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Morin F, Polard L, Fresnel E, Richard M, Schmit H, Martin-Houitte C, Cordioli RL, Lebret M, Mercat A, Beloncle F, Savary D, Richard JC, Lesimple A. A new physiological manikin to test and compare ventilation devices during cardiopulmonary resuscitation. Resusc Plus 2024; 19:100663. [PMID: 38827273 PMCID: PMC11143906 DOI: 10.1016/j.resplu.2024.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Background There is a lack of bench systems permitting to evaluate ventilation devices in the specific context of cardiac arrest. Objectives The objective of the study is to assess if a new physiological manikin may permit to evaluate the performances of medical devices dedicated to ventilation during cardiopulmonary resuscitation (CPR). Methods Specific CPR-related features required to reproduce realistic ventilation were implemented into the SAM (Sarthe Anjou Mayenne) manikin. In the first place, the manikin ability to mimic ventilation during CPR was assessed and compared to real-life tracings of airway pressure, flow and capnogram from three out of hospital cardiac arrest (OHCA) patients. In addition, to illustrate the interest of this manikin, ventilation was evaluated during mechanical continuous chest compressions with two devices dedicated to CPR: the Boussignac cardiac arrest device (B-card - Vygon; Ecouen France) and the Impedance Threshold Device (ITD - Zoll; Chelmsford, MA). Results The SAM manikin enabled precise replication of ventilation tracings as observed in three OHCA patients during CPR, and it allowed for comparison between two distinct ventilation devices. B-card generated a mean, maximum and minimum intrathoracic pressure of 6.3 (±0.1) cmH2O, 18.9 (±1.1) cmH2O and -0.3 (±0.2) cmH2O respectively; while ITD generated a mean, maximum and minimum intrathoracic pressure of -1.6 (±0.0) cmH2O, 5.7 (±0.1) cmH2O and -4.8 (±0.1) cmH2O respectively during CPR. B-card allowed to increase passive ventilation compared to the ITD which resulted in a dramatic limitation of passive ventilation. Conclusion The SAM manikin is an innovative model integrating specific physiological features that permit to accurately evaluate and compare ventilation devices during CPR.
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Affiliation(s)
- François Morin
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- Vent’Lab, University Hospital of Angers, Angers, France
| | - Laura Polard
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
| | | | | | - Hugo Schmit
- Department of Emergency Medicine, Annecy Genevois Hospital, Annecy, France
| | | | | | - Marius Lebret
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
- Kernel Biomedical, Bois-Guillaume, France
- Université Paris-Saclay, UVSQ, Erphan Paris-Saclay University, Versailles, France
| | - Alain Mercat
- Vent’Lab, University Hospital of Angers, Angers, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - François Beloncle
- Vent’Lab, University Hospital of Angers, Angers, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - Dominique Savary
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
- Vent’Lab, University Hospital of Angers, Angers, France
| | - Jean-Christophe Richard
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
- Medical Intensive Care Unit (ICU), Angers University Hospital, Angers, France
| | - Arnaud Lesimple
- Vent’Lab, University Hospital of Angers, Angers, France
- Med2Lab Laboratory, ALMS, Antony, France
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Lord S, Lee J. Critical Care in the Austere Environment. Crit Care Clin 2024; 40:451-462. [PMID: 38796220 DOI: 10.1016/j.ccc.2024.03.006] [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] [Indexed: 05/28/2024]
Abstract
Practice of critical care in austere settings involves navigating rapidly evolving environments, where physical resources, provider availability, and healthcare capacity are constrained. Austere Critical Care focuses on maintaining the highest standard of care possible for patients while also identifying resource limitations, responding to patient surges, and adhering to proper triage practices at the austere site. This includes transferring the patient when able and necessary. This article describes the current practice of critical care medicine in the austere environment, using recent natural disasters, pandemics, and conflicts as case studies.
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Affiliation(s)
- Spencer Lord
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
| | - Jarone Lee
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Mahmoodpor A, Gohari-Moghadam K, Rahimi-Bashar F, Khosh-Fetrat M, Vahedian-Azimi A. 1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study. Sci Rep 2023; 13:12644. [PMID: 37542129 PMCID: PMC10403549 DOI: 10.1038/s41598-023-39992-9] [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: 03/26/2023] [Accepted: 08/03/2023] [Indexed: 08/06/2023] Open
Abstract
The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS‑CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112-1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122-2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143-2.187, P = 0.029). The Kaplan-Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.
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Affiliation(s)
- Ata Mahmoodpor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kievan Gohari-Moghadam
- Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoum Khosh-Fetrat
- Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh Bahayi Street, Vanak Square, P.O. Box 19575-174, Tehran, Iran.
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Chia JJX, Goh MH, Goh MM, Teo CWS, Tan KH, Sewa DW, Ng HF. Contamination of the central medical air supply with water leading to mass ventilator failure. Anaesth Rep 2023; 11:e12239. [PMID: 37396690 PMCID: PMC10313312 DOI: 10.1002/anr3.12239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
Here, we present a case of mass ventilator failure due to contaminated medical air. Multiple ventilators failed routine tests, including almost all of the ventilators in our intensive care unit. A faulty air compressor had led to water contamination of our centre's supply of medical air. Water entered the pipeline supply of air and, hence the ventilators and anaesthetic machines. The disruption of the machines' proportional mixer valve resulted in unreliable delivery of fresh gas flow. This malfunction was discovered during routine pre-use checks, and backup ventilators were available to replace the faulty ventilators. A shortage of equipment was averted due to a serendipitous availability of ventilator stockpiles prepared for the COVID-19 pandemic. Ventilator shortages are commonly described in mass casualty and pandemic scenarios. While there are multiple strategies described in literature to augment and maximise equipment available for mechanical ventilation, stockpiling equipment remains an expensive but necessary component of disaster contingency planning.
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Affiliation(s)
- J. J. X. Chia
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - M. H. Goh
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - M. M. Goh
- Department of NursingSingapore General HospitalSingapore
| | - C. W. S. Teo
- Department of Respiratory TherapySingapore General HospitalSingapore
| | - K. H. Tan
- Department of AnaesthesiologySingapore General HospitalSingapore
| | - D. W. Sewa
- Department of Respiratory and Critical Care MedicineSingapore General HospitalSingapore
| | - H. F. Ng
- Department of Biomedical EngineeringSingapore General HospitalSingapore
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Sousa MLA, Katira BH, Engelberts D, Hsing V, Schreiber A, Jonkman AH, Post M, Dorian P, Brochard LJ. Mechanical Ventilation in ARDS With an Automatic Resuscitator. Respir Care 2023; 68:611-619. [PMID: 36368776 PMCID: PMC10171348 DOI: 10.4187/respcare.10389] [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: 06/28/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Oxylator is an automatic resuscitator, powered only by an oxygen cylinder with no electricity required, that could be used in acute respiratory failure in situations in which standard mechanical ventilation is not available or feasible. We aimed to assess the feasibility and safety of mechanical ventilation by using this automatic resuscitator in an animal model of ARDS. METHODS A randomized experimental study in a porcine ARDS model with 12 pigs randomized to the Oxylator group or the control group (6 per group) and ventilated for 4 h. In the Oxylator group, peak pressure was set at 20 cm H2O and PEEP was set at the lowest observed breathing frequency during a decremental PEEP titration. The control pigs were ventilated with a conventional ventilator by using protective settings and PEEP at the crossing point of collapse and overdistention, as indicated by electrical impedance tomography. Our end points were feasibility and safety as well as respiratory mechanics, gas exchange, and hemodynamics. RESULTS After lung injury, the mean ± SD respiratory system compliance and PaO2 /FIO2 were 13 ± 2 mL/cm H2O and 61 ± 17 mm Hg, respectively. The mean ± SD total PEEP was 10 ± 2 cm H2O and 13 ± 2 cm H2O in the control and Oxylator groups, respectively (P = .046). The mean plateau pressure was kept to < 30 cm H2O in both groups. In the Oxylator group, the tidal volume was transiently > 8 mL/kg but was 6 ± 0.4 mL/kg at 4 h, whereas the breathing frequency increased from 38 ± 4 to 48 ± 3 breaths/min (P < .001). There was no difference in driving pressure, compliance, PaO2 /FIO2 , and pulmonary shunt between the groups. The mean ± SD PaCO2 was higher in the Oxylator group after 4 h, 74 ± 9 mm Hg versus 58 ± 6 mm Hg (P < .001). There were no differences in hemodynamics between the groups, including blood pressure and cardiac output. CONCLUSIONS Short-term mechanical ventilation by using an automatic resuscitator and a fixed pressure setting in an ARDS animal model was feasible and safe.
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Affiliation(s)
- Mayson LA Sousa
- Keenan Centre for Biomedical Research, Critical Care Department, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
| | - Bhushan H Katira
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
| | - Doreen Engelberts
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Hsing
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
| | - Annia Schreiber
- Keenan Centre for Biomedical Research, Critical Care Department, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Annemijn H Jonkman
- Keenan Centre for Biomedical Research, Critical Care Department, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Post
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Keenan Centre for Biomedical Research, Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Laurent J Brochard
- Keenan Centre for Biomedical Research, Critical Care Department, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, Research Institute, Hospital for Sick Children. University of Toronto, Toronto, Ontario, Canada
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Ferré A, Marquion F, Delord M, Gros A, Lacave G, Laurent V, Merceron S, Paul M, Simon C, Troché G, Charbonnel C, Marque-Juillet S, Bruneel F, Legriel S. Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study. Ann Intensive Care 2022; 12:10. [PMID: 35133543 PMCID: PMC8821831 DOI: 10.1186/s13613-022-00981-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44). Conclusions In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00981-2.
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Affiliation(s)
- Alexis Ferré
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
| | - Fabien Marquion
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Marc Delord
- Clinical Research Center, Versailles Hospital, Le Chesnay, France.,Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Antoine Gros
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Guillaume Lacave
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Virginie Laurent
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Sybille Merceron
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Marine Paul
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Christelle Simon
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Gilles Troché
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | | | | | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Stéphane Legriel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.,University Paris-Saclay, UVSQ, INSERM, CESP, "PsyDev" Team, Villejuif, France
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Assessment of open-source, intermediate and ICU ventilators to face the COVID-19 pandemic: A bench study. Eur J Anaesthesiol 2022; 39:474-476. [PMID: 34980842 DOI: 10.1097/eja.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Impact of Air Transport on SpO 2/FiO 2 among Critical COVID-19 Patients during the First Pandemic Wave in France. J Clin Med 2021; 10:jcm10225223. [PMID: 34830505 PMCID: PMC8624612 DOI: 10.3390/jcm10225223] [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: 10/16/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/08/2023] Open
Abstract
During the first wave of the COVID-19 pandemic, some French regions were more affected than others. To relieve those areas most affected, the French government organized transfers of critical patients, notably by plane or helicopter. Our objective was to investigate the impact of such transfers on the pulse oximetric saturation (SpO2)-to-inspired fraction of oxygen (FiO2) ratio among transferred critical patients with COVID-19. We conducted a retrospective study on medical and paramedical records. The primary endpoint was the change in SpO2/FiO2 during transfers. Thirty-eight patients were transferred between 28 March and 5 April 2020, with a mean age of 62.4 years and a mean body mass index of 29.8 kg/m2. The population was 69.7% male, and the leading medical history was hypertension (42.1%), diabetes (34.2%), and dyslipidemia (18.4%). Of 28 patients with full data, we found a decrease of 28.9 points in SpO2/FiO2 (95% confidence interval, 5.8 to 52.1, p = 0.01) between the starting and the arrival intensive care units (SpO2/FiO2, 187.3 ± 61.3 and 158.4 ± 62.8 mmHg, respectively). Air medical transfers organized to relieve intensive care unit teams under surging conditions during the first COVID wave were associated with significant decreases in arterial oxygenation.
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Kangas-Dick A, Wiesel O. Context is Key: Applying Lessons From Retrospective Studies of COVID-19 Associated Pneumomediastinum. J Intensive Care Med 2021; 37:144-146. [PMID: 34636698 DOI: 10.1177/08850666211049150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Aaron Kangas-Dick
- 2042Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ory Wiesel
- Department of Surgery, Division of Thoracic Surgery,36632Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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