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V S, Marwah V, Jyothis MC. Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation. Indian J Crit Care Med 2024; 28:309-310. [PMID: 38477005 PMCID: PMC10926043 DOI: 10.5005/jp-journals-10071-24642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Shrinath V, Marwah V, Jyothis MC. Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation. Indian J Crit Care Med 2024;28(3):309-310.
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Affiliation(s)
- Shrinath V
- Department of Respiratory Medicine, INHS Asvini, Mumbai, Maharashtra, India
| | - Vikas Marwah
- Department of Respiratory Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - MC Jyothis
- Department of Respiratory Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
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Fernando JMG, Marçal MMG, Ferreira ÓR, Oliveira C, Pedreira L, Baixinho CL. Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review. Healthcare (Basel) 2024; 12:545. [PMID: 38470656 PMCID: PMC10930648 DOI: 10.3390/healthcare12050545] [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: 01/10/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there are difficulties in adhering to and maintaining this therapy. The aim of this study is to identify nursing interventions for client and family training in the proper use of noninvasive ventilation in the transition from hospital to community. A scoping review was carried out by searching MEDLINE, CINAHL, Scopus, and Web of Science. The articles were selected by two independent reviewers by applying the predefined eligibility criteria. Regarding transitional care, the authors opted to include studies about interventions to train clients and families during hospital stay, hospital discharge, transition from hospital to home, and the first 30 days after returning home. The eight included publications allowed for identification of interventions related to masks or interfaces, prevention of complications associated with noninvasive ventilation, leakage control, maintenance and cleaning of ventilators and accessories, respiratory training, ventilator monitoring, communication, and behavioral strategies as transitional care priority interventions to guarantee proper training in the transition from hospital to community.
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Affiliation(s)
| | - Margarida Maria Gaio Marçal
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
| | - Óscar Ramos Ferreira
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
| | - Cleoneide Oliveira
- Medical School Estácio Idomed Quixadá, University Center Estacio do Cearà, Fortaleza 60035-111, Brazil;
| | - Larissa Pedreira
- Nursing School, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - Cristina Lavareda Baixinho
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
- Center of Innovative Care and Health Technology (ciTechCare), 2414-016 Leiria, Portugal
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Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2023. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
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Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
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Tack J, Bruyneel A, Bouillon Y, Taton O, Taccone F, Pirson M. Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score. Dimens Crit Care Nurs 2023; 42:286-294. [PMID: 37523728 DOI: 10.1097/dcc.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. METHODS This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. RESULTS During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. CONCLUSION A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.
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Ramping Position to Aid Non-invasive Ventilation (NIV) in Obese Patients in the ICU. J Crit Care Med (Targu Mures) 2023; 9:43-48. [PMID: 36890977 PMCID: PMC9987266 DOI: 10.2478/jccm-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/06/2022] [Indexed: 02/10/2023] Open
Abstract
Introduction The ramping position is recommended to facilitate pre-oxygenation and mask ventilation of obese patients in anaesthetics via improving the airway alignment. Presentation of case series Two cases of obese patients admitted to the intensive care unit (ICU) with type 2 respiratory failure. Both cases showed obstructive breathing patterns on non-invasive ventilation (NIV) and failed resolution of hypercapnia. Ramping position alleviated the obstructive breathing pattern and hypercapnia was subsequently resolved. Conclusion There are no available studies on the rule of the ramping position in aiding NIV in obese patients in the ICU. Accordingly, this case series is significantly important in highlighting the possible benefits of the ramping position for obese patients in settings other than anaesthesia.
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Guziejko K, Minarowski Ł, Mróz R. Case Report: Case report: Non-invasive mechanical ventilation in combination with bronchoscopy in the treatment of respiratory failure of lung cancer patient. F1000Res 2022; 11:1130. [PMID: 37600219 PMCID: PMC10439354 DOI: 10.12688/f1000research.124457.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 08/22/2023] Open
Abstract
Background: Respiratory failure (RF) is a common medical problem among cancer patients. Particularly active or ex-smokers diagnosed with chronic obstructive pulmonary disease (COPD) or lung cancer may develop severe hypoxemic and hypercapnic respiratory failure. Moreover, pneumonitis as a complication of the currently widely used immunotherapy of various cancers, may cause respiratory disorders requiring ventilation support. Non-invasive ventilation (NIV) is recommended as the first-line treatment for this type of respiratory failure and reduces the need for endotracheal intubation. Case presentation: We present a case report of lung cancer patient, who received NIV in the treatment of RF due to an infectious exacerbation of COPD. In addition, NIV enabled assisted flexible bronchoscopy (NIV-FB) to be performed. During the procedure tumor samples were collected for further molecular diagnosis of lung cancer. Improvement of the patient general condition and quality of life was also achieved. Conclusions: NIV can be used at any stage of oncological management in patients with lung cancer. It can also be implemented during endoscopic procedures of the respiratory system, as well as support in palliative care of patients with lung cancer at the end of life. Further studies should evaluate the use of NIV in conjunction with various oncological treatments and identify the exact contradictions for BF with NIV support in advanced cancer patients with RF.
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Affiliation(s)
- Katarzyna Guziejko
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Zurawia 14, 15-540, Poland
| | - Łukasz Minarowski
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Zurawia 14, 15-540, Poland
| | - Robert Mróz
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Zurawia 14, 15-540, Poland
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Oliveira DSD, Firmo RC, Silva Júnior JRD. Comparação da Mortalidade entre Pacientes com Neoplasias submetidos à Ventilação Invasiva e não Invasiva: Estudo de Coorte Retrospectiva. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introdução: O paciente com câncer apresenta alta prevalência de insuficiência respiratória aguda (IRpA) relacionada a complicações do tratamento oncológico. O suporte ventilatório mecânico e a principal terapêutica para resolução dessas complicações. No entanto, tal recurso pode aumentar a mortalidade. Objetivo: Verificar a taxa de mortalidade e os fatores intervenientes de pacientes oncológicos com IRpA expostos a ventilação mecânica invasiva (VMI) e não invasiva (VNI). Método: Estudo de coorte retrospectiva. Foram incluídos 121 pacientes oncológicos em ventilação mecânica separados em grupos: neoplasias hematológicas em VMI (HVMI, n=17), neoplasias hematológicas em VNI (HVNI, n=36), neoplasias solidas em VMI (SVMI, n=39) e neoplasias solidas em VNI (SVNI, n=29). Os desfechos avaliados foram: taxa de mortalidade, tempo de internamento, tempo de exposição a ventilação mecânica, taxa de falha da VNI e fatores relacionados a falha da VNI. Resultados: A taxa de mortalidade geral foi de 47,9%, distribuídos em HVMI (82,4%), HVNI (27,8%), SVMI (69,2%) e SVNI (24,1%). O escore APACHE III elevado foi associado a uma maior taxa de mortalidade. A taxa de mortalidade associada a falha da VNI foi de 71,4% HVNI e 77,8% SVNI. As variáveis associadas a maior taxa de falha da VNI foram o APACHE III>7 e o tempo de exposição a VNI>72 horas. Conclusão: A taxa de mortalidade de pacientes com neoplasia hematológica e solida em IRpA mostrou-se menor em pacientes expostos a VNI.
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Noninvasive Ventilation in Treatment of Respiratory Failure-Related COVID-19 Infection: Review of the Literature. Can Respir J 2022; 2022:9914081. [PMID: 36091330 PMCID: PMC9453089 DOI: 10.1155/2022/9914081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/22/2021] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
The recently diagnosed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in December 2019 commonly affects the respiratory system. The incidence of acute hypoxic respiratory failure varied among epidemiological studies with high percentage of patients requiring mechanical ventilation with a high mortality. Noninvasive ventilation is an alternative tool for ventilatory support instead of invasive mechanical ventilation, especially with scarce resources and intensive care beds. Initially, there were concerns by the national societies regarding utilization of noninvasive ventilation in acute respiratory failure. Recent publications reflect the gained experience with the safe utilization of noninvasive mechanical ventilation. Noninvasive ventilation has beneficiary role in treatment of acute hypoxic respiratory failure with proper indications, setting, monitoring, and timely escalation of therapy. Patients should be monitored frequently for signs of improvement or deterioration in the clinical status. Awareness of indications, contraindications, and parameters reflecting either success or failure of noninvasive ventilation in the management of acute respiratory failure secondary to COVID-19 is essential for improvement of outcomes.
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Altınkaya Çavuş M, Gökbulut Bektaş S, Turan S. Comparison of clinical safety and efficacy of dexmedetomidine, remifentanil, and propofol in patients who cannot tolerate non-invasive mechanical ventilation: A prospective, randomized, cohort study. Front Med (Lausanne) 2022; 9:995799. [PMID: 36111123 PMCID: PMC9468549 DOI: 10.3389/fmed.2022.995799] [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: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectivesNon-invasive ventilation (NIV) is used in intensive care units (ICUs) to treat of respiratory failure. Sedation and analgesia are effective and safe for improving compliance in patients intolerant to NIV. Our study aimed to evaluate the effects of dexmedetomidine, remifentanil, and propofol on the clinical outcomes in NIV intolerant patients.MethodsThis prospective randomized cohort study was conducted in a tertiary ICU, between December 2018 and December 2019. We divided a total of 120 patients into five groups (DEXL, DEXH, REML, REMH, PRO). IBM SPSS Statistics 20 (IBM Corporation, Armonk, New York, USA) was used to conduct the statistical analyses.ResultsThe DEXL, DEXH, REML, and REMH groups consisted of 23 patients each while the PRO group consisted of 28 patients. Seventy-five patients (62.5%) became tolerant of NIV after starting the drugs. The NIV time, IMV time, ICU LOS, hospital LOS, intubation rate, side effects, and mortality were significantly different among the five groups (P = 0.05). In the groups that were given dexmedetomidine (DEXL, and DEXH), NIV failure, mortality, ICU LOS, and hospital LOS were lower than in the other groups.ConclusionIn this prospective study, we compared the results of three drugs (propofol, dexmedetomidine, and remifentanil) in patients with NIV intolerance. The use of sedation increased NIV success in patients with NIV intolerance. NIV failure, mortality, ICU LOS, IMV time, and hospital LOS were found to be lower with dexmedetomidine.
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Affiliation(s)
- Mine Altınkaya Çavuş
- Kayseri City Hospital, Republic of Turkey Ministry of Health Sciences, Kayseri, Turkey
- *Correspondence: Mine Altınkaya Çavuş
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Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, Gonçalves G, Caldeira V, Cabrita B, Perren A, Fiorentino G, Utku T, Piervincenzi E, El-Khatib M, Alpay N, Ferrari R, Abdelrahim MEA, Saeed H, Madney YM, Harb HS, Vargas N, Demirkiran H, Bhakta P, Papadakos P, Gómez-Ríos MÁ, Abad A, Alqahtani JS, Hadda V, Singha SK, Esquinas AM. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022; 26:938-948. [PMID: 36042773 PMCID: PMC9363803 DOI: 10.5005/jp-journals-10071-23950] [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] [Indexed: 11/28/2022] Open
Abstract
Aim This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV). Background NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation. Methods Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done. Review results Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile. Conclusion Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations. How to cite this article Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938–948.
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Affiliation(s)
- Habib MR Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
- Habib MR Karim, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, Phone: +91 9612372585, e-mail:
| | - Irena Šarc
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Camilla Calandra
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, New York, United States
| | - Bushra Mina
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, Iasi, Romania; Consultant in Internal Medicine and Pulmonology, Clinical Hospital of Rehabilitation, Iasi, Romania
| | - Laura D Ciobanu
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gil Gonçalves
- Pulmonology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Vania Caldeira
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Bruno Cabrita
- Department of Intensive Care Medicine EOC, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Andreas Perren
- Respiratory Unit, AO dei Colli Monaldi Hospital, Naples, Italy
| | - Giuseppe Fiorentino
- Department of Anaesthesiology and Reanimation, General Intensive Care, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Tughan Utku
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Italy; Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli University Policlinic, IRCCS, Italy
| | - Edoardo Piervincenzi
- Department of Anesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Mohamad El-Khatib
- Department of Anesthesiology and Reanimation, Cukurova University Faculty of Dentistry, Adana, Turkey
| | - Nilgün Alpay
- Emergency Department, Santa Maria della Scaletta Hospital, AUSL Imola, Imola, Italy
| | - Rodolfo Ferrari
- Noninvasive Ventilation Department, University Clinic for Pulmonary and Allergic Diseases, Golnik, Slovenia
| | - Mohamed EA Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Yasmin M Madney
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hadeer S Harb
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Nicola Vargas
- Geriatric and Intensive Geriatric Cares Unit, Medicine Department, “San Giuseppe Moscati” Hospital, Avellino, Italy
| | - Hilmi Demirkiran
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
| | - Peter Papadakos
- Department of Anesthesiology, University of Rochester, Rochester, New York, United States
| | - Manuel Á Gómez-Ríos
- Department of Anesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, Galicia, Spain
| | - Alfredo Abad
- Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Subrata K Singha
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Mehta C, Mehta Y. Noninvasive Respiratory Devices in COVID-19. Indian J Crit Care Med 2022; 26:770-772. [PMID: 36864875 PMCID: PMC9973168 DOI: 10.5005/jp-journals-10071-24268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Mehta C, Mehta Y. Noninvasive Respiratory Devices in COVID-19. Indian J Crit Care Med 2022;26(7):770-772.
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Affiliation(s)
- Chitra Mehta
- Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India,Yatin Mehta, Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India, Phone: +91 9971698149, e-mail:
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Tan W, Dai B, Xu DY, Li LL, Li J. In-Vitro Comparison of Single Limb and Dual Limb Circuit for Aerosol Delivery via Noninvasive Ventilation. Respir Care 2022; 67:807-813. [PMID: 35473786 PMCID: PMC9994089 DOI: 10.4187/respcare.09543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The effect of single- and dual-limb circuits on aerosol delivery during noninvasive ventilation (NIV) in adult models is unclear. METHODS A noninvasive ventilator equipped with a single-limb circuit or an ICU ventilator equipped with a dual-limb circuit was connected to a simulated lung. Ventilator parameters were adjusted to maintain a tidal volume at ∼500 mL. Aerosol deposition with different placements of a vibrating mesh nebulizer and humidification conditions were compared. Additional experiments by using a non-vented mask or a vented mask were compared in the single-limb circuit only. Aerosol was collected by a disposable filter placed between the simulated lung and the head model (n = 3), and measured by ultraviolet spectrophotometry (276 nm). RESULTS The aerosol deposition varied between 4.12 ± 0.22% and 20.75 ± 0.95%. The greatest aerosol delivery during NIV when using a non-vented mask was found when a vibrating mesh nebulizer was placed between the mask and 15 cm from the exhalation port in the humidified single-limb circuit, and 15 cm from the Y-piece in the inspiratory limb of the humidified dual-limb circuit, and no significant difference of aerosol deposition was found between the two optimal positions (20.03 ± 1.48% vs 18.04 ± 0.93%, respectively; P =.042). There was no difference of aerosol delivery in dry versus humidified circuits, except when a vibrating mesh nebulizer was placed at the humidifier inlet in a dual-limb circuit. When using a vented mask, the aerosol deposition was poor (6.56 ± 0.41 ∼ 8.02 ± 0.39%), regardless of vibrating mesh nebulizer positions and humidification types. CONCLUSIONS During NIV, the aerosol delivery was optimal when a vibrating mesh nebulizer was placed between the non-vented mask and 15 cm from the exhalation port in the single-limb circuit or 15 cm from the Y-piece in the inspiratory limb of the dual-limb circuit; no significant difference was found between the two optimal placements. Humidification had little effect on aerosol delivery. Aerosol delivery was poor in the single-limb circuit with a vented mask.
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Affiliation(s)
- Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dong-Yang Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Li-Li Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois.
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Tan W, Hou HJ, Lu CL, Dai B, Zhao HW, Wang W, Kang J. Effect of Mask Selection on the Leak Test in Ventilators Designed for Noninvasive Ventilation. Respir Care 2022; 67:572-578. [PMID: 35292521 PMCID: PMC9994259 DOI: 10.4187/respcare.08299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The mask leak test used for modern noninvasive ventilators can detect the leak characteristics of masks that are not recommended by the manufacturer, but it has not yet been determined whether this method is acceptable. METHODS A noninvasive ventilator equipped with a single-limb circuit and an oronasal mask was connected to a lung simulator. The ventilator was set to S/T mode, and inspiratory positive airway pressure/expiratory positive airway pressure was set to 10/5, 15/5, and 20/5 cm H2O, respectively. Eight nonmanufacturer-recommended oronasal masks were connected to the ventilator. The lung simulator was used to simulate COPD, restrictive disease, and normal lung, respectively. When switching between masks, the mask leak test was set to "Cancel" or "Start Test" in the noninvasive ventilator. The parameters displayed on the lung simulator and ventilator were recorded before and after the mask leak test. RESULTS There were no significant difference before versus after the mask leak test for any lung simulator parameter, including trigger performance (ie, time from the beginning of the simulated inspiratory effort to the lowest value of airway pressure needed to trigger the ventilator, the magnitude of airway pressure drop needed to trigger, and time to trigger), inspiratory pressure delivery, PEEP, tidal volume, and displayed peak inspiratory pressure (all differences < 10%). At different noninvasive ventilation settings, tidal volumes displayed on the ventilator of the 3 masks were significantly different before and after mask leak test (all P < .05, and difference rate > 10%). CONCLUSIONS The mask leak test had no effect on the ventilator performance when masks not recommended by the manufacturer were used, but tidal volume monitoring may be more accurate when some masks were used.
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Affiliation(s)
- Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hai-Jia Hou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chang-Ling Lu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
| | - Hong-Wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Cammarota G, Simonte R, De Robertis E. Comfort During Non-invasive Ventilation. Front Med (Lausanne) 2022; 9:874250. [PMID: 35402465 PMCID: PMC8988041 DOI: 10.3389/fmed.2022.874250] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 01/03/2023] Open
Abstract
Non-invasive ventilation (NIV) has been shown to be effective in avoiding intubation and improving survival in patients with acute hypoxemic respiratory failure (ARF) when compared to conventional oxygen therapy. However, NIV is associated with high failure rates due, in most cases, to patient discomfort. Therefore, increasing attention has been paid to all those interventions aimed at enhancing patient's tolerance to NIV. Several practical aspects have been considered to improve patient adaptation. In particular, the choice of the interface and the ventilatory setting adopted for NIV play a key role in the success of respiratory assistance. Among the different NIV interfaces, tolerance is poorest for the nasal and oronasal masks, while helmet appears to be better tolerated, resulting in longer use and lower NIV failure rates. The choice of fixing system also significantly affects patient comfort due to pain and possible pressure ulcers related to the device. The ventilatory setting adopted for NIV is associated with varying degrees of patient comfort: patients are more comfortable with pressure-support ventilation (PSV) than controlled ventilation. Furthermore, the use of electrical activity of the diaphragm (EADi)-driven ventilation has been demonstrated to improve patient comfort when compared to PSV, while reducing neural drive and effort. If non-pharmacological remedies fail, sedation can be employed to improve patient's tolerance to NIV. Sedation facilitates ventilation, reduces anxiety, promotes sleep, and modulates physiological responses to stress. Judicious use of sedation may be an option to increase the chances of success in some patients at risk for intubation because of NIV intolerance consequent to pain, discomfort, claustrophobia, or agitation. During the Coronavirus Disease-19 (COVID-19) pandemic, NIV has been extensively employed to face off the massive request for ventilatory assistance. Prone positioning in non-intubated awake COVID-19 patients may improve oxygenation, reduce work of breathing, and, possibly, prevent intubation. Despite these advantages, maintaining prone position can be particularly challenging because poor comfort has been described as the main cause of prone position discontinuation. In conclusion, comfort is one of the major determinants of NIV success. All the strategies aimed to increase comfort during NIV should be pursued.
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Paiva DN, Wagner LE, Dos Santos Marinho SE, Dornelles CFD, de Souza Barbosa JF, de Melo Marinho PÉ. Effectiveness of an adapted diving mask (Owner mask) for non-invasive ventilation in the COVID-19 pandemic scenario: study protocol for a randomized clinical trial. Trials 2022; 23:218. [PMID: 35303958 PMCID: PMC8931183 DOI: 10.1186/s13063-022-06133-y] [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: 08/10/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background Non-invasive ventilation (NIV) is indicated to avoid orotracheal intubation (OTI) to reduce hospital stay and mortality. Patients infected by SARS-CoV2 can progress to respiratory failure (RF); however, in the initial phase, they can be submitted to oxygen therapy and NIV. Such resources can produce aerosol and can cause a high risk of contagion to health professionals. Safe NIV strategies are sought, and therefore, the authors adapted diving masks to be used as NIV masks (called an Owner mask). Objective To assess the Owner mask safety and effectiveness regarding conventional orofacial mask for patients in respiratory failure with and without confirmation or suspicion of COVID-19. Methods A Brazilian multicentric study to assess patients admitted to the intensive care unit regarding their clinical, sociodemographic and anthropometric data. The primary outcome will be the rate of tracheal intubation, and secondary outcomes will include in-hospital mortality, the difference in PaO2/FiO2 ratio and PaCO2 levels, time in the intensive care unit and hospitalization time, adverse effects, degree of comfort and level of satisfaction of the mask use, success rate of NIV (not progressing to OTI), and behavior of the ventilatory variables obtained in NIV with an Owner mask and with a conventional face mask. Patients with COVID-19 and clinical signs indicative of RF will be submitted to NIV with an Owner mask [NIV Owner COVID Group (n = 63)] or with a conventional orofacial mask [NIV orofacial COVID Group (n = 63)], and those patients in RF due to causes not related to COVID-19 will be allocated into the NIV Owner Non-COVID Group (n = 97) or to the NIV Orofacial Non-COVID Group (n = 97) in a randomized way, which will total 383 patients, admitting 20% for loss to follow-up. Discussion This is the first randomized and controlled trial during the COVID-19 pandemic about the safety and effectiveness of the Owner mask compared to the conventional orofacial mask. Experimental studies have shown that the Owner mask enables adequate sealing on the patient’s face and the present study is relevant as it aims to minimize the aerosolization of the virus in the environment and improve the safety of health professionals. Trial registration Brazilian Registry of Clinical Trials (ReBEC): RBR – 7xmbgsz. Registered on 15 April 2021.
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Affiliation(s)
- Dulciane Nunes Paiva
- Post-Graduate Program in Health Promotion, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil.
| | - Litiele Evelin Wagner
- Multiprofessional Residency Health Program, Hospital Santa Cruz, Santa Cruz do Sul, RS, Brazil
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Sullivan ZP, Zazzeron L, Berra L, Hess DR, Bittner EA, Chang MG. Noninvasive respiratory support for COVID-19 patients: when, for whom, and how? J Intensive Care 2022; 10:3. [PMID: 35033204 PMCID: PMC8760575 DOI: 10.1186/s40560-021-00593-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/26/2021] [Indexed: 12/14/2022] Open
Abstract
The significant mortality rate and prolonged ventilator days associated with invasive mechanical ventilation (IMV) in patients with severe COVID-19 have incited a debate surrounding the use of noninvasive respiratory support (NIRS) (i.e., HFNC, CPAP, NIV) as a potential treatment strategy. Central to this debate is the role of NIRS in preventing intubation in patients with mild respiratory disease and the potential beneficial effects on both patient outcome and resource utilization. However, there remains valid concern that use of NIRS may prolong time to intubation and lung protective ventilation in patients with more advanced disease, thereby worsening respiratory mechanics via self-inflicted lung injury. In addition, the risk of aerosolization with the use of NIRS has the potential to increase healthcare worker (HCW) exposure to the virus. We review the existing literature with a focus on rationale, patient selection and outcomes associated with the use of NIRS in COVID-19 and prior pandemics, as well as in patients with acute respiratory failure due to different etiologies (i.e., COPD, cardiogenic pulmonary edema, etc.) to understand the potential role of NIRS in COVID-19 patients. Based on this analysis we suggest an algorithm for NIRS in COVID-19 patients which includes indications and contraindications for use, monitoring recommendations, systems-based practices to reduce HCW exposure, and predictors of NIRS failure. We also discuss future research priorities for addressing unanswered questions regarding NIRS use in COVID-19 with the goal of improving patient outcomes.
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Affiliation(s)
- Zachary P Sullivan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Dean R Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA.
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He J, Yi S, Zhou Y, Hu X, Lun Z, Dong H, Zhang Y. B-Lines by Lung Ultrasound Can Predict Worsening Heart Failure in Acute Myocardial Infarction During Hospitalization and Short-Term Follow-Up. Front Cardiovasc Med 2022; 9:895133. [PMID: 35586654 PMCID: PMC9108169 DOI: 10.3389/fcvm.2022.895133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/12/2022] [Indexed: 12/22/2022] Open
Abstract
Background Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. It has been proved to predict prognosis in heart failure; however, whether it can be used as a short-term prognostic marker in AMI and provide incremental value to Killip classification is unknown. Methods We performed echocardiography and LUS by the 8-zone method in patients enrolled in Guangdong Provincial People's Hospital undergoing percutaneous coronary intervention for AMI from March to July 2021. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The NT-proBNP analysis was performed on the same day. All patients were followed up for 30 days after discharge. The adverse events were defined as all-cause death, worsening heart failure in hospitalization, or re-hospitalization for heart failure during the follow-up. Results Sixty three patients were enrolled consecutively and followed up for 30 days. The number of B-lines at admission (median 7[3-15]) was correlated with NT-proBNP (r = 0.37, p = 0.003) and negatively correlated with ejection fraction (r = -0.43; p < 0.001) separately. In the multivariate analysis, B-line number was an independent predictor of short-term outcomes in AMI patients (in-hospital, adjusted OR 1.13 [95% CI: 1.04-1.23], P = 0.006; 30-day follow-up, adjusted OR 1.09 [95% CI: 1.01-1.18], P = 0.020). For in-hospital results, the area under the receiver operating characteristic curves (AUCs) were 0.639 (P = 0.093), 0.837 (P < 0.001), and 0.847 (P < 0.001) for Killip, LUS and their combination, respectively. For the diagnosis of 30-day adverse events, the AUCs were 0.665 for the Killip classification (P = 0.061), 0.728 for LUS (P = 0.010), and 0.778 for their combination (P = 0.002). Conclusion B-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.
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Affiliation(s)
- Jiexin He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shixin Yi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ziheng Lun
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
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Gao Y, Yan F. Comparison of Intra and Post-operative Sedation efficacy of Dexmedetomidine-Midazolam and Dexmedetomidine-Propofol for Major Abdominal Surgery. Curr Drug Metab 2021; 23:45-56. [PMID: 34732114 DOI: 10.2174/1389200222666211103121832] [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: 02/22/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effectiveness and side effects of dexmedetomidine (DEX) in combination with midazolam and propofol have not been comparatively studied in a single clinical trial as sedative agents to general anesthesia before. OBJECTIVE The objective of this study is to compare intra and post-operative sedation between DEX-Midazolam and DEX-Propofol in patients who underwent major abdominal surgery on the duration of general anesthesia, hemodynamic and sedation effect. METHOD This prospective, randomized, double-blinded clinical trial included 50 patients who were 20 to 60 years of age and admitted for major abdominal surgery. The patients were randomly assigned by a computer-generated random numbers table to sedation with DEX plus midazolam (DM group) (n=25) or DEX plus propofol (DP group) (n=25). In the DM group, patients received a bolus dose of 0.1 mg/kg of midazolam and immediately initiated the intravenous (i.v.) infusion of DEX 1 µg/kg over a 10 min and 0.5 µg/kg/hr by continuous i.v. infusion within operation period. In the DP group, patients received pre-anesthetic i.v. DEX 1 µg/kg over 15 min before anesthesia induction and 0.2-1 µg/kg/hr by continuous i.v. infusion during the operative period. After preoxygenation for at least 2 min, during the surgery, patients received propofol infusion dose of 250 μg/kg/min for 15 min then a basal infusion dose of 50 μg/kg/min. The bispectral index (BIS) value, as well as mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), percutaneous arterial oxygen saturation (SpO2) and end-tidal carbon dioxide tension (ETCO2) were recorded before anesthesia (T0), during anesthesia (at 15-min intervals throughout the surgical procedure), by a blinded observer. Evidence of apnea, hypotension, hypertension and hypoxemia were recorded during surgery. RESULTS The hemodynamic changes, including HR, MAP, BIS, VT, SaO2, and RR had a downward tendency with time, but no significant difference was observed between the groups (P>0.05). However, the two groups showed no significant differences in ETCO2 and SPO2 values in any of the assessed interval (P>0.05). In this study, the two groups showed no significant differences in the incidence of nausea, vomiting, coughing, apnea, hypotension, hypertension, bradycardia and hypoxemia (P>0.05). Respiratory depression and serious adverse events were not reported in either group. Extubation time after surgery was respectively 6.3 ± 1.7 and 5.8 ± 1.4 hr. in the DM and DP groups and the difference was not statistically significant (P= 0.46). CONCLUSION Our study showed no significant differences between the groups in hemodynamic and respiratory changes in each of the time intervals. There were also no significant differences between the two groups in the incidence of complication intra and post-operative. Further investigations are required to specify the optimum doses of using drugs which provide safety in cardiovascular and respiratory system without adverse disturbance during surgery.
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Affiliation(s)
- Yuanyuan Gao
- Department of Anesthesiology, the second hospital of Yulin, Yulin, Shanxi Province. China
| | - Fei Yan
- Department of Anesthesiology, the Hospital of Traditional Chinese Medicine of Yulin, Yulin, Shanxi Province. China
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Effects of Stress Psychological Intervention on the Cardiopulmonary Function, Negative Emotion, Self-Efficacy, and Quality of Life in Patients with Acute Respiratory Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9359102. [PMID: 34552656 PMCID: PMC8452410 DOI: 10.1155/2021/9359102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate the changes in cardiopulmonary function, negative emotion, self-efficacy, and quality of life in patients with acute respiratory failure (ARF) after stress psychological intervention. Methods A prospective study was conducted on 104 patients with ARF admitted to our hospital from March 2019 to March 2021. According to the random number method, the patients were divided into a control group (n = 52) and an experimental group (n = 52). Routine intervention was implemented in the control group, and stress psychological intervention was implemented in the experimental group on the basis of the control group. The cardiopulmonary function, negative emotion, self-efficacy, and quality of life in the two groups were compared. Results The left ventricular ejection fractions and fraction shortening in the experimental group were higher than those in the control group, as well as the left ventricular mass index was lower than that in the control group (P < 0.05). The first forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC in the experimental group were higher than those in the control group (P < 0.05). The Self-Rating Anxiety Scale scores and Self-Rating Depression Scale scores in the experimental group were lower than those in the control group (P < 0.05). The General Self-Efficacy Scale scores of the experimental group were higher than those of the control group (P < 0.05). The Concise Health Measurement Scale scores of the experimental group were higher than those of the control group (P < 0.05). Conclusion Stress psychological intervention in patients with ARF can improve cardiopulmonary function, reduce negative emotions, improve self-efficacy, and improve quality of life.
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Skoczyński S, Ogonowski M, Tobiczyk E, Krzyżak D, Brożek G, Wierzbicka A, Trzaska-Sobczak M, Trejnowska E, Studnicka A, Swinarew A, Kucewicz-Czech E, Gierek D, Rychlik W, Barczyk A. Risk factors of complications during noninvasive mechanical ventilation -assisted flexible bronchoscopy. Adv Med Sci 2021; 66:246-253. [PMID: 33892212 DOI: 10.1016/j.advms.2021.04.001] [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: 10/24/2020] [Revised: 03/15/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Flexible bronchoscopy (FB) causes airway narrowing and may cause respiratory failure (RF). Noninvasive mechanical ventilation (NIV) is used to treat RF. Until recently, little was known about noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) risk and complications. MATERIALS AND METHODS A retrospective analysis of NIV-FB performed in 20 consecutive months (July 1, 2018-February 29, 2020) was performed. Indications for: FB and NIV, as well as impact of comorbidities, blood gas results, pulmonary function test results and sedation depth, were analyzed to reveal NIV-FB risk. Out of a total of 713 FBs, NIV-FB was performed in 50 patients with multiple comorbidities, acute or chronic RF, substantial tracheal narrowing, or after previously unsuccessful FB attempt. RESULTS In three cases, reversible complications were observed. Additionally, due to the severity of underlining disease, two patients were transferred to the ICU where they passed away after >48h. In a single variable analysis, PaO2 69 ± 18.5 and 49 ± 9.0 [mmHg] (p < 0.05) and white blood count (WBC) 10.0 ± 4.81 and 14.4 ± 3.10 (p < 0.05) were found predictive for complications. Left heart disease indicated unfavorable NIV-FB outcome (p = 0.046). CONCLUSIONS NIV-FB is safe in severely ill patients, however procedure-related risk should be further defined and verified in prospective studies.
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22
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Cornillon A, Balbo J, Coffinet J, Floch T, Bard M, Giordano-Orsini G, Malinovsky JM, Kanagaratnam L, Michelet D, Legros V. The ROX index as a predictor of standard oxygen therapy outcomes in thoracic trauma. Scand J Trauma Resusc Emerg Med 2021; 29:81. [PMID: 34154631 PMCID: PMC8215800 DOI: 10.1186/s13049-021-00876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic trauma is commonplace and accounts for 50-70% of the injuries found in severe trauma. Little information is available in the literature as to timing of endotracheal intubation. The main objective of this study was to assess the accuracy of the ROX index in predicting successful standard oxygen (SO) therapy outcomes, and in pre-empting intubation. METHODS Patient selection included all thoracic trauma patients treated with standard oxygen who were admitted to a Level I trauma center between January 1, 2013 and April 30, 2020. Successful standard SO outcomes were defined as non-requirement of invasive mechanical ventilation within the 7 first days after thoracic trauma. RESULTS One hundred seventy one patients were studied, 49 of whom required endotracheal intubation for acute respiratory distress (28.6%). A ROX index score ≤ 12.85 yielded an area under the ROC curve of 0.88 with a 95% CI [0.80-0.94], 81.63sensitivity, 95%CI [0.69-0.91] and 88.52 specificity, 95%CI [0.82-0.94] involving a Youden index of 0.70. Patients with a median ROX index greater than 12.85 within the initial 24 h were less likely to require mechanical ventilation within the initial 7 days of thoracic trauma. CONCLUSION We have shown that a ROX index greater than 12.85 at 24 h was linked to successful standard oxygen therapy outcomes in critical thoracic trauma patients. It is our belief that an early low ROX index in the initial phase of trauma should heighten vigilance on the part of the attending intensivist, who has a duty to optimize management.
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Affiliation(s)
- Adrien Cornillon
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Juliette Balbo
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Julien Coffinet
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Thierry Floch
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France
| | - Mathieu Bard
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,University of Reims Champagne Ardennes, Reims, France
| | - Guillaume Giordano-Orsini
- University of Reims Champagne Ardennes, Reims, France.,Department of Emergency Medicine, Reims University Hospital, Reims, France
| | - Jean-Marc Malinovsky
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France.,University of Reims Champagne Ardennes, Reims, France
| | - Lukshe Kanagaratnam
- University of Reims Champagne Ardennes, Reims, France.,Clinical Research Unit, Reims University Hospital, Reims, France
| | - Daphne Michelet
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Vincent Legros
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France.
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23
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Huespe IA, Marco A, Prado E, Bisso IC, Coria P, Gemelli N, Román ES, Heras MJL. Changes in the management and clinical outcomes of critically ill patients without COVID-19 during the pandemic. Rev Bras Ter Intensiva 2021; 33:68-74. [PMID: 33886854 PMCID: PMC8075343 DOI: 10.5935/0103-507x.20210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To analyze whether changes in medical care due to the application of COVID-19 protocols affected clinical outcomes in patients without COVID-19 during the pandemic. Methods This was a retrospective, observational cohort study carried out in a thirty-eight-bed surgical and medical intensive care unit of a high complexity private hospital. Patients with respiratory failure admitted to the intensive care unit during March and April 2020 and the same months in 2019 were selected. We compared interventions and outcomes of patients without COVID-19 during the pandemic with patients admitted in 2019. The main variables analyzed were intensive care unit respiratory management, number of chest tomography scans and bronchoalveolar lavages, intensive care unit complications, and status at hospital discharge. Results In 2020, a significant reduction in the use of a high-flow nasal cannula was observed: 14 (42%) in 2019 compared to 1 (3%) in 2020. Additionally, in 2020, a significant increase was observed in the number of patients under mechanical ventilation admitted to the intensive care unit from the emergency department, 23 (69%) compared to 11 (31%) in 2019. Nevertheless, the number of patients with mechanical ventilation after 5 days of admission was similar in both years: 24 (69%) in 2019 and 26 (79%) in 2020. Conclusion Intensive care unit protocols based on international recommendations for the COVID-19 pandemic have produced a change in non-COVID-19 patient management. We observed a reduction in the use of a high-flow nasal cannula and an increased number of tracheal intubations in the emergency department. However, no changes in the percentage of intubated patients in the intensive care unit, the number of mechanical ventilation days or the length of stay in intensive care unit.
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Affiliation(s)
- Iván Alfredo Huespe
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina.,Instituto de Medicina Translacional e Engenharia Biomédica, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Consejo Nacional de Investigaciones Científicas y Técnicas - Buenos Aires, Argentina
| | - Agustina Marco
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
| | - Eduardo Prado
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
| | | | - Pablo Coria
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
| | - Nicolas Gemelli
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
| | - Eduardo San Román
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
| | - Marcos José Las Heras
- Unidade de Terapia Intensiva, Hospital Italiano de Buenos Aires - Buenos Aires, Argentina
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24
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Chabert P, Bestion A, Fred AA, Schwebel C, Argaud L, Souweine B, Darmon M, Piriou V, Lehot JJ, Guérin C. Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure. Respir Care 2021; 66:669-678. [PMID: 33376187 PMCID: PMC9993987 DOI: 10.4187/respcare.08362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with neuromuscular disorders (NMD) share the risk of acute respiratory failure (ARF) leading to ICU admissions. Noninvasive ventilation (NIV) is often proposed as an alternative to invasive ventilation. This study describes clinical features, ventilation management, and outcomes of subjects with NMD admitted to ICU and managed for ARF. METHODS We performed a multicenter retrospective study in 7 adult ICUs in the Auvergne-Rhone-Alpes area in France involving subjects with NMD admitted to the ICU for ARF. The primary end point was ICU mortality. Secondary end points were NIV failure, weaning from invasive ventilation, and long-term mortality. We hypothesized a poorer outcome in the case of bulbar musculature involvement. RESULTS A total of 242 subjects were included; 142 subjects had nonhereditary NMD (58.7%), and 100 had hereditary NMD (41.3%). Eleven subjects had home ventilation through a tracheostomy. While 112 were intubated at admission, 119 initially underwent NIV. NIV was successful in avoiding orotracheal intubation in 78 subjects (65.5%). ICU mortality was 13.6%. Factors associated with ICU mortality were nonhereditary NMD and requirement for invasive ventilation. The involvement of bulbar musculature in ARF and hereditary NMD were associated with NIV failure. After a median follow-up of 1.2 y, 53 of 209 subjects had died. CONCLUSIONS The ICU mortality of NMD subjects with ARF was low, with no impact of bulbar muscles involvement. NIV was proposed for approximately half of the subjects, and it was more effective when ARF was not attributed to bulbar musculature involvement. The long-term outcome was good.
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Affiliation(s)
- Paul Chabert
- Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Audrey Bestion
- Unité Hospitalière d'Information Médicale, Hospices Civils de Lyon, Lyon, France
| | - Abla-Akpene Fred
- Unité Hospitalière d'Information Médicale, Hospices Civils de Lyon, Lyon, France
| | - Carole Schwebel
- Médecine Intensive - Réanimation, Hôpital Michalon, CHU Grenoble Alpes, Grenoble, France
| | - Laurent Argaud
- Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
| | - Bertrand Souweine
- Médecine Intensive - Réanimation, Pôle RHEUNNIRS, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Michael Darmon
- Médecine Intensive - Réanimation, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Vincent Piriou
- Université de Lyon, Lyon, France
- Service d'Anesthésie - Réanimation - Médecine Intensive, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jean-Jacques Lehot
- Réanimation Neurologique, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Claude Guérin
- Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Institut Mondor de Recherche Biomédicale, INSERM 955, Créteil, France
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25
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Li N, Zhu L, Sun L, Shao G. The effects of novel coronavirus (SARS-CoV-2) infection on cardiovascular diseases and cardiopulmonary injuries. Stem Cell Res 2021; 51:102168. [PMID: 33485182 PMCID: PMC7801189 DOI: 10.1016/j.scr.2021.102168] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022] Open
Abstract
COVID-19 caused by a novel coronavirus named SARS-CoV-2, can elites severe acute respiratory syndrome, severe lung injury, cardiac injury, and even death and became a worldwide pandemic. SARS-CoV-2 infection may result in cardiac injury via several mechanisms, including the expression of angiotensin-converting enzyme 2 (ACE2) receptor and leading to a cytokine storm, can elicit an exaggerated host immune response. This response contributes to multi-organ dysfunction. As an emerging infectious disease, there are limited data on the effects of this infection on patients with underlying cardiovascular comorbidities. In this review, we summarize the early-stage clinical experiences with COVID-19, with particular focus on patients with cardiovascular diseases and cardiopulmonary injuries, and explores potential available evidence regarding the association between COVID-19, and cardiovascular complications.
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Affiliation(s)
- Ni Li
- Department of Cardiothoracic Surgery, Lihuili Hospital affiliated to Ningbo University, Ningbo, Zhejiang 315041, China; Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Linwen Zhu
- Department of Cardiothoracic Surgery, Lihuili Hospital affiliated to Ningbo University, Ningbo, Zhejiang 315041, China
| | - Lebo Sun
- Department of Cardiothoracic Surgery, Lihuili Hospital affiliated to Ningbo University, Ningbo, Zhejiang 315041, China
| | - Guofeng Shao
- Department of Cardiothoracic Surgery, Lihuili Hospital affiliated to Ningbo University, Ningbo, Zhejiang 315041, China.
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26
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Ghosh S, Ghosh S, Singh A, Salhotra R. Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU. Indian J Crit Care Med 2021; 25:709-714. [PMID: 34316154 PMCID: PMC8286406 DOI: 10.5005/jp-journals-10071-23880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction With emerging evidence supporting other interventions, there is a need to re-examine the safety and efficacy of postextubation noninvasive ventilation (NIV) support in high-risk patients. Methods Data were collected over 4-year period from a multispeciality ICU. High-risk criteria were uniform, and the application of NIV was protocolized. Successful extubation was defined as the absence of both reintubation and NIV support at 72 hours postextubation. Results Extubation success was achieved in 79.6%. At extubation, more patients in the failure group had chronic neurological or kidney diseases, longer days of invasive ventilation, higher sequential organ failure assessment score, and more positive fluid balance. Significant differences were also observed in the indications for prophylactic NIV between the two groups. However, in logistic regression analysis, none of these differences observed in univariate analysis was independently associated with extubation outcome. Failure of postextubation NIV was associated with higher hospital mortality (67.7 vs 10.7%, p <0.001) and longer ICU/hospital length of stay (median 10 vs 6 days, p <0.001 and 13 vs 10 days, p <0.01, respectively). No differences were observed in extubation outcomes between 2016 to 2017 and 2018 to 2019 cohorts. Conclusion High rate of extubation failure and worse patient-centric outcomes associated with prophylactic NIV calls for a relook into the current recommendation of NIV for this indication. How to cite this article Ghosh S, Ghosh S, Singh A, Salhotra R. Impact of Prophylactic Noninvasive Ventilation on Extubation Outcome: A 4-year Prospective Observational Study from a Multidisciplinary ICU. Indian J Crit Care Med 2021;25(6):709–714.
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Affiliation(s)
- Supradip Ghosh
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Sonali Ghosh
- Department of Paediatric Critical Care, QRG Medicare, Faridabad, Haryana, India
| | - Amandeep Singh
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Ripenmeet Salhotra
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
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27
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Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020. [PMID: 33024358 DOI: 10.5005/jp-journals-10071-23513.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
How to cite this article: Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020;24(8):609-610.
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Affiliation(s)
- Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai (UAE)
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28
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Subramaniam A, Haji JY, Kumar P, Ramanathan K, Rajamani A. Noninvasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey. Indian J Crit Care Med 2020; 24:926-931. [PMID: 33281316 PMCID: PMC7689117 DOI: 10.5005/jp-journals-10071-23640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND About 5% of hospitalized coronavirus disease 2019 (COVID-19) patients will need intensive care unit (ICU) admission for hypoxemic respiratory failure requiring oxygen support. The choice between early mechanical ventilation and noninvasive oxygen therapies, such as, high-flow nasal oxygen (HFNO) and/or noninvasive positive-pressure ventilation (NPPV) has to balance the contradictory priorities of protecting healthcare workers by minimizing aerosol-generation and optimizing resource management. This survey over two timeframes aimed to explore the controversial issue of location and noninvasive oxygen therapy in non-intubated ICU patients using a clinical vignette. MATERIALS AND METHODS An online survey was designed, piloted, and distributed electronically to Indian intensivists/anesthetists, from private hospitals, government hospitals, and medical college hospitals (the latter two referred to as first-responder hospitals), who are directly responsible for admitting/managing patients in ICU. RESULTS Of the 204 responses (125/481 in phase 1 and 79/320 in phase 2), 183 responses were included. Respondents from first-responder hospitals were more willing to manage non-intubated hypoxemic patients in neutral pressure rooms, while respondents from private hospitals preferred negative-pressure rooms (p < 0.001). In both the phases, private hospital doctors were less comfortable to use any form of noninvasive oxygen therapies in neutral-pressure rooms compared to first-responder hospitals (low-flow oxygen therapy: 72 vs 50%, p < 0.01; HFNO: 47 vs 24%, p < 0.01 and NPPV: 38 vs 28%, p = 0.20). INTERPRETATION Variations existed in practices among first-responder and private intensivists/anesthetists. The resource optimal private hospital intensivists/anesthetists were less comfortable using noninvasive oxygen therapies in managing COVID-19 patients. This may reflect differential resource availability necessitating resolution at national, state, and local levels. HOW TO CITE THIS ARTICLE Subramaniam A, Haji JY, Kumar P, Ramanathan K, Rajamani A. Noninvasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey. Indian J Crit Care Med 2020;24(10):926-931.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care, Frankston Hospital, Frankston, VIC Monash University, VIC, Frankston, Australia
| | - Jumana Y Haji
- Department of Anesthesia and Critical Care, Aster CMI Hospital, Bengaluru, Karnataka, India
- Jumana Y Haji, Department of Anesthesia and Critical Care, Aster CMI Hospital, Bengaluru, Karnataka, India, Phone: +91 9686521100, e-mail:
| | - Prashant Kumar
- Department of Critical Care Medicine, Kailash Hospital Neuro Institute KHNI, Noida, Uttar Pradesh, India
| | | | - Arvind Rajamani
- Department of Intensive Care, University of Sydney, Nepean Clinical School and Nepean Hospital, Kingswood, New South Wales, Australia
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29
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Ramirez GA, Bozzolo EP, Castelli E, Marinosci A, Angelillo P, Damanti S, Scotti R, Gobbi A, Centurioni C, Di Scala F, Morgillo A, Castagna A, Conte C, Assanelli A, De Cobelli F, Calcaterra B, Cabrini L, Carcó F, Turi S, Silvani P, Dagna L, Zangrillo A, Landoni G, Tresoldi M. Continuous positive airway pressure and pronation outside the intensive care unit in COVID 19 ARDS. Minerva Med 2020; 113:281-290. [PMID: 32996727 DOI: 10.23736/s0026-4806.20.06952-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the ntensive care unit during a pandemic. METHODS In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure = 10 cm H2O, FiO2 = 0.6, daily treatment duration: 4x3hcycles) and respiratory physiotherapy including pronation outside the intensive care unit were followed up. RESULTS Of 90 ARDS patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the intensive care unit and with a median (interquartile) follow up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (p=0.033). No safety issues were observed. CONCLUSIONS Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the intensive care unit setting during the pandemic.
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Affiliation(s)
- Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Castelli
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Piera Angelillo
- Unit of Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clarissa Centurioni
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Flavia Di Scala
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Morgillo
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Organ Transplants, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Unit of Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Calcaterra
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST-Settelaghi, Varese, Italy
| | - Francesco Carcó
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Turi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy - .,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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30
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Neetz B, Herth FJF, Müller MM. [Treatment recommendations for mechanical ventilation of COVID‑19 patients]. GEFASSCHIRURGIE 2020; 25:408-416. [PMID: 32963422 PMCID: PMC7499005 DOI: 10.1007/s00772-020-00702-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/15/2022]
Abstract
Hintergrund Aufgrund der Neuartigkeit der COVID‑19-Erkrankung existieren keine evidenzbasierten Empfehlungen für die Beatmung dieser Patienten. Fragestellung Darstellung von Parametern, die eine individualisierte lungen- und diaphragmaprotektive Beatmung ermöglichen. Material und Methode Selektive Literaturrecherche und Diskussion von Expertenempfehlungen. Ergebnisse In der aktuellen Literatur wird der Unterschied des ARDS bei COVID‑19 zum klassischen ARDS beschrieben. Evidenzbasierte Empfehlungen zum Umgang mit dieser Diskrepanz gibt es nicht. In der Vergangenheit wurden bereits Parameter und Ansätze für eine personalisierte Beatmungsstrategie eingeführt und erprobt. Schlussfolgerungen Unter Verwendung der dargestellten Parameter ist es möglich, die Beatmung von COVID‑19-Patienten zu individualisieren, um so dem heterogenen klinischen Bild des COVID‑19-ARDS gerecht zu werden.
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Affiliation(s)
- B. Neetz
- Thoraxklinik am Universitätsklinikum Heidelberg, Pneumologie und Beatmungsmedizin, Translational Lung Research Center Heidelberg (TLRC), Röntgenstraße 1, 69126 Heidelberg, Deutschland
| | - F. J. F. Herth
- Thoraxklinik am Universitätsklinikum Heidelberg, Pneumologie und Beatmungsmedizin, Translational Lung Research Center Heidelberg (TLRC), Röntgenstraße 1, 69126 Heidelberg, Deutschland
| | - M. M. Müller
- Thoraxklinik am Universitätsklinikum Heidelberg, Pneumologie und Beatmungsmedizin, Translational Lung Research Center Heidelberg (TLRC), Röntgenstraße 1, 69126 Heidelberg, Deutschland
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31
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Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020; 24:609-610. [PMID: 33024358 PMCID: PMC7519619 DOI: 10.5005/jp-journals-10071-23513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
How to cite this article: Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020;24(8):609-610.
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Affiliation(s)
- Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai (UAE)
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32
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Ghosh S, Chawla A, Jhalani R, Salhotra R, Arora G, Nagar S, Bhadauria AS, Mishra K, Singh A, Lyall A. Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit. Indian J Crit Care Med 2020; 24:1185-1192. [PMID: 33446970 PMCID: PMC7775937 DOI: 10.5005/jp-journals-10071-23673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Prophylactic use of noninvasive ventilation (NIV) is recommended following extubation in patients at high risk of extubation failure. In a prospective cohort study, we examined the impact of prophylactic NIV in this subset of patients, potentially exploring the risk factors for extubation failure in them and the impact of extubation failure on organ function. We also explored the effect of fluid balance on extubation failure or success in this high-risk patient subgroup. Materials and methods Consecutive adult patients (≥18 years) admitted in the mixed intensive care unit (ICU) of a tertiary care center, between January 1, 2018, and December 31, 2019, who passed a spontaneous breathing trial (SBT) following at least 12 hours of invasive mechanical ventilation and put on prophylactic NIV for being at a high risk of extubation failure, were prospectively followed throughout their hospital stay. Extubation failure was defined as developing respiratory failure within 72 hours postextubation requiring reintubation or still requiring NIV support at 72 hours postextubation. Results A total of 85 patients were included in the study. 11.8% of patients had extubation failure at 72 hours with an overall reintubation rate of 10.5%. Higher age (p < 0.05), longer duration of invasive ventilation (p < 0.05), and higher sequential organ failure assessment (SOFA) score at extubation (p < 0.05) were identified as risk factors for extubation failure in univariate analysis. However, in the multivariate analysis, only a higher SOFA score remained statistically significant in forward logistic regression analysis (p < 0.05). We found a clear trend toward worsening organ function score in the extubation failure group in the first 72 hours postextubation, suggesting extubation failure as a risk factor for organ dysfunction. Cumulative fluid balance was higher both at extubation and in subsequent 3 days postextubation in the failure group, but the differences were not statistically significant. Conclusion Higher age, longer duration of invasive ventilation, and higher baseline SOFA score at extubation remain risk factors for extubation failure even in this high-risk subset of patients on prophylactic NIV. Extubation failure is associated with the worsening of organ function. A trend toward higher cumulative fluid balance both at extubation and postextubation, suggests aggressive de-resuscitation as a potentially helpful strategy in preventing extubation failure. How to cite this article Ghosh S, Chawla A, Jhalani R, Salhotra R, Arora G, Nagar S, et al. Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit. Indian J Crit Care Med 2020;24(12):1185–1192.
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Affiliation(s)
- Supradip Ghosh
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Aayush Chawla
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Ranupriya Jhalani
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Ripenmeet Salhotra
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Garima Arora
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Satyanarayan Nagar
- Department of Anesthesia and Critical Care Medicine, MP Birla Hospital, Chittorgarh, Rajasthan, India
| | - Abhay S Bhadauria
- Department of Critical Care Medicine, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Kirtee Mishra
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Amandeep Singh
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
| | - Aditya Lyall
- Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India
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Ge H, Zhou JC, Lv F, Zhang J, Yi J, Yang C, Zhang L, Zhou Y, Ren B, Pan Q, Zhang Z. Cumulative oxygen deficit is a novel predictor for the timing of invasive mechanical ventilation in COVID-19 patients with respiratory distress. PeerJ 2020; 8:e10497. [PMID: 33312774 PMCID: PMC7703393 DOI: 10.7717/peerj.10497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The timing of invasive mechanical ventilation (IMV) is controversial in COVID-19 patients with acute respiratory hypoxemia. The study aimed to develop a novel predictor called cumulative oxygen deficit (COD) for the risk stratification. METHODS The study was conducted in four designated hospitals for treating COVID-19 patients in Jingmen, Wuhan, from January to March 2020. COD was defined to account for both the magnitude and duration of hypoxemia. A higher value of COD indicated more oxygen deficit. The predictive performance of COD was calculated in multivariable Cox regression models. RESULTS A number of 111 patients including 80 in the non-IMV group and 31 in the IMV group were included. Patients with IMV had substantially lower PaO2 (62 (49, 89) vs. 90.5 (68, 125.25) mmHg; p < 0.001), and higher COD (-6.87 (-29.36, 52.38) vs. -231.68 (-1040.78, 119.83) mmHg·day) than patients without IMV. As compared to patients with COD < 0, patients with COD > 30 mmHg·day had higher risk of fatality (HR: 3.79, 95% CI [2.57-16.93]; p = 0.037), and those with COD > 50 mmHg·day were 10 times more likely to die (HR: 10.45, 95% CI [1.28-85.37]; p = 0.029). CONCLUSIONS The study developed a novel predictor COD which considered both magnitude and duration of hypoxemia, to assist risk stratification of COVID-19 patients with acute respiratory distress.
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Affiliation(s)
- Huiqing Ge
- Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-cang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - FangFang Lv
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junli Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Yi
- Thoracic Cardiovascular Surgery, Jingmen First People’s Hospital, Hubei, China
| | - Changming Yang
- Department of Anesthesiology, The First People’s of Hospital of Jingmen City, Hubei, China
| | - Lingwei Zhang
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yuhan Zhou
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Binbin Ren
- Department of Infectious Disease, Jinhua Municipal Central Hospiltal, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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