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Ippolito M, Galvano AN, Cortegiani A. Long-term outcomes in critically ill patients with acute respiratory failure. Curr Opin Crit Care 2024; 30:510-522. [PMID: 39158188 DOI: 10.1097/mcc.0000000000001196] [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: 08/20/2024]
Abstract
PURPOSE OF REVIEW This review aims to explore the latest evidence on long-term outcomes in patients admitted to the ICU because of acute respiratory failure (ARF). RECENT FINDINGS As the survival rate of critically ill patients with acute respiratory failure improves, long-term mortality and disability still influence the quality of life of survivors and their caregivers. Patients admitted to the ICU because of ARF are at risk of developing the postintensive care syndrome, which presents with physical, cognitive and mental symptoms, all of which may impair their quality of life. Caregivers seem to be affected as well, which may lead to intergenerational trauma. The need for more care, including prone positioning, invasive support (e.g. mechanical ventilation, ECMO) and deep sedation are probably adjunctive risk factors for poor long-term outcomes. SUMMARY There is not much data on the long-term outcomes of patients who have survived ARF. More follow-up studies should be conducted, especially in centers providing higher levels of costly care (e.g. ECMO). Randomized controlled trials on interventions for ARF should include patient-centered long-term outcomes in addition to mortality rates. The high mortality rates associated with ARF mandate collaboration among multiple centers to achieve an adequate sample size for studying the long-term outcomes of survivors.
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Affiliation(s)
- Mariachiara Ippolito
- Department of Anesthesia, Analgesia, Intensive Care and Emergency. University Hospital Policlinico Paolo Giaccone
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.). University of Palermo, Palermo, Italy
| | - Alberto Nicolò Galvano
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.). University of Palermo, Palermo, Italy
| | - Andrea Cortegiani
- Department of Anesthesia, Analgesia, Intensive Care and Emergency. University Hospital Policlinico Paolo Giaccone
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.). University of Palermo, Palermo, Italy
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Hileman BA, Martucci G, Subramanian H. Metabolic support for patients on extra-corporeal membrane oxygenation. Curr Opin Crit Care 2024; 30:305-310. [PMID: 38841988 DOI: 10.1097/mcc.0000000000001162] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize recent research on metabolic support during extracorporeal membrane oxygenation. In this review, we cover the evidence on nutritional supplementation, both the route of supplementation, timing of initiation of supplementation as well as quantities of supplementation needed. In addition, we discuss the recent trend in awake extracorporeal membrane oxygenation (ECMO) and its benefits to patients. RECENT FINDINGS As ECMO use continues to increase over the last few years, for both cardiovascular as well as respiratory failure, the need to optimize the metabolic states of patients has arisen. Increasing evidence has pointed towards this hitherto unexplored domain of patient care having a large impact on outcomes. Additionally, strategies such as awake ECMO for select patients has allowed them to preserve muscle mass which could aid in a faster recovery. SUMMARY There is a role of optimal metabolic support in the early recovery of patients on ECMO that is currently under-recognized. Future directions of research that aim to improve post ECMO outcomes must focus on this area.
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Affiliation(s)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lucchini A, Villa M, Giani M, Andreossi M, Alessandra V, Vigo V, Gatti S, Ferlicca D, Teggia Droghi M, Rezoagli E, Foti G, Pozzi M, Irccs San Gerardo Follow-Up Group. Long term outcome in patients treated with veno-venous extracorporeal membrane oxygenation: A prospective observational study. Intensive Crit Care Nurs 2024; 82:103631. [PMID: 38309144 DOI: 10.1016/j.iccn.2024.103631] [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: 06/25/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Over the last few decades, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for severe respiratory failure has increased. AIM This study aimed to assess the long-term outcomes of patients treated with VV-ECMO for respiratory failure. METHODS We performed a single-centre prospective evaluation of patients on VV-ECMO who were successfully discharged from the intensive care unit of an Italian University Hospital between January 2018 and May 2021. The enrolled patients underwent follow-up evaluations at 6 and 12 months after ICU discharge. The follow-up team performed psychological and functional assessments using the following instruments: Hospital Anxiety and Depression Scale (HADS), Post-traumatic Stress Disorder Symptom Severity Scale (PTSS-10), Euro Quality Five Domains Five Levels (EQ-5L-5D), and 6-minute walk test. RESULTS We enrolled 33 patients who were evaluated at a follow-up clinic. The median patient age was 51 years (range: 45-58 years). The median duration of VV-ECMO support was 12 (9-19) days and the length of ICU stay was 23 (18-42) days. A HADS score higher than 14 was reported in 8 (24 %) and 7 (21 %) patients at the six- and twelve-month visit, respectively. PTSS-10 total score ≥ 35 points was present in three (9 %) and two (6 %) patients at the six- and twelve-month examination. The median EQ-5L-5D-VAS was respectively 80 (80-90) and 87.5 (70-95). The PTSS-10 score significantly decreased from six to 12 months in COVID-19 survivors (p = 0.024). CONCLUSIONS In this cohort of patients treated with VV-ECMO, cognitive and psychological outcomes were good and comparable to those of patients with Adult Respiratory Distress Syndrome (ARDS) managed without ECMO. IMPLICATIONS FOR CLINICAL PRACTICE The findings of this study confirm the need for long-term follow-up and rehabilitation programs for every ICU survivor after discharge. COVID-19 survivors treated with VV-ECMO had outcomes comparable to those reported in non-COVID patients.
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Affiliation(s)
- Alberto Lucchini
- Direction of health and social professions - General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Marta Villa
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Marco Giani
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Mara Andreossi
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Valentino Alessandra
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Veronica Vigo
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Stefano Gatti
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Daniela Ferlicca
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Maddalena Teggia Droghi
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Emanuele Rezoagli
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Giuseppe Foti
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Matteo Pozzi
- University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy; Cardiosurgical ICU Fondazione IRCCS San Gerardo dei Tintori - Monza.
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Tigano S, Caruso A, Liotta C, LaVia L, Vargas M, Romagnoli S, Landoni G, Sanfilippo F. Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: A meta-analysis. Resuscitation 2024; 194:110071. [PMID: 38061577 DOI: 10.1016/j.resuscitation.2023.110071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient's outcome remains unclear. METHODS We conducted a systematic review (PubMed and Scopus) and meta-analysis investigating the effects of exposure to severe hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. When both adjusted and unadjusted Odds Ratio (OR) were provided, we used the adjusted one. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds. RESULTS Data from 10 observational studies were included. Nine studies reported data on mortality (n = 5 refractory CA, n = 4 CS), and 4 on neurological outcome. As compared to normal oxygenation levels, exposure to severe hyperoxemia was associated with higher mortality (nine studies; OR: 1.80 [1.16-2.78]; p = 0.009; I2 = 83%; low certainty of evidence) and worse neurological outcome (four studies; OR: 1.97 [1.30-2.96]; p = 0.001; I2 = 0%; low certainty of evidence). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (>200 or >300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p = 0.13). Analysis restricted to studies providing adjusted OR data confirmed an increased likelihood of poorer neurological outcome (three studies; OR: 2.11 [1.32-3.38]; p = 0.002) in patients exposed to severe hyperoxemia but did not suggest higher mortality (five studies; OR: 1.68 [0.89-3.18]; p = 0.11). CONCLUSIONS Severe hyperoxemia exposure after initiation of VA-ECMO may be associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support.
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Affiliation(s)
- Stefano Tigano
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Alessandro Caruso
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Calogero Liotta
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi LaVia
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Florence, Italy; Department of Anetshesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy.
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Wang F, Zhang Y, Wu S, Xie H, Lin D, Wen X, Duan Z, Lu Y, Liu Z, Hu S, Liu J. Post-discharge experiences of patients with extracorporeal membrane oxygenation support: A qualitative study. Perfusion 2024; 39:189-200. [PMID: 36282873 DOI: 10.1177/02676591221135165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
PURPOSE To explore the life experiences of patients who have been discharged after undergoing extracorporeal membrane oxygenation (ECMO) support. DESIGN A qualitative descriptive approach was used. METHODS Patients who have undergone ECMO support and have been discharged were recruited. Thirteen participants were involved in this study. The data were collected through a semi-structured interview and analyzed using the Colaizzi method. FINDINGS Four major themes in life experiences were reported by the participants: changes in physical function, changes in psychological state, active adaptation to daily life, and substantial rehabilitation needs. CONCLUSION Different, continuous, and convenient post-discharge physical and mental interventions, social support, spiritual support, and rehabilitation services should be provided according to the patient's circumstances. We also call on the government to increase the patient reimbursement rate for ECMO treatment. These measures may help to improve the quality of life of patients.
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Affiliation(s)
- FengZhen Wang
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - YuHao Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - ShuJing Wu
- Department of Nursing, Gannan Healthcare Vocational College, Ganzhou City, Jiangxi, China
| | - HongYing Xie
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi, China
| | - DongMei Lin
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi, China
| | - XianMing Wen
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - ZhiSheng Duan
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - YuFeng Lu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - ZiYou Liu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Shuo Hu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Jian Liu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
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Yu A, Zhang M, Wang Y, Yan L, Guo C, Deng J, Xiong J. Health-related quality of life assessment instruments for extracorporeal membrane oxygenation survivors: A scoping review. Perfusion 2023:2676591231211518. [PMID: 37934027 DOI: 10.1177/02676591231211518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Extracorporeal membrane oxygenation (ECMO) has been successfully and widely used in adult patients for the past 5 years. About 50% of these patients can survive and are discharged from hospitals. Health-related quality of life (HRQOL) is crucial for evaluating survived ECMO patients. This scoping review aims to identify instruments commonly used to measure HRQOL of ECMO survivors and give pertinent instrument characteristics. METHODS A systematic search was conducted in PubMed, Web of Science, EMBASE (OVID), MEDLINE (OVID), CINAHL (EBSCO), Cochrane Library, and three Chinese databases from January 2012 to December 2021. Two reviewers independently reviewed publication selection and data extraction. RESULTS Twenty-nine studies met the inclusion criteria. Most studies (93%) were cross-sectional, and the median (or average) follow-up time ranged from 3 months to 9 years. Two prospective studies (7%) followed patients longitudinally until 1 year after discharge. ECMO survivors had poorer long-term HRQOL than the general population. However, it is comparable to or better than patients with other critical or chronic illnesses. Identified HRQOL assessment instruments show four generic HRQOL instruments, one disease-specific HRQOL instrument, and nineteen single-dimensional instruments. Seven instruments were used in more than three articles. SF-36 (86.2%), IES/IES-R (41.4%), and HADS (37.9%) were the most frequently used instruments. CONCLUSION The timing, frequency, and tools for HRQOL assessment of ECMO survivors are variable. No ECMO-specific HRQOL instrument was developed and validated. Further studies on assessment instruments are warranted. Research is also needed to identify interventions that may enhance HRQOL in ECMO survivors.
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Affiliation(s)
- Anqi Yu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yan
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chunling Guo
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juan Deng
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jie Xiong
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Burša F, Frelich M, Sklienka P, Jor O, Máca J. Long-Term Outcomes of Extracorporeal Life Support in Respiratory Failure. J Clin Med 2023; 12:5196. [PMID: 37629239 PMCID: PMC10455442 DOI: 10.3390/jcm12165196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Although extracorporeal life support is an expensive method with serious risks of complications, it is nowadays a well-established and generally accepted method of organ support. In patients with severe respiratory failure, when conventional mechanical ventilation cannot ensure adequate blood gas exchange, veno-venous extracorporeal membrane oxygenation (ECMO) is the method of choice. An improvement in oxygenation or normalization of acid-base balance by itself does not necessarily mean an improvement in the outcome but allows us to prevent potential negative effects of mechanical ventilation, which can be considered a crucial part of complex care leading potentially to an improvement in the outcome. The disconnection from ECMO or discharge from the intensive care unit should not be viewed as the main goal, and the long-term outcome of the ECMO-surviving patients should also be considered. Approximately three-quarters of patients survive the veno-venous ECMO, but various (both physical and psychological) health problems may persist. Despite these, a large proportion of these patients are eventually able to return to everyday life with relatively little limitation of respiratory function. In this review, we summarize the available knowledge on long-term mortality and quality of life of ECMO patients with respiratory failure.
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Affiliation(s)
- Filip Burša
- Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, 708 00 Ostrava, Czech Republic; (F.B.); (M.F.); (P.S.); (O.J.)
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Michal Frelich
- Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, 708 00 Ostrava, Czech Republic; (F.B.); (M.F.); (P.S.); (O.J.)
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Peter Sklienka
- Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, 708 00 Ostrava, Czech Republic; (F.B.); (M.F.); (P.S.); (O.J.)
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Ondřej Jor
- Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, 708 00 Ostrava, Czech Republic; (F.B.); (M.F.); (P.S.); (O.J.)
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Jan Máca
- Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, 708 00 Ostrava, Czech Republic; (F.B.); (M.F.); (P.S.); (O.J.)
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Simone B, Ippolito M, Iozzo P, Zuccaro F, Giarratano A, Cecconi M, Tabah A, Cortegiani A. Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic: A Secondary Analysis of the COVISIT International Survey. Healthcare (Basel) 2023; 11:healthcare11050669. [PMID: 36900674 PMCID: PMC10001082 DOI: 10.3390/healthcare11050669] [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: 01/16/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic. METHODS A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy. RESULTS Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy). CONCLUSION Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.
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Affiliation(s)
- Barbara Simone
- Department of Surgical, Oncological and Oral Science, University of Palermo, Via Liborio Giuffrè 5, 90127 Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo, Via Liborio Giuffrè 5, 90127 Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Pasquale Iozzo
- Department of Anaesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Francesco Zuccaro
- Department of Anesthesia and Intensive Care, Ospedale Madonna delle Grazie, Azienda Sanitaria Matera, 75100 Matera, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science, University of Palermo, Via Liborio Giuffrè 5, 90127 Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Redcliffe, QLD 4020, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Antimicrobial Optimisation Group, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo, Via Liborio Giuffrè 5, 90127 Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-0916552751
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Crow J, Lindsley J, Cho SM, Wang J, Lantry JH, Kim BS, Tahsili-Fahadan P. Analgosedation in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation Support. ASAIO J 2022; 68:1419-1427. [PMID: 35593878 PMCID: PMC9675878 DOI: 10.1097/mat.0000000000001758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an increasingly utilized intervention for cardiopulmonary failure. Analgosedation during ECMO support is essential to ensure adequate pain and agitation control and ventilator synchrony, optimize ECMO support, facilitate patient assessment, and minimize adverse events. Although the principles of analgosedation are likely similar for all critically ill patients, ECMO circuitry alters medication pharmacodynamics and pharmacokinetics. The lack of clinical guidelines for analgosedation during ECMO, especially at times of medication shortage, can affect patient management. Here, we review pharmacological considerations, protocols, and special considerations for analgosedation in critically ill adults receiving ECMO support.
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Affiliation(s)
- Jessica Crow
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD
| | - John Lindsley
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD
| | - Sung-Min Cho
- Neurocritical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jing Wang
- Medical Critical Care Service, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - James H Lantry
- Medical Critical Care Service, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
| | - Bo S. Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pouya Tahsili-Fahadan
- Neurocritical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Medical Critical Care Service, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
- Department of Medical Education, University of Virginia, Inova Fairfax Medical Campus, Falls Church, VA
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Lumlertgul N, Wright R, Hutson G, Milicevic JK, Vlachopanos G, Lee KCH, Pirondini L, Gregson J, Sanderson B, Leach R, Camporota L, Barrett NA, Ostermann M. Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study. Ann Intensive Care 2022; 12:70. [PMID: 35870022 PMCID: PMC9308118 DOI: 10.1186/s13613-022-01046-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute kidney injury (AKI) is a frequent complication in patients with severe respiratory failure receiving extracorporeal membrane oxygenation (ECMO). However, little is known of long-term kidney function in ECMO survivors. We aimed to assess the long-term mortality and kidney outcomes in adult patients treated with veno-venous ECMO (VV-ECMO). Methods This was a single-centre retrospective study of adult patients (≥ 18 years old) who were treated with VV-ECMO at a commissioned ECMO centre in the UK between 1st September 2010, and 30th November 2016. AKI was defined and staged using the serum creatinine and urine output criteria of the Kidney Diseases: Improving Global Outcomes (KDIGO) classification. The primary outcome was 1-year mortality. Secondary outcomes were long-term mortality (up to March 2020), 1-year incidence of end-stage kidney disease (ESKD) or chronic kidney disease (CKD) among AKI patients who received renal replacement therapy (AKI-RRT), AKI patients who did not receive RRT (AKI-no RRT) and patients without AKI (non-AKI). Results A total of 300 patients [57% male; median age 44.5; interquartile range (IQR) 34–54] were included in the final analysis. Past medical histories included diabetes (12%), hypertension (17%), and CKD (2.3%). The main cause of severe respiratory failure was pulmonary infection (72%). AKI occurred in 230 patients (76.7%) and 59.3% received renal replacement therapy (RRT). One-year mortality was 32% in AKI-RRT patients vs. 21.4% in non-AKI patients (p = 0.014). The median follow-up time was 4.35 years. Patients who received RRT had a higher risk of 1-year mortality than those who did not receive RRT (adjusted HR 1.80, 95% CI 1.06, 3.06; p = 0.029). ESKD occurred in 3 patients, all of whom were in the AKI-RRT group. At 1-year, 41.2% of survivors had serum creatinine results available. Among these, CKD was prevalent in 33.3% of AKI-RRT patients vs. 4.3% in non-AKI patients (p = 0.004). Conclusions VV-EMCO patients with AKI-RRT had high long-term mortality. Monitoring of kidney function after hospital discharge was poor. In patients with follow-up creatinine results available, the CKD prevalence was high at 1 year, especially in AKI-RRT patients. More awareness about this serious long-term complication and appropriate follow-up interventions are required. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01046-0.
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11
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Mazzeffi MA, Krajewski M, Shelton K, Dalia A, Najam F, Gutsche J, Nurok M. Measuring and Reporting Quality for Adult Extracorporeal Membrane Oxygenation Centers: Is It Possible and Is It Time? Anesth Analg 2022; 135:719-724. [DOI: 10.1213/ane.0000000000006080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Zhu YB, Yao Y, Xu Y, Huang HB. Nitrogen balance and outcomes in critically ill patients: A systematic review and meta-analysis. Front Nutr 2022; 9:961207. [PMID: 36071933 PMCID: PMC9441883 DOI: 10.3389/fnut.2022.961207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveNitrogen balance (NB) is a commonly used nutrition indicator in clinical practice, while its relation to the interpretation of protein malnutrition and outcomes in critically ill patients remains unclear. This study aimed to evaluate the impact of NB on prognosis in such a patient population.MethodsWe searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to May 10, 2022. Meta-analyses were performed to evaluate the relationship between NB (initial, final, or absolute change of NB levels) and prognosis and important clinical outcomes in critically ill patients. Pooled odds ratios (ORs) and mean differences (MDs) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity.ResultsEight studies with 1,409 patients were eligible. These studies were moderate to high quality. When pooled, the initial NB was comparable between the survival and non-survival groups (five studies, MD 1.20, 95% CI, −0.70 to 3.11, I2 = 77%; P = 0.22), while a significantly higher final NB in the survival group than that in the death group (two studies, MD 3.69, 95% CI, 1.92–5.46, I2 = 55%; P < 0.0001). Two studies provided the absolute change of NB over time and suggested survival patients had more increased NB (MD 4.16 g/day, 95% CI, 3.70–4.61, I2 = 0%; P < 0.00001). Similarly, for studies utilizing multivariate logistic regression, we found an improved NB (four studies, OR 0.85, 95% CI, 0.73–0.99, I2 = 61%; P = 0.04) but not an initial NB (two studies, OR 0.92, 95% CI 0.78–1.08, I2 = 55%; P = 0.31) was significantly associated the risk of all-cause mortality. These results were further confirmed in subgroup analyses. In addition, patients with improved NB had more protein and calorie intake and a similar length of stay in hospital than those without.ConclusionsOur results suggested that an improved NB but not the initial NB level was associated with all-cause mortality in critically ill patients. This highlights the requirement for dynamic monitoring of NB during nutrition treatment. Further randomized clinical trials examining the impact of NB-guided protein intake on clinical outcomes in critically ill patients are warranted.Systematic review registrationINPLASY202250134, https://doi.org/10.37766/inplasy2022.5.0134.
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Affiliation(s)
- Yi-Bing Zhu
- Department of Emergency, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Yao
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- *Correspondence: Hui-Bin Huang
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13
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Sanfilippo F, Currò JM, La Via L, Dezio V, Martucci G, Brancati S, Murabito P, Pappalardo F, Astuto M. Use of nafamostat mesilate for anticoagulation during extracorporeal membrane oxygenation: A systematic review. Artif Organs 2022; 46:2371-2381. [PMID: 35531906 DOI: 10.1111/aor.14276] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/10/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) represents an advanced option for supporting refractory respiratory and/or cardiac failure. Systemic anticoagulation with unfractionated heparin (UFH) is routinely used. However, patients with bleeding risk and/or heparin-related side effects may necessitate alternative strategies: among these, nafamostat mesilate (NM) has been reported. METHODS We conducted a systematic literature search (PubMed and EMBASE, updated 12/08/2021), including all studies reporting NM anticoagulation for ECMO. We focused on reasons for starting NM, its dose and the anticoagulation monitoring approach, the incidence of bleeding/thrombosis complications, the NM-related side effects, ECMO weaning, and mortality. RESULTS The search revealed 11 relevant findings, all with retrospective design. Of these, three large studies reported a control group receiving UFH, the other were case series (n = 3) or case reports (n = 5). The main reason reported for NM use was an ongoing or high risk of bleeding. The NM dose varied largely as did the anticoagulation monitoring approach. The average NM dose ranged from 0.46 to 0.67 mg/kg/h, but two groups of authors reported larger doses when monitoring anticoagulation with ACT. Conflicting findings were found on bleeding and thrombosis. The only NM-related side effect was hyperkalemia (n = 2 studies) with an incidence of 15%-18% in patients anticoagulated with NM. Weaning and survival varied across studies. CONCLUSION Anticoagulation with NM in ECMO has not been prospectively studied. While several centers have experience with this approach in high-risk patients, prospective studies are warranted to establish the optimal space of this approach in ECMO.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Jessica Marika Currò
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Federico Pappalardo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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14
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Shih E, DiMaio JM, Squiers JJ, Rao A, Rahimighazikalayeh G, Meidan TC, Monday KA, Blough B, Meyer D, Schwartz GS, George TJ. Extracorporeal membrane oxygenation for respiratory failure in phases of COVID-19 variants. J Card Surg 2022; 37:2972-2979. [PMID: 35488784 PMCID: PMC9348093 DOI: 10.1111/jocs.16563] [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: 03/28/2022] [Accepted: 04/17/2022] [Indexed: 01/19/2023]
Abstract
Background Adaptive mutations of the severe acute respiratory syndrome‐related coronavirus (SARS‐CoV‐2) virus have emerged throughout the coronavirus disease 2019 (COVID‐19) pandemic. The characterization of outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory distress from COVID‐19 during the peak prevalence of different variants is not well known. Methods There were 131 patients with laboratory‐confirmed SARS‐CoV‐2 infection supported by ECMO at two referral centers within a large healthcare system. Three predominant variant phase time windows (Pre‐Alpha, Alpha, and Delta) were determined by a change‐point analyzer based on random population sampling and viral genome sequencing. Patient demographics and outcomes were compared. Results The average age of patients was 46.9 ± 10.5 years and 70.2% (92/131) were male. Patients cannulated for ECMO during the Delta variant wave were younger compared to earlier Pre‐Alpha (39.3 ± 7.8 vs. 48.0 ± 11.1 years) and Alpha phases (39.3 ± 7.8 vs. 47.2 ± 7.7 years) (p < .01). The predominantly affected race in the Pre‐Alpha phase was Hispanic (52.2%; 47/90), while in Alpha (61.5%; 16/26) and Delta (40%; 6/15) variant waves, most patients were White (p < .01). Most patients received a tracheostomy (82.4%; 108/131) with a trend toward early intervention in later phases compared to Pre‐Alpha (p < .01). There was no significant difference between the duration of ECMO, mechanical support, intensive care unit (ICU) length of stay (LOS), or hospital LOS over the three variant phases. The in‐hospital mortality was overall 41.5% (54/131) and was also similar. Six‐month survival of patients who survived to discharge was 92.2% (71/77). Conclusions There was no significant difference in survival or time on ECMO support in patients during the peak prevalence of the three variants.
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Affiliation(s)
- Emily Shih
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospitals, Plano, Texas, USA.,Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - John J Squiers
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospitals, Plano, Texas, USA
| | - Arundhati Rao
- Department of Pathology, Baylor Scott and White Temple, Temple, Texas, USA
| | | | - Talia C Meidan
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Kara A Monday
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Britton Blough
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Dan Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gary S Schwartz
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Timothy J George
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospitals, Plano, Texas, USA
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15
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Ethical Lessons from an Intensivist's Perspective. J Clin Med 2022; 11:jcm11061613. [PMID: 35329939 PMCID: PMC8949962 DOI: 10.3390/jcm11061613] [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: 02/12/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Intensive care units (ICUs) around the world have been hugely impacted by the SARS-CoV-2 pandemic and the vast numbers of patients admitted with COVID-19, requiring respiratory support and prolonged stays. This pressure, with resulting shortages of ICU beds, equipment, and staff has raised ethical dilemmas as physicians have had to determine how best to allocate the sparse resources. Here, we reflect on some of the major ethical aspects of the COVID-19 pandemic, including resource allocation and rationing, end-of-life decision-making, and communication and staff support. Importantly, these issues are regularly faced in non-pandemic ICU patient management and useful lessons can be learned from the discussions that have occurred as a result of the COVID-19 situation.
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16
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Lin WJ, Chang YL, Weng LC, Tsai FC, Huang HC, Yeh SL, Chen KH. Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063333. [PMID: 35329031 PMCID: PMC8954682 DOI: 10.3390/ijerph19063333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/16/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study’s aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015–October 2016 (n = 52) and September 2019–August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale–Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.
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Affiliation(s)
- Wan-Jung Lin
- Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Huei-Chiun Huang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Correspondence: ; Tel.: +886-3-211-8800 (ext. 5211)
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17
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Chen KH, Lee PS, Tsai FC, Weng LC, Yeh SL, Huang HC, Lin SS. Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study. Heart Lung 2021; 52:76-85. [PMID: 34911020 DOI: 10.1016/j.hrtlng.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.
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Affiliation(s)
- Kang-Hua Chen
- Associate Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Associate Research Fellow, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan.
| | - Pei-Shan Lee
- Surgical Intensive Care Unit, Fu Jen Catholic University Hospital, Taipei, Taiwan
| | - Feng-Chun Tsai
- Associate Professor, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou Branch, Taiwan
| | - Li-Chueh Weng
- Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Research Fellow, Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Ling Yeh
- Director, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan; Adjunct Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Huei-Chiun Huang
- Case Manager, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Siang Lin
- Clinical Nursing Teacher, Department of Nursing, Chang Gung University of Science and Technology Taiwan
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18
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Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives. J Multidiscip Healthc 2021; 14:2719-2730. [PMID: 34611408 PMCID: PMC8486274 DOI: 10.2147/jmdh.s240563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.
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Affiliation(s)
- Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Marino
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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19
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One-Year Functional, Cognitive, and Psychological Outcomes Following the Use of Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019: A Prospective Study. Crit Care Explor 2021; 3:e0537. [PMID: 34589715 PMCID: PMC8437214 DOI: 10.1097/cce.0000000000000537] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To prospectively describe 1-year outcomes, with a focus on functional outcome, cognitive outcome, and the burden of anxiety, depression, and post-traumatic stress disorder, in coronavirus disease 2019 patients managed with extracorporeal membrane oxygenation. Design Prospective case series. Setting Tertiary extracorporeal membrane oxygenation center in the United States. Patients Adult coronavirus disease 2019 acute respiratory distress syndrome patients managed with extracorporeal membrane oxygenation March 1, 2020, to July 31, 2020. Interventions Baseline variables, treatment measures, and short-term outcomes were obtained from the medical record. Survivors were interviewed by telephone, a year following the index intensive care admission. Functional outcome was assessed using the modified Rankin Scale and the World Health Organization Disability Assessment Scale 2.0. Cognitive status was assessed with the 5-minute Montreal Cognitive Assessment. The Hospital Anxiety and Depression Scale was used to screen for anxiety and depression. Screening for post-traumatic stress disorder was performed with the Posttraumatic Stress Disorder Checklist 5 instrument. Measurements and Main Results Twenty-three patients were managed with extracorporeal membrane oxygenation, 14 (61%) survived to hospital discharge. Thirteen (57%) were alive at 1 year. One patient was dependent on mechanical ventilation, another intermittently required supplemental oxygen at 1 year. The median modified Rankin Scale score was 2 (interquartile range, 1-2), median World Health Organization Disability Assessment Scale 2.0 impairment score was 21% (interquartile range, 6-42%). Six of 12 previously employed individuals (50%) had returned to work, and 10 of 12 (83%) were entirely independent in activities of daily living. The median Montreal Cognitive Assessment score was 14 (interquartile range, 13-14). Of 10 patients assessed with Hospital Anxiety and Depression Scale, 4 (40%) screened positive for depression and 6 (60%) for anxiety. Four of 10 (40%) screened positive for post-traumatic stress disorder. Conclusions Functional impairment was common a year following the use of extracorporeal membrane oxygenation in coronavirus disease 2019, although the majority achieved independence in daily living and about half returned to work. Long-term anxiety, depression, and post-traumatic stress disorder were common, but cognitive impairment was not.
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20
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Park HY, Cho HW, Song IA, Lee S, Oh TK. Long-term mortality associated with depression among South Korean survivors of extracorporeal membrane oxygenation. Brain Behav 2021; 11:e02218. [PMID: 34056866 PMCID: PMC8323046 DOI: 10.1002/brb3.2218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Depression is an important sequela in critically ill patients. However, its prevalence after extracorporeal membrane oxygenation (ECMO) therapy and its association with long-term mortality remain controversial. METHODS Data were extracted from the South Korean National Health Insurance Service database in this population-based cohort study. Adults who received ECMO therapy from 2006 to 2014 were included. Survivors of ECMO were defined as patients who underwent ECMO and survived over 365 days after the initiation of ECMO therapy. RESULTS A total of 3,055 survivors of ECMO were included in the final analysis. They were classified into the pre-ECMO depression group (n = 275 [9.0%]), post-ECMO depression group (n = 331 [10.8%]), and other ECMO survivor group. In the multivariable Cox regression model, a 1.52-fold higher mortality was observed in the post-ECMO depression group than in the other groups (hazard ratio, 1.52; 95% confidence interval, 1.17-1.96; p = .002). However, there was no statistically significant difference between the pre-ECMO depression group and the other groups (p = .075). CONCLUSIONS The prevalence of pre- and post-ECMO depression was 9.0% and 10.8%, respectively. Additionally, post-ECMO depression was associated with an increased 5 year all-cause mortality; however, pre-ECMO depression was not.
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Affiliation(s)
- Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyoung-Won Cho
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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21
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Kurniawati ER, Rutjens VGH, Vranken NPA, Delnoij TSR, Lorusso R, van der Horst ICC, Maessen JG, Weerwind PW. Quality of life following adult veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review. Qual Life Res 2021; 30:2123-2135. [PMID: 33826058 PMCID: PMC8024673 DOI: 10.1007/s11136-021-02834-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully for the past decade in adult patients with acute respiratory distress syndrome (ARDS) refractory to conventional ventilatory support. However, knowledge of the health-related quality of life (HRQoL) in VV-ECMO patients is still limited. Thus, this study aimed to provide a comprehensive overview of the HRQoL following VV-ECMO support in ARDS patients. METHODS A systematic search was performed on PubMed and Web of Science databases from January 1st, 2009 to October 19th, 2020. Studies reporting on HRQoL following VV-ECMO for ARDS in adults were included. Two authors independently selected studies, extracted data, and assessed methodological quality. RESULTS Eight studies were eligible for inclusion, consisting of seven observational studies and one randomized controlled trial (total N = 441). All eight studies had a quantitative design and reported 265 VV-ECMO survivors to have a reduced HRQoL compared to a generally healthy population. Follow-up time varied between six months to three years. Additionally, only four studies (total N = 335) compared the HRQoL of VV-ECMO (N = 159) to conventionally treated survivors (N = 176), with one study showing a significantly better HRQoL in VV-ECMO survivors, while three studies were stating comparable HRQoL across groups. Notably, most survivors in these studies appeared to experience varying degrees of anxiety, depression, and post-traumatic stress disorder (PTSD). CONCLUSIONS ARDS survivors supported by VV-ECMO have a decline in HRQoL and suffered from physical and psychological impairments. This HRQoL reduction is comparable or even better to the HRQoL in conventionally treated ARDS survivors.
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Affiliation(s)
- E R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - V G H Rutjens
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - N P A Vranken
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - T S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - I C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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22
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Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review. Curr Treat Options Neurol 2021; 23:15. [PMID: 33814895 PMCID: PMC8009934 DOI: 10.1007/s11940-021-00671-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/21/2023]
Abstract
Purpose Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists. Recent findings The most common neurologic injuries include intracerebral hemorrhage, ischemic stroke, seizure, cerebral edema, intracranial hypertension, global cerebral hypoxia/anoxia, and brain death. These result from events prior to initiation of ECMO, failure of ECMO to provide adequate oxygen delivery, and/or complications that occur during ECMO. ECMO survivors also experience neurological and psychological sequelae similar to other survivors of critical illness. Summary Since many of the risk factors for neurologic injury cannot be easily mitigated, early diagnosis and intervention are crucial to limit morbidity and mortality from neurologic injury during ECMO.
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23
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Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:85-91. [PMID: 33679255 PMCID: PMC7925253 DOI: 10.1007/s40140-021-00443-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/06/2023]
Abstract
Purpose of Review To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously. Recent Findings Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients. Summary A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.
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24
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Abstract
COVID-19 is a new disease. Most research into the disease has focused on prevention of viral spread and treatment, but little is known about how patients recover. Nurses, whether in hospital, the community or in primary care, have a key role in supporting recovery from COVID-19. In this article, direct evidence from studies of COVID-19, and indirect evidence from studies of infections caused by other coronaviruses (eg SARS, MERS) and of the ICU experience are explored to identify the potential course of recovery and areas where nurses can help. Most people will have an uncomplicated recovery. However, it appears that a more complicated recovery is likely to be associated with severe disease. A minority, possibly those needing hospitalisation, and/or with pre-existing physical or psychological comorbidities, may experience long-term physical effects, fatigue and mental health difficulties. The support that nurses, as part of a multidisciplinary team, can provide to facilitate recovery is discussed.
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Affiliation(s)
| | - Beverly Coghlan
- Registered Nurse, Specialist Trauma Therapist/Acceptance and Commitment Therapist, Actworks Limited
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25
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2019. Critical care. Minerva Anestesiol 2020; 86:102-113. [PMID: 31994860 DOI: 10.23736/s0375-9393.20.14384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, ASST - Spedali Civili Children's Hospital, Brescia, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Accident and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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26
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Mayer KP, Jolley SE, Etchill EW, Fakhri S, Hoffman J, Sevin CM, Zwischenberger JB, Rove JY. Long-term recovery of survivors of coronavirus disease (COVID-19) treated with extracorporeal membrane oxygenation: The next imperative. ACTA ACUST UNITED AC 2020; 5:163-168. [PMID: 34173554 PMCID: PMC7687357 DOI: 10.1016/j.xjon.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Ky
| | - Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Eric W Etchill
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Shoaib Fakhri
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Jordan Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, Vanderbilt University, Nashville, Tenn
| | - Carla M Sevin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn
| | - Joseph B Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Kentucky, Lexington, Ky
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colo
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27
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Worsham CM, Banzett RB, Schwartzstein RM. Dyspnea, Acute Respiratory Failure, Psychological Trauma, and Post-ICU Mental Health: A Caution and a Call for Research. Chest 2020; 159:749-756. [PMID: 33011205 PMCID: PMC7528739 DOI: 10.1016/j.chest.2020.09.251] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/01/2022] Open
Abstract
Dyspnea is an uncomfortable sensation with the potential to cause psychological trauma. Patients presenting with acute respiratory failure, particularly when tidal volume is restricted during mechanical ventilation, may experience the most distressing form of dyspnea known as air hunger. Air hunger activates brain pathways known to be involved in posttraumatic stress disorder (PTSD), anxiety, and depression. These conditions are considered part of the post-intensive care syndrome. These sequelae may be even more prevalent among patients with ARDS. Low tidal volume, a mainstay of modern therapy for ARDS, is difficult to avoid and is likely to cause air hunger despite sedation. Adjunctive neuromuscular blockade does not prevent or relieve air hunger, but it does prevent the patient from communicating discomfort to caregivers. Consequently, paralysis may also contribute to the development of PTSD. Although research has identified post-ARDS PTSD as a cause for concern, and investigators have taken steps to quantify the burden of disease, there is little information to guide mechanical ventilation strategies designed to reduce its occurrence. We suggest such efforts will be more successful if they are directed at the known mechanisms of air hunger. Investigation of the antidyspnea effects of sedative and analgesic drugs commonly used in the ICU and their impact on post-ARDS PTSD symptoms is a logical next step. Although in practice we often accept negative consequences of life-saving therapies as unavoidable, we must understand the negative sequelae of our therapies and work to minimize them under our primary directive to "first, do no harm" to patients.
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Affiliation(s)
- Christopher M Worsham
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA; Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Robert B Banzett
- Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Richard M Schwartzstein
- Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
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28
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Azoulay E, Kentish-Barnes N. A 5-point strategy for improved connection with relatives of critically ill patients with COVID-19. THE LANCET RESPIRATORY MEDICINE 2020; 8:e52. [PMID: 32380024 PMCID: PMC7198186 DOI: 10.1016/s2213-2600(20)30223-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis AP-HP, Paris University, Paris 75010, France.
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, Hôpital Saint-Louis AP-HP, Paris University, Paris 75010, France
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29
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Abstract
Introduction: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury common in critically ill patients and characterized by significant morbidity and mortality. It frequently manifests long-lasting effects beyond hospitalization, from cognitive impairment to physical weakness.Areas covered: Several complications of ARDS have been identified in patients after hospital discharge. The authors conducted literature searches to identify observational studies, randomized clinical trials, systematic reviews, and guidelines. A summary of is presented here to outline the sequelae of ARDS and their risk factors with a focus on the limited but growing research into possible therapies. Long term sequelae of ARDS commonly identified in the literature include long-term cognitive impairment, psychological morbidities, neuromuscular weakness, pulmonary dysfunction, and ongoing healthcare utilization with reduced quality of life.Expert opinion: Given the public health significance of long-term complications following ARDS, the development of new therapies for prevention and treatment is of vital importance. Furthering knowledge of the pathophysiology of these impairments will provide a framework to develop new therapeutic targets to fuel future clinical trials in this area of critical care medicine.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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30
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Stressors and strains of next of kin of patients with ARDS in intensive care: A qualitative interview study using a stress-strain approach. Intensive Crit Care Nurs 2019; 57:102783. [PMID: 31882326 DOI: 10.1016/j.iccn.2019.102783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 09/16/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to explore and analyse the stressors and strains of next of kin of acute respiratory distress syndrome (ARDS) patients during their stay in the intensive care unit utilising the stressors and strain approach as a theoretical framework. METHODS Data collection was performed as semi-standardised qualitative interviews. 35 families of patients with ARDS were approached when visiting the intensive care unit. Participants were recruited until thematic saturation was reached; finally, 17 persons (age ranging from 26 to 71 years, nine women) took part. Systematic content analysis was conducted on the theoretical foundations of the stressors and strain approach. FINDINGS Numerous stressors were identified; they can be divided into three main categories: in relation to organising the visit, occurring during the visit and arising at home. These stressors were reported highly consistently throughout participants. However, the strains resulting from these stressors were varying in manifestation and level. CONCLUSIONS This study explores the manifold stressors and strains of next of kin of a critically ill patient. Some stressors are inherent to the life-threatening condition of a family member; others arise from the health care system and could be modified. The level of strain experienced depends on social support, individual coping skills and life circumstances.
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31
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Knudson KA, Gustafson CM, Sadler LS, Whittemore R, Redeker NS, Andrews LK, Mangi A, Funk M. Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): An integrative review. Heart Lung 2019; 48:538-552. [DOI: 10.1016/j.hrtlng.2019.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
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32
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Auzinger G. Long-term outcome after VV ECMO: like the iceberg beneath the Titanic. Minerva Anestesiol 2019; 85:934-936. [PMID: 31064171 DOI: 10.23736/s0375-9393.19.13688-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Georg Auzinger
- Department of Critical Care and ECMO, King's College Hospital, King's Health Partners, London, UK - .,Department of Critical Care, Cleveland Clinic, London, UK -
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