1
|
Algarni AM, Alfaifi MS, Al Bshabshe AA, Omair OM, Alsultan MA, Alzahrani HM, Alali HE, Alsabaani AA, Alqarni AM, Alghanem SA, Al Mufareh BS, Almemari AM, Sindi AA, Ozturan IU, Alhadhira AA, Shujaa AS, Alotaibi AH, Awladthani MM, Alsaad AA, Almarshed AA, AlQahtani AM, Harris TR, Alyahya BA, Assiri SA, Abuzeyad FH, Kazim SN, Al-Fares AA, Almazroua FY, Marzook NT, Basri AA, Elsafti AM, Alalshaikh AS, Özturan CA, Alawad YI, AlOmari A, Alkhateeb MA, Farooq MM, AlMutairi LA, Alasfour MM, Al Haber MI, Umar UKA, Bokhary NH, Alqahtani SF, Almutairi A, Alyahya HF, Alzahrani WS, Alsalmi F, Omair AM, Alasmari FM, Alfifi SY, Al-Nujimi MS, Foroutan F. Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol. PLoS One 2024; 19:e0281208. [PMID: 38232095 PMCID: PMC10793907 DOI: 10.1371/journal.pone.0281208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION The study is registered at ClinicalTrials.gov (NCT05172479).
Collapse
Affiliation(s)
| | - Musa S. Alfaifi
- Emergency Medicine Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Othman M. Omair
- Emergency Medicine Department, Aseer Central Hospital, Abha, Saudi Arabia
| | | | | | - Hadi E. Alali
- Emergency Medicine Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Ali M. Alqarni
- Radiology Department, Prince Mashary Bin Saud Hospital, Belgraishi, Saudi Arabia
| | - Salah A. Alghanem
- Emergency Medicine Department, Bahrain Defence Force Hospital, Al Riffa, Bahrain
| | - Bandar S. Al Mufareh
- Emergency Medicine Department, Royal Commission Hospital in Jubail, Jubail, Saudi Arabia
| | - Ayesha M. Almemari
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Ibrahim U. Ozturan
- Kocaeli University, Faculty of Medicine, Emergency Medicine Department, Kocaeli, Turkey
| | - Abdullah A. Alhadhira
- Emergency Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Asaad S. Shujaa
- Emergency Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Abdullah H. Alotaibi
- Emergency Medicine Department, King Abdullah University Hospital, Riyadh, Saudi Arabia
| | | | - Ahmed A. Alsaad
- Emergency Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | | | - Tim R. Harris
- Emergency Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Saad A. Assiri
- Emergency Medicine Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Feras H. Abuzeyad
- Emergency Medicine Department, King Hamad University Hospital, Muharraq, Bahrain
| | - Sara N. Kazim
- Emergency Medicine Department, Rashid Hospital, Dubai, United Arab Emirates
| | | | | | - Naif T. Marzook
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdullah A. Basri
- Emergency Medicine Department, Bahrain Defence Force Hospital, Al Riffa, Bahrain
| | | | | | - Cansu A. Özturan
- Emergency Medicine Department, Gölcük Necati Çelik State Hospital, Gölcük, Kocaeli, Turkey
| | - Yousef I. Alawad
- Emergency Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Awad AlOmari
- Critical Care Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Malek A. Alkhateeb
- Emergency Medicine Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Moonis M. Farooq
- Emergency Medicine Department, King Hamad University Hospital, Muharraq, Bahrain
| | | | | | - Mohammad I. Al Haber
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Umma-Kulthum A. Umar
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Nidal H. Bokhary
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saeed F. Alqahtani
- Emergency Medicine Department, Aseer Central Hospital, Abha, Saudi Arabia
| | | | - Hisham F. Alyahya
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Wejdan S. Alzahrani
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fawziah Alsalmi
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | | | | | | | - Farid Foroutan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Deane AM, Alhazzani W, Guyatt G, Finfer S, Marshall JC, Myburgh J, Zytaruk N, Hardie M, Saunders L, Knowles S, Lauzier F, Chapman MJ, English S, Muscedere J, Arabi Y, Ostermann M, Venkatesh B, Young P, Thabane L, Billot L, Heels-Ansdell D, Al-Fares AA, Hammond NE, Hall R, Rajbhandari D, Poole A, Johnson D, Iqbal M, Reis G, Xie F, Cook DJ. REVISE: Re- Evaluating the Inhibition of Stress Erosions in the ICU: a randomised trial protocol. BMJ Open 2023; 13:e075588. [PMID: 37968012 PMCID: PMC10660838 DOI: 10.1136/bmjopen-2023-075588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The Re-Evaluating the Inhibition of Stress Erosions (REVISE) Trial aims to determine the impact of the proton pump inhibitor pantoprazole compared with placebo on clinically important upper gastrointestinal (GI) bleeding in the intensive care unit (ICU), 90-day mortality and other endpoints in critically ill adults. The objective of this report is to describe the rationale, methodology, ethics and management of REVISE. METHODS AND ANALYSIS REVISE is an international, randomised, concealed, stratified, blinded parallel-group individual patient trial being conducted in ICUs in Canada, Australia, Saudi Arabia, UK, US, Kuwait, Pakistan and Brazil. Patients≥18 years old expected to remain invasively mechanically ventilated beyond the calendar day after enrolment are being randomised to either 40 mg pantoprazole intravenously or an identical placebo daily while mechanically ventilated in the ICU. The primary efficacy outcome is clinically important upper GI bleeding within 90 days of randomisation. The primary safety outcome is 90-day all-cause mortality. Secondary outcomes include rates of ventilator-associated pneumonia, Clostridioides difficile infection, new renal replacement therapy, ICU and hospital mortality, and patient-important GI bleeding. Tertiary outcomes are total red blood cells transfused, peak serum creatinine level in the ICU, and duration of mechanical ventilation, ICU and hospital stay. The sample size is 4800 patients; one interim analysis was conducted after 2400 patients had complete 90-day follow-up; the Data Monitoring Committee recommended continuing the trial. ETHICS AND DISSEMINATION All participating centres receive research ethics approval before initiation by hospital, region or country, including, but not limited to - Australia: Northern Sydney Local Health District Human Research Ethics Committee and Mater Misericordiae Ltd Human Research Ethics Committee; Brazil: Comissão Nacional de Ética em Pesquisa; Canada: Hamilton Integrated Research Ethics Board; Kuwait: Ministry of Health Standing Committee for Coordination of Health and Medical Research; Pakistan: Maroof Institutional Review Board; Saudi Arabia: Ministry of National Guard Health Affairs Institutional Review Board: United Kingdom: Hampshire B Research Ethics Committee; United States: Institutional Review Board of the Nebraska Medical Centre. The results of this trial will inform clinical practice and guidelines worldwide. TRIAL REGISTRATION NUMBER NCT03374800.
Collapse
Affiliation(s)
- Adam M Deane
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Waleed Alhazzani
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Simon Finfer
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - John C Marshall
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - John Myburgh
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Nicole Zytaruk
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Miranda Hardie
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lois Saunders
- Research Institute, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Serena Knowles
- Critical Care Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Francois Lauzier
- Departments of Anesthesiology, Medicine & Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval, Laval, Quebec, Canada
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shane English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Yaseen Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | | | - Paul Young
- Intensive Care Department, Wellington Hospital, London, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Laurent Billot
- Statistics Division, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Abdulrahman A Al-Fares
- Departments of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Naomi E Hammond
- Critical Care Medicine, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - R Hall
- Departments of Anesthesia, Critical Care and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dorrilyn Rajbhandari
- Critical Care Medicine, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Alexis Poole
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Daniel Johnson
- Departments of Critical Care and Anesthesia, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mobeen Iqbal
- Intensive Care Department, Maroof International Hospital, Islamabad, Pakistan
| | - Gilmar Reis
- Cardresearch-Cardiologia Assistencial e de Pesquisa LTDA, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, Mcmaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Arabi YM, Al-Dorzi HM, Sadat M, Muharib D, Algethamy H, Al-Hameed F, Mady A, AlGhamdi A, Almekhlafi GA, Al-Fares AA, Kharaba A, Al Bshabshe A, Maghrabi K, Al Ghamdi K, Rasool G, Chalabi J, AlHumedi HI, Sakkijha MH, Alamrey NK, Alhutail RH, Sifaoui K, Almaani M, Alqahtani R, Qureshi AS, Hejazi MM, Arishi H, AlQahtani S, Ghazi AM, Baaziz ST, Azhar AO, Alabbas SF, AlAqeely M, AlOrabi O, Al-Mutawa A, AlOtaibi M, Aldibaasi O, Jose J, Starkopf J, Preiser JC, Perner A, Al-Dawood A. Replacing protein via enteral nutrition in a stepwise approach in critically ill patients: the REPLENISH randomized clinical trial protocol. Trials 2023; 24:485. [PMID: 37518058 PMCID: PMC10388494 DOI: 10.1186/s13063-023-07507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Protein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2-2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8-1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. METHODS The REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients. DISCUSSION The study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04475666 . Registered on July 17, 2020.
Collapse
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Hasan M Al-Dorzi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Dina Muharib
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Al-Hameed
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Adnan AlGhamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb A Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ayman Kharaba
- Pulmonary & Critical Care Departments, King Fahad Hospital, Medinah, Saudi Arabia
- Critical Care Units, Ministry of Health, Madinah, Saudi Arabia
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Al Ghamdi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ghulam Rasool
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Abdulaziz Hospital, Ministry of National Guard Health Affairs, AlAhsa, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, AlAhsa, Saudi Arabia
| | - Haifaa Ibrahim AlHumedi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maram Hasan Sakkijha
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Norah Khalid Alamrey
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rabeah Hamad Alhutail
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kaouthar Sifaoui
- Pulmonary & Critical Care Departments, King Fahad Hospital, Medinah, Saudi Arabia
- Critical Care Units, Ministry of Health, Madinah, Saudi Arabia
| | - Mohammed Almaani
- Adult Critical Care Services, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rakan Alqahtani
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad S Qureshi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Madinah, Saudi Arabia
| | - Mohammed Moneer Hejazi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hatim Arishi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Samah AlQahtani
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amro Mohamed Ghazi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh T Baaziz
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer Othman Azhar
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Fahad Alabbas
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed AlAqeely
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ohoud AlOrabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Aliaa Al-Mutawa
- Department of Nutrition, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Maha AlOtaibi
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Omar Aldibaasi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jesna Jose
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Joel Starkopf
- Clinic of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | | | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Abdulaziz Al-Dawood
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Arabi YM, Aldekhyl S, Al Qahtani S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, Al Qasim E, Kharaba A, Albrahim T, Alshahrani MS, Al-Fares AA, Al Bshabshe A, Mady A, Al Duhailib Z, Algethamy H, Jose J, Al Mutairi M, Al Zumai O, Al Haji H, Alaqeily A, Al Aseri Z, Al-Omari A, Al-Dawood A, Tlayjeh H. Effect of Helmet Noninvasive Ventilation vs Usual Respiratory Support on Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: The HELMET-COVID Randomized Clinical Trial. JAMA 2022; 328:1063-1072. [PMID: 36125473 PMCID: PMC9490511 DOI: 10.1001/jama.2022.15599] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Helmet noninvasive ventilation has been used in patients with COVID-19 with the premise that helmet interface is more effective than mask interface in delivering prolonged treatments with high positive airway pressure, but data about its effectiveness are limited. OBJECTIVE To evaluate whether helmet noninvasive ventilation compared with usual respiratory support reduces mortality in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, pragmatic, randomized clinical trial that was conducted in 8 sites in Saudi Arabia and Kuwait between February 8, 2021, and November 16, 2021. Adult patients with acute hypoxemic respiratory failure (n = 320) due to suspected or confirmed COVID-19 were included. The final follow-up date for the primary outcome was December 14, 2021. INTERVENTIONS Patients were randomized to receive helmet noninvasive ventilation (n = 159) or usual respiratory support (n = 161), which included mask noninvasive ventilation, high-flow nasal oxygen, and standard oxygen. MAIN OUTCOMES AND MEASURES The primary outcome was 28-day all-cause mortality. There were 12 prespecified secondary outcomes, including endotracheal intubation, barotrauma, skin pressure injury, and serious adverse events. RESULTS Among 322 patients who were randomized, 320 were included in the primary analysis, all of whom completed the trial. Median age was 58 years, and 187 were men (58.4%). Within 28 days, 43 of 159 patients (27.0%) died in the helmet noninvasive ventilation group compared with 42 of 161 (26.1%) in the usual respiratory support group (risk difference, 1.0% [95% CI, -8.7% to 10.6%]; relative risk, 1.04 [95% CI, 0.72-1.49]; P = .85). Within 28 days, 75 of 159 patients (47.2%) required endotracheal intubation in the helmet noninvasive ventilation group compared with 81 of 161 (50.3%) in the usual respiratory support group (risk difference, -3.1% [95% CI, -14.1% to 7.8%]; relative risk, 0.94 [95% CI, 0.75-1.17]). There were no significant differences between the 2 groups in any of the prespecified secondary end points. Barotrauma occurred in 30 of 159 patients (18.9%) in the helmet noninvasive ventilation group and 25 of 161 (15.5%) in the usual respiratory support group. Skin pressure injury occurred in 5 of 159 patients (3.1%) in the helmet noninvasive ventilation group and 10 of 161 (6.2%) in the usual respiratory support group. There were 2 serious adverse events in the helmet noninvasive ventilation group and 1 in the usual respiratory support group. CONCLUSIONS AND RELEVANCE Results of this study suggest that helmet noninvasive ventilation did not significantly reduce 28-day mortality compared with usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. However, interpretation of the findings is limited by imprecision in the effect estimate, which does not exclude potentially clinically important benefit or harm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04477668.
Collapse
Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sara Aldekhyl
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Khulaif Al Harbi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ayman Kharaba
- Pulmonary and Critical Care Departments, King Fahad Hospital, Madinah, Kingdom of Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Mohammed S. Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Abdulrahman A. Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Zainab Al Duhailib
- Adult Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Jesna Jose
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Bioinformatics and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al Mutairi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Zumai
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Al Haji
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alaqeily
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Awad Al-Omari
- Alfaisal University, Critical Care and Infectious Disease and Infection Control Departments, Dr Sulaiman Al Habib Medical Group, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
5
|
Arabi Y, Aldekhyl S, Al Qahtani S, Al-Dorzi HM, Abdukahil SA, Jose J, Al Harbi MK, Al Haji H, Al Mutairi M, Al Zumai O, Al Qasim E, Al Wehaibi W, Alshahrani M, Albrahim T, Mady A, Al Bshabshe A, Al Aseri Z, Al Duhailib Z, Kharaba A, Alqahtani R, Algethamy H, Alfaris O, Alnafel O, Al-Fares AA, Tlayjeh H. Helmet noninvasive ventilation for COVID-19 patients (Helmet-COVID): statistical analysis plan for a randomized controlled trial. Trials 2022; 23:105. [PMID: 35109898 PMCID: PMC8808278 DOI: 10.1186/s13063-021-05988-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support is frequently needed for patients with acute hypoxemic respiratory failure due to coronavirus disease 19 (COVID-19). Helmet noninvasive ventilation has multiple advantages over other oxygen support modalities but data about effectiveness are limited. METHODS In this multicenter randomized trial of helmet noninvasive ventilation for COVID-19 patients, 320 adult ICU patients (aged ≥14 years or as per local standards) with suspected or confirmed COVID-19 and acute hypoxemic respiratory failure (ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 200 despite supplemental oxygen with a partial/non-rebreathing mask at a flow rate of 10 L/min or higher) will be randomized to helmet noninvasive ventilation with usual care or usual care alone, which may include mask noninvasive ventilation, high-flow nasal oxygen, or standard oxygen therapy. The primary outcome is death from any cause within 28 days after randomization. The trial has 80% power to detect a 15% absolute risk reduction in 28-day mortality from 40 to 25%. The primary outcome will be compared between the helmet and usual care group in the intention-to-treat using the chi-square test. Results will be reported as relative risk and 95% confidence interval. The first patient was enrolled on February 8, 2021. As of August 1, 2021, 252 patients have been enrolled from 7 centers in Saudi Arabia and Kuwait. DISCUSSION We developed a detailed statistical analysis plan to guide the analysis of the Helmet-COVID trial, which is expected to conclude enrollment in November 2021. TRIAL REGISTRATION ClinicalTrials.gov NCT04477668 . Registered on July 20, 2020.
Collapse
Affiliation(s)
- Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sara Aldekhyl
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jesna Jose
- Bioinformatics and Biostatistics Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Khulaif Al Harbi
- Department of Anesthesia, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Husain Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar Al Zumai
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Research Office, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Wedyan Al Wehaibi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zainab Al Duhailib
- Adult Critical Care Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- Pulmonary & Critical Care Departments, King Fahad Hospital Madinah Critical Care Units, Madinah, Saudi Arabia
| | - Rakan Alqahtani
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Omar Alfaris
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar Alnafel
- Internal Medicine and Intensive Care Department, King Salman Specialist Hospital, Hail, Saudi Arabia
| | - Abdulrahman A. Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Arabi YM, Tlayjeh H, Aldekhyl S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, Al Haji H, Al Mutairi M, Al Zumai O, Al Qasim E, Al Wehaibi W, Al Qahtani S, Al-Hameed F, Chalabi J, Alshahrani M, Albrahim T, Alharthy A, Mady A, Bin Eshaq A, Al Bshabshe AA, Al Aseri Z, Al Duhailib Z, Kharaba A, Alqahtani R, Al Ghamdi A, Altalag A, Alghamdi K, Almaani M, Algethamy H, Al Aqeily A, Al Baseet F, Al Samannoudi H, Al Obaidi M, Ismaiel YT, Al-Fares AA. Helmet Non-Invasive Ventilation for COVID-19 Patients (Helmet-COVID): study protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e052169. [PMID: 34446500 PMCID: PMC8392742 DOI: 10.1136/bmjopen-2021-052169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) delivered by helmet has been used for respiratory support of patients with acute hypoxaemic respiratory failure due to COVID-19 pneumonia. The aim of this study was to compare helmet NIV with usual care versus usual care alone to reduce mortality. METHODS AND ANALYSIS This is a multicentre, pragmatic, parallel randomised controlled trial that compares helmet NIV with usual care to usual care alone in a 1:1 ratio. A total of 320 patients will be enrolled in this study. The primary outcome is 28-day all-cause mortality. The primary outcome will be compared between the two study groups in the intention-to-treat and per-protocol cohorts. An interim analysis will be conducted for both safety and effectiveness. ETHICS AND DISSEMINATION Approvals are obtained from the institutional review boards of each participating institution. Our findings will be published in peer-reviewed journals and presented at relevant conferences and meetings. TRIAL REGISTRATION NUMBER NCT04477668.
Collapse
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sara Aldekhyl
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hasan M Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammad Khulaif Al Harbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Husain Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar Al Zumai
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wedyan Al Wehaibi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad Al-Hameed
- Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
| | - Mohammed Alshahrani
- Departments of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | | | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Abdulhadi Bin Eshaq
- Intensive Care Department, King Khalid Hospital Najran, Najran, Saudi Arabia
| | - Ali A Al Bshabshe
- College of Medicine, King Khalid University, Abha, Saudi Arabia
- Intensive Care Department, Aseer Central Hospital, Abha, Saudi Arabia
| | - Zohair Al Aseri
- Departments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zainab Al Duhailib
- Adult Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- Pulmonary and Critical Care Departments, King Fahad Hospital Madinah, Madinah, Saudi Arabia
| | - Rakan Alqahtani
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Adnan Al Ghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Altalag
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Intensive Care Department, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammed Almaani
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmad Al Aqeily
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal Al Baseet
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hashem Al Samannoudi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Al Obaidi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yassin T Ismaiel
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait
| |
Collapse
|
7
|
Rabie AA, Azzam MH, Al-Fares AA, Abdelbary A, Mufti HN, Hassan IF, Chakraborty A, Oza P, Elhazmi A, Alfoudri H, Pooboni SK, Alharthy A, Brodie D, Zakhary B, Shekar K, Antonini MV, Barrett NA, Peek G, Combes A, Arabi YM. Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India. Intensive Care Med 2021; 47:887-895. [PMID: 34156477 PMCID: PMC8217786 DOI: 10.1007/s00134-021-06451-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 01/15/2023]
Abstract
Purpose Extracorporeal membrane oxygenation (ECMO) use for severe coronavirus disease 2019 (COVID-19) patients has increased during the course of the pandemic. As uncertainty existed regarding patient’s outcomes, early guidelines recommended against establishing new ECMO centers. We aimed to explore the epidemiology and outcomes of ECMO for COVID-19 related cardiopulmonary failure in five countries in the Middle East and India and to evaluate the results of ECMO in 5 new centers. Methods This is a retrospective, multicenter international, observational study conducted in 19 ECMO centers in five countries in the Middle East and India from March 1, 2020, to September 30, 2020. We included patients with COVID-19 who received ECMO for refractory hypoxemia and severe respiratory acidosis with or without circulatory failure. Data collection included demographic data, ECMO-related specific data, pre-ECMO patient condition, 24 h post-ECMO initiation data, and outcome. The primary outcome was survival to home discharge. Secondary outcomes included mortality during ECMO, survival to decannulation, and outcomes stratified by center type. Results Three hundred and seven COVID-19 patients received ECMO support during the study period, of whom 78 (25%) were treated in the new ECMO centers. The median age was 45 years (interquartile range IQR 37–52), and 81% were men. New center patients were younger, were less frequently male, had received higher PEEP, more frequently inotropes and prone positioning before ECMO and were less frequently retrieved from a peripheral center on ECMO. Survival to home discharge was 45%. In patients treated in new and established centers, survival was 55 and 41% (p = 0.03), respectively. Multivariable analysis retained only a SOFA score < 12 at ECMO initiation as associated with survival (odds ratio, OR 1.93 (95% CI 1.05–3.58), p = 0.034), but not treatment in a new center (OR 1.65 (95% CI 0.75–3.67)). Conclusions During pandemics, ECMO may provide favorable outcomes in highly selected patients as resources allow. Newly formed ECMO centers with appropriate supervision of regional experts may have satisfactory results. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06451-w.
Collapse
Affiliation(s)
- Ahmed A Rabie
- Critical Care Department, King Saud Medical City, 12746 Ulaishah discreet, Riyadh, Saudi Arabia.
| | - Mohamed H Azzam
- Critical Care Department, King Abdullah Medical Complex, Ministry of Health, Jeddah, Saudi Arabia
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital Center for Respiratory and Cardiac Failure, Kuwait Extracorporeal Life Support Program, Jaber Al-Ahmed Hospital Critical Care Unit, Ministry of Health, Kuwait City, Kuwait
| | | | - Hani N Mufti
- Section of Cardiac Surgery, Department of Cardiac Sciences, King Faisal Cardiac Center, King Abdulaziz Medical City, MNGHA, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ibrahim F Hassan
- Medical Critical Care Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Arpan Chakraborty
- Cardiac Anesthesia, Critical Care and ECMO Services, Medica Superspecialty Hospital, Kolkata, India
| | - Pranay Oza
- Riddhi Vinayak Multispecialty Hospital, Mumbai, India
| | - Alyaa Elhazmi
- Adult Critical Care Department, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Huda Alfoudri
- Department of Anaesthesia, Critical Care, and Pain Management, Al-Adan Hospital Ministry of Health, Hadiya, Kuwait
| | - Suneel Kumar Pooboni
- Department of Pediatric Critical Care, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Abdulrahman Alharthy
- Critical Care Department, King Saud Medical City, 12746 Ulaishah discreet, Riyadh, Saudi Arabia
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia College of Physicians and Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Bishoy Zakhary
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Nicholas A Barrett
- Faculty of Life Sciences and Medicine, Department of Critical Care, Centre of Human and Applied Physiological Sciences, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Giles Peek
- Department of Cardiothoracic Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Alain Combes
- Institute of Cardio-Metabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.,Service de Médecine Intensive-Réanimation, Institute de Cardiologie, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Al-Fares AA, Ferguson ND, Ma J, Cypel M, Keshavjee S, Fan E, Del Sorbo L. Achieving Safe Liberation During Weaning from VV-ECMO in Patients with Severe ARDS: The role of Tidal Volume and Inspiratory Effort. Chest 2021; 160:1704-1713. [PMID: 34166645 DOI: 10.1016/j.chest.2021.05.068] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Weaning from venovenous extracorporeal membrane oxygenation (VV-ECMO) is not well studied. VV-ECMO can be discontinued when patients tolerate non-injurious mechanical ventilation (MV) during a sweep gas off trial (SGOT). However, predictors of safe liberation are unknown. RESEARCH QUESTION Can safe liberation from VV-ECMO be predicted at the bedside? STUDY DESIGN AND METHODS We conducted 2 observational studies of adults weaned from VV-ECMO for severe ARDS at Toronto General Hospital. We analyzed MV settings, respiratory mechanics and clinical variables to predict safe liberation from VV-ECMO, defined a priori as avoidance of ECMO recannulation, increase MV support, need for rescue therapy or hemodynamic instability developed within 48 hours after decannulation. RESULTS During both studies, 83 patients were weaned from VV-ECMO, of whom 21 (25%) did not meet criteria for safe liberation. In the retrospective study, higher tidal volume per predicted body weight (VTpbw, OR 1.58, 95%CI 1.05-2.40, P=0.03) and heart rate (HR, OR 1.07, 95%CI 1.01-1.13, P=0.02) at the end of SGOT were significantly associated with increased odds of unsafe liberation when adjusted for age (OR 1.02, 95%CI 0.95-1.09, P=0.63) and SOFA (OR 1.16, 95%CI 0.86-1.56, P=0.34). Change in ventilatory ratio (VR) had an imprecise association (OR 2.71, 95%CI 0.93-7.92, P=0.06) with unsafe liberation when adjusted for age (OR 1.03, 95%CI 0.96-1.10, P=0.42), SOFA (OR 1.11, 95%CI 0.81-1.51, P=0.52) and heart rate (OR 1.07, 95%CI 1.01-1.13, P=0.02). In the prospective study, patients who had unsafe liberation from VV-ECMO also had significantly higher inspiratory efforts (esophageal pressure swings 9 [7-13] vs 18 [7-25] cmH2O, p=0.03), and worse outcomes (longer MV duration, ICU and hospital length of stay). INTERPRETATION Patients with higher tidal volume, heart rate, ventilatory ratio, and esophageal pressures swings during SGOT were less likely to achieve safe liberation from VV-ECMO.
Collapse
Affiliation(s)
- Abdulrahman A Al-Fares
- Deapartment of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait(,); Kuwait Extracorporeal life support program, Al-Amiri Hospital Center for Advance Respiratory and Cardiac Failure, Ministry of Health, Kuwait; Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Extracorporeal Life Support Program, Toronto General Hospital, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Extracorporeal Life Support Program, Toronto General Hospital, Canada; Institute of Health Management, Policy and Evaluation, University of Toronto; Toronto General Hospital Research Institute, Toronto, Canada
| | - Jin Ma
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Marcelo Cypel
- Extracorporeal Life Support Program, Toronto General Hospital, Canada; Toronto General Hospital Research Institute, Toronto, Canada
| | - Shaf Keshavjee
- Extracorporeal Life Support Program, Toronto General Hospital, Canada; Toronto General Hospital Research Institute, Toronto, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Extracorporeal Life Support Program, Toronto General Hospital, Canada; Institute of Health Management, Policy and Evaluation, University of Toronto; Toronto General Hospital Research Institute, Toronto, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Extracorporeal Life Support Program, Toronto General Hospital, Canada.
| |
Collapse
|
9
|
Al-Fares AA, Randhawa VK, Englesakis M, McDonald MA, Nagpal AD, Estep JD, Soltesz EG, Fan E. Optimal Strategy and Timing of Left Ventricular Venting During Veno-Arterial Extracorporeal Life Support for Adults in Cardiogenic Shock. Circ Heart Fail 2019; 12:e006486. [DOI: 10.1161/circheartfailure.119.006486] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background:
Veno-arterial extracorporeal life support (VA-ECLS) is widely used to treat refractory cardiogenic shock. However, increased left ventricular (LV) afterload in VA-ECLS can worsen pulmonary congestion and compromise myocardial recovery. Our objectives were to explore the efficacy, safety, and optimal timing of adjunctive LV venting strategies.
Methods:
A systematic search was performed on Medline, EMBASE, PubMed, CDSR, CCRCT, CINAHL, ClinicalTrials.Gov, and WHO ICTRP from inception until January 2019 for all relevant studies, including LV venting. Data were analyzed for mortality and weaning from VA-ECLS on the basis of timing of LV venting, along with adverse complications.
Results:
A total of 7995 patients were included from 62 observational studies, wherein 3458 patients had LV venting during VA-ECLS. LV venting significantly improved weaning from VA-ECLS (odds ratio, 0.62 [95% CI, 0.47–0.83];
P
=0.001) and reduced short-term (30 day; risk ratio [RR], 0.86 [95% CI, 0.77–0.96];
P
=0.008) but not in-hospital (RR, 0.92 [95% CI, 0.83–1.01]
P
=0.09) or long-term (6 months; RR, 0.96 [95% CI, 0.90–1.03];
P
=0.27) mortality. Early (<12 hours; RR, 0.86 [95% CI, 0.75–0.99];
P
=0.03) but not late (≥12 hours; RR, 0.99 [95% CI, 0.71–1.38];
P
=0.93) LV venting significantly reduced short-term mortality. Patients with LV venting spent more time on VA-ECLS (3.6 versus 2.8 days,
P
<0.001), and mechanical ventilation (7.1 versus 4.6 days,
P
=0.013). With the exception of hemolysis (RR, 2.18 [95% CI, 1.58–3.01];
P
<0.00001), overall adverse events did not differ.
Conclusions:
LV venting, especially if done early (<12 hours), appears to be associated with an increased success of weaning and reduced short-term mortality. Future studies are required to delineate the importance of any or early LV venting adjuncts on mortality and morbidity outcomes.
Collapse
Affiliation(s)
- Abdulrahman A. Al-Fares
- Interdepartmental Division of Critical Care Medicine (A.A.A.-F., E.F.), Toronto General Hospital, University of Toronto, ON, Canada
- Extracorporeal Life Support Program (A.A.A.-F., E.F.), Toronto General Hospital, University of Toronto, ON, Canada
- Al-Amiri Hospital, Ministry of Health, Kuwait (A.A.A.-F.)
| | - Varinder K. Randhawa
- Departments of Cardiovascular Medicine (V.K.R., J.D.E.), Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Marina Englesakis
- Library and Information Services (M.E.), Toronto General Hospital, University of Toronto, ON, Canada
| | - Michael A. McDonald
- Division of Cardiology, Peter Munk Cardiac Centre (M.A.M.), Toronto General Hospital, University of Toronto, ON, Canada
| | - A. Dave Nagpal
- Divisions of Cardiac Surgery and Critical Care, London Health Sciences Center, ON, Canada (A.D.N.)
| | - Jerry D. Estep
- Departments of Cardiovascular Medicine (V.K.R., J.D.E.), Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Edward G. Soltesz
- Thoracic and Cardiovascular Surgery (E.G.S.), Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine (A.A.A.-F., E.F.), Toronto General Hospital, University of Toronto, ON, Canada
- Extracorporeal Life Support Program (A.A.A.-F., E.F.), Toronto General Hospital, University of Toronto, ON, Canada
| |
Collapse
|
10
|
|