung Hong
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Steindal SA, Hofsø K, Aagaard H, Mariussen KL, Andresen B, Christensen VL, Heggdal K, Wallander Karlsen MM, Kvande ME, Kynø NM, Langerud AK, Ohnstad MO, Sørensen K, Larsen MH. Non-invasive ventilation in the care of patients with chronic obstructive pulmonary disease with palliative care needs: a scoping review. BMC Palliat Care 2024; 23:27. [PMID: 38287312 PMCID: PMC10823671 DOI: 10.1186/s12904-024-01365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Patients with severe chronic obstructive pulmonary disease (COPD) could have palliative care (PC) needs because of unmet needs such as dyspnoea. This may lead to anxiety and may have an impact on patients' ability to perform daily activities of living. PC can be started when patients with COPD have unmet needs and can be provided alongside disease-modifying therapies. Non-invasive ventilation (NIV) could be an important measure to manage dyspnoea in patients with COPD in need of PC. A scoping review was conducted to gain an overview of the existing research and to identify knowledge gaps. The aim of this scoping review was to systematically map published studies on the use of NIV in patients with COPD with PC needs, including the perspectives and experiences of patients, families, and healthcare professionals (HCPs). METHODS This review was conducted following the framework of Arksey and O'Malley. The reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The review protocol was published. AMED, CINAHL, Embase, MEDLINE, PEDro, and PsycInfo were searched from inception to November 14, 2022. The included studies had to report the perspectives and experiences of COPD patients, relatives, and HCPs regarding NIV in the care of patients with COPD with PC needs. In pairs, the authors independently assessed studies' eligibility and extracted data. The data were organised thematically. The results were discussed in a consultation exercise. RESULTS This review included 33 papers from 32 studies. Four thematic groupings were identified: preferences and attitudes towards the use of NIV; patient participation in the decision-making process of NIV treatment; conflicting results on the perceived benefits and burdens of treatment; and heterogenous clinical outcomes in experimental studies. Patients perceived NIV as a 'life buoy' to keep them alive. Many patients wanted to take part in the decision-making process regarding NIV treatment but expressed varying degrees of inclusion by HCPs in such decision-making. Conflicting findings were identified regarding the perceived benefits and burdens of NIV treatment. Diversity in heterogeneous clinical outcomes were reported in experimental studies. CONCLUSIONS There is a need for more studies designed to investigate the effectiveness of NIV as a palliative measure for patients with COPD with PC needs using comprehensive outcomes. It is especially important to gain more knowledge on the experiences of all stakeholders in the use of home-based NIV treatment to these patients.
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Affiliation(s)
- Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway.
- Faculty of Health Sciences, VID Specialized University, Mail Box 184 Vinderen, 0319, Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Hanne Aagaard
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Brith Andresen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- The Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Mail Box 184 Vinderen, 0319, Oslo, Norway
| | | | - Monica E Kvande
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Nina M Kynø
- Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Anne Kathrine Langerud
- Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway
- Department of Post-Operative and Critical Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Mari Oma Ohnstad
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Kari Sørensen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Coudroy R. Continuous positive airway pressure or high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure unrelated to COVID-19: Another brick in the wall? Respirology 2024; 29:8-10. [PMID: 37730238 DOI: 10.1111/resp.14607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
See related article
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Affiliation(s)
- Rémi Coudroy
- CHU de Poitiers, Service de Médecine Intensive Réanimation, Poitiers, France
- Université de Poitiers, INSERM CIC 1402, IS-ALIVE Research Group, Poitiers, France
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Gilaed A, Shorbaji N, Katzir O, Ankol S, Badarni K, Andrawus E, Roimi M, Katz A, Bar-Lavie Y, Raz A, Epstein D. Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study. Injury 2024; 55:111194. [PMID: 37978015 DOI: 10.1016/j.injury.2023.111194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND A significant proportion of patients with severe chest trauma require mechanical ventilation (MV). Early prediction of the duration of MV may influence clinical decisions. We aimed to determine early risk factors for prolonged MV among adults suffering from severe blunt thoracic trauma. METHODS This retrospective, single-center, cohort study included all patients admitted between January 2014 and December 2020 due to severe blunt chest trauma. The primary outcome was prolonged MV, defined as invasive MV lasting more than 14 days. Multivariable logistic regression was performed to identify independent risk factors for prolonged MV. RESULTS The final analysis included 378 patients. The median duration of MV was 9.7 (IQR 3.0-18.0) days. 221 (58.5 %) patients required MV for more than 7 days and 143 (37.8 %) for more than 14 days. Male gender (aOR 3.01, 95 % CI 1.63-5.58, p < 0.001), age (aOR 1.40, 95 % CI 1.21-1.63, p < 0.001, for each category above 30 years), presence of severe head trauma (aOR 3.77, 95 % CI 2.23-6.38, p < 0.001), and transfusion of >5 blood units on admission (aOR 2.85, 95 % CI 1.62-5.02, p < 0.001) were independently associated with prolonged MV. The number of fractured ribs and the extent of lung contusions were associated with MV for more than 7 days, but not for 14 days. In the subgroup of 134 patients without concomitant head trauma, age (aOR 1.63, 95 % CI 1.18-2.27, p = 0.004, for each category above 30 years), respiratory comorbidities (aOR 9.70, 95 % CI 1.49-63.01, p = 0.017), worse p/f ratio during the first 24 h (aOR 1.55, 95 % CI 1.15-2.09, p = 0.004), and transfusion of >5 blood units on admission (aOR 5.71 95 % CI 1.84-17.68, p = 0.003) were independently associated with MV for more than 14 days. CONCLUSIONS Several predictors have been identified as independently associated with prolonged MV. Patients who meet these criteria are at high risk for prolonged MV and should be considered for interventions that could potentially shorten MV duration and reduce associated complications. Hemodynamically stable, healthy young patients suffering from severe thoracic trauma but no head injury, including those with extensive lung contusions and rib fractures, have a low risk of prolonged MV.
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Affiliation(s)
- Aran Gilaed
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Nadeem Shorbaji
- Department of Diagnostic Imaging, Rambam Health Care Center, Haifa, Israel
| | - Ori Katzir
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaked Ankol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Karawan Badarni
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Elias Andrawus
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Michael Roimi
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amit Katz
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Yaron Bar-Lavie
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Aeyal Raz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel.
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Zhang J, Yi Q, Zhou C, Luo Y, Wei H, Ge H, Liu H, Zhang J, Li X, Xie X, Pan P, Yi M, Cheng L, Zhou H, Liu L, Aili A, Liu Y, Peng L, Pu J, Zhou H. Risk factors of in-hospital mortality and discriminating capacity of NIVO score in exacerbations of COPD requiring noninvasive ventilation. Chron Respir Dis 2024; 21:14799731241249474. [PMID: 38652928 PMCID: PMC11041537 DOI: 10.1177/14799731241249474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is recommended as the initial mode of ventilation to treat acute respiratory failure in patients with AECOPD. The Noninvasive Ventilation Outcomes (NIVO) score has been proposed to evaluate the prognosis in patients with AECOPD requiring assisted NIV. However, it is not validated in Chinese patients. METHODS We used data from the MAGNET AECOPD Registry study, which is a prospective, noninterventional, multicenter, real-world study conducted between September 2017 and July 2021 in China. Data for the potential risk factors of mortality were collected and the NIVO score was calculated, and the in-hospital mortality was evaluated using the NIVO risk score. RESULTS A total of 1164 patients were included in the study, and 57 patients (4.9%) died during their hospital stay. Multiple logistic regression analysis revealed that age ≥75 years, DBP <60 mmHg, Glasgow Coma Scale ≤14, anemia and BUN >7 mmol/L were independent predictors of in-hospital mortality. The in-hospital mortality was associated with an increase in the risk level of NIVO score and the difference was statistically significant (p < .001). The NIVO risk score showed an acceptable accuracy for predicting the in-hospital mortality in AECOPD requiring assisted NIV (AUC: 0.657, 95% CI: 0.584-0.729, p < .001). CONCLUSION Our findings identified predictors of mortality in patients with AECOPD receiving NIV, providing useful information to identify severe patients and guide the management of AECOPD. The NIVO score showed an acceptable predictive value for AECOPD receiving NIV in Chinese patients, and additional studies are needed to develop and validate predictive scores based on specific populations.
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Affiliation(s)
- Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chen Zhou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, China
| | - Xiufang Xie
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Mengqiu Yi
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, China
| | - Lina Cheng
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, China
| | - Hui Zhou
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, China
| | - Adila Aili
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - on behalf of the MAGNET AECOPD Registry Investigators
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, China
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, China
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, China
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Chiappero C, Mattei A, Guidelli L, Millotti S, Ceccherini E, Oczkowski S, Scala R. Prone positioning during CPAP therapy in SARS-CoV-2 pneumonia: a concise clinical review. Ther Adv Respir Dis 2024; 18:17534666231219630. [PMID: 38159215 PMCID: PMC10757797 DOI: 10.1177/17534666231219630] [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: 07/03/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
During the COVID-19 pandemic, the number of patients with hypoxemic acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia threatened to overwhelm intensive care units. To reduce the need for invasive mechanical ventilation (IMV), clinicians tried noninvasive strategies to manage ARF, including the use of awake prone positioning (PP) with continuous positive airway pressure (CPAP). In this article, we review the patho-physiologic rationale, clinical effectiveness and practical issues of the use of PP during CPAP in non-intubated, spontaneously breathing patients affected by SARS-CoV-2 pneumonia with ARF. Use of PP during CPAP appears to be safe and feasible and may have a lower rate of adverse events compared to IMV. A better response to PP is observed among patients in early phases of acute respiratory distress syndrome. While PP during CPAP may improve oxygenation, the impact on the need for intubation and mortality remains unclear. It is possible to speculate on the role of PP during CPAP in terms of improvement of ventilation mechanics and reduction of strain stress.
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Affiliation(s)
- Chiara Chiappero
- Cardiovascular and Thoracic Department, Pneumology, AOU Città della Salute e della Scienza di Torino – Molinette hospital, c.so Bramante 88, Turin 10126, Italy
| | - Alessio Mattei
- Cardiovascular and Thoracic Department, Pneumology, AOU Città della Salute e della Scienza di Torino – Molinette hospital, Turin, Italy
| | - Luca Guidelli
- CardioThoraco-Neuro-Vascular Department, Pulmonology and RICU, S Donato Hospital USL Toscana Sudest, Arezzo, Italy
| | - Serena Millotti
- UOP RF Arezzo, Department of Healthcare technical professions, Rehabilitation and Prevention, USL Toscana Sudest, Arezzo, Italy
| | - Emiliano Ceccherini
- UOP RF Arezzo, Department of Healthcare technical professions, Rehabilitation and Prevention, USL Toscana Sudest, Arezzo, Italy
| | - Simon Oczkowski
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Raffaele Scala
- CardioThoraco-Neuro-Vascular Department, Pulmonology and RICU, S Donato Hospital USL Toscana Sudest, Arezzo, Italy
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Watson A, Yadollahi S, Fahmy A, Mahar S, Fritche D, Beecham R, Saeed K, Dushianthan A. Non-Invasive Ventilation for Community-Acquired Pneumonia: Outcomes and Predictors of Failure from an ICU Cohort. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:81. [PMID: 38256342 PMCID: PMC10821344 DOI: 10.3390/medicina60010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The use of non-invasive ventilation (NIV) for community-acquired pneumonia (CAP) remains controversial. NIV failure in the setting of acute hypoxemic respiratory failure is associated with increased mortality, highlighting the need for careful patient selection. Methods and Methods: This is a retrospective observational cohort study. We included 140 patients with severe CAP, treated with either NIV or invasive mechanical ventilation (IMV) as their primary oxygenation strategy. Results: The median PaO2/FiO2 ratio and SOFA score upon ICU admission were 151 mmHg and 6, respectively. We managed 76% of patients with NIV initially and report an NIV success rate of 59%. Overall, the 28-day mortality was 25%, whilst for patients with NIV success, the mortality was significantly lower at 13%. In the univariate analysis, NIV failure was associated with the SOFA score (OR 1.33), the HACOR score (OR 1.14) and the presence of septic shock (OR 3.99). The SOFA score has an AUC of 0.75 for NIV failure upon ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. Conclusions: Our results suggest that a SOFA ≤ 4 and an HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.
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Affiliation(s)
- Adam Watson
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Sina Yadollahi
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Alexander Fahmy
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Sania Mahar
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Dominic Fritche
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Ryan Beecham
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Kordo Saeed
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
- Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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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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Mosier JM, Subbian V, Pungitore S, Prabhudesai D, Essay P, Bedrick EJ, Stocking JC, Fisher JM. Noninvasive vs Invasive Respiratory Support for Patients with Acute Hypoxemic Respiratory Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.23.23300368. [PMID: 38234784 PMCID: PMC10793521 DOI: 10.1101/2023.12.23.23300368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Rationale Noninvasive respiratory support modalities are common alternatives to mechanical ventilation for patients with early acute hypoxemic respiratory failure. These modalities include noninvasive positive pressure ventilation, using either continuous or bilevel positive airway pressure, and nasal high flow using a high flow nasal cannula system. However, outcomes data historically compare noninvasive respiratory support to conventional oxygen rather than to mechanical ventilation. Objectives The goal of this study was to compare the outcomes of in-hospital death and alive discharge in patients with acute hypoxemic respiratory failure when treated initially with noninvasive respiratory support compared to patients treated initially with invasive mechanical ventilation. Methods We used a validated phenotyping algorithm to classify all patients with eligible International Classification of Diseases codes at a large healthcare network between January 1, 2018 and December 31, 2019 into noninvasive respiratory support and invasive mechanical ventilation cohorts. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders, with estimated cumulative incidence curves. Secondary outcomes included time-to-hospital discharge alive. A secondary analysis was conducted to examine potential differences between noninvasive positive pressure ventilation and nasal high flow. Results During the study period, 3177 patients met inclusion criteria (40% invasive mechanical ventilation, 60% noninvasive respiratory support). Initial noninvasive respiratory support was not associated with a decreased hazard of in-hospital death (HR: 0.65, 95% CI: 0.35 - 1.2), but was associated with an increased hazard of discharge alive (HR: 2.26, 95% CI: 1.92 - 2.67). In-hospital death varied between the nasal high flow (HR 3.27, 95% CI: 1.43 - 7.45) and noninvasive positive pressure ventilation (HR 0.52, 95% CI 0.25 - 1.07), but both were associated with increased likelihood of discharge alive (nasal high flow HR 2.12, 95 CI: 1.25 - 3.57; noninvasive positive pressure ventilation HR 2.29, 95% CI: 1.92 - 2.74). Conclusion These observational data from a large healthcare network show that noninvasive respiratory support is not associated with reduced hazards of in-hospital death but is associated with hospital discharge alive. There are also potential differences between the noninvasive respiratory support modalities.
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Thille AW, Boissier F, Coudroy R, Le Pape S, Arrivé F, Marchasson L, Frat JP, Ragot S. Sex difference in the risk of extubation failure in ICUs. Ann Intensive Care 2023; 13:130. [PMID: 38112851 PMCID: PMC10730492 DOI: 10.1186/s13613-023-01225-7] [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: 09/21/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist. METHODS Post hoc analysis of a large-scale clinical trial including patients at high risk of extubation failure in ICUs, with the aim of assessing the risk of extubation failure according to sex. The primary outcome was reintubation within the 7 days following extubation. RESULTS Out of 641 patients, 425 (66%) were males and 216 (34%) were females. Males were more likely to be admitted for cardiac arrest and to have underlying ischemic heart disease whereas females were more likely to be admitted for coma and to have obesity. Whereas the rate of reintubation at 48 h was significantly higher in males than in females (11.0% vs. 6.0%; difference, + 5.0 [95% CI, 0.2 to 9.2]; P = 0.038), the rate of reintubation at day 7 did not significantly differ between males and females (16.7% vs. 11.1%; difference, + 5.6% [95%CI, - 0.3 to 10.8], P = 0.059). Using multivariable logistic regression analysis, male sex was independently associated with reintubation within the 7 days following extubation (adjusted OR 1.70 [95% CI, 1.01 to 2.89]; P = 0.048), even after adjustment on reason for admission, body-mass index, severity score, respiratory rate before extubation, and noninvasive ventilation after extubation. CONCLUSION In this post hoc analysis of a clinical trial including a homogeneous subset of patients at high risk of extubation failure, sex was independently associated with reintubation. The role of sex on outcomes should be systematically examined in future studies of critically ill patients.
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Affiliation(s)
- Arnaud W Thille
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France.
- INSERM, CIC 1402 IS-ALIVE, University of Poitiers, Poitiers, France.
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
- INSERM, CIC 1402 IS-ALIVE, University of Poitiers, Poitiers, France
| | - Rémi Coudroy
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
- INSERM, CIC 1402 IS-ALIVE, University of Poitiers, Poitiers, France
| | - Sylvain Le Pape
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
| | - François Arrivé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
| | - Laura Marchasson
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
| | - Jean-Pierre Frat
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 Rue La Milétrie, 86021, Poitiers Cedex, France
- INSERM, CIC 1402 IS-ALIVE, University of Poitiers, Poitiers, France
| | - Stéphanie Ragot
- INSERM, CIC 1402 IS-ALIVE, University of Poitiers, Poitiers, France
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