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Muñoz Lezcano S, Armengol de la Hoz MÁ, Corbi A, López F, García MS, Reiz AN, González TF, Zlatkov VY. Predictors of mechanical ventilation and mortality in critically ill patients with COVID-19 pneumonia. Med Intensiva 2024; 48:3-13. [PMID: 37500305 DOI: 10.1016/j.medine.2023.07.009] [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: 03/03/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To determine if potential predictors for invasive mechanical ventilation (IMV) are also determinants for mortality in COVID-19-associated acute respiratory distress syndrome (C-ARDS). DESIGN Single center highly detailed longitudinal observational study. SETTING Tertiary hospital ICU: two first COVID-19 pandemic waves, Madrid, Spain. PATIENTS OR PARTICIPANTS 280 patients with C-ARDS, not requiring IMV on admission. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Target: endotracheal intubation and IMV, mortality. PREDICTORS demographics, hourly evolution of oxygenation, clinical data, and laboratory results. RESULTS The time between symptom onset and ICU admission, the APACHE II score, the ROX index, and procalcitonin levels in blood were potential predictors related to both IMV and mortality. The ROX index was the most significant predictor associated with IMV, while APACHE II, LDH, and DaysSympICU were the most with mortality. CONCLUSIONS According to the results of the analysis, there are significant predictors linked with IMV and mortality in C-ARDS patients, including the time between symptom onset and ICU admission, the severity of the COVID-19 waves, and several clinical and laboratory measures. These findings may help clinicians to better identify patients at risk for IMV and mortality and improve their management.
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Affiliation(s)
- Sergio Muñoz Lezcano
- PhD Student of the Program in Computer Science, Universidad Internacional de La Rioja (UNIR), Avenida de La Paz, 137, 26006 Logroño, La Rioja, Spain.
| | | | - Alberto Corbi
- Research Institute for Innovation & Technology in Education (iTED), Universidad Internacional de La Rioja (UNIR), Avenida de La Paz, 137, 26006 Logroño, La Rioja, Spain
| | - Fernando López
- Mathematical Analysis and Applied Mathematics Department, Faculty of Mathematics. Universidad Complutense de Madrid, Spain
| | - Miguel Sánchez García
- Critical Care Department, Hospital Clínico San Carlos, Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Nuñez Reiz
- Critical Care Department, Hospital Universitario Clínico San Carlos, Martín Lagos s/n, 28040 Madrid, Spain
| | | | - Viktor Yordanov Zlatkov
- PhD Student of the Program in Computer Science, Universidad Internacional de La Rioja (UNIR), Avenida de La Paz, 137, 26006 Logroño, La Rioja, Spain
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Redruello-Guerrero P, Ruiz-Del-Pino M, Jiménez-Gutiérrez C, Jiménez-Gutiérrez P, Carrascos-Cáliz A, Romero-Linares A, Láinez Ramos-Bossini AJ, Rivera-Izquierdo M, Cárdenas-Cruz A. COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis. Med Intensiva 2023; 47:583-593. [PMID: 37302941 PMCID: PMC10251196 DOI: 10.1016/j.medine.2023.06.001] [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: 12/14/2022] [Revised: 02/19/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). DESIGN Systematic review with meta-analysis. SETTING Intensive Care Unit (ICU). PARTICIPANTS Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay. INTERVENTIONS Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD. MAIN VARIABLES OF INTEREST Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis. RESULTS Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution. CONCLUSIONS Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).
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Affiliation(s)
| | - Marta Ruiz-Del-Pino
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Anestesiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Paula Jiménez-Gutiérrez
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Ana Carrascos-Cáliz
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Alejandro Romero-Linares
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Grupo de investigación PAIDI CTS 609 CriticalLab, Hospital Universitario de Poniente, Almería, Spain; Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio Jesús Láinez Ramos-Bossini
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Servicio de Radiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Rivera-Izquierdo
- Instituto Biosanitario de Granada (ibs GRANADA), Granada, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
| | - Antonio Cárdenas-Cruz
- Departamento de Medicina, Universidad de Granada, Granada, Spain; Servicio de Medicina Intensiva, Hospital Universitario de Poniente, Almería, Spain.
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de Miguel-Balsa E, Blasco-Ruso T, Gómez-Medrano N, Mirabet-Guijarro M, Martínez-Pérez A, Alcalá-López A. Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic. Med Intensiva 2023; 47:575-582. [PMID: 37147214 PMCID: PMC10110926 DOI: 10.1016/j.medine.2023.03.011] [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: 10/16/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DESIGN A retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SETTING Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). PARTICIPANTS Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). INTERVENTIONS IMV. PP maneuvers. MAIN VARIABLES OF INTEREST Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. RESULTS Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). CONCLUSIONS PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.
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Affiliation(s)
- Eva de Miguel-Balsa
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain.
| | - Teresa Blasco-Ruso
- Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
| | - Norma Gómez-Medrano
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María Mirabet-Guijarro
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Alba Martínez-Pérez
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Adoración Alcalá-López
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Escobar MA, Navarro E, Rositi ES, Obligado R, Morel Vulliez GG, De Vito EL. [Respiratory and physical recovery in cervical spinal cord injury. Seventeen years' experience in a weaning and rehabilitation center: An observational study]. Rehabilitacion (Madr) 2022; 56:125-132. [PMID: 33256992 DOI: 10.1016/j.rh.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Spinal cord injury (SCI) is a devastating entity that generates substantial disability. The outcome of respiratory and motor features has an impact in human and social well-being. We analyzed demographic characteristics, motor and respiratory outcomes, and determined equipment needs at discharge in a weaning and rehabilitation center. MATERIAL AND METHOD Observational, descriptive and retrospective study of medical records between January 2002 and December 2018. Tracheostomised cervical SCI patients with invasive mechanical ventilation were included. Forced vital capacity (upright and supine), maximal inspiratory and expiratory pressures, ASIA and Spinal Cord Independence MeasureIII (SCIMIII) were obtained. RESULTS Of 1603 patients, 3.5% had SCI, and 28 met the inclusion criteria. The most frequent level of injury was C4-C5 (17/28), 21/28 had ASIAA classification, and 19 showed no change in either the ASIA or the SCIM score. In all, 22/28 patients were weaned, while 15/28 were decannulated. Twenty four patients were discharged to home. The most relevant change in SCIMIII was in the 5th component of respiration and sphincter subscale, related to weaning and tracheostomy. At discharge, 23/24 patients needed both respiratory and motor aids. CONCLUSIONS The admission rate of SCI patients was low in our weaning and rehabilitation center, with almost all being admitted for traumatic causes. Severity remained unchanged in most ASIAA patients. Respiratory recovery was more clinically significant than recovery of motor function. Upon discharge, most of our patients had to be equipped with both respiratory and motor aids.
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Affiliation(s)
- M A Escobar
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Servicio de Kinesiología y Fisiatría, Hospital Municipal de Vicente López Dr. B. Houssay, Ciudad Autónoma de Buenos Aires, Argentina
| | - E Navarro
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Unidad de Kinesiología, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina.
| | - E S Rositi
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Servicio de Kinesiología, HIGA Petrona V. de Cordero, San Fernando, Buenos Aires, Argentina
| | - R Obligado
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina
| | - G G Morel Vulliez
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Servicio de Rehabilitación, HIGA Eva Perón, San Martín, Buenos Aires, Argentina
| | - E L De Vito
- Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Instituto de Investigaciones Médicas Alfredo Lanari, UBA, Argentina
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Picazo L, Gracia Arnillas MP, Muñoz-Bermúdez R, Durán X, Álvarez Lerma F, Masclans JR. Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study. Med Intensiva 2020; 45:354-361. [PMID: 34294233 DOI: 10.1016/j.medine.2019.11.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. DESIGN A retrospective pre-post quasi-experimental study was carried out. SETTING A polyvalent ICU with 14 beds. PATIENTS All patients connected to IMV for >48h during 2014 and 2016 were included. INTERVENTIONS During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). MAIN OUTCOME MEASURES The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. RESULTS A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. CONCLUSIONS In our population, active humidification in patients ventilated for >48h was not associated to an increase in respiratory infectious complications.
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Affiliation(s)
- L Picazo
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - M P Gracia Arnillas
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - R Muñoz-Bermúdez
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - X Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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6
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Picazo L, Gracia Arnillas MP, Muñoz-Bermúdez R, Durán X, Álvarez Lerma F, Masclans JR. Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study. Med Intensiva 2020. [PMID: 31924444 DOI: 10.1016/j.medin.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. DESIGN A retrospective pre-post quasi-experimental study was carried out. SETTING A polyvalent ICU with 14 beds. PATIENTS All patients connected to IMV for>48hours during 2014 and 2016 were included. INTERVENTIONS During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). MAIN OUTCOME MEASURES The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. RESULTS A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. CONCLUSIONS In our population, active humidification in patients ventilated for>48hours was not associated to an increase in respiratory infectious complications.
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Affiliation(s)
- L Picazo
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - M P Gracia Arnillas
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - R Muñoz-Bermúdez
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - X Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España.
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Marín MC, Elizalde J, Villagómez A, Cerón U, Poblano M, Palma-Lara I, Sánchez JR, Monares E, Arellano A, Muriel A, Peñuelas Ó, Frutos-Vivar F, Esteban A. Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico. Med Intensiva 2019; 44:333-343. [PMID: 31130359 DOI: 10.1016/j.medin.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). DESIGN A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. SETTING Intensive Care Units (ICUs) in Mexico. PARTICIPANTS Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. INTERVENTIONS None. PRINCIPAL VARIABLES OF INTEREST Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. RESULTS A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). CONCLUSIONS The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.
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Affiliation(s)
- M C Marín
- Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México; Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Elizalde
- Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Villagómez
- Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México
| | - U Cerón
- Unidad de Cuidados Intensivos, Hospital Español de México, Ciudad de México, México
| | - M Poblano
- Unidad de Cuidados Intensivos, Hospital H+ Querétaro, Ciudad de México, México
| | - I Palma-Lara
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - J R Sánchez
- Unidad de Cuidados Intensivos, Hospital Regional de PEMEX, Ciudad Madero (Tamaulipas), México
| | - E Monares
- Unidad de Cuidados Intensivos, Hospital San Ángel Inn Universidad, Ciudad de México, México
| | - A Arellano
- Unidad de Cuidados Intensivos, Hospital Regional de Alta Especialidad Ixtapaluca, SSA, Ixtapaluca (Estado de México)
| | - A Muriel
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Ó Peñuelas
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España.
| | - F Frutos-Vivar
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España
| | - A Esteban
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España
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Bermúdez Barrezueta L, García Carbonell N, López Montes J, Gómez Zafra R, Marín Reina P, Herrmannova J, Casero Soriano J. [High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates]. An Pediatr (Barc) 2016; 86:37-44. [PMID: 27068070 DOI: 10.1016/j.anpedi.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/29/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether the availability of heated humidified high-flow nasal cannula (HFNC) therapy was associated with a decrease in need for mechanical ventilation in neonates hospitalised with acute bronchiolitis. METHODS A combined retrospective and prospective (ambispective) cohort study was performed in a type II-B Neonatal Unit, including hospitalised neonates with acute bronchiolitis after the introduction of HFNC (HFNC-period; October 2011-April 2015). They were compared with a historical cohort prior to the availability of this technique (pre-HFNC; January 2008-May 2011). The need for mechanical ventilation between the two study groups was analysed. Clinical parameters and technique-related complications were evaluated in neonates treated with HFNC. RESULTS A total of 112 neonates were included, 56 after the introduction of HFNC and 56 from the period before the introduction of HFNC. None of patients in the HFNC-period required intubation, compared with 3.6% of the patients in the pre-HFNC group. The availability of HFNC resulted in a significant decrease in the need for non-invasive mechanical ventilation (30.4% vs 10.7%; P=.01), with a relative risk (RR) of .353 (95% CI; .150-.829), an absolute risk reduction (ARR) of 19.6% (95% CI; 5.13 - 34.2), yielding a NNT of 5. In the HFNC-period, 22 patients received high flow therapy, and 22.7% (95% CI; 7.8 to 45.4) required non-invasive ventilation. Treatment with HFNC was associated with a significant decrease in heart rate (P=.03), respiratory rate (P=.01), and an improvement in the Wood-Downes Férres score (P=.00). No adverse effects were observed. CONCLUSIONS The availability of HFNC reduces the need for non-invasive mechanical ventilation, allowing a safe and effective medical management of neonates with acute bronchiolitis.
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Affiliation(s)
| | - Nuria García Carbonell
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Jorge López Montes
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Rafael Gómez Zafra
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Purificación Marín Reina
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Jana Herrmannova
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Javier Casero Soriano
- Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Belenguer-Muncharaz A, Albert-Rodrigo L, Ferrandiz-Sellés A, Cebrián-Graullera G. [Ten-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit]. Med Intensiva 2013; 37:452-60. [PMID: 23890541 DOI: 10.1016/j.medin.2012.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 08/27/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A comparison was made between invasive mechanical ventilation (IMV) and noninvasive positive pressure ventilation (NPPV) in haematological patients with acute respiratory failure. DESIGN A retrospective observational study was made from 2001 to December 2011. SETTING A clinical-surgical intensive care unit (ICU) in a tertiary hospital. PATIENTS Patients with hematological malignancies suffering acute respiratory failure (ARF) and requiring mechanical ventilation in the form of either IMV or NPPV. VARIABLES OF INTEREST Analysis of infection and organ failure rates, duration of mechanical ventilation and ICU and hospital stays, as well as ICU, hospital and mortality after 90 days. The same variables were analyzed in the comparison between NPPV success and failure. RESULTS Forty-one patients were included, of which 35 required IMV and 6 NPPV. ICU mortality was higher in the IMV group (100% vs 37% in NPPV, P=.006). The intubation rate in NPPV was 40%. Compared with successful NPPV, failure in the NPPV group involved more complications, a longer duration of mechanical ventilation and ICU stay, and greater ICU and hospital mortality. Multivariate analysis of mortality in the NPPV group identified NPPV failure (OR 13 [95%CI 1.33-77.96], P=.008) and progression to acute respiratory distress syndrome (OR 10 [95%CI 1.95-89.22], P=.03) as prognostic factors. CONCLUSION The use of NPPV reduced mortality compared with IMV. NPPV failure was associated with more complications.
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Affiliation(s)
- A Belenguer-Muncharaz
- Servicio de Medicina Intensiva, Hospital General de Castellón, Castellón de la Plana, España.
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