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Tsonas AM, van Meenen DM, Botta M, Shrestha GS, Roca O, Paulus F, Neto AS, Schultz MJ. Hyperoxemia in invasively ventilated COVID-19 patients-Insights from the PRoVENT-COVID study. Pulmonology 2024; 30:272-281. [PMID: 36274046 PMCID: PMC10155497 DOI: 10.1016/j.pulmoe.2022.09.003] [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: 03/14/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We determined the prevalences of hyperoxemia and excessive oxygen use, and the epidemiology, ventilation characteristics and outcomes associated with hyperoxemia in invasively ventilated patients with coronavirus disease 2019 (COVID-19). METHODS Post hoc analysis of a national, multicentre, observational study in 22 ICUs. Patients were classified in the first two days of invasive ventilation as 'hyperoxemic' or 'normoxemic'. The co-primary endpoints were prevalence of hyperoxemia (PaO2 > 90 mmHg) and prevalence of excessive oxygen use (FiO2 ≥ 60% while PaO2 > 90 mmHg or SpO2 > 92%). Secondary endpoints included ventilator settings and ventilation parameters, duration of ventilation, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, and at day 28 and 90. We used propensity matching to control for observed confounding factors that may influence endpoints. RESULTS Of 851 COVID-19 patients, 225 (26.4%) were classified as hyperoxemic. Excessive oxygen use occurred in 385 (45.2%) patients. Acute respiratory distress syndrome (ARDS) severity was lowest in hyperoxemic patients. Hyperoxemic patients were ventilated with higher positive end-expiratory pressure (PEEP), while rescue therapies for hypoxemia were applied more often in normoxemic patients. Neither in the unmatched nor in the matched analysis were there differences between hyperoxemic and normoxemic patients with regard to any of the clinical outcomes. CONCLUSION In this cohort of invasively ventilated COVID-19 patients, hyperoxemia occurred often and so did excessive oxygen use. The main differences between hyperoxemic and normoxemic patients were ARDS severity and use of PEEP. Clinical outcomes were not different between hyperoxemic and normoxemic patients.
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Affiliation(s)
- A M Tsonas
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands.
| | - D M van Meenen
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands
| | - M Botta
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands
| | - G S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - O Roca
- Department of Intensive Care, Vall d'Hebron Univerity Hospital, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, Spain
| | - F Paulus
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands; ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands
| | - A S Neto
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M J Schultz
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands; Department of Critical Care Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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2
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Maclean N, Davies P, Lewis S. Is prone positioning a valid intervention for ARDS in the deployed intensive care unit? BMJ Mil Health 2024:e002302. [PMID: 38569719 DOI: 10.1136/military-2022-002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
Prone positioning is an intervention used for patients with acute respiratory distress syndrome (ARDS) whose hypoxia is worsening despite conventional treatment. Previously used infrequently, it became an important treatment escalation strategy for hypoxia during the COVID-19 pandemic. Current evidence for prone positioning suggests increased survivability in intubated patients with moderate to severe ARDS who are prone for >12 hours a day. As a relatively low-cost, low-tech intervention with a growing evidence base, the viability of prone positioning in the deployed land environment is considered in this article. The practical technique of prone positioning is easy to teach to healthcare staff experienced in manual handling. However, it requires significant resources, in particular staff numbers, and time to execute and maintain, and necessitates a pressure-minimising mattress. Additionally, staff are placed at increased risk of musculoskeletal injuries and potential exposure to aerosolised microbes if there is a disconnection of the breathing system. We conclude that in the deployed 2/1/2/12 facility (or larger), with access to higher staff numbers and high-specification mattresses, prone positioning is a valid escalation technique for intubated hypoxic patients with ARDS. However, in smaller facilities where resources are constrained, its implementation is unlikely to be achievable.
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Affiliation(s)
| | - P Davies
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
- Joint Hosptial Group (South East), Frimley, UK
| | - S Lewis
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
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3
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Esmeijer AA, van der Ven F, Koornstra E, Kuipers L, van Oosten P, Swart P, Valk CM, Schultz MJ, Paulus F, Stilma W. Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19-A Dutch National Survey. J Clin Med 2024; 13:1983. [PMID: 38610748 PMCID: PMC11012421 DOI: 10.3390/jcm13071983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Airway care interventions and prone positioning are used in critically ill patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) to improve oxygenation and facilitate mucus removal. At the onset of the COVID-19 pandemic, the decision-making process regarding the practice of airway care interventions and prone positioning was challenging. Objective: To provide an overview of the practice of airway care interventions and prone positioning during the second wave of the pandemic in the Netherlands. Method: Web-based survey design. Seventy ICU nurses, each representing one intensive care in the Netherlands, were contacted for participation. Potential items were generated based on a literature search and formulated by a multidisciplinary team. Questions were pilot tested for face and construct validity by four intensive care nurses from four different hospitals. Results: The response rate was 53/77 (69%). This survey revealed widespread use of airway care interventions in the Netherlands in COVID-19 patients, despite questionable benefits. Additionally, prone positioning was used in invasively and non-invasively ventilated patients. Conclusions: The use of airway care interventions and prone positioning is time consuming and comes with the production of waste. Further research is needed to assess the effectiveness, workload, and environmental impact of airway care interventions and prone positioning.
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Affiliation(s)
- Andrea A. Esmeijer
- Department of Intensive Care, Amsterdam University Medical Center, Location VUmc, 1081 HV Amsterdam, The Netherlands (L.K.)
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Fleur van der Ven
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care, Rode Kruis Ziekenhuis, 1942 LE Beverwijk, The Netherlands
| | - Eveline Koornstra
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Location ‘Oost’, 1091 AC Amsterdam, The Netherlands;
| | - Laurien Kuipers
- Department of Intensive Care, Amsterdam University Medical Center, Location VUmc, 1081 HV Amsterdam, The Netherlands (L.K.)
| | - Paula van Oosten
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Pien Swart
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Christel M. Valk
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University Vienna, 1090 Vienna, Austria
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Willemke Stilma
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
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4
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Spadaro S, Jimenez-Santana JD, La Rosa R, Spinazzola G, Argente Navarro P, Volta CA, Scaramuzzo G. Prone Positioning and Molecular Biomarkers in COVID and Non-COVID ARDS: A Narrative Review. J Clin Med 2024; 13:317. [PMID: 38256451 PMCID: PMC10816213 DOI: 10.3390/jcm13020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
Prone positioning (PP) represents a therapeutic intervention with the proven capacity of ameliorating gas exchanges and ventilatory mechanics indicated in acute respiratory distress syndrome (ARDS). When PP is selectively applied to moderate-severe cases of ARDS, it sensitively affects clinical outcomes, including mortality. After the COVID-19 outbreak, clinical application of PP peaked worldwide and was applied in 60% of treated cases, according to large reports. Research on this topic has revealed many physiological underpinnings of PP, focusing on regional ventilation redistribution and the reduction of parenchymal stress and strain. However, there is a lack of evidence on biomarkers behavior in different phases and phenotypes of ARDS. Patients response to PP are, to date, decided on PaO2/FiO2 ratio improvement, whereas scarce data exist on biomarker tracking during PP. The purpose of this review is to explore current evidence on the clinical relevance of biomarkers in the setting of moderate-severe ARDS of different etiologies (i.e., COVID and non-COVID-related ARDS). Moreover, this review focuses on how PP may modulate biomarkers and which biomarkers may have a role in outcome prediction in ARDS patients.
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Affiliation(s)
- Savino Spadaro
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Jose Daniel Jimenez-Santana
- Department of Anaesthesiology, Hospital Universitari i Politécnic la Fe, 46026 Valencia, Spain; (J.D.J.-S.); (P.A.N.)
| | - Riccardo La Rosa
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Giorgia Spinazzola
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Gemelli, IRCSS, 00168 Rome, Italy;
| | - Pilar Argente Navarro
- Department of Anaesthesiology, Hospital Universitari i Politécnic la Fe, 46026 Valencia, Spain; (J.D.J.-S.); (P.A.N.)
| | - Carlo Alberto Volta
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Gaetano Scaramuzzo
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
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5
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Graziani M, Rigutini AG, Bartolini D, Traballi L, Luzi L, Regina R, Bossi F, Caponi C, Becattini C. Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis. Intern Emerg Med 2024; 19:147-158. [PMID: 37796372 PMCID: PMC10827908 DOI: 10.1007/s11739-023-03434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
The role of awake prone positioning (aPP) in patients with acute hypoxemic respiratory failure is debated. We performed a systematic review and meta-analysis to evaluate the role of aPP in acute respiratory failure related to COronaVIrus Disease-19 (COVID-19). Studies reporting on the clinical course of patients with acute respiratory failure related to COVID-19 treated or not treated by aPP were included in the systematic review and meta-analysis (ProsperoID: CRD42022333211). The primary study outcome was the composite of in-hospital death or orotracheal intubation; the individual components of the primary outcome were secondary study outcomes. The composite of in-hospital death or orotracheal intubation was available for 6 studies (1884 patients), five randomized and one prospective; a significant reduction in the risk of this outcome was observed in patients treated vs. not treated by aPP (33.5% vs. 39.8%; OR 0.73, 95% CI 0.60-0.89; I2 0%). In-hospital death was reported in 34 studies (6808 patients) and occurred in 17.4% vs. 23.5% of patients treated or not treated with aPP (random effect OR 0.60, 95% CI 0.46-0.79; I2 59%); orotracheal intubation was observed in 25.8% vs. 32.7% of patients treated or not treated with aPP (27 studies, 5369 patients; random effect OR 0.85, 95% CI 0.56-1.27; I2 84%). aPP reduces the risk for death or orotracheal intubation in patients with acute respiratory failure related to COVID-19. Further studies should be conducted to confirm the clinical benefit of aPP outside the ICU.Registration Prospero ID: CRD42022333211.
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Affiliation(s)
- Mara Graziani
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
| | | | - Diletta Bartolini
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Laura Traballi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Lorenzo Luzi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Rossana Regina
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Francesco Bossi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Carla Caponi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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6
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Wintjens MSJN, van Rosmalen F, Hemmelder MH, Hulsewe-Evers HPMG, Kusters YHAM, Ubben JFH, van Renswouw DAM, Gilissen KMH, van der Horst ICC, van Mook WNKA, van Bussel BCT. Prone positioning is followed by a transient decrease in glomerular filtration rate: the prospective Maastricht Intensive Care COVID cohort. J Nephrol 2023; 36:2669-2671. [PMID: 37668876 DOI: 10.1007/s40620-023-01767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Marieke S J N Wintjens
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Marc H Hemmelder
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hendrina P M G Hulsewe-Evers
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Yvo H A M Kusters
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johannes F H Ubben
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Anesthesiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daisy A M van Renswouw
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Katrien M H Gilissen
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debeyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Care and Public, Health Research Institute (CAPHRI), Maastricht, The Netherlands
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7
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Taghboulit NEI, Andrejak C, Mahjoub Y, Toublanc B, Mayeux I, Delomez J, Mercier M, Leriche P, Maizel J, Dupont H, Jounieaux V, Basille D. Long-term survival comparison between the first and second waves among 265 critical COVID-19 patients admitted to the ICU: A retrospective cohort study. Respir Med Res 2023; 84:101057. [PMID: 37918184 DOI: 10.1016/j.resmer.2023.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUD Management of severe COVID-19 patients admitted to ICU considerably evolved during the first months of the pandemic. It is unclear, however, whether these changes improved long-term survival of these critically ill patients. METHODS We conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to a French ICU between February 2020 and January 2021, a timeframe that covered the first two waves of the pandemic. Primary outcome was to compare long-term survival between the first and second waves. Survival predictor were identified using a Cox proportional-hazards model. RESULTS We included 265 patients in the cohort: 140 (52.8 %) and 125 (47.2 %) belonging to the first and second waves, respectively. Baseline characteristics of the patients were similar between the two waves. During W2, use of early corticotherapy increased (86.4% vs. 17.8 %; p <0.001), as well as high-flow oxygen therapy use (68.5% vs. 37.4 %; p<0.001). Need for invasive mechanical ventilation decreased (49.6% vs. 72.9 %; p <0.001) and ICU length of stay was shorter (11 [6-22] vs 19 [8-32]days; p = 0.008). ICU mortality was 32.8 % without significant difference between waves. Survival analysis revealed that 3 variables were independently associated with a worse long-term prognosis: a higher SAPS II score (1.05 [1.04-1.06]; p<0.001), a higher age (1.05 [1.01-1.08]; p = 0.005) and admission during W2 (2.22 [1.15-4.28]; p = 0.017). DISCUSSION Despite substantial changes on management of severe COVID-19 patients, we observed a decreased long-term survival among patients admitted during the second wave. We also noted a shorter ICU length of stay.
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Affiliation(s)
- Nour-El-Imane Taghboulit
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Claire Andrejak
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France; AGIR Unit - UR4294, University Picardie Jules Verne, 1, rue des Louvels, 80037 Amiens Cedex 1, France; RECIF Unit, University Picardie Jules Verne, 1, rue des Louvels, 80037 Amiens Cedex 1, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Bénédicte Toublanc
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Isabelle Mayeux
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Julia Delomez
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Marie Mercier
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Pauline Leriche
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Julien Maizel
- Intensive Care Department, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France
| | - Vincent Jounieaux
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France; AGIR Unit - UR4294, University Picardie Jules Verne, 1, rue des Louvels, 80037 Amiens Cedex 1, France
| | - Damien Basille
- Department of Respiratory Disease and Critical Care Unit, University Hospital Centre Amiens-Picardie, Amiens, France 1, Rue du Professeur Christian Cabrol 80054 Amiens-Cedex, France; AGIR Unit - UR4294, University Picardie Jules Verne, 1, rue des Louvels, 80037 Amiens Cedex 1, France; RECIF Unit, University Picardie Jules Verne, 1, rue des Louvels, 80037 Amiens Cedex 1, France.
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8
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Heines SJH, Becher TH, van der Horst ICC, Bergmans DCJJ. Clinical Applicability of Electrical Impedance Tomography in Patient-Tailored Ventilation: A Narrative Review. Tomography 2023; 9:1903-1932. [PMID: 37888742 PMCID: PMC10611090 DOI: 10.3390/tomography9050150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Electrical Impedance Tomography (EIT) is a non-invasive bedside imaging technique that provides real-time lung ventilation information on critically ill patients. EIT can potentially become a valuable tool for optimising mechanical ventilation, especially in patients with acute respiratory distress syndrome (ARDS). In addition, EIT has been shown to improve the understanding of ventilation distribution and lung aeration, which can help tailor ventilatory strategies according to patient needs. Evidence from critically ill patients shows that EIT can reduce the duration of mechanical ventilation and prevent lung injury due to overdistension or collapse. EIT can also identify the presence of lung collapse or recruitment during a recruitment manoeuvre, which may guide further therapy. Despite its potential benefits, EIT has not yet been widely used in clinical practice. This may, in part, be due to the challenges associated with its implementation, including the need for specialised equipment and trained personnel and further validation of its usefulness in clinical settings. Nevertheless, ongoing research focuses on improving mechanical ventilation and clinical outcomes in critically ill patients.
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Affiliation(s)
- Serge J. H. Heines
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
| | - Tobias H. Becher
- Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, University Medical Centre Schleswig-Holstein, 24118 Kiel, Germany;
| | - Iwan C. C. van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Dennis C. J. J. Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (I.C.C.v.d.H.); (D.C.J.J.B.)
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
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9
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Fayed M, Maroun W, Elnahla A, Yeldo N, Was JR, Penning DH. Prone Vs. Supine Position Ventilation in Intubated COVID-19 Patients: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39636. [PMID: 37388580 PMCID: PMC10305786 DOI: 10.7759/cureus.39636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Whether prone positioning of patients undergoing mechanical ventilation for COVID-19 pneumonia has benefits over supine positioning is not clear. We conducted a systematic review with meta-analysis to determine whether prone versus supine positioning during ventilation resulted in different outcomes for patients with COVID-19 pneumonia. We searched Ovid Medline, Embase, and Web of Science for prospective and retrospective studies up through April 2023. We included studies that compared outcomes of patients with COVID-19 after ventilation in prone and supine positions. The primary outcomes were three mortality measures: hospital, overall, and intensive care unit (ICU). Secondary outcomes were mechanical ventilation days, intensive care unit (ICU) length of stay, and hospital length of stay. We conducted risk of bias analysis and used meta-analysis software to analyze results. Mean difference (MD) was used for continuous data, and odds ratio (OR) was used for dichotomous data, both with 95% CIs. Significant heterogeneity (I2) was considered if I2 was >50%. A statistically significant result was considered if the p-value was <0.05. Of 1787 articles identified, 93 were retrieved, and seven retrospective cohort studies encompassing 5216 patients with COVID-19 were analyzed. ICU mortality was significantly higher in the prone group (OR 2.22, 95% CI 1.43-3.43; p=0.0004). No statistically significant difference was observed between prone and supine groups for hospital mortality (OR, 0.95; 95% CI, 0.66-1.37; p=0.78) or overall mortality (OR, 1.08; 95% CI, 0.72-1.64; p=0.71). Studies that analyzed primary outcomes had significant heterogeneity. Hospital length of stay was significantly higher in the prone than in the supine group (MD, 6.06; 95 % CI, 3.15-8.97; p<0.0001). ICU length of stay and days of mechanical ventilation did not differ between the two groups. In conclusion, mechanical ventilation with prone positioning for all patients with COVID-19 pneumonia may not provide a mortality benefit over supine positioning.
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Affiliation(s)
- Mohamed Fayed
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Wissam Maroun
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Ahmed Elnahla
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Nicholas Yeldo
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Jessica R Was
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Donald H Penning
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
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Lee HJ, Kim J, Choi M, Choi WI, Joh J, Park J, Kim J. Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis. Eur J Med Res 2022; 27:310. [PMID: 36572946 PMCID: PMC9792321 DOI: 10.1186/s40001-022-00953-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prone position has already been demonstrated to improve survival in non-COVID acute respiratory distress syndrome and has been widely performed in COVID-19 patients with respiratory failure, both in non-intubated and intubated patients. However, the beneficial effect of the prone position in COVID-19 pneumonia still remains controversial. Therefore, we aimed to evaluate the effectiveness and safety of the prone position compared with the non-prone in non-intubated and intubated COVID-19 patients, respectively. METHODS We searched the MEDLINE, EMBASE, and Cochrane databases, as well as one Korean domestic database, on July 9, 2021, and updated the search 9 times to September 14, 2022. Studies that compared prone and non-prone positions in patients with COVID-19 were eligible for inclusion. The primary outcomes were mortality, need for intubation, and adverse events. RESULTS Of the 1259 records identified, 9 randomized controlled trials (RCTs) and 23 nonrandomized studies (NRSs) were eligible. In the non-intubated patients, the prone position reduced the intubation rate compared with the non-prone position in 6 RCTs (n = 2156, RR 0.81, P = 0.0002) and in 18 NRSs (n = 3374, RR 0.65, P = 0.002). In the subgroup analysis according to the oxygen delivery method, the results were constant only in the HFNC or NIV subgroup. For mortality, RCTs reported no difference between prone and non-prone groups, but in NRSs, the prone position had a significant advantage in mortality [18 NRSs, n = 3361, relative risk (RR) 0.56, P < 0.00001] regardless of the oxygen delivery methods shown in the subgroup analysis. There was no RCT for intubated patients, and mortality did not differ between the prone and non-prone groups in NRSs. Adverse events reported in both the non-intubated and intubated groups were mild and similar between the prone and non-intubated groups. CONCLUSION For non-intubated patients with COVID-19, prone positioning reduced the risk of intubation, particularly in patients requiring a high-flow oxygen system. However, the survival benefit was unclear between the prone and non-prone groups. There was insufficient evidence to support the beneficial effects of prone positioning in intubated patients. Trial registration This study was registered in the Prospective Register of Systematic Reviews on February 16, 2022 (Registration No.: CRD42022311150 ).
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Affiliation(s)
- Hyeon-Jeong Lee
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
| | - Junghyun Kim
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, South Korea ,grid.256753.00000 0004 0470 5964Division of Pulmonary and Allergy, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-do South Korea
| | - Miyoung Choi
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
| | - Won-Il Choi
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Gyeonggi-do South Korea
| | - Joonsung Joh
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
| | - Joohae Kim
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, South Korea
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Cornejo RA, Montoya J, Gajardo AIJ, Graf J, Alegría L, Baghetti R, Irarrázaval A, Santis C, Pavez N, Leighton S, Tomicic V, Morales D, Ruiz C, Navarrete P, Vargas P, Gálvez R, Espinosa V, Lazo M, Pérez-Araos RA, Garay O, Sepúlveda P, Martinez E, Bruhn A, Rossel N, Martin MJ, Medel JN, Oviedo V, Vera M, Torres V, Montes JM, Salazar Á, Muñoz C, Tala F, Migueles M, Ortiz C, Gómez F, Contreras L, Daviu I, Rodriguez Y, Ortiz C, Aquevedo A, Parada R, Vargas C, Gatica M, Guerrero D, Valenzuela A, Torrejón D. Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile. Ann Intensive Care 2022; 12:109. [PMCID: PMC9702866 DOI: 10.1186/s13613-022-01082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.
Methods
Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.
Results
We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.
Conclusions
Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
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12
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Engerström L, Thermaenius J, Mårtensson J, Oldner A, Petersson J, Kåhlin J, Larsson E. Prevalence and impact of early prone position on 30-day mortality in mechanically ventilated patients with COVID-19: a nationwide cohort study. Crit Care 2022; 26:264. [PMID: 36058932 PMCID: PMC9441133 DOI: 10.1186/s13054-022-04122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
COVID-19 ARDS shares features with non-COVID ARDS but also demonstrates distinct physiological differences. Despite a lack of strong evidence, prone positioning has been advocated as a key therapy for COVID-19 ARDS. The effects of prone position in critically ill patients with COVID-19 are not fully understood, nor is the optimal time of initiation defined. In this nationwide cohort study, we aimed to investigate the association between early initiation of prone position and mortality in mechanically ventilated COVID-19 patients with low oxygenation on ICU admission.
Methods
Using the Swedish Intensive Care Registry (SIR), all Swedish ICU patients ≥ 18 years of age with COVID-19 admitted between March 2020, and April 2021 were identified. A study-population of patients with PaO2/FiO2 ratio ≤ 20 kPa on ICU admission and receiving invasive mechanical ventilation within 24 h from ICU admission was generated. In this study-population, the association between early use of prone position (within 24 h from intubation) and 30-day mortality was estimated using univariate and multivariable logistic regression models.
Results
The total study cohort included 6350 ICU patients with COVID-19, of whom 46.4% were treated with prone position ventilation. Overall, 30-day mortality was 24.3%. In the study-population of 1714 patients with lower admission oxygenation (PaO2/FiO2 ratio ≤ 20 kPa), the utilization of early prone increased from 8.5% in March 2020 to 48.1% in April 2021. The crude 30-day mortality was 27.2% compared to 30.2% in patients not receiving early prone positioning. We found no significant association between early use of prone positioning and survival.
Conclusions
During the first three waves of the COVID-19 pandemic, almost half of the patients in Sweden were treated with prone position ventilation. We found no association between early use of prone positioning and survival in patients on mechanical ventilation with severe hypoxemia on ICU admission. To fully elucidate the effect and timing of prone position ventilation in critically ill patients with COVID-19 further studies are desirable.
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Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study. Eur J Med Res 2022; 27:149. [PMID: 35962440 PMCID: PMC9372953 DOI: 10.1186/s40001-022-00776-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background To investigate whether prone position can reduce the risk of patients with mild or moderate COVID-19 who progress to severe or critical illness. Methods The prone position group was treated in prone position on the day of admission in addition to conventional treatment. Indicators such as saturation of pulse oximetry (SpO2), heart rate, blood pressure, respiratory rate, and prone position-related adverse events were recorded before prone ventilation, 5 min after prone position and 30 min after prone position. Meanwhile, the cases of severe and critical patients, the percentage of transformation and the final clinical outcome of this group were analyzed. Conversion rates and mortality were calculated for patients with mild or moderate COVID-19 retrieved from the database who received only conventional care without combined prone positioning as control group. Results (1) A total of 34 patients were included in prone position group. There were significant differences in SpO2 between the first 4 days after admission and the day of discharge (F = 3.17, P < 0.001). (2) The main complications were back and neck muscle soreness (55.9%), followed by abdominal distension (8.9%). (3) In control group, a total of 4873 cases of mild and moderate patients were included from 19 literatures, with an average deterioration rate of 22.7% and mortality rate of 1.7%. (4) In prone position group, there were no severe or critical transformation cases and also no death cases. The prone position group had a significantly lower deterioration rate when compared with the control group (χ2 = 9.962, P < 0.01). Conclusion Prone position improves SpO2 in patients with mild or moderate COVID-19. It can also reduce the percentage of mild or moderate patients progressing to severe or critical patients. The application of prone position is a simple, feasible, safe and effective treatment method in such patients.
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Chua EX, Wong ZZ, Hasan MS, Atan R, Yunos NM, Yip HW, Teoh WY, Ramli MAS, Ng KT. Prone ventilation in intubated COVID-19 patients: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:780-789. [PMID: 35809681 PMCID: PMC9259191 DOI: 10.1016/j.bjane.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022]
Abstract
Background The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. Results Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies: 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence: very low) and peripheral oxygen saturation (SpO2) (studies: 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence: ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies: 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p = 0.32; evidence: very low), mortality rate (studies: 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p = 0.24; evidence: very low), or number of patients discharged alive (studies: 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p = 0.28; evidence: very low). Conclusion Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.
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Affiliation(s)
- Ee Xin Chua
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Zhen Zhe Wong
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Rafidah Atan
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Nor'azim Mohd Yunos
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Hing Wa Yip
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Wan Yi Teoh
- University of Liverpool, Faculty of Medicine, Liverpool L69 3BX, United Kingdom
| | - Mohd Afiq Syahmi Ramli
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Ka Ting Ng
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia.
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Battaglini D, Pelosi P, Rocco PRM. Prone positioning in COVID-19 ARDS: more pros than cons. J Bras Pneumol 2022; 48:e20220065. [PMID: 35584468 PMCID: PMC9064653 DOI: 10.36416/1806-3756/e20220065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Denise Battaglini
- . Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - per l'Oncologia e le Neuroscienze, Genova, Italia
| | - Paolo Pelosi
- . Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - per l'Oncologia e le Neuroscienze, Genova, Italia
- . Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italia
| | - Patricia R M Rocco
- . Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
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Kho ME, Rewa OG, Boyd JG, Choong K, Stewart GCH, Herridge MS. Outcomes of critically ill COVID-19 survivors and caregivers: a case study-centred narrative review. Can J Anaesth 2022; 69:630-643. [PMID: 35102495 PMCID: PMC8802985 DOI: 10.1007/s12630-022-02194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Critical illness is a transformative experience for both patients and their family members. For COVID-19 patients admitted to the intensive care unit (ICU), survival may be the start of a long road to recovery. Our knowledge of the post-ICU long-term sequelae of acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) may inform our understanding and management of the long-term effects of COVID-19. SOURCE We identified international and Canadian epidemiologic data on ICU admissions for COVID-19, COVID-19 pathophysiology, emerging ICU practice patterns, early reports of long-term outcomes, and federal support programs for survivors and their families. Centred around an illustrating case study, we applied relevant literature from ARDS and SARS to contextualize knowledge within emerging COVID-19 research and extrapolate findings to future long-term outcomes. PRINCIPAL FINDINGS COVID-19 is a multisystem disease with unknown long-term morbidity and mortality. Its pathophysiology is distinct and unique from ARDS, SARS, and critical illness. Nevertheless, based on initial reports of critical care management for COVID-19 and the varied injurious supportive practices employed in the ICU, patients and families are at risk for post-intensive care syndrome. The distinct incremental risk of COVID-19 multiple organ dysfunction is unknown. The risk of mood disorders in family members may be further exacerbated by imposed isolation and stigma. CONCLUSION Emerging literature on COVID-19 outcomes suggests some similarities with those of ARDS/SARS and prolonged mechanical ventilation. The pathophysiology of COVID-19 is presented here in the context of early outcome data and to inform an agenda for longitudinal research for patients and families.
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Kingston Health Sciences Centre, and Department of Critical Care, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Karen Choong
- Department of Pediatrics and the Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, ON, Canada
| | | | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto and University Health Network, Toronto General Hospital, Toronto, ON, Canada
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Brioni M, Meli A, Grasselli G. Mechanical Ventilation for COVID-19 Patients. Semin Respir Crit Care Med 2022; 43:405-416. [PMID: 35439831 DOI: 10.1055/s-0042-1744305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-invasive ventilation (NIV) or invasive mechanical ventilation (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered in hospital wards and nonintensive care environments, intubated patients require intensive care unit (ICU) admission and support. Thus, the lack of ICU beds generated by the pandemic has often forced the use of NIV in severely hypoxemic patients treated outside the ICU. In this context, awake prone positioning has been widely adopted to ameliorate oxygenation during noninvasive respiratory support. Still, the incidence of NIV failure and the role of patient self-induced lung injury on hospital outcomes of COVID-19 subjects need to be elucidated. On the other hand, endotracheal intubation is indicated when gas exchange deterioration, muscular exhaustion, and/or neurological impairment ensue. Yet, the best timing for intubation in COVID-19 is still widely debated, as it is the safest use of neuromuscular blocking agents. Not differently from other types of acute respiratory distress syndrome, the aim of MV during COVID-19 is to provide adequate gas exchange while avoiding ventilator-induced lung injury. At the same time, the use of rescue therapies is advocated when standard care is unable to guarantee sufficient organ support. Nevertheless, the general shortage of health care resources experienced during SARS-CoV-2 pandemic might affect the utilization of high-cost, highly specialized, and long-term supports. In this article, we describe the state-of-the-art of NIV and MV setting and their usage for acute hypoxemic respiratory failure of COVID-19 patients.
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Affiliation(s)
- Matteo Brioni
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Meli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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