1
|
Nakornnoi B, Tscheikuna J, Rittayamai N. The effects of real-time waveform analysis software on patient ventilator synchronization during pressure support ventilation: a randomized crossover physiological study. BMC Pulm Med 2024; 24:212. [PMID: 38693506 PMCID: PMC11064376 DOI: 10.1186/s12890-024-03039-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Patient-ventilator asynchrony commonly occurs during pressure support ventilation (PSV). IntelliSync + software (Hamilton Medical AG, Bonaduz, Switzerland) is a new ventilation technology that continuously analyzes ventilator waveforms to detect the beginning and end of patient inspiration in real time. This study aimed to evaluate the physiological effect of IntelliSync + software on inspiratory trigger delay time, delta airway (Paw) and esophageal (Pes) pressure drop during the trigger phase, airway occlusion pressure at 0.1 s (P0.1), and hemodynamic variables. METHODS A randomized crossover physiologic study was conducted in 14 mechanically ventilated patients under PSV. Patients were randomly assigned to receive conventional flow trigger and cycling, inspiratory trigger synchronization (I-sync), cycle synchronization (C-sync), and inspiratory trigger and cycle synchronization (I/C-sync) for 15 min at each step. Other ventilator settings were kept constant. Paw, Pes, airflow, P0.1, respiratory rate, SpO2, and hemodynamic variables were recorded. The primary outcome was inspiratory trigger and cycle delay time between each intervention. Secondary outcomes were delta Paw and Pes drop during the trigger phase, P0.1, SpO2, and hemodynamic variables. RESULTS The time to initiate the trigger was significantly shorter with I-sync compared to baseline (208.9±91.7 vs. 301.4±131.7 msec; P = 0.002) and I/C-sync compared to baseline (222.8±94.0 vs. 301.4±131.7 msec; P = 0.005). The I/C-sync group had significantly lower delta Paw and Pes drop during the trigger phase compared to C-sync group (-0.7±0.4 vs. -1.2±0.8 cmH2O; P = 0.028 and - 1.8±2.2 vs. -2.8±3.2 cmH2O; P = 0.011, respectively). No statistically significant differences were found in cycle delay time, P0.1 and other physiological variables between the groups. CONCLUSIONS IntelliSync + software reduced inspiratory trigger delay time compared to the conventional flow trigger system during PSV mode. However, no significant improvements in cycle delay time and other physiological variables were observed with IntelliSync + software. TRIAL REGISTRATION This study was registered in the Thai Clinical Trial Registry (TCTR20200528003; date of registration 28/05/2020).
Collapse
Affiliation(s)
- Barnpot Nakornnoi
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jamsak Tscheikuna
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
2
|
Rittayamai N, Marinpong V, Chuaychoo B, Tscheikuna J, Brochard LJ. Ultrasound Evaluation of Parasternal Intercostal, Diaphragm Activity, and Their Ratio in Male Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2024; 209:1016-1018. [PMID: 38319129 DOI: 10.1164/rccm.202310-1769le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024] Open
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilasinee Marinpong
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjamas Chuaychoo
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jamsak Tscheikuna
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Laurent J Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Arunsurat I, Rittayamai N, Chuaychoo B, Tangchityongsiva S, Promsarn S, Yuenyong S, Chow CW, Brochard L. Bronchodilator Efficacy of High-Flow Nasal Cannula in COPD: Vibrating Mesh Nebulizer Versus Jet Nebulizer. Respir Care 2024; 69:157-165. [PMID: 37607815 PMCID: PMC10898469 DOI: 10.4187/respcare.11139] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Jet nebulizers are commonly used for bronchodilator therapy in COPD. High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer on airway and lung function in subjects with stable COPD. METHODS This randomized non-inferiority crossover physiologic study enrolled subjects with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-h washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in FEV1 from baseline. Secondary outcomes included changes in other respiratory-related parameters and nebulization time compared between the 2 devices. RESULTS Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV1 from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] min vs 20 [16-22] min, respectively, P < .001). CONCLUSIONS Bronchodilator therapy via HFNC-VMN was not inferior to jet nebulizer for subjects with stable COPD and can significantly improve airway oscillometry mechanics and decrease nebulization time compared to jet nebulizer.
Collapse
Affiliation(s)
- Itthiphat Arunsurat
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Benjamas Chuaychoo
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Tangchityongsiva
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Simaporn Promsarn
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somruthai Yuenyong
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chung-Wai Chow
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and Toronto Lung Transplant Programme, Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac Dis 2023; 15:5466-5474. [PMID: 37969272 PMCID: PMC10636453 DOI: 10.21037/jtd-23-732] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Background Noninvasive ventilation (NIV) is recommended for use in patients with acute respiratory failure of various etiologies. However, we do not know whether the use of NIV in general medical wards is safe and effective. This study aimed to evaluate the safety and efficacy of using NIV and factors associated with NIV failure in general medical wards. Methods A prospective cohort study was conducted in general medical wards of the University Hospital. Adult patients with acute respiratory failure treated with NIV were enrolled. The subjects were managed by a multidisciplinary care team that was well trained in the NIV device. The primary outcome was the rate of NIV failure at 48 hours. Secondary outcomes included hospital mortality and factors associated with NIV failure. Results A total of 86 patients were enrolled. The mean age was 70±17 years old. The Acute Physiology and Chronic Health Evaluation (APACHE) III and the Sequential Organ Failure Assessment (SOFA) scores were 56±17 and 4±3, respectively. The most common indication of NIV use was cardiogenic pulmonary edema (34.9%). The rate of NIV failure at 48 hours and hospital mortality were 20.9% and 12.8%, respectively. The SOFA score was associated with failure of NIV at 48 hours [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.16-1.89; P=0.002]. Conclusions NIV was safe and effective on general medical wards. Cardiogenic pulmonary edema was the most common indication for the application of NIV. The SOFA score was associated with the failure of NIV at 48 hours.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalinee Pravarnpat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichian Srilam
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satit Bunyarid
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nitipatana Chierakul
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Pham T, Heunks L, Bellani G, Madotto F, Aragao I, Beduneau G, Goligher EC, Grasselli G, Laake JH, Mancebo J, Peñuelas O, Piquilloud L, Pesenti A, Wunsch H, van Haren F, Brochard L, Laffey JG, Acharya SP, Amin P, Arabi Y, Aragao I, Bauer P, Beduneau G, Beitler J, Berkius J, Bugedo G, Camporota L, Cerny V, Cho YJ, Clarkson K, Estenssoro E, Goligher E, Grasselli G, Gritsan A, Hashemian SM, Hermans G, Heunks LM, Jovanovic B, Kurahashi K, Laake JH, Matamis D, Moerer O, Molnar Z, Ozyilmaz E, Panka B, Papali A, Peñuelas Ó, Perbet S, Piquilloud L, Qiu H, Razek AA, Rittayamai N, Roldan R, Serpa Neto A, Szuldrzynski K, Talmor D, Tomescu D, Van Haren F, Villagomez A, Zeggwagh AA, Abe T, Aboshady A, Acampo-de Jong M, Acharya S, Adderley J, Adiguzel N, Agrawal VK, Aguilar G, Aguirre G, Aguirre-Bermeo H, Ahlström B, Akbas T, Akker M, Al Sadeh G, Alamri S, Algaba A, Ali M, Aliberti A, Allegue JM, Alvarez D, Amador J, Andersen FH, Ansari S, Apichatbutr Y, Apostolopoulou O, Arabi Y, Arellano D, Arica M, Arikan H, Arinaga K, Arnal JM, Asano K, Asín-Corrochano M, Avalos Cabrera JM, Avila Fuentes S, Aydemir S, Aygencel G, Azevedo L, Bacakoglu F, Badie J, Baedorf Kassis E, Bai G, Balaraj G, Ballico B, Banner-Goodspeed V, Banwarie P, Barbieri R, Baronia A, Barrett J, Barrot L, Barrueco-Francioni JE, Barry J, Bauer P, Bawangade H, Beavis S, Beck E, Beehre N, Belenguer Muncharaz A, Bellani G, Belliato M, Bellissima A, Beltramelli R, Ben Souissi A, Benitez-Cano A, Benlamin M, Benslama A, Bento L, Benvenuti D, Berkius J, Bernabe L, Bersten A, Berta G, Bertini P, Bertram-Ralph E, Besbes M, Bettini LR, Beuret P, Bewley J, Bezzi M, Bhakhtiani L, Bhandary R, Bhowmick K, Bihari S, Bissett B, Blythe D, Bocher S, Boedjawan N, Bojanowski CM, Boni E, Boraso S, Borelli M, Borello S, Borislavova M, Bosma KJ, Bottiroli M, Boyd O, Bozbay S, Briva A, Brochard L, Bruel C, Bruni A, Buehner U, Bugedo G, Bulpa P, Burt K, Buscot M, Buttera S, Cabrera J, Caccese R, Caironi P, Canchos Gutierrez I, Canedo N, Cani A, Cappellini I, Carazo J, Cardonnet LP, Carpio D, Carriedo D, Carrillo R, Carvalho J, Caser E, Castelli A, Castillo Quintero M, Castro H, Catorze N, Cengiz M, Cereijo E, Ceunen H, Chaintoutis C, Chang Y, Chaparro G, Chapman C, Chau S, Chavez CE, Chelazzi C, Chelly J, Chemouni F, Chen K, Chena A, Chiarandini P, Chilton P, Chiumello D, Cho YJ, Chou-Lie Y, Chudeau N, Cinel I, Cinnella G, Clark M, Clark T, Clarkson K, Clementi S, Coaguila L, Codecido AJ, Collins A, Colombo R, Conde J, Consales G, Cook T, Coppadoro A, Cornejo R, Cortegiani A, Coxo C, Cracchiolo AN, Crespo Ramirez M, Crova P, Cruz J, Cubattoli L, Çukurova Z, Curto F, Czempik P, D'Andrea R, da Silva Ramos F, Dangers L, Danguy des Déserts M, Danin PE, Dantas F, Daubin C, Dawei W, de Haro C, de Jesus Montelongo F, De Mendoza D, de Pablo R, De Pascale G, De Rosa S, Decavèle M, Declercq PL, Deicas A, del Carmen Campos Moreno M, Dellamonica J, Delmas B, Demirkiran O, Demirkiran H, Dendane T, di Mussi R, Diakaki C, Diaz A, Diaz W, Dikmen Y, Dimoula A, Doble P, Doha N, Domingos G, Dres M, Dries D, Duggal A, Duke G, Dunts P, Dybwik K, Dykyy M, Eckert P, Efe S, Elatrous S, Elay G, Elmaryul AS, Elsaadany M, Elsayed H, Elsayed S, Emery M, Ena S, Eng K, Englert JA, Erdogan E, Ergin Ozcan P, Eroglu E, Escobar M, Esen F, Esen Tekeli A, Esquivel A, Esquivel Gallegos H, Ezzouine H, Facchini A, Faheem M, Fanelli V, Farina MF, Fartoukh M, Fehrle L, Feng F, Feng Y, Fernandez I, Fernandez B, Fernandez-Rodriguez ML, Ferrando C, Ferreira da Silva MJ, Ferreruela M, Ferrier J, Flamm Zamorano MJ, Flood L, Floris L, Fluckiger M, Forteza C, Fortunato A, Frans E, Frattari A, Fredes S, Frenzel T, Fumagalli R, Furche MA, Fusari M, Fysh E, Galeas-Lopez JL, Galerneau LM, Garcia A, Garcia MF, Garcia E, Garcia Olivares P, Garlicki J, Garnero A, Garofalo E, Gautam P, Gazenkampf A, Gelinotte S, Gelormini D, Ghrenassia E, Giacomucci A, Giannoni R, Gigante A, Glober N, Gnesin P, Gollo Y, Gomaa D, Gomero Paredes R, Gomes R, Gomez RA, Gomez O, Gomez A, Gondim L, Gonzalez M, Gonzalez I, Gonzalez-Castro A, Gordillo Romero O, Gordo F, Gouin P, Graf Santos J, Grainne R, Grando M, Granov Grabovica S, Grasselli G, Grasso S, Grasso R, Grimmer L, Grissom C, Gritsan A, Gu Q, Guan XD, Guarracino F, Guasch N, Guatteri L, Gueret R, Guérin C, Guerot E, Guitard PG, Gül F, Gumus A, Gurjar M, Gutierrez P, Hachimi A, Hadzibegovic A, Hagan S, Hammel C, Han Song J, Hanlon G, Hashemian SM, Heines S, Henriksson J, Herbrecht JE, Heredia Orbegoso GO, Hermans G, Hermon A, Hernandez R, Hernandez C, Herrera L, Herrera-Gutierrez M, Heunks L, Hidalgo J, Hill D, Holmquist D, Homez M, Hongtao X, Hormis A, Horner D, Hornos MC, Hou M, House S, Housni B, Hugill K, Humphreys S, Humbert L, Hunter S, Hwa Young L, Iezzi N, Ilutovich S, Inal V, Innes R, Ioannides P, Iotti GA, Ippolito M, Irie H, Iriyama H, Itagaki T, Izura J, Izza S, Jabeen R, Jamaati H, Jamadarkhana S, Jamoussi A, Jankowski M, Jaramillo LA, Jeon K, Jeong Lee S, Jeswani D, Jha S, Jiang L, Jing C, Jochmans S, Johnstad BA, Jongmin L, Joret A, Jovanovic B, Junhasavasdikul D, Jurado MT, Kam E, Kamohara H, Kane C, Kara I, Karakurt S, Karnjanarachata C, Kataoka J, Katayama S, Kaushik S, Kelebek Girgin N, Kerr K, Kerslake I, Khairnar P, Khalid A, Khan A, Khanna AK, Khorasanee R, Kienhorst D, Kirakli C, Knafelj R, Kol MK, Kongpolprom N, Kopitko C, Korkmaz Ekren P, Kubisz-Pudelko A, Kulcsar Z, Kumasawa J, Kurahashi K, Kuriyama A, Kutchak F, Laake JH, Labarca E, Labat F, Laborda C, Laca Barrera MA, Lagache L, Landaverde Lopez A, Lanspa M, Lascari V, Le Meur M, Lee SH, Lee YJ, Lee J, Lee WY, Lee J, Legernaes T, Leiner T, Lemiale V, Leonor T, Lepper PM, Li D, Li H, Li O, Lima AR, Lind D, Litton E, Liu N, Liu L, Liu J, Llitjos JF, Llorente B, Lopez R, Lopez CE, Lopez Nava C, Lovazzano P, Lu M, Lucchese F, Lugano M, Lugo Goytia G, Luo H, Lynch C, Macheda S, Madrigal Robles VH, Maggiore SM, Magret Iglesias M, Malaga P, Mallapura Maheswarappa H, Malpartida G, Malyarchikov A, Mansson H, Manzano A, Marey I, Marin N, Marin MDC, Markman E, Martin F, Martin A, Martin Dal Gesso C, Martinez F, Martínez-Fidalgo C, Martin-Loeches I, Mas A, Masaaki S, Maseda E, Massa E, Mattsson A, Maugeri J, McCredie V, McCullough J, McGuinness S, McKown A, Medve L, Mei C, Mellado Artigas R, Mendes V, Mervat MKE, Michaux I, Mikhaeil M, Milagros O, Milet I, Millan MT, Minwei Z, Mirabella L, Mishra S, Mistraletti G, Mochizuki K, Moerer O, Moghal A, Mojoli F, Molin A, Molnar Z, Montiel R, Montini L, Monza G, Mora Aznar M, Morakul S, Morales M, Moreno Torres D, Morocho Tutillo DR, Motherway C, Mouhssine D, Mouloudi E, Muñoz T, Munoz de Cabo C, Mustafa M, Muthuchellappan R, Muthukrishnan M, Muttini S, Nagata I, Nahar D, Nakanishi M, Nakayama I, Namendys-Silva SA, Nanchal R, Nandakumar S, Nasi A, Nasir K, Navalesi P, Naz Aslam T, Nga Phan T, Nichol A, Niiyama S, Nikolakopoulou S, Nikolic E, Nitta K, Noc M, Nonas S, Nseir S, Nur Soyturk A, Obata Y, Oeckler R, Oguchi M, Ohshimo S, Oikonomou M, Ojados A, Oliveira MT, Oliveira Filho W, Oliveri C, Olmos A, Omura K, Orlandi MC, Orsenigo F, Ortiz-Ruiz De Gordoa L, Ota K, Ovalle Olmos R, Öveges N, Oziemski P, Ozkan Kuscu O, Özyilmaz E, Pachas Alvarado F, Pagella G, Palaniswamy V, Palazon Sanchez EL, Palmese S, Pan G, Pan W, Panka B, Papanikolaou M, Papavasilopoulou T, Parekh A, Parke R, Parrilla FJ, Parrilla D, Pasha T, Pasin L, Patão L, Patel M, Patel G, Pati BK, Patil J, Pattnaik S, Paul D, Pavesi M, Pavlotsky VA, Paz G, Paz E, Pecci E, Pellegrini C, Peña Padilla AG, Perchiazzi G, Pereira T, Pereira V, Perez M, Perez Calvo C, Perez Cheng M, Perez Maita R, Pérez-Araos R, Perez-Teran P, Perez-Torres D, Perkins G, Persona P, Petnak T, Petrova M, Pham T, Philippart F, Picetti E, Pierucci E, Piervincenzi E, Pinciroli R, Pintado MC, Piquilloud L, Piraino T, Piras S, Piras C, Pirompanich P, Pisani L, Platas E, Plotnikow G, Porras W, Porta V, Portilla M, Portugal J, Povoa P, Prat G, Pratto R, Preda G, Prieto I, Prol-Silva E, Pugh R, Qi Y, Qian C, Qin T, Qiu H, Qu H, Quintana T, Quispe Sierra R, Quispe Soto R, Rabbani R, Rabee M, Rabie A, Rahe Pereira MA, Rai A, Raj Ashok S, Rajab M, Ramdhani N, Ramey E, Ranieri M, Rathod D, Ray B, Redwanul Huq SM, Regli A, Reina R, Resano Sarmiento N, Reynaud F, Rialp G, Ricart P, Rice T, Richardson A, Rieder M, Rinket M, Rios F, Rios F, Risso Vazquez A, Rittayamai N, Riva I, Rivette M, Roca O, Roche-Campo F, Rodriguez C, Rodriguez G, Rodriguez Gonzalez D, Rodriguez Tucto XY, Rogers A, Romano ME, Rørtveit L, Rose A, Roux D, Rouze A, Rubatto Birri PN, Ruilan W, Ruiz Robledo A, Ruiz-Aguilar AL, Sadahiro T, Saez I, Sagardia J, Saha R, Saha R, Saiphoklang N, Saito S, Salem M, Sales G, Salgado P, Samavedam S, Sami Mebazaa M, Samuelsson L, San Juan Roman N, Sanchez P, Sanchez-Ballesteros J, Sandoval Y, Sani E, Santos M, Santos C, Sanui M, Saravanabavan L, Sari S, Sarkany A, Sauneuf B, Savioli M, Sazak H, Scano R, Schneider F, Schortgen F, Schultz MJ, Schwarz GL, Seçkin Yücesoy F, Seely A, Seiler F, Seker Tekdos Y, Seok Chan K, Serano L, Serednicki W, Serpa Neto A, Setten M, Shah A, Shah B, Shang Y, Shanmugasundaram P, Shapovalov K, Shebl E, Shiga T, Shime N, Shin P, Short J, Shuhua C, Siddiqui S, Silesky Jimenez JI, Silva D, Silva Sales B, Simons K, Sjøbø BÅ, Slessor D, Smiechowicz J, Smischney N, Smith P, Smith T, Smith M, Snape S, Snyman L, Soetens F, Sook Hong K, Sosa Medellin MÁ, Soto G, Souloy X, Sousa E, Sovatzis S, Sozutek D, Spadaro S, Spagnoli M, Spångfors M, Spittle N, Spivey M, Stapleton A, Stefanovic B, Stephenson L, Stevenson E, Strand K, Strano MT, Straus S, Sun C, Sun R, Sundaram V, SunPark T, Surlemont E, Sutherasan Y, Szabo Z, Szuldrzynski K, Tainter C, Takaba A, Tallott M, Tamasato T, Tang Z, Tangsujaritvijit V, Taniguchi L, Taniguchi D, Tarantino F, Teerapuncharoen K, Temprano S, Terragni P, Terzi N, Thakur A, Theerawit P, Thille AW, Thomas M, Thungtitigul P, Thyrault M, Tilouch N, Timenetsky K, Tirapu J, Todeschini M, Tomas R, Tomaszewski C, Tonetti T, Tonnelier A, Trinder J, Trongtrakul K, Truwit J, Tsuei B, Tulaimat A, Turan S, Turkoglu M, Tyagi S, Ubeda A, Vagginelli F, Valenti MF, Vallverdu I, Van Axel A, van den Hul I, van der Hoeven H, Van Der Meer N, Van Haren F, Vanhoof M, Vargas-Ordoñez M, Vaschetto R, Vascotto E, Vatsik M, Vaz A, Vazquez-Sanchez A, Ventura S, Vermeijden JW, Vidal A, Vieira J, Vilela Costa Pinto B, Villagomez A, Villagra A, Villegas Succar C, Vinorum OG, Vitale G, Vj R, Vochin A, Voiriot G, Volta CA, von Seth M, Wajdi M, Walsh D, Wang S, Wardi G, Ween-Velken NC, Wei BL, Weller D, Welsh D, Welters I, Wert M, Whiteley S, Wilby E, Williams E, Williams K, Wilson A, Wojtas J, Won Huh J, Wrathall D, Wright C, Wu JF, Xi G, Xing ZJ, Xu H, Yamamoto K, Yan J, Yáñez J, Yang X, Yates E, Yazicioglu Mocin O, Ye Z, Yildirim F, Yoshida N, Yoshido HHL, Young Lee B, Yu R, Yu G, Yu T, Yuan B, Yuangtrakul N, Yumoto T, Yun X, Zakalik G, Zaki A, Zalba-Etayo B, Zambon M, Zang B, Zani G, Zarka J, Zerbi SM, Zerman A, Zetterquist H, Zhang J, Zhang H, Zhang W, Zhang G, Zhang W, Zhao H, Zheng J, Zhu B, Zumaran R. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; 11:465-476. [PMID: 36693401 DOI: 10.1016/s2213-2600(22)00449-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. METHODS WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. FINDINGS Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. INTERPRETATION In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. FUNDING European Society of Intensive Care Medicine, European Respiratory Society.
Collapse
Affiliation(s)
- Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Leo Heunks
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Fabiana Madotto
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Aragao
- Department of Intensive Care Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gaëtan Beduneau
- Normandie University, UNIROUEN, UR 3830, CHU Rouen, Department of Medical Intensive Care, F-76000 Rouen, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute University Health Network, Toronto, Canada
| | - Giacomo Grasselli
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development, Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Jordi Mancebo
- Department of Intensive Care Medicine, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonio Pesenti
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frank van Haren
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland; School of Medicine, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Songmuang J, Akatat P, Wattanagulanurak S, Rittayamai N, Sripalakit S. Comparison Study between Using Disposable and Non-Disposable Ventilator Circuits on Ventilator-Associated Pneumonia and Health Care Costs at a Respiratory Care Unit, Siriraj Hospital. Siriraj Med J 2023. [DOI: 10.33192/smj.v75i3.260866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objective: This research aimed to compare the incidence of ventilator-associated pneumonia (VAP) and ventilator circuit costs among patients using disposable ventilator circuits and patients using non-disposable ventilator circuits.
Materials and Methods: Observational research was performed consisting of the following: A retrospective chart review of a group of patients who used non-disposable circuits (n=193) and a prospective cohort study of a group of patients using disposable circuits (n=166). The sample was purposively selected based on the following inclusion criteria: patients aged 18 years old and over who were admitted to the Respiratory Care Unit, Siriraj Hospital and ventilated >48 h.
Results: VAP incidence in the group non-disposable circuits was 10.41/1,000 ventilator days (n=27, 13.8%) and 10.82 /1,000 ventilator days (n=24, 14.4%) in the group disposable circuits (p=0.871). According to the data analysis using the U-control chart, no statistically significant differences were found. The unit cost of the non-disposable circuit was lower than that of the disposable circuit (THB 295.94), while the work unit personnel satisfaction toward working with disposable circuits was at a good level (Mean=3.83) and medium level (Mean=3.12) in non-disposable circuits (p=0.002).
Conclusion: The type of ventilator circuits had no effects on VAP rate. The unit cost of non-disposable circuits was lower than that of disposable circuits, while the work unit personnel had a higher satisfaction working with disposable circuits than non-disposable circuits.
Collapse
|
7
|
Rittayamai N, Grieco DL, Brochard L. Noninvasive respiratory support in intensive care medicine. Intensive Care Med 2022; 48:1211-1214. [PMID: 35759009 PMCID: PMC9244137 DOI: 10.1007/s00134-022-06762-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Domenico L Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy.,Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
8
|
Pisani L, Algera AG, Neto AS, Azevedo L, Pham T, Paulus F, de Abreu MG, Pelosi P, Dondorp AM, Bellani G, Laffey JG, Schultz MJ, Martinez A, Leal L, Jorge Pereira A, de Oliveira Maia M, Neto JA, Piras C, Caser EB, Moreira CL, Braga Gusman P, Dalcomune DM, Ribeiro de Carvalho AG, Gondim LAR, Castelo Branco Reis LM, da Cunha Ribeiro D, de Assis Simões L, Campos RS, Fernandez Versiani dos Anjos JC, Bruzzi Carvalho F, Alves RA, Nunes LB, Réa-Neto Á, de Oliveira MC, Tannous L, Cardoso Gomes B, Rodriguez FB, Abelha P, Lugarinho ME, Japiassu A, de Melo HK, Lopes EA, Varaschin P, de Souza Dantas VC, Freitas Knibel M, Ponte M, de Azambuja Rodrigues PM, Costa Filho RC, Saddy F, Wanderley Castellões TF, Silva SA, Osorio LAG, Mannarino D, Espinoza R, Righy C, Soares M, Salluh J, Tanaka L, Aragão D, Tavares ME, Kehdi MGP, Rezende VMC, Carbonell RCC, Teixeira C, de Oliveira RP, Maccari JG, Castro PS, Berto P, Schwarz P, Torelly AP, Lisboa T, Moraes E, Dal-Pizzol F, Tomasi Damiani C, Ritter C, Ferreira JC, Teixeira Costa R, Caruso P, Amendola CP, de Oliveira AMRR, Silva UVA, Sanches LC, Almeida RDS, Azevedo LC, Park M, Schettino G, Assunção MS, Silva E, Barboza CE, Junior APN, Marzocchi Tierno PFGM, Malbouisson LM, Oliveira L, Cristovao D, Neto ML, Rego Ê, Fernandes FE, Romano MLP, Cavalcanti AB, de Souza Barros D, Rodgers H, Dixon B, Smith R, Kol M, Wong H, Schmid W, Hermans G, Ceunen H, Bourgeois M, Anquez N, Suzumura ÉA, Decruyenaere J, DeCrop L, Neto AS, Souza dos Santos R, Beraldo D, dos Santos MC, Pellegrini JAS, Piras C, Oliveira V, Munhoz C, Meira KL, Peçanha AC, da Silva Ramos FJ, Maia I, Bahl M, Biondi R, Prado D, Pinto SF, Salgado J, Falcão LF, Macruz T, de Oliveira GA, Cavalcanti AB, Romano MLP, Ruas K, Mecatti GC, Caser EB, Gava IA, Carreño N, Morales M, Avendaño R, Aguirre S, Luciano PM, Sribar A, Klaric V, Skilijic S, Dvorscak MB, Krkusek M, Jurjevic M, Karanovic N, Simurina T, Stourac P, Kratochvil M, Pacheco ED, Máca J, Wrigge H, Schlegel C, Treschan TA, Schaefer M, Aytulun A, Kienbaum P, Clarkson K, Jaafar R, Collins D, Mazza BF, Plant R, Melchionda G, Di Lauro E, Cortegiani A, Russotto V, Caione R, Mestria D, Volta CA, Spadaro S, Botteri M, Machado FR, Seghelini E, Brazzi L, Sales G, D'Antini D, Molin A, Severgnini P, Bacuzzi A, Peluso L, Verrastro P, Raimondo P, Ferreira E, Gecaj-Gashi A, Simonis FD, Tuinman PR, Alberts E, van den Hul I, Kuiper M, de Wilde RBP, Koopmans M, Kose I, Zincircioglu Ç, dos Santos RB, Dogan N, Aydin D, Denker AS, Buyukkocak U, Akgun N, Turan G, Senturk E, Demirtürk Z, Özcan PE, Ekinci O, Colombo AS, Saylan S, Eren G, Ulger F, Dilek A, Ulusoy H, Goktas U, Soyoral L, Toman H, Orak Y, Kahveci F, Nogueira AC, Mills GH, Pinder A, Walker R, Harrison J, Snell J, Seasman C, Pearson R, Sharman M, Kaloo C, Bynorth N, Fernandes JB, Matthews K, Hughes C, Rose A, Simeson K, Niska L, Huneke N, Adderly J, Padilla-Harris C, Oliver R, Brohi F, Nóbrega RS, Wilson N, Talbot H, Wilson D, Smith D, Dark P, Evans T, Fisher N, Montgomery J, Fitzell P, Muench C, do CS Martins B, Hugill K, Cirstea E, Bentley A, Lynch K, White I, Cooper J, Brazier M, Devile M, Parris M, Gill P, Soriano F, Patel T, Criswell J, Trodd D, Griffin D, Martin J, Wreybrown C, Bewley J, Sweet K, Grimmer L, Kozlowski M, Morsch RD, James S, Limb J, Cowton A, Rogerson D, Downes C, Melbourne S, Humphries R, Pulletz M, Moreton S, Janes S, Nunes ALB, Corner A, Linnett V, Ritzema J, Watters M, Windebank S, Chenna S, Howard-Griffin R, Turner K, Suresh S, Blaylock H, de Almeida JP, Bell S, Blenk K, Everett L, Hopkins P, Mellis C, Hadfield D, Harris C, Chan A, Birch S, Pegg C, Hajjar L, Plowright C, Cooper L, Hatton T, McCullagh I, Wright S, Scott C, Boyd C, Holliday M, Poultney U, Crowther H, Moulin S, Thornthwaite S, Hollister N, Hunt J, Skinner A, Matsa R, Salt R, Matthews C, Reschreiter H, Camsooksai J, Venner N, Giannini FP, Barcraft-Barnes H, Tbaily L, Pogson D, Mouland J, Rose S, Lamb N, Tarmey N, Knighton J, Giles J, Weller D, Baptiston Nunes AL, Reed I, Hormis A, Pearson S, Harris M, Howe J, Paddle J, Burt K, Welters I, Walker A, Youds L, Rios F, Hendry S, Shaw D, Williams K, Hollands R, Carnahan M, Stickley J, Miller C, Donaldson D, Tonks L, Creagh-Brown B, Van Haren F, Hull D, Boyd O, Ortiz-Ruiz L, Gopal S, Metherell S, Spencer H, Frey C, Brown C, Clifford G, Leaver S, Sottiaux T, Ryan C, Mellinghoff JM, Prudden SP, Green HG, Roy AR, Furneval JF, Bell AB, Lakhani SL, Fasting LF, Murray LM, Lora FS, Preller K, McInerney A, Beavis S, Whileman A, Toms J, Glenn S, Ramali M, Ghosh A, Bullock C, Barrell L, Azevedo LC, Young E, Robertson H, Faulkner M, MacNaughton P, Tyson S, Pulak P, Sewell TA, Smalley C, Jacob R, Santos C, Depuydt P, Alzugaray P, Vidal Melo MF, Joyce K, Needleman J, Ahsan A, Faiz A, Alam AKMS, Khatoon SN, Nath RK, Rahman Chowdhury MA, Fan E, Banik D, Mondol MK, Bhuiyan SR, Nazneed S, Sultana R, Hamid T, Hossain M, Reza ST, Asaduzzaman M, Salim M, Bugedo G, Mostafa Kamal AH, Taher SM, Taohid TM, Karmaker P, Roy S, Das S, Sarkar SA, Dutta ML, Roy P, Iyer S, Qiu H, Krishna B, Sampath S, Pattnaik R, Kasi CK, Shah J, Dongre A, Reza Hashemian SM, Nooraei N, Raessi Estabragh R, Malekmohammad M, Gonzalez M, Khoundabi B, Mobasher M, Mohd Yunos N, Kassim M, Voon CM, Das SS, Azauddin SNS, Dorasamy D, Tai LL, Mat Nor MB, Silesky J, Zarudin N, Hasan MS, Jamaluddin MFH, Othman Jailani MI, Kayashta G, Adhikari A, Pangeni R, Hashmi M, Joseph S, Akhtar A, Cerny V, Qadeer A, Memon I, Ali SM, Idrees F, Kamal S, Hanif S, Rehman AU, Taqi A, Hussain T, Farooq A, Nielsen J, Khaskheli S, Hayat M, Indraratna K, Beane A, Haniffa R, Samaranayake U, Mathanalagan S, Gunaratne A, Mithraratne N, Thilakasiri K, Jibaja M, Pilimatalawwe C, Dilhani YAH, Fernando M, Ranatunge K, Samarasinghe L, Vaas M, Edirisooriya M, Sigera C, Arumoli J, De Silva K, Pham T, Kudavidanage B, Pinto V, Dissanayake L, Chittawatanarat K, Kongpolprom N, Silachamroon U, Pornsuriyasak P, Petnak T, Singhatas P, Tangsujaritvijit V, Wrigge H, Rungruanghiranya S, Piriyapatsom A, Juntaping K, Trongtrakul K, Thungtitigul P, Tajarernmuang P, Chatmongkolchart S, Bhurayanontachai R, Akaraborworn O, Navasakulpong A, Matamis D, Surasit K, Thwaites L, Nadjm B, Vu Quoc D, Nguyen Thi Thanh H, Nguyen Van K, Duong Bich T, Lam Minh Y, Ranero JL, Hashemian SM, Amin P, Clarkson K, Bellani G, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Lorente JA, Larsson A, Piquilloud L, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Milstein C, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Depuydt P, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Ampinelli AMR, Nassar Jr AP, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Ismail DMABPH, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Canestrini S, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Qiu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Nielsen J, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Pham T, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PLM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Ould Zein S, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HBF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Mohammadreza Hashemian S, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Terragni P, Pattarino I, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Gonzalez DR, Dector DM, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Zeggwagh AA, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Heunks LM, Van Wezel HM, Heines SJ, Buise MP, Simonis FD, Schultz MJ, Goodson JC, rowne TSB, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Laake JH, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Yoshido HHL, Aguilar RZ, Oscanoa FAM, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan BC, Andruszkiewicz P, Jakubowska K, Cox CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Lorente MDC, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Pere CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Perez Cheng M, Perez Losada E, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Blasco Navalpotro MA, Abad RD, Montiel González R, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Diaz JCJS, Lopez EB, Moya DDL, Alfonso AAT, Eugenio Luis PS, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Piquilloud L, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Ben Souissi A, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McNamee L, McAuley D, Steinberg J, Hopkins P, Mellis C, Stansil F, Kakar V, Hadfield D, Brown C, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, Thomas RRJM, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, De Gordoa LOR, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugave M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, Trinder TJ, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Hurtado J, Nin N, Hurtado J, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Mesar T, Cowley RA, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Schlichting AB, Delsing A, Elmasri M, Crouch DR, Ismail D, Blakeman TC, Dreyer KR, Gomaa D, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M, Van Haren F. Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies. The Lancet Global Health 2022; 10:e227-e235. [PMID: 34914899 PMCID: PMC8766316 DOI: 10.1016/s2214-109x(21)00485-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
Collapse
|
9
|
Puchongmart C, Nakornchai T, Rittayamai N, Monsomboon A, Prapruetkit N, Limsuwat C, Ruangsomboon O, Chakorn T. Number of attempts required by emergency physicians to achieve competency in diaphragmatic ultrasound imaging. J Clin Ultrasound 2022; 50:256-262. [PMID: 34972254 DOI: 10.1002/jcu.23133] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This research aimed to determine the number of attempts that emergency physicians need to become proficient in undertaking diaphragmatic ultrasound imaging. METHODS A prospective observational study was conducted at the emergency department (ED) of a tertiary-care university hospital. Sixteen emergency physicians were each required to obtain a set of images of the right hemidiaphragm of five dyspneic patients using both diaphragmatic excursion and thickness techniques. The images were subsequently reviewed by a specialist using American College of Emergency Physician guidelines. If the evaluations of a physician did not reach the expected standard, the physician was to be given feedback and requested to collect images from another five patients. The process was to be repeated until such time as the images obtained by the physician were deemed to be up to standard. RESULTS Eighty patients, twelve emergency medicine residents, and four attending physicians were enrolled. Following a didactic session on diaphragmatic ultrasound imaging and its interpretation, practicing on five patients proved sufficient to achieve an adequate level of competency in conducting diaphragmatic ultrasound examinations. CONCLUSION Practicing on five patients is sufficient for emergency physicians to achieve an adequate level of competency in conducting right-sided diaphragmatic ultrasound examinations.
Collapse
Affiliation(s)
- Chanokporn Puchongmart
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Nakornchai
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apichaya Monsomboon
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattakarn Prapruetkit
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chok Limsuwat
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tipa Chakorn
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
10
|
Rittayamai N, Ratchaneewong N, Tanomsina P, Kongla W. Validation of rapid shallow breathing index displayed by the ventilator compared to the standard technique in patients with readiness for weaning. BMC Pulm Med 2021; 21:310. [PMID: 34600522 PMCID: PMC8486963 DOI: 10.1186/s12890-021-01680-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid shallow breathing index (RSBI) is the most commonly used parameter for predicting weaning outcome. Measurement of RSBI by Wright spirometer (RSBIstandard) is the standard method in routine clinical practice. Data specific to the accuracy and reliability of the RSBI value displayed by the ventilator (RSBIvent) are scarce. Accordingly, this study aimed to evaluate the association between the average value of RSBIvent at different time points and RSBIstandard, and to assess the accuracy and reliability of these two RSBI measurement techniques. METHODS This prospective cohort study included mechanically ventilated patients who were ready to wean. At the beginning of spontaneous breathing trial using the flow-by method, RSBI was measured by two different techniques at the same time, including: (1) Wright spirometer (breathing frequency/average tidal volume in 1 min) (RSBIstandard), and (2) the values displayed on the ventilator at 0, 15, 30, 45, and 60 s (RSBIvent). RESULTS Forty-seven patients were enrolled. The RSBIvent value was significantly higher than the RSBIstandard value for every comparison. According to Spearman's correlation coefficient (r) and intraclass correlation coefficient (ICC), the average value of RSBI from 5 time points (0, 15, 30, 45, and 60 s) showed the best correlation with the standard technique (r = 0.76 [P < 0.001], and ICC = 0.79 [95% CI 0.61-0.88], respectively). Bland-Altman plot also showed the best agreement between RSBIstandard and the RSBIvent value averaged among 5 time points (mean difference - 17.1 breaths/min/L). CONCLUSIONS We found that the ventilator significantly overestimates the RSBI value compared to the standard technique by Wright spirometer. The average RSBIvent value among 5 time points (0, 15, 30, 45, and 60 s) was found to best correlate with RSBIstandard.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Natwipha Ratchaneewong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pirat Tanomsina
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Withoon Kongla
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| |
Collapse
|
11
|
Lersritwimanmaen P, Rittayamai N, Tscheikuna J, J Brochard L. High-Flow Oxygen Therapy in Tracheostomized Subjects With Prolonged Mechanical Ventilation: A Randomized Crossover Physiologic Study. Respir Care 2021; 66:806-813. [PMID: 33653909 PMCID: PMC9994105 DOI: 10.4187/respcare.08585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-flow oxygen therapy via tracheostomy (HFT) can be used in tracheostomized patients during ventilator disconnection. The physiologic effects of this technique are unknown. We hypothesized that HFT would reduce inspiratory effort and improve breathing pattern compared to conventional oxygen therapy via T-tube. This study aimed to evaluate the physiologic effects of HFT compared to conventional O2 in patients with prolonged mechanical ventilation. METHODS A randomized crossover physiologic study was conducted in adult tracheostomized patients who experienced temporary periods of ventilator disconnection. Subjects were ventilated with pressure support ventilation (PSV) for 15 min and were then randomly assigned to HFT or conventional O2 via T-tube for 30 min. After a washout period, subjects were switched to the other system. Esophageal pressure (Pes), breathing frequency, blood pressure, heart rate, [Formula: see text], and transcutaneously measured pressure of carbon dioxide ([Formula: see text]) were recorded. The primary outcome was inspiratory effort as determined by the simplified esophageal pressure-time product (sPTPes). Secondary outcomes were Pes swing, breathing frequency, heart rate, mean arterial pressure, [Formula: see text], and [Formula: see text] between groups. RESULTS Twenty-two subjects were enrolled: sPTPes per minute was significantly higher with HFT and conventional O2 compared to PSV (153.5 ± 97.9, 163.5 ± 111.3, and 86.8 ± 51.1 cm H2O × s/min, respectively, P = .001), but it was not different between HFT and conventional O2 (P = .72). Breathing frequency increased significantly after switching from PSV to HFT and conventional O2 (23 ± 4 vs 26 ± 6 and 23 ± 4 vs 27 ± 5 breaths/min, respectively, P = .001). [Formula: see text] was higher with conventional O2 compared to HFT (P = .02). No differences in [Formula: see text], mean arterial pressure, or heart rate were observed between HFT and conventional O2. CONCLUSIONS Inspiratory effort and breathing frequency increased significantly during unassisted breathing compared to PSV in tracheostomized subjects, but HFT via tracheostomy provided no measurable additional physiologic benefit compared to O2 therapy via T-tube.
Collapse
Affiliation(s)
- Patharapan Lersritwimanmaen
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Jamsak Tscheikuna
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Sklar MC, Madotto F, Jonkman A, Rauseo M, Soliman I, Damiani LF, Telias I, Dubo S, Chen L, Rittayamai N, Chen GQ, Goligher EC, Dres M, Coudroy R, Pham T, Artigas RM, Friedrich JO, Sinderby C, Heunks L, Brochard L. Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients. Crit Care 2021; 25:26. [PMID: 33430930 PMCID: PMC7798017 DOI: 10.1186/s13054-020-03435-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity. METHODS Prospective observational study in critically ill patients. Diaphragm electrical activity (EAdi) was continuously recorded after intubation looking for resumption of a minimal level of diaphragm activity (beginning of the first 24 h period with median EAdi > 7 µV, a threshold based on literature and correlations with diaphragm thickening fraction). Recordings were collected until full spontaneous breathing, extubation, death or 120 h. A 1 h waveform recording was collected daily to identify reverse triggering. RESULTS Seventy-five patients were enrolled and 69 analyzed (mean age ± standard deviation 63 ± 16 years). Reasons for ventilation were respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter disconnections occurred. The median time for resumption of EAdi was 22 h (interquartile range 0-50 h); 35/69 (51%) of patients resumed activity within 24 h while 4 had no recovery after 5 days. Late recovery was associated with use of sedative agents, cumulative doses of propofol and fentanyl, controlled ventilation and age (older patients receiving less sedation). Severity of illness, oxygenation, renal and hepatic function, reason for intubation were not associated with EAdi resumption. At least 20% of patients initiated EAdi with reverse triggering. CONCLUSION Low levels of diaphragm electrical activity are common in the early course of mechanical ventilation: 50% of patients do not recover diaphragmatic activity within one day. Sedatives are the main factors accounting for this delay independently from lung or general severity. Trial Registration ClinicalTrials.gov (NCT02434016). Registered on April 27, 2015. First patients enrolled June 2015.
Collapse
Affiliation(s)
- Michael Chaim Sklar
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Fabiana Madotto
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Value Based Health-Care Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Annemijn Jonkman
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Michela Rauseo
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Ibrahim Soliman
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - L Felipe Damiani
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Departamento de Ciencias de La Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Irene Telias
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Sebastian Dubo
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Departamento de Kinesiologiá, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.,Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile
| | - Lu Chen
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Nuttapol Rittayamai
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 65106, Thailand
| | - Guang-Qiang Chen
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Ewan C Goligher
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Toronto General Hospital Research Institute, Toronto, ON, Canada.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Martin Dres
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Pneumology and Critical Care Department, Public Assistance - Paris Hospital, Pitie-Salpetriere Hospital, Paris, France
| | - Remi Coudroy
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Médecine Intensive Réanimation, CHU de Poitiers, INSERM CIC1402 Alive Group, Université de Poitiers, Poitiers, France
| | - Tai Pham
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, France
| | - Ricard M Artigas
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Jan O Friedrich
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Christer Sinderby
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Institute for Biomedical Engineering and Science Technology (iBEST), Ryerson University and St-Michael's Hospital, Toronto, Canada
| | - Leo Heunks
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
13
|
Ricard JD, Roca O, Lemiale V, Corley A, Braunlich J, Jones P, Kang BJ, Lellouche F, Nava S, Rittayamai N, Spoletini G, Jaber S, Hernandez G. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med 2020; 46:2238-2247. [PMID: 32901374 PMCID: PMC7478440 DOI: 10.1007/s00134-020-06228-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [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: 05/12/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.
Collapse
Affiliation(s)
- Jean-Damien Ricard
- Medico-surgical ICU, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France. .,Université de Paris, IAME, U1137, Inserm, 75018, Paris, France.
| | - Oriol Roca
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Jens Braunlich
- Department of Respiratory Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.,Klinikum Emden, Bolardusstrasse 20, 26721, Emden, Germany
| | - Peter Jones
- School of Medicine, University of Auckland, Auckland, New Zealand.,Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - François Lellouche
- Quebec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - Stefano Nava
- Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Giulia Spoletini
- Department of Respiratory Medicine, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Samir Jaber
- Saint Eloi ICU, Montpellier University Hospital and PhyMedExp, INSERM, CNRS, 34000, Montpellier, France
| | - Gonzalo Hernandez
- Intensive Care Medicine, University Hospital Virgen de la Salud, Toledo, Spain
| |
Collapse
|
14
|
Telias I, Junhasavasdikul D, Rittayamai N, Piquilloud L, Chen L, Ferguson ND, Goligher EC, Brochard L. Airway Occlusion Pressure As an Estimate of Respiratory Drive and Inspiratory Effort during Assisted Ventilation. Am J Respir Crit Care Med 2020; 201:1086-1098. [PMID: 32097569 DOI: 10.1164/rccm.201907-1425oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Rationale: Monitoring and controlling respiratory drive and effort may help to minimize lung and diaphragm injury. Airway occlusion pressure (P0.1) is a noninvasive measure of respiratory drive.Objectives: To determine 1) the validity of "ventilator" P0.1 (P0.1vent) displayed on the screen as a measure of drive, 2) the ability of P0.1 to detect potentially injurious levels of effort, and 3) how P0.1vent displayed by different ventilators compares to a "reference" P0.1 (P0.1ref) measured from airway pressure recording during an occlusion.Methods: Analysis of three studies in patients, one in healthy subjects, under assisted ventilation, and a bench study with six ventilators. P0.1vent was validated against measures of drive (electrical activity of the diaphragm and muscular pressure over time) and P0.1ref. Performance of P0.1ref and P0.1vent to detect predefined potentially injurious effort was tested using derivation and validation datasets using esophageal pressure-time product as the reference standard.Measurements and Main Results: P0.1vent correlated well with measures of drive and with the esophageal pressure-time product (within-subjects R2 = 0.8). P0.1ref >3.5 cm H2O was 80% sensitive and 77% specific for detecting high effort (≥200 cm H2O ⋅ s ⋅ min-1); P0.1ref ≤1.0 cm H2O was 100% sensitive and 92% specific for low effort (≤50 cm H2O ⋅ s ⋅ min-1). The area under the receiver operating characteristics curve for P0.1vent to detect potentially high and low effort were 0.81 and 0.92, respectively. Bench experiments showed a low mean bias for P0.1vent compared with P0.1ref for most ventilators but precision varied; in patients, precision was lower. Ventilators estimating P0.1vent without occlusions could underestimate P0.1ref.Conclusions: P0.1 is a reliable bedside tool to assess respiratory drive and detect potentially injurious inspiratory effort.
Collapse
Affiliation(s)
- Irene Telias
- Interdepartmental Division of Critical Care Medicine and.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Detajin Junhasavasdikul
- Interdepartmental Division of Critical Care Medicine and.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine Ramathibodi Hospital and
| | - Nuttapol Rittayamai
- Interdepartmental Division of Critical Care Medicine and.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lise Piquilloud
- Adult Intensive Care and Burn Unit, University Hospital and University of Lausanne, Lausanne, Switzerland; and
| | - Lu Chen
- Interdepartmental Division of Critical Care Medicine and.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine and.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine and.,Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine and.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Sereearuno T, Rittayamai N, Lawansil S, Thirapatarapong W. Effectiveness of a chest physiotherapy care map in hospitalized patients. Heart Lung 2020; 49:616-621. [PMID: 32340869 DOI: 10.1016/j.hrtlng.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Conventional chest physiotherapy (chest PT) has been widely used to facilitate airway clearance. However, conventional chest PT is time consuming, unnecessary prescriptions result in heavier workloads for therapists. Therefore, judicious prescription of chest PT is important. PURPOSE To develop a chest physiotherapy care-map and evaluate its efficacy. METHOD Seventy-eight hospitalized patients who were consulted for chest PT were enrolled and consecutively allocated into two groups of 39 patients. Group I and II was enrolled before and after the implementation of the chest PT map, respectively. RESULT After the care-map was implemented, the chest PT prescription rate decreased from 56.4% to 33.3%, (p = 0.040). The duration of conventional chest PT trended to lower but not reaching significance from 4.5 (1-28) to 4 (2-9) days, (p = 0.582). The mean cost of chest PT was reduced by 38.2% (p = 0.019). CONCLUSION Chest PT care-map is an effective tool to reduce unnecessary chest PT prescriptions, lower costs, and more effectively allocate therapist time.
Collapse
Affiliation(s)
- T Sereearuno
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - S Lawansil
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Thirapatarapong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
16
|
Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Rittayamai N, Harhay MO, Reid WD, Tomlinson G, Rozenberg D, McClelland W, Riegler S, Slutsky AS, Brochard L, Ferguson ND, Goligher EC. Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults. JAMA Netw Open 2020; 3:e1921520. [PMID: 32074293 DOI: 10.1001/jamanetworkopen.2019.21520] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Low diaphragm muscle mass at the outset of mechanical ventilation may predispose critically ill patients to poor clinical outcomes. OBJECTIVE To determine whether lower baseline diaphragm thickness (Tdi) is associated with delayed liberation from mechanical ventilation and complications of acute respiratory failure (reintubation, tracheostomy, prolonged ventilation >14 days, or death in the hospital). DESIGN, SETTING, AND PARTICIPANTS Secondary analysis (July 2018 to June 2019) of a prospective cohort study (data collected May 2013 to January 2016). Participants were 193 critically ill adult patients receiving invasive mechanical ventilation at 3 intensive care units in Toronto, Ontario, Canada. EXPOSURES Diaphragm thickness was measured by ultrasonography within 36 hours of intubation and then daily. Patients were classified as having low or high diaphragm muscle mass according to the median baseline Tdi. MAIN OUTCOMES AND MEASURES The primary outcome was time to liberation from ventilation accounting for the competing risk of death and adjusting for age, body mass index, severity of illness, sepsis, change in Tdi during ventilation, baseline comorbidity, and study center. Secondary outcomes included in-hospital death and complications of acute respiratory failure. RESULTS A total of 193 patients were available for analysis; the mean (SD) age was 60 (15) years, 73 (38%) were female, and the median (interquartile range) Sequential Organ Failure Assessment score was 10 (8-13). Median (interquartile range) baseline Tdi was 2.3 (2.0-2.7) mm. In the primary prespecified analysis, baseline Tdi of 2.3 mm or less was associated with delayed liberation from mechanical ventilation (adjusted hazard ratio for liberation, 0.51; 95% CI, 0.36-0.74). Lower baseline Tdi was associated a higher risk of complications of acute respiratory failure (adjusted odds ratio, 1.77; 95% CI, 1.20-2.61 per 0.5-mm decrement) and prolonged weaning (adjusted odds ratio, 2.30; 95% CI, 1.42-3.74). Lower baseline Tdi was also associated with a higher risk of in-hospital death (adjusted odds ratio, 1.47; 95% CI, 1.00-2.16 per 0.5-mm decrement), particularly after discharge from the intensive care unit (adjusted odds ratio, 2.68; 95% CI, 1.35-5.32 per 0.5-mm decrement). CONCLUSIONS AND RELEVANCE In this study, low baseline diaphragm muscle mass in critically ill patients was associated with prolonged mechanical ventilation, complications of acute respiratory failure, and an increased risk of death in the hospital.
Collapse
Affiliation(s)
- Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Dres
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- AP-HP, Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Nuttapol Rittayamai
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Siriraj Hospital, Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Michael O Harhay
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - W Darlene Reid
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - William McClelland
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Stephen Riegler
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I, Sklar MC, Rauseo M, Ferguson ND, Fan E, Richard JCM, Brochard L. Potential for Lung Recruitment Estimated by the Recruitment-to-Inflation Ratio in Acute Respiratory Distress Syndrome. A Clinical Trial. Am J Respir Crit Care Med 2020; 201:178-187. [DOI: 10.1164/rccm.201902-0334oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lu Chen
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael’s Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, and
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lorenzo Del Sorbo
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Domenico L. Grieco
- Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ibrahim Soliman
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Michael C. Sklar
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michela Rauseo
- Anestesia e Rianimazione, Ospedali Riuniti di Foggia, Foggia, Italy; and
| | - Niall D. Ferguson
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eddy Fan
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology and Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Laurent Brochard
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael’s Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, and
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Chuaychoo B, Kositanont U, Niyomthong P, Rittayamai N, Srisuma S, Rattanasaengloet K, Wongsrisakunkaew W, Thongam J, Songserm T. Comparison of immunogenicity between intradermal and intramuscular injections of repeated annual identical influenza virus strains post-pandemic (2011-2012) in COPD patients. Hum Vaccin Immunother 2019; 16:1371-1379. [PMID: 31770051 DOI: 10.1080/21645515.2019.1692559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We compared the antibody responses and persistence of the reduced-dose, 9 µg hemagglutinin (HA)/strain intradermal (ID) injection via the Mantoux technique and the 15 μg HA/strain intramuscular (IM) injection of the repeated annual identical trivalent, inactivated, split-virion vaccine 2011-2012 in chronic obstructive pulmonary disease (COPD) patients. Eighty patients were randomized to ID (n = 41) and IM (n = 39) groups. Four weeks post-vaccination, the antibody responses of the two groups were similar; those for influenza A(H1N1)pdm09 and influenza A(H3N2)-but not influenza B-met the criteria of the Committee for Proprietary Medicinal Products (CPMP). The antibody responses for influenza A(H1N1)pdm09 rapidly declined in both groups, especially with the ID injection, whereas those for influenza A(H3N2) maintained above the CPMP criteria throughout 12 months post-vaccination. The geometric mean titres for influenza A(H1N1)pdm09 persisted above the protective threshold (≥ 40) until 6 months post-vaccination in both the ID and IM groups. The seroprotection rates of the ID and IM groups were above 60% until 3 months and 6 months post-vaccination, respectively. In conclusion, the 9 μg HA/strain ID injection of vaccine 2011-2012 elicited antibody responses similar to the standard dose of 15 μg of the HA/strain IM injection at 4 weeks post-vaccination. However, the antibody responses for influenza A(H1N1)pdm09 rapidly declined, especially in the case of the ID injection, whereas they were comparable for influenza A(H3N2). Additional strategies for increasing vaccine durability should be considered, especially for new pandemic strains affecting elderly COPD patients.
Collapse
Affiliation(s)
- Benjamas Chuaychoo
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Uraiwan Kositanont
- Department of Microbiology, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand.,Faculty of Public Health, Thammasat University , Bangkok, Thailand
| | - Parichat Niyomthong
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand.,Medicine Unit, Phrae Medical Education Center, Naresuan University , Phitsanulok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Sorachai Srisuma
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Kanokwan Rattanasaengloet
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Walaiporn Wongsrisakunkaew
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Julalux Thongam
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Thaweesak Songserm
- Department of Veterinary Pathology, Kamphaeng Saen, Kasetsart University , Nakhon Pathom, Thailand
| |
Collapse
|
19
|
Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care 2019; 9:122. [PMID: 31641959 PMCID: PMC6805835 DOI: 10.1186/s13613-019-0597-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background Non-invasive ventilation (NIV) is preferred as the initial ventilatory support to treat acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). High-flow nasal cannula (HFNC) may be an alternative method; however, the effects of HFNC in hypercapnic COPD are not well known. This preliminary study aimed at assessing the physiologic effects of HFNC at different flow rates in hypercapnic COPD and to compare it with NIV. Methods A prospective physiologic study enrolled 12 hypercapnic COPD patients who had initially required NIV, and were ventilated with HFNC at flow rates increasing from 10 to 50 L/min for 15 min in each step. The primary outcome was the effort to breathe estimated by a simplified esophageal pressure–time product (sPTPes). The other studied variables were respiratory rate, oxygen saturation (SpO2), and transcutaneous CO2 pressure (PtcCO2). Results Before NIV initiation, the median [interquartile range] pH was 7.36 [7.28–7.37] with a PaCO2 of 51 [42–60] mmHg. sPTPes per minute was significantly lower with HFNC at 30 L/min than 10 and 20 L/min (p < 0.001), and did not significantly differ with NIV (median inspiratory/expiratory positive airway pressure of 11 [10–12] and [5–5] cmH2O, respectively). At 50 L/min, sPTPes per minute increased compared to 30 L/min half of the patients. Respiratory rate was lower (p = 0.003) and SpO2 was higher (p = 0.028) with higher flows (30–50 L/min) compared to flow rate of 10 L/min and not different than with NIV. No significant differences in PtcCO2 between NIV and HFNC at different flow rates were observed (p = 0.335). Conclusions Applying HFNC at 30 L/min for a short duration reduces inspiratory effort in comparison to 10 and 20 L/min, and resulted in similar effect than NIV delivered at modest levels of pressure support in hypercapnic COPD with mild to moderate exacerbation. Higher flow rates reduce respiratory rate but sometimes increase the effort to breathe. Using HFNC at 30 L/min in hypercapnic COPD patients should be further evaluated. Trial registration Thai Clinical Trials Registry, TCTR20160902001. Registered 31 August 2016, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2008.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Prapinpa Phuangchoei
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Jamsak Tscheikuna
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nattakarn Praphruetkit
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Rittayamai N, Hemvimon S, Chierakul N. The evolution of diaphragm activity and function determined by ultrasound during spontaneous breathing trials. J Crit Care 2019; 51:133-138. [DOI: 10.1016/j.jcrc.2019.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
|
21
|
Dres M, Younes M, Rittayamai N, Kendzerska T, Telias I, Grieco DL, Pham T, Junhasavasdikul D, Chau E, Mehta S, Wilcox ME, Leung R, Drouot X, Brochard L. Sleep and Pathological Wakefulness at the Time of Liberation from Mechanical Ventilation (SLEEWE). A Prospective Multicenter Physiological Study. Am J Respir Crit Care Med 2019; 199:1106-1115. [DOI: 10.1164/rccm.201811-2119oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Martin Dres
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Service de Pneumologie, Médecine Intensive—Réanimation, Département R3S AP-HP, Groupe Hospitalier Pitié–Salpétrière Charles Foix, Paris, France
| | - Magdy Younes
- YRT Ltd., Winnipeg, Manitoba, Canada
- Sleep Disorders Centre, Winnipeg, Manitoba, Canada
| | - Nuttapol Rittayamai
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tetyana Kendzerska
- Division of Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Irene Telias
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Domenico Luca Grieco
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tai Pham
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Detajin Junhasavasdikul
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edmond Chau
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - M. Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Critical Care, Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada; and
| | - Richard Leung
- Division of Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Xavier Drouot
- Neurophysiologie Clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Aswanetmanee P, Limsuwat C, Rittayamai N, Wongsurakeit P. NONINVASIVE VENTILATION IN ACUTE HYPOXEMIC RESPIRATORY FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Chest 2019. [DOI: 10.1016/j.chest.2019.02.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
23
|
Sklar MC, Dres M, Rittayamai N, West B, Grieco DL, Telias I, Junhasavasdikul D, Rauseo M, Pham T, Madotto F, Campbell C, Tullis E, Brochard L. High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study. Ann Intensive Care 2018; 8:85. [PMID: 30187270 PMCID: PMC6125258 DOI: 10.1186/s13613-018-0432-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/30/2018] [Indexed: 12/26/2022] Open
Abstract
Background Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO2 (PtcCO2), hemodynamics, dyspnea and comfort. Methods Adult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order. Results Fifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min, p = 0.01) and minute ventilation (by 2 L/min, p = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (p = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (p ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO2, PtcCO2 or dyspnea. Conclusions In adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation. Clinical trial registration Ethics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871). Electronic supplementary material The online version of this article (10.1186/s13613-018-0432-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michael C Sklar
- Department of Anesthesia, University of Toronto, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Martin Dres
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada.,Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, Paris, France
| | - Nuttapol Rittayamai
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Brent West
- Division of Respirology, St. Michael's Hospital, Toronto, Canada
| | - Domenico Luca Grieco
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada
| | - Detajin Junhasavasdikul
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada.,Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Michela Rauseo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Tai Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Fabiana Madotto
- Department of Medicine and Surgery, Research Center on Public Health, University of Milano-Bicocca, Monza, Italy
| | - Carolyn Campbell
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada
| | - Elizabeth Tullis
- Division of Respirology, St. Michael's Hospital, Toronto, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada.
| |
Collapse
|
24
|
Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Vorona S, Sklar MC, Rittayamai N, Lanys A, Murray A, Brace D, Urrea C, Reid WD, Tomlinson G, Slutsky AS, Kavanagh BP, Brochard LJ, Ferguson ND. Mechanical Ventilation–induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. Am J Respir Crit Care Med 2018; 197:204-213. [DOI: 10.1164/rccm.201703-0536oc] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Medicine
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Martin Dres
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Respiratory and Critical Care Department, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Gordon D. Rubenfeld
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada
| | - Damon C. Scales
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada
| | - Margaret S. Herridge
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
- Toronto General Research Institute, Toronto, Canada; and
| | - Stefannie Vorona
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Michael C. Sklar
- Department of Anesthesia, and
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Nuttapol Rittayamai
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Ashley Lanys
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Alistair Murray
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Deborah Brace
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Cristian Urrea
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - George Tomlinson
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Arthur S. Slutsky
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Brian P. Kavanagh
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Anesthesia, and
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
| | - Laurent J. Brochard
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
25
|
Sklar MC, Burns K, Rittayamai N, Lanys A, Rauseo M, Chen L, Dres M, Chen GQ, Goligher EC, Adhikari NKJ, Brochard L, Friedrich JO. Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis. Am J Respir Crit Care Med 2017; 195:1477-1485. [PMID: 27768396 DOI: 10.1164/rccm.201607-1338oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. OBJECTIVES We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. METHODS We searched Medline, Excerpta Medica Database, and Web of Science from inception to January 2016 to identify randomized and nonrandomized clinical trials reporting physiologic measurements of respiratory effort (pressure-time product) or work of breathing during at least two SBT techniques. Secondary outcomes included the rapid shallow breathing index (RSBI), and effort measured before and after extubation. The quality of physiologic measurement and research design was appraised for each study. Outcomes were analyzed using ratio of means. MEASUREMENTS AND MAIN RESULTS Among 4,138 citations, 16 studies (n = 239) were included. Compared with T-piece, pressure support ventilation significantly reduced work by 30% (ratio of means [RoM], 0.70; 95% confidence interval [CI], 0.57-0.86), effort by 30% (RoM, 0.70; 95% CI, 0.60-0.82), and RSBI by 20% (RoM, 0.80; 95% CI, 0.75-0.86). Continuous positive airway pressure had significantly lower pressure-time product by 18% (RoM, 0.82; 95% CI, 0.68-0.999) compared with T-piece, and reduced RSBI by 16% (RoM, 0.84; 95% CI, 0.74-0.95). Studies comparing SBTs with the postextubation period demonstrated that pressure support induced significantly lower effort and RSBI; T-piece reduced effort, but not the work, compared with postextubation. Work, effort, and RSBI measured while intubated on the ventilator with continuous positive airway pressure of 0 cm H2O were no different than extubation. CONCLUSIONS Pressure support reduces respiratory effort compared with T-piece. Continuous positive airway pressure of 0 cm H2O and T-piece more accurately reflect the physiologic conditions after extubation.
Collapse
Affiliation(s)
- Michael C Sklar
- 1 Department of Anesthesiology and.,2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Karen Burns
- 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.,2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nuttapol Rittayamai
- 4 Department of Medicine, Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ashley Lanys
- 2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michela Rauseo
- 2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,5 Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Lu Chen
- 2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Martin Dres
- 2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,6 Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Guang-Qiang Chen
- 2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,7 Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ewan C Goligher
- 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.,8 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada; and
| | - Neill K J Adhikari
- 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.,9 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurent Brochard
- 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.,2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jan O Friedrich
- 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.,2 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Burns KEA, Soliman I, Adhikari NKJ, Zwein A, Wong JTY, Gomez-Builes C, Pellegrini JA, Chen L, Rittayamai N, Sklar M, Brochard LJ, Friedrich JO. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Crit Care 2017; 21:127. [PMID: 28576127 PMCID: PMC5455092 DOI: 10.1186/s13054-017-1698-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990-2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data. RESULTS We identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89-1.11; I 2 = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02-1.10; 11 trials, n = 1904; I 2 = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01-1.12; I 2 = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success. CONCLUSIONS Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2-10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1-12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.
Collapse
Affiliation(s)
- Karen E A Burns
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ibrahim Soliman
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amer Zwein
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Jessica T Y Wong
- Department of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carolina Gomez-Builes
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Jose Augusto Pellegrini
- Division of Critical Care of Moinhos de Vento Hospital, Porto Alegre, Brazil
- Division of Critical Care of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lu Chen
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Nuttapol Rittayamai
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Michael Sklar
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Laurent J Brochard
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Jan O Friedrich
- St Michael's Hospital and the Keenan Research Centre/Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
27
|
Beloncle F, Piquilloud L, Rittayamai N, Sinderby C, Rozé H, Brochard L. A diaphragmatic electrical activity-based optimization strategy during pressure support ventilation improves synchronization but does not impact work of breathing. Crit Care 2017; 21:21. [PMID: 28137269 PMCID: PMC5282691 DOI: 10.1186/s13054-017-1599-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
Background Poor patient-ventilator synchronization is often observed during pressure support ventilation (PSV) and has been associated with prolonged duration of mechanical ventilation and poor outcome. Diaphragmatic electrical activity (Eadi) recorded using specialized nasogastric tubes is a surrogate of respiratory brain stem output. This study aimed at testing whether adapting ventilator settings during PSV using a protocolized Eadi-based optimization strategy, or Eadi-triggered and -cycled assisted pressure ventilation (or PSVN) could (1) improve patient-ventilator interaction and (2) reduce or normalize patient respiratory effort as estimated by the work of breathing (WOB) and the pressure time product (PTP). Methods This was a prospective cross-over study. Patients with a known chronic pulmonary obstructive or restrictive disease, asynchronies or suspected intrinsic positive end-expiratory pressure (PEEP) who were ventilated using PSV were enrolled in the study. Four different ventilator settings were sequentially applied for 15 minutes (step 1: baseline PSV as set by the clinician, step 2: Eadi-optimized PSV to adjust PS level, inspiratory trigger, and cycling settings, step 3: step 2 + PEEP adjustment, step 4: PSVN). The same settings as step 3 were applied again after step 4 to rule out a potential effect of time. Breathing pattern, trigger delay (Td), inspiratory time in excess (Tiex), pressure-time product (PTP), and work of breathing (WOB) were measured at the end of each step. Results Eleven patients were enrolled in the study. Eadi-optimized PSV reduced Td without altering Tiex in comparison with baseline PSV. PSVN reduced Td and Tiex in comparison with baseline and Eadi-optimized PSV. Respiratory pattern did not change during the four steps. The improvement in patient-ventilator interaction did not lead to changes in WOB or PTP. Conclusions Eadi-optimized PSV allows improving patient ventilator interaction but does not alter patient effort in patients with mild asynchrony. Trial registration Clinicaltrials.gov identifier: NCT 02067403. Registered 7 February 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1599-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Francois Beloncle
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Medical Intensive Care Unit, Hospital of Angers, University of Angers, Angers, France
| | - Lise Piquilloud
- Medical Intensive Care Unit, Hospital of Angers, University of Angers, Angers, France.,Adult Intensive Care and Burn Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nuttapol Rittayamai
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Christer Sinderby
- Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Hadrien Rozé
- CHU de Bordeaux, Service d'Anesthesie-Reanimation 2, Pessac, 33600, France
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| |
Collapse
|
28
|
Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, Carmona SA, Moors I, Mokart D, Pène F, Lambert J, Meleti DE, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne L, Rabbat A, Lebert C, Perez P, Chaize M, Kafetzopoulos D, Renault A, Meert AP, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V, Azoulay E, Benoit D, Georgopoulos D, Martins-Branco D, Sousa M, Marum S, Bouw MJ, Galstyan G, Makarova P, Parovichnikova E, Kuzmina L, Troitskaya V, Drize N, Briassoulis G, Gemdzhian E, Savchenko V, Chao HC, Kılıc E, Demiriz B, Uygur ML, Sürücü M, Cınar K, Yıldırım AE, Kiss K, Suberviola B, Köves B, Csernus V, Molnár Z, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Riera J, Gaffney S, Black E, Docking R, Judge C, Drew T, Misran H, Munshi R, McGovern L, Coyle M, Dunne L, Rellan L, Deasy E, Lavin P, Fahy A, Darcy DM, Donnelly M, Ismail NH, Hall T, Wykes K, Jack J, Ngu WC, Sanchez M, Morgan P, Ruiz-Ramos J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andrés JL, Castellanos A, Ijssennagger CE, ten Hoorn S, Robles JC, van Wijk A, van den Broek JM, Tuinman PR, Elmenshawy AM, Hammond BD, Gibbon G, Belcham T, Burton K, Taniguchi LU, Ramos FJS, Lopez E, Momma AK, Martins-Filho APR, Bartocci JJ, Lopes MFD, Sad MH, Rodrigues CM, Pires EMC, Vieira JM, Leite MA, Murbach LD, Vicente R, Osaku EF, Barreto J, Duarte ST, Taba S, Miglioranza D, Gund DP, Lordani CF, Costa CRLM, Ogasawara SM, Jorge AC, Miñambres E, Duarte PAD, Spadaro S, Capuzzo M, Corte FD, Terranova S, Scaramuzzo G, Fogagnolo A, Bertacchini S, Bellonzi A, Ragazzi R, Santibañez M, Volta CA, Cruz C, Nunes A, Pereira FS, Aragão I, Cardoso AF, Santos C, Malheiro MJ, Castro H, Cardoso T, Le Guen M, Paratz J, Kenardy J, Comans T, Coyer F, Thomas P, Boots R, Pereira N, Vilas-Boas A, Gomes E, Dias C, Moore J, Torres J, Carvalho D, Molinos E, Vales C, Araújo R, Cruz C, Nunes A, Pereira FS, Cardoso AF, Santos C, Mason N, Malheiro MJ, Castro H, Cardoso T, Karnatovskaia L, Philbrick K, Ognjen G, Clark M, Montero RM, Varas JL, Sánchez-Elvira LA, Windpassinger M, Delgado CP, Díaz PV, Ruiz BL, Guerrero AP, Galache JAC, Jiménez R, Rebollo S, Alejandro O, Fernández A, Moreno S, Plattner O, Herrera L, Ojados A, Galindo M, Murcia J, Contreras M, Sánchez-Argente S, Bonilla Y, Rodríguez MD, Allegue JM, Cakin Ö, Mascha E, Parlak H, Kirca H, Mutlu F, Aydınlı B, Cengiz M, Ramazanoglu A, Jung EJ, Oh SY, Lee H, Filho NMF, Sessler DI, Ricaldi EF, Gomes SS, Ramos BB, De Lucia CV, Ballalai CS, Oliveira JCA, Araponga GP, Veiga LN, Silva CS, Garrido ME, Research O, Domenech JC, Montalvo AP, Chornet TC, Martinez PC, Ribas MP, Costa RG, Ortega AC, Forbes C, Prescott H, Lal A, Melia U, Khan FA, Dela Pena EG, Dizon JS, Perez PPP, Wong CMJ, Garach MM, Romero OM, Puerta RR, Diaz FA, Bailon AMP, Fontanet J, Pinel AC, Maldonado LP, Kalaiselvan MS, kumar RLS, Renuka MK, Kumar ASA, De Rosa S, Ferrari F, Checcacci SC, Rigobello A, van den Berg JP, Joannidis M, Politi F, Pellizzari A, Bonato R, Fernandez-Carmona A, Macias-Guarasa I, Gutierrez-Rodriguez R, Martinez-Lopez P, Diaz-Castellanos MA, Fernandez-Carmona A, Struys MMRF, Arias-Diaz M, Aguilar-Alonso E, Macias-Guarasa I, Martinez-Lopez P, Diaz-Castellanos MA, Nikandish RN, Artemenko V, Budnyuk A, Bassi GL, Senussi T, Vereecke HEM, Idone F, Xiol EA, Travierso C, Chiurazzi C, Motos A, Amaro R, Hua Y, Fernández-Barat L, Ranzani OT, Bobi Q, Jensen EW, Rigol M, Torres A, Youn A, Hwang JG, Garach MM, Romero OM, Ossorio MEY, Diaz FA, Bailon AMP, Pinel AC, Rood PJT, Maldonado LP, Teixeira C, Figueira H, Oliveira R, Mota A, Aragão I, Kamp O, Cruciger O, Aach M, Kaczmarek C, van de Schoor F, Waydhas C, Schildhauer TA, Hamsen U, Camprubí-Rimblas M, Chimenti L, Guillamat-Prats R, Lebouvier T, Bringué J, Tijero J, Gómez MN, van Tertholen K, Blanch L, Artigas A, Tagliabue G, Ji M, Jagers JVS, Easton PA, Souza RB, Liberatore AMA, Martins AMCRPF, Vieira JCF, Pickkers P, Kang YR, Nakamae MN, Koh IHJ, Hong JY, Shin MH, Park MS, Pomprapa A, Pickerodt PA, Hofferberth MBT, Russ M, van den Boogaard M, Braun W, Walter M, Francis R, Lachmann B, Leonhardt S, Koh IHJ, Souza RB, Martins AMCRPF, Vieira JCF, Liberatore AMA, Beardow ZJ, Landaverde-López A, Canedo-Castillo NA, Esquivel-Chávez A, Arvizu-Tachiquín PC, Sánchez-Hurtado LA, Baltazar-Torres JA, Cardoso V, Krystopchuk A, Castro S, Melão L, Redhead H, Firmino S, Marreiros A, Granja C, Almaziad S, Kubbara A, Barnett W, Nakity R, Alamoudi W, Altook R, Tarazi T, Paramasivam K, Fida M, Safi F, Assaly R, Santini A, Milesi M, Maraffi T, Pugni P, Andreis DT, Cavenago M, Gattinoni L, Numan T, Protti A, Perchiazzi G, Borges JB, Bayat S, Porra L, Broche L, Pellegrini M, Scaramuzzo G, Hedenstierna G, Larsson A, van den Boogaard M, Pellegrini M, Hedenstierna G, Roneus A, Segelsjö M, Vestito MC, Larsson A, Perchiazzi G, Gremo E, Nyberg A, Castegren M, Kamper AM, Pikwer A, Yoshida T, Engelberts D, Otulakowski G, Katira B, Post M, Ferguson ND, Brochard L, Amato MBP, Kavanagh BP, Rood P, Koch N, Huber W, Hoellthaler J, Mair S, Phillip V, Schmid RM, Beitz A, Baladrón V, Calvo FJR, Padilla D, Peelen LM, Villarejo P, Villazala R, Yuste AS, Bejarano N, Steenstra RJ, Banierink H, Hof J, van der Horst IC, Nijsten MW, Hoekstra M, Zeman PM, Roedl K, Sterz F, Horvatits T, Horvatits K, Drolz A, Herkner H, Fuhrmann V, Kott M, Zitta K, Brandt B, Slooter AJ, Schildhauer C, Elke G, Hummitzsch L, Frerichs I, Weiler N, Albrecht M, González LR, Alonso DC, Ortiz AB, Sánchez RDP, van Ewijk CE, Lucas JH, Roedl K, Sterz F, Drolz A, Horvatits K, Horvatits T, Herkner H, Fuhrmann V, Horvatits T, Drolz A, Jacobs GE, Roedl K, Rutter K, Ferlitsch A, Fauler G, Trauner M, Fuhrmann V, Horvatits T, Pischke S, Fischer L, Thaiss F, Girbes ARJ, Koch M, Bangert K, Fuhrmann V, Kluge S, Lohse AW, Nashan B, Sterneck M, Faenza S, Siniscalchi A, Pierucci E, Myatra SN, Mancini E, Ricci D, Gemelli C, Cuoghi A, Magnani S, Atti M, Sotos F, Cánovas J, López A, Burruezo A, Harish MM, Torres D, Herrera-Gutierrez ME, Barrueco-Francioni J, Arias-Verdú D, Lozano-Saez R, Quesada-Garcia G, Seller-Pérez G, Figueiredo A, Anzola Y, Pereira R, Prabu NR, Bento L, Arias-Verdú D, Lai M, Deiana M, Barrueco-Francioni J, Herrera-Gutierrez ME, Seller-Perez G, Vardas K, Ilia S, Sertedaki A, Siddiqui S, Charmadari E, Stratakis CA, Briassouli E, Goukos D, Psarra K, Botoula E, Tsagarakis S, Mageira E, Routsi C, Nanas S, Kulkarni AP, Briassoulis G, Boscolo A, Bertini D, Campello E, Lucchetta V, Piasentini E, Radu CM, Manesso L, Simioni P, Ori C, Divatia JV, Su H, Lam YM, Willis K, Pullar V, Hubner RP, Tsang JL, de Guadiana-Romualdo LG, Rebollo-Acebes S, Esteban-Torrella P, Jiménez-Sánchez R, Murbach LD, Jiménez-Santos E, Ortín-Freire A, Hernando-Holgado A, Albaladejo-Otón MD, Coelho L, Rabello L, Salluh J, Martin-Loeches I, Rodriguez A, Nseir S, Leite MA, Póvoa P, Varis E, Pettilä V, Poukkanen M, Jacob S, Karlsson S, Perner A, Takala J, Wilkman E, Lundberg OHM, Osaku EF, Bergenzaun L, Rydén J, Rosenqvist M, Melander O, Chew MS, Rodriguez-Ruiz E, Vaquero RH, Lago AL, Allut JLG, Gestal AE, Costa CRLM, Gonzalez MAG, Kishihara Y, Yasuda H, Rebollo S, de Guadiana-Romualdo LG, Jimenez R, Torrella PE, Fernandez A, Sanchez S, Ortin A, Pelenz M, Bassi GL, Prats RG, Artigas A, Aguilera E, Marti D, Ranzani OT, Rigol M, Fernandez L, Ferrer M, Martin-Loeches I, Neitzke NM, Torres A, Lanziotti VS, Póvoa P, Pulcheri L, Ribeiro MO, Barbosa AP, e Silva JRL, Soares M, Salluh JIF, Garcia IP, Moraes MM, Martin AD, Marqués MG, Moreno AP, Pizarraya AG, Diaz JP, Ibañez MP, Smani Y, Connell MM, Zhang LA, Parker RS, Jaskowiak JL, Banerjee I, Clermont G, Norberg E, Oras J, Cuisinier A, Maufrais C, Payen JF, Nottin S, Walther G, Bouzat P, Silva MMM, Arib S, Bilotta F, Badenes R, Rubulotta F, Mirek S, Crippa IA, Monfort B, Stazi E, Roig AL, Creteur J, Zaponi RS, Taccone FS, Magnoni S, Marando M, Pifferi S, Conte V, Ortolano F, Carbonara M, Bertani G, Scola E, Cadioli M, Abentroth LRL, Triulzi F, Colombo A, Stocchetti N, Rotzel HB, Lázaro AS, Prada DA, Guimillo MR, Piqueras CS, Guia JR, Simon MG, Ogasawara SM, Arizmendi AM, Carratalá A, El Maraghi S, Yehia A, Bakry M, Shoman A, Backes FN, Bianchin MM, Vieira SRR, de Souza A, Jorge AC, Backes AN, Klein C, Kalaiselvan MS, Renuka MK, Arunkumar AS, Lozano A, Lheureux O, Badenes R, Vincent JL, Creteur J, Duarte PAD, Taccone FS, Gallaher C, Cattlin S, Gordon S, Picard J, Fontana V, Bond O, Nobile L, Vincent JL, Creteur J, Hernández-Sánchez N, Taccone FS, Mrozek S, Delamarre L, Capilla F, Al-Saati T, Fourcade O, Geeraerts T, Dominguez-Berrot AM, Gonzalez-Vaquero M, Vallejo-Pascual ME, Sánchez-Hurtado LA, Gupta D, Ivory BD, Chopra M, McCarthy J, Felderhof CL, MacNeil C, Rubulotta F, Waldauf P, Maggiorini M, Duska F, García-Guillen FJ, Fumis RRL, Junior JMV, Amarante G, Skorko A, Sanders S, Aron J, Kroll RJ, Redfearn C, Krishnan P, Khalil JE, Ñamendys-Silva SA, Kovari F, Kongpolprom N, Gulia V, Lourenço E, Melão L, Duro C, Baptista G, Alves A, Arminda B, Rodrigues M, Maghsoudi B, Marreiros A, Granja C, Hayward J, Baldwin F, Gray R, Katinakis PA, Stijf M, Ten Kleij M, Jansen-Frederiks M, Broek R, Emami M, de Bruijne M, Spronk PE, Sinha K, Luney M, Palmer K, Keating L, Abu-Habsa M, Bahl R, Baskaralingam N, Ahmad A, Khosravi MB, Kanapeckaite L, Bhatti P, Glace S, Jeyabraba S, Lewis HF, Kostopoulos A, Raja M, West A, Ely A, Turkoglu LM, Zand F, Zolfaghari P, Baptista JP, Marques MP, Martins P, Pimentel J, Gupta D, Su YC, Villacres S, Stone ME, Parsikia A, Tabatabaie HR, Medar S, O’Dea KP, Porter J, Tirlapur N, Jonathan JM, Singh S, Takata M, Abu-Habsa M, Ahmad A, McWhirter E, Masjedi M, Lyon R, Hariz ML, Azmi E, Alkhan J, Honeybul S, Movsisyan V, Petrikov S, Marutyan Z, Aliev I, Evdokimov A, Sabetiyan G, Antonucci E, Merz T, Hartmann C, Pelosi P, Calzia E, Radermacher P, Nußbaum B, Hartmann C, Huber-Lang M, Gröger M, Mokri A, Radermacher P, Nußbaum B, Nußbaum B, Antonucci E, Calzia E, Pelosi P, Radermacher P, Hartmann C, Svoren-Jabalera E, Davenport EE, Troubleyn J, Humburg P, Knight J, Hinds CJ, Jun IJ, Kim WJ, Lee EH, Besch G, Perrotti A, Puyraveau M, Carteron L, Diltoer M, Baltres M, Samain E, Chocron S, Pili-Floury S, Plata-Menchaca EP, Sabater-Riera J, Estruch M, Boza E, Sbraga F, Toscana-Fernández J, Jacobs R, Bruguera-Pellicer E, Ordoñez-Llanos J, Pérez-Fernández XL, Cavaleiro P, Tralhão A, Arrigo M, Lopes JP, Lebrun M, Cholley B, PerezVela JL, Nguyen DN, MarinMateos H, Rivera JJJ, Llorente MAA, De Marcos BG, Fernandez FJG, Laborda CG, Zamora DF, Delgado JCL, Imperiali C, Berbel-Franco D, De Waele E, Dastis M, Moreno-Gonzalez G, Perez-Sanchez J, Romera-Peregrina I, Abellan-Lencina R, Martinez-Pascual A, Fuentes-Mila V, Gonzalez-Romero M, Górka J, Górka K, De Regt J, Iwaniec T, Frołow M, Polok K, Fronczek J, Kózka M, Musiał J, Szczeklik W, Pérez AG, Ordoñez PF, Giribet A, Honoré PM, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Ampatzidou F, Sileli M, Kehagioglou G, Madesis A, Van Gorp V, Karaiskos T, Moursia C, Maleoglou H, Leleki K, Drossos G, Uz Z, Ince Y, Papatella R, Bulent E, Guerci P, Spapen HD, Ince C, De Mol B, Vicka V, Gineityte D, Ringaitiene D, Norkiene I, Sipylaite J, Möller C, Fleischmann C, Thomas-Rueddel DO, Contreras RS, Vlasakov V, Rochwerg B, Theurer P, Gattinoni L, Reinhart K, Hartog CS, Pérez AG, Al Sibai JZ, Camblor PM, Fernandez PA, Toapanta ND, Gala JMG, Guisasola JS, Albaiceta GM, Tamura T, Yatabe T, Miyajima I, Yamashita K, Yokoyama M, Ampatzidou F, Kehagioglou G, Moreno G, Dalampini E, Nastou M, Baddour A, Ignatiadis A, Asteri T, Drossos G, Hathorn KE, Purtle SW, Horkan CM, Gibbons FK, Sabater J, Christopher KB, Viana MV, Tonietto TA, Gross LA, Costa VL, Tavares ALJ, Lisboa BO, Moraes RB, Vieira SR, Viana LV, Torrado H, Azevedo MJ, Ceniccola GD, Pequeno RSF, Holanda TP, Mendonça VS, Araújo WMC, Carvalho LSF, Segaran E, Vickers L, Brinchmann K, Gonzalez M, Wignall I, Rubulotta F, De Brito-Ashurst I, del Olmo R, Esteban MJ, Vaquerizo C, Carreño R, Gálvez V, Kaminsky G, Nieto B, Marin M, Fuentes M, De la Torre MA, Torres E, Alonso A, Velayos C, Saldaña T, Escribá A, GRIP J, Kölegård R, Sundblad P, Farigola E, Rooyackers O, Naser B, Jaziri F, Jazia AB, Barghouth M, Hentati O, Skouri W, El Euch M, Mahfoudhi M, Turki S, Gonzalez A, Abdelghni KB, Abdallah B, Maha BNM, Cánovas J, Sotos F, López A, Lorente M, Burruezo A, Torres D, Polok K, Fernandez J, Włudarczyk A, Górka J, Hałek A, Musiał J, Szczeklik W, Jazia AB, Jaziri F, Bargouth M, Bennasr M, Turki S, Vera A, Abdelghani KB, Abdallah TB, de Grooth HJ, Geenen IL, Parienti JJ, Straaten HMOV, Shum HP, King HS, Chan KC, Yan WW, Gisbert X, Londoño JG, Cardenas CL, Pedrosa MM, Gubianas CM, Bertolin CF, Batllori NV, Sirvent JM, Wykes K, Jack J, Morgan P, Juliá C, Mukhopadhyay A, Chan HY, Kowitlawakul Y, Remani D, Leong CSF, Henry CJ, Puthucheary ZA, Mendsaikhan N, Begzjav T, Lundeg G, Uya J, Dünser M, Espinoza EDV, Welsh SP, Motta MF, Guerra E, Zerpa MCL, Zechner F, Furche M, Berdaguer F, Birri PNR, Corral L, Risso-Vazquez A, Dubin A, Masevicius FD, Greaney D, Magee A, Fitzpatrick G, Lugo-Cob RG, Sánchez-Hurtado LA, Arvizu-Tachiquín PC, Tejeda-Huezo BC, Elias-Jones I, Cano-Oviedo AA, Baltazar-Torres JA, Aydogan MS, Togal T, Taha A, Chai HZ, Kam C, Razali SSY, Sivasamy V, Kuan LY, Gemmell L, Poulose V, Morales MAL, Castro S, Pires T, Melão L, Krystopchuk A, Pereira I, Granja C, Taniguchi LU, Pires EMC, MacKay A, Vieira JM, Azevedo LCP, Randall D, Adwaney A, Blunden M, Prowle JR, Kirwan CJ, Thomas N, Martin A, Owen H, Darwin L, Conway D, Atkinson D, Sharman M, Moore J, Barbanti C, Amour J, Gaudard P, Rozec B, Mauriat P, M’rini M, Leger PL, Cambonie G, Liet JM, Girard C, Laroche S, Damas P, Assaf Z, Loron G, Lecourt L, Pouard P, Randall D, Adwaney A, Blunden M, Prowle J, Kirwan CJ, Kim SH, Na S, Kim J, Oh SY, Jung CW, Yoo SH, Min SH, Chung EJ, Lee H, Lee NJ, Lee KW, Suh KS, Ryu HG, Marshall DC, Goodson RJ, Salciccioli JD, Shalhoub J, Potter EK, Kirk-Bayley J, Karanjia ND, Forni LG, Creagh-Brown BC, Bossy M, Nyman M, Tailor A, Creagh-Brown B, D’Antini D, Spadaro S, Valentino F, Sollitto F, Cinnella G, Mirabella L, Calvo FJR, Bejarano N, Padilla D, Baladron V, Villajero P, Villazala R, Redondo J, Yuste AS, Liu J, Shen F, Teboul JL, Anguel N, Beurton A, Bezaz N, Richard C, Monnet X, Fossali T, Colombo R, Ottolina D, Rossetti M, Mazzucco C, Marchi A, Porta A, Catena E, Tollisen KH, Andersen GØ, Heyerdahl F, Jacobsen D, de Waard MC, Girbes ARJ, van IJzendoorn MCO, Buter H, Kingma WP, Navis GJ, Boerma EC, Rulisek J, Balik M, Zacharov S, Kim HS, Jeon SJ, Namgung H, Lee E, Lee E, Cho YJ, Lee YJ, Huang A, Cioccari L, Luethi N, Mårtensson J, Bellomo R, Forsberg M, Edman G, Höjer J, Forsberg S, Freile MTC, Hidalgo FN, Molina JAM, Lecumberri R, Rosselló AF, Travieso PM, Leon GT, Sanchez JG, Frias LS, Rosello DB, Verdejo JAG, Serrano JAN, Winterwerp D, van Galen T, Vazin A, Karimzade I, Zand A, Ozen E, Ekemen S, Akcan A, Sen E, Yelken BB, Kureshi N, Fenerty L, Thibault-Halman G, Erdogan M, Walling S, Green RS, Clarke DB, Briassoulis P, Kalimeris K, Ntzouvani A, Nomikos T, Papaparaskeva K, Politi E, Kostopanagiotou G, Crewdson K, Rehn M, Weaver A, Brohi K, Lockey D, Wright S, Thomas K, Baker C, Mansfield L, Stafford V, Wade C, Watson G, Bryant A, Chadwick T, Shen J, Wilkinson J, Furneval J, Henderson A, Hugill K, Howard P, Roy A, Bonner S, Baudouin S, Ramírez CS, Escalada SH, Viera MAH, Santana MC, Balcázar LC, Monroy NS, Campelo FA, Vázquez CFL, Santana PS, Santana SR, Carteron L, Patet C, Quintard H, Solari D, Bouzat P, Oddo M, Wollersheim T, Malleike J, Haas K, Carbon N, Schneider J, Birchmeier C, Fielitz J, Spuler S, Weber-Carstens S, Enseñat L, Pérez-Madrigal A, Saludes P, Proença L, Gruartmoner G, Espinal C, Mesquida J, Huber W, Eckmann M, Elkmann F, Gruber A, Lahmer T, Mayr U, Herner A, Schellnegger R, Schneider J, Schmid RM, Ayoub W, Samy W, Esmat A, Battah A, Mukhtar S, Mongkolpun W, Cortés DO, Cordeiro CPR, Vincent JL, Creteur J, Funcke S, Groesdonk H, Saugel B, Wagenpfeil G, Wagenpfeil S, Reuter DA, Fernandez MM, Fernandez R, Magret M, González-Castro A, Bouza MT, Ibañez M, García C, Balerdi B, Mas A, Arauzo V, Añón JM, Ruiz F, Ferreres J, Tomás R, Alabert M, Tizón AI, Altaba S, Llamas N, Goligher EC, Fan E, Herridge M, Vorona S, Sklar M, Dres M, Rittayamai N, Lanys A, Urrea C, Tomlinson G, Reid WD, Rubenfeld GD, Kavanagh BP, Brochard LJ, Ferguson ND, Neto AS, de Abreu MG, Pelosi P, Schultz MJ, Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM, Rolland-Debord C, Bureau C, Poitou T, Clavel M, Perbet S, Terzi N, Kouatchet A, Similowski T, Demoule A, Hunfeld N, Trogrlic Z, Ladage S, Osse RJ, Koch B, Rietdijk W, Devlin J, van der Jagt M, Picetti E, Ceccarelli P, Mensi F, Malchiodi L, Risolo S, Rossi I, Antonini MV, Servadei F, Caspani ML, Roquilly A, Lasocki S, Seguin P, Geeraerts T, Perrigault PF, Dahyot-Fizelier C, Paugam-Burtz C, Cook F, Cinotti R, dit Latte DD, Mahe PJ, Fortuit C, Feuillet F, Asehnoune K, Marzorati C, Spina S, Scaravilli V, Vargiolu A, Riva M, Giussani C, Sganzerla E, Citerio G, Barbadillo S, de Molina FJG, Álvarez-Lerma F, Rodríguez A, Zakharkina T, Martin-Loeches I, Matamoros S, Povoa P, Torres A, Kastelijn J, Hofstra JJ, de Jong M, Schultz M, Sterk P, Artigas A, Bos LJ, Moreau AS, Martin-Loeches I, Povoa P, Salluh J, Rodriguez A, Nseir S, de Jong E, van Oers JA, Beishuizen A, Girbes ARJ, Nijsten MWN, de Lange DW, Bonvicini D, Labate D, Benacchio L, Olivieri A, Pizzirani E, Lopez-Delgado JC, Gonzalez-Romero M, Fuentes-Mila V, Berbel-Franco D, Romera-Peregrina I, Martinez-Pascual A, Perez-Sanchez J, Abellan-Lencina R, Ávila-Espinoza RE, Moreno-Gonzalez G, Sbraga F, Griffiths S, Grocott MPW, Creagh-Brown B, Doyle J, Wilkerson P, Soon Y, Huddart S, Dickinson M, Riga A, Zuleika A, Miyamoto K, Kawazoe Y, Morimoto T, Yamamoto T, Fuke A, Hashimoto A, Koami H, Beppu S, Katayama Y, Ito M, Ohta Y, Yamamura H, Rygård SL, Holst LB, Wetterslev J, Johansson PI, Perner A, Soliman IW, de Lange DW, van Dijk D, van Delden JJM, Cremer OL, Slooter AJC, Peelen LM, McWilliams D, Snelson C, Neves AD, Loudet CI, Busico M, Vazquez D, Villalba D, Veronesi M, Lischinsky A, López FJL, Mori LB, Plotnikow G, Díaz A, Giannasi S, Hernandez R, Krzisnik L, Cecotti C, Viola L, Lopez R, Sottile JP, Benavent G, Estenssoro E, Chen CM, Lai CC, Cheng KC, Chou W, Chan KS, Roeker LE, Horkan CM, Gibbons FK, Christopher KB, Weijs PJM, Mogensen KM, Rawn JD, Robinson MK, Christopher KB, Tang Z, Qiu C, Ouyang B, Cai C, Guan X, Regueira T, Cea L, Carlos SJ, Elisa B, Puebla C, Vargas A, Poulsen MK, Thomsen LP, Kjærgaard S, Rees SE, Karbing DS, Wollersheim T, Frank S, Müller MC, Carbon NM, Skrypnikov V, Pickerodt PA, Falk R, Mahlau A, Weber-Carstens S, Lee A, Inglis R, Morgan R, Barker G, Kamata K, Abe T, Saitoh D, Tokuda Y, Green RS, Butler MB, Erdogan M, Hwa HT, Gil LJ, Vaquero RH, Rodriguez-Ruiz E, Lago AL, Allut JLG, Gestal AE, Gonzalez MAG, Thomas-Rüddel DO, Schwarzkopf D, Fleischmann C, Reinhart K, Suwanpasu S, Sattayasomboon Y, Filho NMF, Oliveira JCA, Ballalai CS, De Lucia CV, Araponga GP, Veiga LN, Silva CS, Garrido ME, Ramos BB, Ricaldi EF, Gomes SS, Gemmell L, MacKay A, Wright C, Docking RI, Doherty P, Black E, Stenhouse P, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Yatabe T, Inoue S, Sakaguchi M, Egi M, Abdelhamid YA, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Hokka M, Egi M, Mizobuchi S, Kar P, Plummer M, Abdelhamid YA, Giersch E, Summers M, Hatzinikolas S, Heller S, Chapman M, Jones K, Horowitz M, Deane A, Schweizer R, Jacquet-Lagreze M, Portran P, Junot S, Allaouchiche B, Fellahi JL, Guerci P, Ergin B, Kapucu A, Ince C, Cioccari L, Luethi N, Crisman M, Bellomo R, Mårtensson J, Shinotsuka CR, Fagnoul D, Brasseur A, Orbegozo D, Vincent JL, Preiser JC, Preiser JC, Lheureux O, Thooft A, Brimioulle S, Vincent JL, Iwasaka H, Tahara S, Nagamine M, Ichigatani A, Cabrera AR, Zepeda EM, Granillo JF, Sánchez JSA, Montoya AAT, Montenegro AP, Blanco GAG, Robles CMC, Drolz A, Horvatits T, Roedl K, Rutter K, Kluge S, Funk GC, Schneeweiss B, Fuhrmann V, Sabetian G, Pooresmaeel F, Zand F, Ghaffaripour S, Farbod A, Tabei H, Taheri L, Anandanadesan R, Metaxa V, Teixeira C, Pereira SM, Hernández-Marrero P, Carvalho AS, Beckmann M, Hartog CS, Schwarzkopf D, Raadts A, Robertsen A, Førde R, Skaga NO, Helseth E, Honeybul S, Ho K, Lopez PM, Gonzalez MN, Ortega PN, Sola EC, Spasova T, de la Torre-Prados MV, Kopecky O, Rusinova K, Waldauf P, Cepeplikova Z, Balik M, Domínguez JP, Almudevar PM, Carmona SA, Muñoz JJR, Castañeda DP, Abellán AN, Villamizar PR, Ramos JV, Pérez LP, Lucendo AP, Ejarque MC, Estella A, Camps VL, Martín MC, Masnou N, Barbosa S, Varela A, Palma I, Cristina L, Nunes E, Pereira I, Campello G, Granja C, Pande R, Pandey M, Varghese S, Chanu M, Van Dam MJ, Ter Braak EWMT, Estella A, Gracia M, Viciana R, Recuerda M, Fontaiña LP, Tharmalingam B, Kovari F, Rose L, Mcginlay M, Amin R, Burns K, Connolly B, Hart N, Jouvet P, Katz S, Leasa D, Mawdsley C, Mcauley D, Schultz M, Blackwood B, Denham S, Worrall R, Arshad M, Isherwood P, Khadjibaev A, Sabirov D, Rosstalnaya A, Parpibaev F, Sharipova V, Blanco GAG, Guzman CIO, Sánchez JSA, Granillo JF, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Shafi M, Tomar DS, Harne R, Arora DP, Talwar N, Mazumdar S, Cha YS, Lee SJ, Tyagi N, Rajput RK, Taneja S, Singh VK, Sharma SC, Mittal S, Rao BK, Ayachi J, Fraj N, Romdhani S, Khedher A, Meddeb K, Sma N, Azouzi A, Bouneb R, Chouchene I, El Ghardallou M, Boussarsar M, Jennings R, Walter E, Ribeiro JM, Moniz I, Marçal R, Santos AC, Candeias C, e Silva ZC, Gomez SEZ, Nieto ORP, Gonzalez JAC, Cuellar AIV, Mildh H, Pettilä V, Korhonen AM, Karlsson S, Ala-Kokko T, Reinikainen M, Vaara ST, Zaleska-Kociecka M, Grabowski M, Dąbrowski M, Wozniak S, Piotrowska K, Banaszewski M, Imiela J. ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
29
|
Bos L, Schouten L, van Vught L, Wiewel M, Ong D, Cremer O, Artigas A, Martin-Loeches I, Hoogendijk A, van der Poll T, Horn J, Juffermans N, Schultz M, de Prost N, Pham T, Carteaux G, Dessap AM, Brun-Buisson C, Fan E, Bellani G, Laffey J, Mercat A, Brochard L, Maitre B, Howells PA, Thickett DR, Knox C, Park DP, Gao F, Tucker O, Whitehouse T, McAuley DF, Perkins GD, Pham T, Laffey J, Bellani G, Fan E, Pisani L, Roozeman JP, Simonis FD, Giangregorio A, Schouten LR, Van der Hoeven SM, Horn J, Neto AS, Festic E, Dondorp AM, Grasso S, Bos LD, Schultz MJ, Koster-Brouwer M, Verboom D, Scicluna B, van de Groep K, Frencken J, Schultz M, van der Poll T, Bonten M, Cremer O, Ko JI, Kim KS, Suh GJ, Kwon WY, Kim K, Shin JH, Ranzani OT, Prina E, Menendez R, Ceccato A, Mendez R, Cilloniz C, Gabarrus A, Ferrer M, Torres A, Urbano A, Zhang LA, Swigon D, Pike F, Parker RS, Clermont G, Scheer C, Kuhn SO, Modler A, Vollmer M, Fuchs C, Hahnenkamp K, Rehberg S, Gründling M, Taggu A, Darang N, Öveges N, László I, Tánczos K, Németh M, Lebák G, Tudor B, Érces D, Kaszaki J, Huber W, Oerding H, Holst R, Toft P, Nedergaard HK, Haberlandt T, Jensen HI, Toft P, Park S, Kim S, Cho YJ, Trásy D, Lim YJ, Chan A, Tang S, Nunes SL, Forsberg S, Blomqvist H, Berggren L, Sörberg M, Sarapohja T, Wickerts CJ, Molnár Z, Hofhuis JGM, Rose L, Blackwood B, Akerman E, Mcgaughey J, Egerod I, Fossum M, Foss H, Georgiou E, Graff HJ, Ferrara G, Kalafati M, Sperlinga R, Schafer A, Wojnicka AG, Spronk PE, Zand F, Khalili F, Afshari R, Sabetian G, Masjedi M, Edul VSK, Maghsudi B, Khodaei HH, Javadpour S, Petramfar P, Nasimi S, Vazin A, Ziaian B, Tabei H, Gunther A, Hansen JO, Canales HS, Sackey P, Storm H, Bernhardsson J, Sundin Ø, Bjärtå A, Bienert A, Smuszkiewicz P, Wiczling P, Przybylowski K, Borsuk A, Martins E, Trojanowska I, Matysiak J, Kokot Z, Paterska M, Grzeskowiak E, Messina A, Bonicolini E, Colombo D, Moro G, Romagnoli S, Canullán C, De Gaudio AR, Corte FD, Romano SM, Silversides JA, Major E, Mann EE, Ferguson AJ, Mcauley DF, Marshall JC, Blackwood B, Murias G, Fan E, Diaz-Rodriguez JA, Silva-Medina R, Gomez-Sandoval E, Gomez-Gonzalez N, Soriano-Orozco R, Gonzalez-Carrillo PL, Hernández-Flores M, Pilarczyk K, Lubarksi J, Pozo MO, Wendt D, Dusse F, Günter J, Huschens B, Demircioglu E, Jakob H, Palmaccio A, Dell’Anna AM, Grieco DL, Torrini F, Eguillor JFC, Iaquaniello C, Bongiovanni F, Antonelli M, Toscani L, Antonakaki D, Bastoni D, Aya HD, Rhodes A, Cecconi M, Jozwiak M, Buscetti MG, Depret F, Teboul JL, Alphonsine J, Lai C, Richard C, Monnet X, László I, Demeter G, Öveges N, Tánczos K, Ince C, Németh M, Trásy D, Kertmegi I, Érces D, Tudor B, Kaszaki J, Molnár Z, Hasanin A, Lotfy A, El-adawy A, Dubin A, Nassar H, Mahmoud S, Abougabal A, Mukhtar A, Quinty F, Habchi S, Luzi A, Antok E, Hernandez G, Lara B, Aya HD, Enberg L, Ortega M, Leon P, Kripper C, Aguilera P, Kattan E, Bakker J, Huber W, Lehmann M, Sakka S, Rhodes A, Bein B, Schmid RM, Preti J, Creteur J, Herpain A, Marc J, Zogheib E, Trojette F, Bar S, Kontar L, Fletcher N, Titeca D, Richecoeur J, Gelee B, Verrier N, Mercier R, Lorne E, Maizel J, Dupont H, Slama M, Abdelfattah ME, Grounds RM, Eladawy A, Elsayed MAA, Mukhtar A, Montenegro AP, Zepeda EM, Granillo JF, Sánchez JSA, Alejo GC, Cabrera AR, Montoya AAT, Cecconi M, Lee C, Hatib F, Cannesson M, Theerawit P, Morasert T, Sutherasan Y, Zani G, Mescolini S, Diamanti M, Righetti R, Jacquet-Lagrèze M, Scaramuzza A, Papetti M, Terenzoni M, Gecele C, Fusari M, Hakim KA, Chaari A, Ismail M, Elsaka AH, Mahmoud TM, Riche M, Bousselmi K, Kauts V, Casey WF, Hutchings SD, Naumann D, Wendon J, Watts S, Kirkman E, Jian Z, Buddi S, Schweizer R, Lee C, Settels J, Hatib F, Pinsky MR, Bertini P, Guarracino F, Trepte C, Richter P, Haas SA, Eichhorn V, Portran P, Kubitz JC, Reuter DA, Soliman MS, Hamimy WI, Fouad AZ, Mukhtar AM, Charlton M, Tonks L, Mclelland L, Coats TJ, Fornier W, Thompson JP, Sims MR, Williams D, Roushdy DZ, Soliman RA, Nahas RA, Arafa MY, Hung WT, Chiang CC, Huang WC, Lilot M, Lin KC, Lin SC, Cheng CC, Kang PL, Wann SR, Mar GY, Liu CP, Carranza ML, Fernandez HS, Roman JAS, Neidecker J, Lucena F, Garcia AC, Vazquez AL, Serrano AL, Moreira LS, Vidal-Perez R, Herranz UA, Acuna JMG, Gil CP, Allut JLG, Fellahi JL, Sedes PR, Lopez CM, Paz ES, Rodriguez CG, Gonzalez-Juanatey JR, Vallejo-Baez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Escoresca-Ortega A, Tsvetanova-Spasova T, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Aron J, Marharaj R, Gervasio K, Bottiroli M, Mondino M, De Caria D, Gutiérrez-Pizarraya A, Calini A, Montrasio E, Milazzo F, Gagliardone MP, Vallejo-Báez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Tsvetanova-Spasova T, Charris-Castro L, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Moreira LS, Vidal-Perez R, Anido U, Gil CP, Acuna JMG, Sedes PR, Lopez CM, Corcia-Palomo Y, Paz ES, Allut JLG, Rodriguez CG, Gonzalez-Juanatey JR, Hamdaoui Y, Khedher A, Cheikh-Bouhlel M, Ayachi J, Meddeb K, Sma N, Fernandez-Delgado E, Fraj N, Aicha NB, Romdhani S, Bouneb R, Chouchene I, Boussarsar M, Dela Cruz MPRDL, Bernardo JM, Galfo F, Dyson A, Garnacho-Montero J, Singer M, Marino A, Dyson A, Singer M, Chao CC, Hou P, Huang WC, Hung CC, Chiang CH, Hung WT, Roger C, Lin KC, Lin SC, Liou YJ, Hung SM, Lin YS, Cheng CC, Kuo FY, Chiou KR, Chen CJ, Yan LS, Muller L, Liu CY, Wang HH, Kang PL, Chen HL, Ho CK, Mar GY, Liu CP, Grewal S, Gopal S, Corbett C, Elotmani L, Wilson A, Capps J, Ayoub W, Lomas A, Ghani S, Moore J, Atkinson D, Sharman M, Swinnen W, Pauwels J, Lipman J, Mignolet K, Pannier E, Koch A, Sarens T, Temmerman W, Elmenshawy AM, Fayed AM, Elboriuny M, Hamdy E, Zakaria E, Lefrant JY, Falk AC, Petosic A, Olafsen K, Wøien H, Flaatten H, Sunde K, Agra JJC, Cabrera JLS, Santana JDM, Alzola LM, Roberts JA, Pérez HR, Pires TC, Calderón H, Pereira A, Castro S, Granja C, Norkiene I, Urbanaviciute I, Kezyte G, Ringaitiene D, Muñoz-Bermúdez R, Jovaisa T, Vogel G, Johansson UB, Sandgren A, Svensen C, Joelsson-Alm E, Leite MA, Murbach LD, Osaku EF, Costa CRLM, Samper M, Pelenz M, Neitzke NM, Moraes MM, Jaskowiak JL, Silva MMM, Zaponi RS, Abentroth LRL, Ogasawara SM, Jorge AC, Duarte PAD, Climent C, Murbach LD, Leite MA, Osaku EF, Barreto J, Duarte ST, Taba S, Miglioranza D, Gund DP, Lordani CF, Costa CRLM, Vasco F, Ogasawara SM, Jorge AC, Duarte PAD, Vollmer H, Gager M, Waldmann C, Mazzeo AT, Tesio R, Filippini C, Vallero ME, Sara V, Giolitti C, Caccia S, Medugno M, Tenaglia T, Rosato R, Mastromauro I, Brazzi L, Terragni PP, Urbino R, Fanelli V, Luque S, Ranieri VM, Mascia L, Ballantyne J, Paton L, Mackay A, Perez-Teran P, Roca O, Ruiz-Rodriguez JC, Zapatero A, Serra J, Campillo N, Masclans JR, Bianzina S, Cornara P, Rodi G, Tavazzi G, Pozzi M, Iotti GA, Mojoli F, Braschi A, Vishnu A, Cerrato SG, Buche D, Pande R, Moolenaar DLJ, Bakhshi-Raiez F, Dongelmans DA, de Keizer NF, de Lange DW, Fernández IF, Baño DM, Moreno JLB, Masclans JR, Rubio RJ, Scott J, Phelan D, Morely D, O’Flynn J, Stapleton P, Lynch M, Marsh B, Carton E, O’Loughlin C, Alvarez-Lerma F, Cheng KC, Sung MI, Elghonemi MO, Saleh MH, Meyhoff TS, Krag M, Hjortrup PB, Perner A, Møller MH, Öhman T, Brugger SC, Sigmundsson T, Redondo E, Hallbäck M, Suarez-Sipmann F, Björne H, Sander CH, Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Jimenez GJ, Algieri I, Guanziroli M, Vergani G, Tonetti T, Tomic I, Colombo A, Crimella F, Carlesso E, Colombo A, Gasparovic V, Torner MM, Gattinoni L, El-Sherif R, Al-Basser MA, Raafat A, El-Sherif A, Simonis FD, Schouten LRA, Cremer OL, Ong DSY, Amoruso G, Cabello JT, Cinnella G, Schultz MJ, Bos LDJ, Huber W, Schmidle P, Findeisen M, Hoppmann P, Jaitner J, Brettner F, Schmid RM, Garrido BB, Lahmer T, Festic E, Rajagopalan G, Bansal V, Frank R, Hinds R, Levitt J, Siddiqui S, Gilbert JP, Sim K, Casals XN, Wang CH, Hu HC, Li IJ, Tang WR, Kao KC, Persona P, De Cassai A, Franco M, Facchin F, Ori C, Gaite FB, Rossi S, Goffi A, Li SH, Hu HC, Chiu LC, Hung CY, Chang CH, Kao KC, Ruiz BL, Varas JL, Vidal MV, Montero RM, Delgado CP, Navarrete O, Mezquita MV, Peces EA, Nakamura MAM, Hajjar LA, Galas FRBG, Ortiz TA, Amato MBP, Martínez MP, Bitker L, Costes N, Le Bars D, Lavenne F, Mojgan D, Richard JC, Chiurazzi C, Cressoni M, Massari D, Guanziroli M, Gusarov V, Vergani G, Gotti M, Brioni M, Algieri I, Cadringher P, Tonetti T, Chiumello D, Gattinoni L, Zerman A, Türkoğlu M, Shilkin D, Arık G, Yıldırım F, Güllü Z, Kara I, Boyacı N, Aydoğan BB, Gaygısız Ü, Gönderen K, Aygencel G, Aydoğdu M, Dementienko M, Ülger Z, Gürsel G, Riera J, Toral CM, Mazo C, Martínez M, Baldirà J, Lagunes L, Roman A, Deu M, Nesterova E, Rello J, Levine DJ, Mohus RM, Askim Å, Paulsen J, Mehl A, Dewan AT, Damås JK, Solligård E, Åsvold BO, Lashenkova N, Paulsen J, Askim Å, Mohus RM, Mehl A, DeWan A, Solligård E, Damås JK, Åsvold BO, Aktepe O, Kara A, Kuzovlev A, Yeter H, Topeli A, Norrenberg M, Devroey M, Khader H, Preiser JC, Tang Z, Qiu C, Tong L, Cai C, Zamyatin M, Theodorakopoulou M, Diamantakis A, Kontogiorgi M, Chrysanthopoulou E, Christodoulopoulou T, Frantzeskaki F, Lygnos M, Apostolopoulou O, Armaganidis A, Moon JY, Demoule A, Park MR, Kwon IS, Chon GR, Ahn JY, Kwon SJ, Chang YJ, Lee JY, Yoon SY, Lee JW, Kostalas M, Carreira S, Mckinlay J, Kooner G, Dudas G, Horton A, Kerr C, Karanjia N, Creagh-Brown B, Altintas ND, Izdes S, Keremoglu O, Lavault S, Alkan A, Neselioglu S, Erel O, Tardif N, Gustafsson T, Rooyackers O, MacEachern KN, Traille M, Bromberg I, Lapinsky SE, Palancca O, Moore MJ, Tang Z, Cai C, Tong L, García-Garmendia JL, Villarrasa-Clemente F, Maroto-Monserrat F, Rufo-Tejeiro O, Jorge-Amigo V, Sánchez-Santamaría M, Morawiec E, Colón-Pallarés C, Barrero-Almodóvar A, Gallego-Lara S, Anthon CT, Müller RB, Haase N, Møller K, Hjortrup PB, Wetterslev J, Perner A, Mayaux J, Nakanishi M, Kuriyama A, Fukuoka T, Abd el Halim MA, Elsaid hafez MH, Moktar AM, Eladawy A, Elazizy HM, Hakim KA, Chaari A, Arnulf I, Elbahr M, Ismail M, Mahmoud T, Kauts V, Bousselmi K, Khalil E, Casey W, Zaky SH, Rizk A, Elghonemi MO, Similowski T, Ahmed R, Vieira JCF, Souza RB, Liberatore AMA, Koh IHJ, Ospina-Tascón GA, Marin AFG, Echeverry GJ, Bermudez WF, Madriñan-Navia HJ, Rasmussen BS, Valencia JD, Quiñonez E, Marulanda A, Arango-Dávila CA, Bruhn A, Hernandez G, De Backer D, Cortes DO, Su F, Vincent JL, Maltesen RG, Creteur J, Tullo L, Mirabella L, Di Molfetta P, Cinnella G, Dambrosio M, Lujan CV, irigoyen JL, Cartanya ferré M, García RC, Hanifa M, Mukhtar A, Ahmed M, El Ayashi M, Hasanin A, Ayman E, Salem M, Eladawy A, Fathy S, Nassar H, Zaghlol A, Pedersen S, Arzapalo MFA, Valsø Å, Sunde K, Rustøen T, Schou-Bredal I, Skogstad L, Tøien K, Padilla C, Palmeiro Y, Egbaria W, Kristensen SR, Kigli R, Maertens B, Blot K, Blot S, Santana-Santos E, dos Santos ER, Ferretti-Rebustini REDL, dos Santos RDCCDO, Verardino RGS, Bortolotto LA, Wimmer R, Doyle AM, Naldrett I, Tillman J, Price S, Shrestha S, Pearson P, Greaves J, Goodall D, Berry A, Richardson A, Panigada M, Odundo GO, Omengo P, Obonyo P, Chanzu NM, Kleinpell R, Sarris SJ, Nedved P, Heitschmidt M, Ben-Ghezala H, Snouda S, Bassi GL, Djobbi S, Ben-Ghezala H, Snouda S, Rose L, Adhikari NKJ, Leasa D, Fergusson D, Mckim DA, Weblin J, Tucker O, Ranzani OT, McWilliams D, Doesburg F, Cnossen F, Dieperink W, Bult W, Nijsten MWN, Galvez-Blanco GA, Zepeda EM, Guzman CIO, Sánchez JSA, Kolobow T, Granillo JF, Stroud JS, Thomson R, Llaurado-Serra M, Lobo-Civico A, Pi-Guerrero M, Blanco-Sanchez I, Piñol-Tena A, Paños-Espinosa C, Alabart-Segura Y, Zanella A, Coloma-Gomez B, Fernandez-Blanco A, Braga-Dias F, Treso-Geira M, Valeiras-Valero A, Martinez-Reyes L, Sandiumenge A, Jimenez-Herrera MF, Prada R, Juárez P, Cressoni M, Argandoña R, Díaz JJ, Ramirez CS, Saavedra P, Santana SR, Obukhova O, Kashiya S, Kurmukov IA, Pronina AM, Simeone P, Berra L, Puybasset L, Auzias G, Coulon O, Lesimple B, Torkomian G, Velly L, Bienert A, Bartkowska-Sniatkowska A, Wiczling P, Szerkus O, Parrini V, Siluk D, Bartkowiak-Wieczorek J, Rosada-Kurasinska J, Warzybok J, Borsuk A, Kaliszan R, Grzeskowiak E, Caballero CH, Roberts S, Isgro G, Kandil H, Hall D, Guillaume G, Passouant O, Dumas F, Bougouin W, Champigneulle B, Arnaout M, Chelly J, Chiche JD, Varenne O, Salati G, Mira JP, Marijon E, Cariou A, Beerepoot M, Touw HR, Parlevliet K, Boer C, Elbers PW, Tuinman PR, Reina ÁJR, Livigni S, Palomo YC, Bermúdez RM, Villén LM, García IP, Izurieta JRN, Bernal JBP, Jiménez FJJ, Cota-Delgado F, de la Torre-Prados MV, Fernández-Porcel A, Amatu A, Nuevo-Ortega P, Cámara-Sola E, Tsvetanova-Spasova T, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Kaneko T, Tanaka H, Kamikawa M, Karashima R, Andreotti A, Iwashita S, Irie H, Kasaoka S, Arola O, Laitio R, Saraste A, Airaksinen J, Pietilä M, Hynninen M, Wennervirta J, Tagliaferri F, Bäcklund M, Ylikoski E, Silvasti P, Nukarinen E, Grönlund J, Harjola VP, Niiranen J, Korpi K, Varpula M, Roine RO, Moise G, Laitio T, Salah S, Hassen BG, Fehmi AM, Kim S, Hsu YC, Barea-Mendoza J, García-Fuentes C, Castillo-Jaramillo M, Dominguez-Aguado H, Mercurio G, Viejo-Moreno R, Terceros-Almanza L, Aznárez SB, Mudarra-Reche C, Xu W, Chico-Fernández M, Montejo-González JC, Crewdson K, Thomas M, Merghani M, Costa A, Fenner L, Morgan P, Lockey D, van Lieshout EJ, Oomen B, Binnekade JM, Dongelmans DA, de Haan RJ, Juffermans NP, Vroom MB, Vezzani A, Algarte R, Martínez L, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Sheikh O, Pogson D, Clinton R, Lindau S, Riccio F, Gemmell L, MacKay A, Arthur A, Young L, Sinclair A, Markopoulou D, Venetsanou K, Filippou L, Salla E, Babel J, Stratouli S, Alamanos I, Guirgis AH, Rodriguez RG, Lorente MJF, Guarasa IM, Ukere A, Meisner S, Greiwe G, Opitz B, Cavana M, Benten D, Nashan B, Fischer L, Trepte CJC, Reuter DA, Haas SA, Behem CR, Tavazzi G, Ana B, Vazir A, Consonni D, Gibson D, Price S, Masjedi M, Hadavi MR, alam MR, Sasani MR, Parenti N, Agrusta F, Palazzi C, Pifferi B, Pesenti A, Sganzerla R, Tagliazucchi F, Luciani A, Möller M, Müller-Engelmann J, Montag G, Adams P, Lange C, Neuzner J, Gradaus R, Gattinoni L, Wodack KH, Thürk F, Waldmann AD, Grässler MF, Nishimoto S, Böhm SH, Kaniusas E, Reuter DA, Trepte CJ, Sigmundsson T, Torres A, Öhman T, Redondo E, Hallbäck M, Wallin M, Sipman FS, Oldner A, Sander CH, Björne H, Colinas L, Hernandez G, Mansouri P, Vicho R, Serna M, Cuena R, Canabal A, Chaari A, Hakim KA, Etman M, El Bahr M, El Sakka A, Bousselmi K, Zand F, Arali A, Kauts V, Casey WF, Bond O, De Santis P, Iesu E, Franchi F, Vincent JL, Creteur J, Scolletta S, Zahed L, Taccone FS, Marutyan Z, Hamidova L, Shakotko A, Movsisyan V, Uysupova I, Evdokimov A, Petrikov S, Gonen C, Haftacı E, Dehghanrad F, Balci C, Calvo FJR, Bejarano N, Baladron V, Villazala R, Redondo J, Padilla D, Villarejo P, Akcan-Arikan A, Kennedy CE, Bahrani M, Arzapalo MFA, Gomez-Gonzalez C, Mas-Font S, Puppo-Moreno A, Herrera-Gutierrez M, Garcia-Garcia M, Aldunate-Calvo S, Plata-Menchaca EP, Pérez-Fernández XL, Estruch M, Ghorbani M, Betbese-Roig A, Campos PC, Lora MR, Gaibor NDT, Medina RSC, Sanguino VDG, Casanova EJ, Riera JS, Kritmetapak K, Peerapornratana S, Cambiaghi B, Kittiskulnam P, Dissayabutra T, Tiranathanagul K, Susantithapong P, Praditpornsilpa K, Tungsanga K, Eiam-Ong S, Srisawat N, Winkelmann T, Busch T, Moerer O, Meixensberger J, Bercker S, Cabeza EMF, Sánchez MS, Giménez NC, Melón CG, de Lucas EH, Estañ PM, Bernal MH, de Lorenzo y Mateos AG, Mauri T, Ergin B, Guerci P, Specht PAC, Ince Y, Ince C, Balik M, Zakharchenko M, Los F, Brodska H, de Tymowski C, Kunze-Szikszay N, Augustin P, Desmard M, Montravers P, Stapel SN, de Boer R, Oudemans HM, Hollinger A, Schweingruber T, Jockers F, Dickenmann M, Ritter C, Siegemund M, Runciman N, Ralston M, Appleton R, Mauri T, Alban L, Turrini C, Sasso T, Langer T, Panigada M, Pesenti A, Taccone P, Carlesso E, Marenghi C, Grasselli G, Pesenti A, Wibart P, Reginault T, Garcia M, Barbrel B, Benard A, Quintel M, Bader C, Vargas F, Bui HN, Hilbert G, Simón JMS, Sánchez PC, Ferrón FR, de Acilu MG, Marin J, Antonia V, Vilander LM, Ruano L, Monica M, Ferrer R, Masclans JR, Roca O, Hong G, Kim DH, Kim YS, Park JS, Jee YK, Kaunisto MA, xiang ZY, Jia-xing W, dan WX, long NW, Yu W, Yan Z, Cheng X, Kobayashi T, Onodera Y, Akimoto R, Vaara ST, Sugiura A, Suzuki H, Iwabuchi M, Nakane M, Kawamae K, Sanchez PC, Rodriguez MDB, Delgado MR, Sánchez VMDP, Gómez AM, Pettilä V, Simón JMS, Beuret P, Fortes C, Lauer M, Reboul M, Chakarian JC, Fabre X, Philippon-Jouve B, Devillez S, Clerc M, Mulier JLGH, Rittayamai N, Sklar M, Dres M, Rauseo M, Campbell C, West B, Tullis DE, Brochard L, Onodera Y, Akimoto R, Rozemeijer S, Suzuki H, Okada M, Nakane M, Kawamae K, Ahmad N, Wood M, Glossop A, Lucas JH, Ortiz AB, Alonso DC, Spoelstra-de Man AME, De Pablo Sánchez R, González LR, Costa R, Spinazzola G, Pizza A, Ferrone G, Rossi M, Antonelli M, Conti G, Ribeiro H, Elbers PE, Alves J, Sousa M, Reis P, Socolovsky CS, Cauley RP, Frankel JE, Beam AL, Olaniran KO, Gibbons FK, Christopher KB, Tuinman PR, Pennington J, Zolfaghari P, King HS, Kong HHY, Shum HP, Yan WW, Kaymak C, Okumus N, Sari A, Erdogdu B, de Waard MC, Aksun S, Basar H, Ozcan A, Ozcan N, Oztuna D, Malmgren JA, Lundin S, Torén K, Eckerström M, Wallin A, Oudemans-van Straaten HM, Waldenström AC, Riccio FC, Pogson D, Antonio ACP, Leivas AF, Kenji F, James E, Morgan P, Carroll G, Gemmell L, Liberatore AMA, MacKay A, Wright C, Ballantyne J, Jonnada S, Gerrard CS, Jones N, Salciccioli JD, Marshall DC, Komorowski M, Hartley A, Souza RB, Sykes MC, Goodson R, Shalhoub J, Villanueva JRF, Garda RF, Lago AML, Ruiz ER, Vaquero RH, Rodríguez CG, Pérez EV, Martins AMCRPF, Hilasque C, Oliva I, Sirgo G, Martin MC, Olona M, Gilavert MC, Bodí M, Ebm C, Aggarwal G, Huddart S, Vieira JCF, Quiney N, Cecconi M, Fernandes SM, Silva JS, Gouveia J, Silva D, Marques R, Bento H, Alvarez A, Silva ZC, Koh IHJ, Diaz DD, Martínez MV, Herrejon EP, de la Gandara AM, Gonzalo G, Lopez MA, de Gopegui Miguelena PR, Matilla CIB, Chueca PS, Longares MDCR, Martínez MG, Abril RR, Aguilar ALR, de Murillas RGL, Fernández RF, Laborías PM, Castellanos MAD, Laborías MEM, Cho J, Kim J, Park J, Sánchez RJ, Woo S, West T, Powell E, Rimmer A, Orford C, Jones N, Williams J, Matilla CIB, de Gopegui Miguelena PR, Chueca PS, Gascón LM, Abril RR, Longares MDCR, Aguilar ALR, de Murillas RGL, Bourne RS, Shulman R, Tomlin M, Mills GH, Borthwick M, Berry W, Mulero MDR, Huertas DG, Manzano F, Villagrán-Ramírez F, Ruiz-Perea A, Rodríguez-Mejías C, Santiago-Ruiz F, Colmenero-Ruiz M, König C, Matt B, Kortgen A, Freire AO, Hartog CS, Wong A, Balan C, Barker G, Srisawat N, Peerapornratana S, Laoveeravat P, Tachaboon S, Eiam-ong S, Paratz J, Muñoz AO, Kayambu G, Boots R, Arzapalo MFA, Vlasenko R, Gromova E, Loginov S, Kiselevskiy M, Dolgikova Y, Tang KB, Chau CM, Acebes SR, Lam KN, Gil E, Suh GY, Park CM, Park J, Chung CR, Lee CT, Chao A, Shih PY, Chang YF, Martínez ÁF, Lai CH, Hsu YC, Yeh YC, Cheng YJ, Colella V, Zarrillo N, D’Amico M, Forfori F, Pezza B, Laddomada T, Aliaga SM, Beltramelli V, Pizzaballa ML, Doronzio A, Balicco B, Kiers D, van der Heijden W, Gerretsen J, de Mast Q, el Messaoudi S, Rongen G, Para LH, Gomes M, Kox M, Pickkers P, Riksen NP, Kashiwagi Y, Okada M, Hayashi K, Inagaki Y, Fujita S, Nakamae MN, Payá JM, Kang YR, Souza RB, Liberatore AMA, Koh IHJ, Blet A, Sadoune M, Lemarié J, Bihry N, Bern R, Polidano E, Mulero FR, Merval R, Launay JM, Lévy B, Samuel JL, Mebazaa A, Hartmann J, Harm S, Weber V, Guerci P, Ince Y, Heeman P, Ergin B, Ince C, Uz Z, Massey M, Ince Y, Papatella R, Bulent E, Guerci P, Toraman F, Ince C, Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearse RM, O’Dywer MJ, Trogrlic Z, van der Jagt M, Lingsma H, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, van Achterberg T, Bakker J, Gommers DAMPJ, Ista E, Krajčová A, Waldauf P, Duška F, Shah A, Roy N, McKechnie S, Doree C, Fisher S, Stanworth SJ, Jensen JF, Overgaard D, Bestle MH, Christensen DF, Egerod I, Pivkina A, Gusarov V, Zhivotneva I, Pasko N, Zamyatin M, Jensen JF, Egerod I, Bestle MH, Christensen DF, Alklit A, Hansen RL, Knudsen H, Grode LB, Overgaard D, Hravnak M, Chen L, Dubrawski A, Clermont G, Pinsky MR, Parry SM, Knight LD, Connolly BC, Baldwin CE, Puthucheary ZA, Denehy L, Hart N, Morris PE, Mortimore J, Granger CL, Jensen HI, Piers R, Van den Bulcke B, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Ryan C, Dawson D, Ball J, Noone K, Aisling B, Prudden S, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Aron J, Lumley G, Milliken D, Dhadwal K, McGrath BA, Lynch SJ, Bovento B, Sharpe G, Grainger E, Pieri-Davies S, Wallace S, McGrath B, Lynch SJ, Bovento B, Grainger E, Pieri-Davies S, Sharpe G, Wallace S, Jung M, Cho J, Park H, Suh G, Kousha O, Paddle J, Gripenberg LG, Rehal MS, Wernerman J, Rooyackers O, de Grooth HJ, Choo WP, Spoelstra-de Man AM, Swart EL, Oudemans-van Straaten HM, Talan L, Güven G, Altıntas ND, Padar M, Uusvel G, Starkopf L, Starkopf J, Blaser AR, Kalaiselvan MS, Arunkumar AS, Renuka MK, Shivkumar RL, Volbeda M, ten Kate D, Hoekstra M, van der Maaten JM, Nijsten MW, Komaromi A, Rooyackers O, Wernerman J, Norberg Å, Smedberg M, Mori M, Pettersson L, Norberg Å, Rooyackers O, Wernerman J, Theodorakopoulou M, Christodoulopoulou T, Diamantakis A, Frantzeskaki F, Kontogiorgi M, Chrysanthopoulou E, Lygnos M, Diakaki C, Armaganidis A, Gundogan K, Dogan E, Coskun R, Muhtaroglu S, Sungur M, Ziegler T, Guven M, Kleyman A, Khaliq W, Andreas D, Singer M, Meierhans R, Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
30
|
Chuaychoo B, Kositanont U, Rittayamai N, Niyomthong P, Songserm T, Maranetra KN, Rattanasaengloet K, Nana A. The immunogenicity of the intradermal injection of seasonal trivalent influenza vaccine containing influenza A(H1N1)pdm09 in COPD patients soon after a pandemic. Hum Vaccin Immunother 2016; 12:1728-37. [PMID: 27153158 DOI: 10.1080/21645515.2016.1149276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The antibody responses of a reduced-dose intradermal seasonal influenza vaccination have never been studied in COPD patients soon after a pandemic. A total of 149 COPD patients (60 y of age or older) were randomized to receive trivalent influenza vaccine (Sanofi-Pasteur, France) either 9 µg of hemagglutinin (HA) per strain split into 2-site intradermal (ID) injections via the Mantoux technique or one intramuscular (IM) injection of 15 µg of HA per strain. The geometric mean titers, seroconversion factors, seroconversion rates and seroprotection rates for influenza A(H3N2) and B administered through the ID injection (n = 75) were similar to those obtained with the IM injection (n = 74) 4 weeks post-vaccination. The antibody responses for influenza A(H1N1)pdm09 administered through the ID injection were lower than those obtained with the IM injection, but all of these responses met the 3 criteria proposed by the Committee for Proprietary Medicinal Products (CPMP) for annual re-licensure. The seroprotection rates 4 weeks post-vaccination for influenza A(H1N1)pdm09 were 64.0% (95%CI 52.7-74.0%) in the ID group vs. 78.4% (95% CI 67.6-86.3%) in the IM group (p = 0.053). Influenza-related acute respiratory illness (ARI), diagnosed as a 4-fold rise in HI titers with a convalescent titer > 1:40, and/or the RT-PCR between the ID group (5.3%) and the IM group (8.1%) were not significantly different. The reduced-dose intradermal influenza vaccine may expand vaccine coverage in cases of vaccine shortage.
Collapse
Affiliation(s)
- Benjamas Chuaychoo
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| | | | - Nuttapol Rittayamai
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| | - Parichat Niyomthong
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| | - Thaweesak Songserm
- c Department of Veterinary Pathology , KamphaengSaen , Nakhon Pathom , Thailand
| | - Khun Nanta Maranetra
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| | - Kanokwan Rattanasaengloet
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| | - Arth Nana
- a Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital , Bangkok , Thailand
| |
Collapse
|
31
|
Beloncle F, Akoumianaki E, Rittayamai N, Lyazidi A, Brochard L. Accuracy of delivered airway pressure and work of breathing estimation during proportional assist ventilation: a bench study. Ann Intensive Care 2016; 6:30. [PMID: 27076185 PMCID: PMC4830790 DOI: 10.1186/s13613-016-0131-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/21/2016] [Indexed: 12/24/2022] Open
Abstract
Background Proportional assist ventilation+ (PAV+) delivers airway pressure (Paw) in proportion to patient effort (Pmus) by using the equation of motion of the respiratory system. PAV+ calculates automatically respiratory mechanics (elastance and resistance); the work of breathing (WOB) is estimated by the ventilator. The accuracy of Pmus estimation and hence accuracy of the delivered Paw and WOB calculation have not been assessed. This study aimed at assessing the accuracy of delivered Paw and calculated WOB by PAV+ and examining the factors influencing this accuracy. Methods Using an active lung model with different respiratory mechanics, we compared (1) the actual delivered Paw by the ventilator to the theoretical Paw as defined by the equation of motion and (2) the WOB value displayed by the ventilator to the WOB measured from a Campbell diagram. Results Irrespective of respiratory mechanics and gain, the ventilator provided a Paw approximately 25 % lower than expected. This underassistance was greatest at the beginning of the inspiration. Intrinsic PEEP (PEEPi), associated with an increase in trigger delay, was a major factor affecting PAV+ accuracy. The absolute value of total WOB displayed by the ventilator was underestimated, but the changes in WOB were accurately detected by the ventilator. Conclusion The assistance provided by PAV+ well follows Pmus but with a constant underassistance. This is associated with an underestimation by the ventilator of the WOB. PEEPi can be a major factor contributing to PAV+ inaccuracy. Clinical recommendations should include using a high trigger sensitivity and a careful PEEP titration. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0131-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Francois Beloncle
- Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Medical Intensive Care Unit, Hospital of Angers, University of Angers, Angers, France
| | - Evangelia Akoumianaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Crete, Greece
| | - Nuttapol Rittayamai
- Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Aissam Lyazidi
- Institut Supérieur des Sciences de la Santé, Université Hassan 1er, Settat, Morocco
| | - Laurent Brochard
- Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
32
|
Rittayamai N, Wilcox E, Drouot X, Mehta S, Goffi A, Brochard L. Positive and negative effects of mechanical ventilation on sleep in the ICU: a review with clinical recommendations. Intensive Care Med 2016; 42:531-541. [PMID: 26759012 DOI: 10.1007/s00134-015-4179-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/19/2015] [Accepted: 12/06/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Sleep is an essential physiologic process that helps to restore normal body homeostasis. Sleep disturbances have been shown to be associated with poor clinical outcomes, such as a greater risk of cardiovascular disease and increasing mortality. Critically ill patients, particularly those receiving mechanical ventilation, may be more susceptible to sleep disruption. METHODS AND RESULTS Mechanical ventilation is an important factor influencing sleep in critically ill patients as it may have positive or negative effects, depending on patient population, mode, and specific settings. Other causes of sleep disruption include the acute illness itself, the daily routine care, and the effects of medications. Improving sleep in patients admitted to an intensive care unit has the potential to improve both short- and long-term clinical outcomes. In this article we review the specific aspects of sleep in critically ill mechanically ventilated patients, including abnormal sleep patterns and loss of circadian rhythm, as well as the effects of mechanical ventilation and intravenous sedatives on sleep quality and quantity. CONCLUSIONS We provide recommendations for clinicians regarding optimal ventilatory settings and discuss fields for future research.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada
| | - Xavier Drouot
- CHU de Poitiers, Service de Neurophysiologie Clinique, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.,INSERM CIC 1402, Poitiers, France
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
33
|
Rittayamai N, Beloncle F, Waheed R, Chen L, Rauseo M, Chen G, Goligher EC, Richard JCM, Brochard L. Effect of different pressure-targeted modes of ventilation on transpulmonary pressure and inspiratory effort. Intensive Care Med Exp 2015. [PMCID: PMC4798477 DOI: 10.1186/2197-425x-3-s1-a825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
34
|
Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, Rittayamai N, Lanys A, Tomlinson G, Singh JM, Bolz SS, Rubenfeld GD, Kavanagh BP, Brochard LJ, Ferguson ND. Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort. Am J Respir Crit Care Med 2015; 192:1080-8. [DOI: 10.1164/rccm.201503-0620oc] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
35
|
Rittayamai N, Katsios CM, Beloncle F, Friedrich JO, Mancebo J, Brochard L. Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure: A Physiology-Based Narrative and Systematic Review. Chest 2015; 148:340-355. [PMID: 25927671 DOI: 10.1378/chest.14-3169] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mechanical ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes. METHODS We performed a systematic review and meta-analysis to determine whether pressure control-continuous mandatory ventilation (PC-CMV) or pressure control-inverse ratio ventilation (PC-IRV) has demonstrated advantages over volume control-continuous mandatory ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models. RESULTS Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes. CONCLUSIONS The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of ventilation of patients with acute respiratory failure.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Christina M Katsios
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - François Beloncle
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Medical Intensive Care Unit, Hospital of Angers, Université d'Angers, Angers, France
| | - Jan O Friedrich
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain
| | - Laurent Brochard
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada.
| |
Collapse
|
36
|
Abstract
BACKGROUND Acute dyspnea and hypoxemia are 2 of the most common problems in the emergency room. Oxygen therapy is an essential supportive treatment to correct these issues. In this study, we investigated the physiologic effects of high-flow nasal oxygen cannula (HFNC) compared with conventional oxygen therapy (COT) in subjects with acute dyspnea and hypoxemia in the emergency room. METHODS A prospective randomized comparative study was conducted in the emergency department of a university hospital. Forty subjects were randomized to receive HFNC or COT for 1 h. The primary outcome was level of dyspnea, and secondary outcomes included change in breathing frequency, subject comfort, adverse events, and rate of hospitalization. RESULTS Common causes of acute dyspnea and hypoxemia were congestive heart failure, asthma exacerbation, COPD exacerbation, and pneumonia. HFNC significantly improved dyspnea (2.0 ± 1.8 vs 3.8 ± 2.3, P = .01) and subject comfort (1.6 ± 1.7 vs 3.7 ± 2.4, P = .01) compared with COT. No statistically significant difference in breathing frequency was found between the 2 groups at the end of the study. HFNC was well tolerated, and no serious adverse events were found. The rate of hospitalization in the HFNC group was lower than in the COT group, but there was no statistically significant difference (50% vs 65%, P = .34). CONCLUSIONS HFNC improved dyspnea and comfort in subjects presenting with acute dyspnea and hypoxemia in the emergency department. HFNC may benefit patients requiring oxygen therapy in the emergency room.
Collapse
Affiliation(s)
| | - Jamsak Tscheikuna
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine
| | - Nattakarn Praphruetkit
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunthorn Kijpinyochai
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
37
|
Rittayamai N, Brochard L. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome. Eur Respir Rev 2015; 24:132-40. [DOI: 10.1183/09059180.00012414] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS.
Collapse
|
38
|
Chen GQ, Xu M, Chen XL, Rittayamai N, Kim M, Soliman I, Yang YL, Zhou JX, Brochard L. CAN THEORETICAL VALUES FOR CHEST WALL COMPLIANCE BE USED IN ARDS PATIENTS? Intensive Care Med Exp 2015. [PMCID: PMC4797189 DOI: 10.1186/2197-425x-3-s1-a999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Rittayamai N, Muangman N, Ruangchira-Urai R. Extensive pulmonary alveolar microlithiasis. Respirol Case Rep 2014; 2:4-6. [PMID: 25473548 PMCID: PMC4184717 DOI: 10.1002/rcr2.30] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/11/2013] [Indexed: 12/03/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare pulmonary disorder that is caused by abnormal sodium-dependent phosphate co-transporter from the mutation of SLC34A2 gene, leading to accumulation of microliths in the alveoli. We report the extensive pulmonary alveolar microlithiasis in an elderly woman who presented with progressive dyspnea for 2 months. Chest radiograph revealed diffuse pulmonary calcification. Tissue histopathology from open lung biopsy demonstrated widespread intra-alveolar laminated calcium deposits compatible with pulmonary alveolar microlithiasis.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberbulosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Nisa Muangman
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Ruchira Ruangchira-Urai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| |
Collapse
|
40
|
Beloncle F, Rittayamai N, Akoumianaki E, Brochard L. 0989. Accuracy of delivered airway pressure during proportional assist ventilation +. A bench study. Intensive Care Med Exp 2014. [PMCID: PMC4796648 DOI: 10.1186/2197-425x-2-s1-p74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
41
|
Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care 2013; 59:485-90. [PMID: 24046462 DOI: 10.4187/respcare.02397] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Compare the short-term benefit of high-flow nasal cannula (HFNC) with non-rebreathing mask in terms of change in dyspnea, physiologic variables, and patient comfort in subjects after endotracheal extubation. METHODS A randomized crossover study was conducted in a 10-bed respiratory care unit in a university hospital. Seventeen mechanically ventilated subjects were randomized after extubation to either Protocol A (applied HFNC for 30 min, followed by non-rebreathing mask for another 30 min) or Protocol B (applied non-rebreathing mask for 30 min, followed by HFNC for another 30 min). The level of dyspnea, breathing frequency, heart rate, blood pressure, oxygen saturation, and patient comfort were recorded. The results were expressed as mean ± SD, frequency, or percentage. Categorical variables were compared by chi-square test or Fisher exact test, and continuous variables were compared by dependent or paired t test. Statistical significance was defined as P < .05. RESULTS Seventeen subjects were divided into 2 groups: 9 subjects in Protocol A and 8 subjects in Protocol B. The baseline characteristics and physiologic parameters before extubation were not significantly different in each protocol. At the end of study, HFNC indicated less dyspnea (P = .04) and lower breathing frequency (P = .009) and heart rate (P = .006) compared with non-rebreathing mask. Most of the subjects (88.2%) preferred HFNC to non-rebreathing mask. CONCLUSIONS HFNC can improve dyspnea and physiologic parameters, including breathing frequency and heart rate, in extubated subjects compared with conventional oxygen therapy. This device may have a potential role for use after endotracheal extubation.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | |
Collapse
|
42
|
Chierakul N, Rittayamai N, Passaranon P, Chamchod C, Suntiwuth B. Respiratory health effect of persons accidentally expose to high concentration of chlorine gas. J Med Assoc Thai 2013; 96 Suppl 2:S17-S21. [PMID: 23590017] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the short term and long term respiratory health effects of subjects who accidentally exposed to high concentration of chlorine gas. MATERIAL AND METHOD There was an accidental leakage of sodium hypochlorite from an industrial factory in Rayong province in June 2010. Medical records of those who developed severe symptoms after exposed to high concentration of chlorine gas were reviewed. Prospective observational study was conducted after hospital discharge by interviewing with respiratory health questionnaires, physical examination, spirometry, methacholine challenge test, and home peak expiratory flow (PEF) monitoring at 2, 5 and 8 months after the event. RESULTS Among 1,434 persons exposed to chlorine gas, 92 developed severe symptoms required hospital admission and 21 participated in the follow-up study at 2 months there after. Respiratory symptoms were noted in 18 participants. Three most common symptoms were dyspnea (81%), chest tightness (71%), and cough (67%). Obstructive defect from spirometry was identified in 2 participants, one of which also had bronchial hyper responsiveness (BHR) compatible with reactive airway dysfunction syndrome (RADS). Seven participants had abnormal PEF variability. There were 10 and 5 participants left in the follow-up visit at 5 and 8 months respectively. Two participants had persistent obstructive defect with additional two subjects were noticed. Those who had BHR and abnormal PEF variability remained unchanged. CONCLUSION Acute exposure to high concentration of chlorine gas causes both significant short and long term respiratory health effects. Most of the patients although have gradual improvement of respiratory symptoms, but some symptoms remain persistent. Few patients have lung function impairment lasting for at least 8 months.
Collapse
Affiliation(s)
- Nitipatana Chierakul
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | |
Collapse
|
43
|
Rittayamai N, Chuaychoo B, Sriwijitkamol A. Prevalence of osteoporosis and osteopenia in Thai COPD patients. J Med Assoc Thai 2012; 95:1021-1027. [PMID: 23061305] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the prevalence of osteoporosis and osteopenia in Thai COPD patients and the factors associated with osteoporosis. MATERIAL AND METHOD A cross sectional study was used to evaluate 102 male stable COPD patients. Bone mineral density at lumbar spine (L2-4) and femoral neck were measured by dual energy x-ray absorptiometer scan. Demographic data including age, body mass index (BMI), inhaled corticosteroids use, tobacco smoke, force expiratory volume at 1 second (FEV1), and high sensitivity C-reactive protein (hs-CRP) were analyzed. RESULTS The overall prevalence of osteoporosis and osteopenia according to the lowest T-score at either L2-4 or femoral neck were 31.4% and 32.4%, respectively. This prevalence of osteoporosis in COPD patients was higher than that in age-matched Thai males from historical data (31.4% vs. 12.6%, respectively). BMI and hs-CRP were significantly associated with osteoporosis. There was no association between osteoporosis and severity of COPD, age, smoking, and corticosteroid use. The predictive value of BMI < 20.5 kg/m2 and hs-CRP > 2.3 mg/L demonstrated risk of osteoporosis in COPD patients (adjusted Odds ratio 7.2 and 4.1, respectively). CONCLUSION The prevalence of osteoporosis and osteopenia in Thai COPD patients was higher than that in normal age-matched Thai males. Osteoporosis was associated with low BMl and high level of hs-CRP when compared to COPD patients with normal bone mineral density.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | |
Collapse
|
44
|
Rittayamai N, Tscheikuna J. Amyloidosis and respiratory tract involvement: report of two cases. J Med Assoc Thai 2011; 94:1150-1153. [PMID: 21970207] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Amyloidosis is a group of diseases in which amyloid deposit in the extracellular space in an abnormal insoluble fibrillar form. The most important amyloid precursors are immunoglobulin light chain (AL) and serum amyloid-associated protein (AA). Amyloidosis can manifest as localized or systemic disease and respiratory system is one of the target organs that can be involved by amyloid. The authors report two cases of pulmonary amyloidosis presented with diffuse interstitial pulmonary amyloidosis and tracheobronchial involvement.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | |
Collapse
|