Parasternal Intercostal Muscle Thickness Fraction (PICTF%): Ultrasound a New Tool for Weaning Prediction?

How to cite this article: Bhattacharya D, Esquinas AM, Mandal M. Parasternal Intercostal Muscle Thickness Fraction (PICTF%): Ultrasound a New Tool for Weaning Prediction? Indian J Crit Care Med 2024;28(4):404.

Is the mNutric Score, the Only Independent Risk Factor for Abdominal Muscle Thickness Influencing Weaning?

How to cite this article: Goswami A, Bhattacharya D, Mandal M, Esquinas AM. Is the mNutric Score, the Only Independent Risk Factor for Abdominal Muscle Thickness Influencing Weaning? Indian J Crit Care Med 2023;27(9):686-687.

Non-invasive Ventilation and High-Flow Nasal Cannula in Head/Brain Injury with Risk of Pneumocephalus: Is There a Potential Application?

Non-invasive ventilation application in neurocritical care with risk of pneumocephalus is controversial. Non-invasive ventilation-related increased intrathoracic pressure increases intracranial pressure via direct transmission of intrathoracic pressure to the intracranial cavity. In addition, increased thoracic pressure decreases venous return to the heart and increases vena jugularis interna pressure, thereby increasing cerebral blood volume. Pneumocephalus is one of the major concerns after non-invasive ventilation application in head/brain trauma patients. Non-invasive mechanical ventilation may be performed in limited conditions in head trauma/brain surgery with appropriate and close monitoring. High-flow nasal cannula oxygen therapy can provide higher FiO2 as manifested by a larger increase in PaO2/FiO2 ratio and provide the theoretical basis in pneumocephalus because augmenting the PaO2 more effectively would accelerate nitrogen (N2) washout. As a result, non-invasive mechanical ventilation may be performed in limited manner in head trauma/ brain surgery with appropriate and close monitoring.

Biphasic cuirass ventilation in the escalation of non-invasive ventilation in COVID-19: Case report and review

Ventilatory alternatives to prolong noninvasive ventilation in COVID-19 patients are attractive and poorly understood. New devices to deliver negative noninvasive ventilation as biphasic cuirass ventilation (BCV) have been introduced. BCV device assist in spontaneous breathing and support ventilation. We describe a case of the combination of BCV with high-flow nasal oxygenation (HFNO) in the treatment of a COVID-19 pneumonia patient that required prolonged NIV leading to face mask intolerance, ventilator dependency secondary to residual lung fibrosis and respiratory muscular weakness. BCV provides an efficient non-invasive approach in de-escalation of therapy and weaning of prolonged NIV.

Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel Consensus

BACKGROUND

Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD.

METHOD

A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders.

RESULTS

In the first round, 34 statements were circulated. Panel members marked 'agree' or 'disagree' for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements.

CONCLUSIONS

Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV.

Cytokine Release Syndrome (CRS) in Severe COVID-19 Patients: Two Controversial and Interesting Case Reports and Literature Review

Background

Cytokine release syndrome (CRS) represents a potentially life-threatening and systematic inflammatory response where it is noted an increase of secretion of proinflammatory cytokines from lymphocytes, myeloid cells like macrophages, dendritic cells, and monocytes. This syndrome is characteristic of some conditions such as viral infections, administration of antibody-based therapy, auto immune disease, and immunotherapy, especially in severe COVID-19 patients.

Case reports

We presented two cases of COVID-19 patients in which the clinical picture significantly deteriorated during hospitalization, where the value of CRP, ferritin, LDH, and IL-6 dramatically increased, especially values of IL-6 were recorded over 2000. We treated them with third-generation cephalosporins, carbapenems, glycopeptides, metronidazole, anti-IL-6 inhibitor, low molecular weight heparin (LMWH), glucocorticoids, immunoglobulins (IVIG), and vitamins. Both patients were successfully treated and were discharged from the hospital with a recommendation for oral anticoagulant therapy.

Conclusion

CRS is a complex syndrome. In the future, it is necessary to educate doctors about this syndrome, as well as to develop drugs whose goal would be to reduce the inflammatory response in already developed diseases.

Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability

How to cite this article: Karim HMR, Esquinas AM. Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability. Indian J Crit Care Med 2022;26(10):1152.

Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe?

How to cite this article: Karim HMR, Esquinas AM. Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe? Indian J Crit Care Med 2022;26(10):1161.

Ocular disorders in non-invasive ventilation and CPAP therapy-A case report

BACKGROUND

The benefits of non-invasive ventilation (NIV) in the treatment of several chronic and acute disorders are well documented. However, the side effects associated with this type of treatment must always be taken into account. Patients often fail to mention ocular symptoms.

CLINICAL CASE

A male, 80 years old, autonomous in activities of daily living, with a personal history of chronic obstructive pulmonary disease (COPD) and chronic hypercapnic respiratory failure was admitted to the emergency room due to dyspnea and a depressed level of consciousness. The patient deteriorated to severe respiratory acidosis and was started on NIV. On the third day of admission there was note of significant ocular irritation in addition to a dermal lesion on the bridge of the nose. Ophthalmology reported a corneal ulcer and bilateral conjunctivitis and prescribed topical antibiotic and steroids, with improvement of the symptoms.

DISCUSSION

Ocular disorders in relation with NIV are more common than documented in clinical practice. It's essential that every professional that deals with this type of therapy is sensitive to the recognition and early diagnosis of this secondary effect, motivating timely evaluation. This case exemplifies the rapid onset of this type of complication, especially if the staff is poorly trained in NIV application and in patients with a decreased level of consciousness. Centers need to develop protocols to evaluate patients under NIV for ocular symptoms, with the goal of early therapeutic intervention. The creation and divulgation of these procedures will drastically improve the quality of care to acute and chronic patients in need of NIV.

Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations

Aim

This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).

Background

NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation.

Methods

Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done.

Review results

Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile.

Conclusion

Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations.

How to cite this article

Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938–948.

Intelligent Volume-Assured Pressure Support vs. Spontaneous/Timed Mode as a Weaning Strategy in COPD-Evaluation of a New Ventilation Strategy

We thank Salama S et al [...].

An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study

Background

Heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) have been used to predict noninvasive ventilation (NIV) failure. However, the HACOR score fails to consider baseline data. Here, we aimed to update the HACOR score to take into account baseline data and test its predictive power for NIV failure primarily after 1–2 h of NIV.

Methods

A multicenter prospective observational study was performed in 18 hospitals in China and Turkey. Patients who received NIV because of hypoxemic respiratory failure were enrolled. In Chongqing, China, 1451 patients were enrolled in the training cohort. Outside of Chongqing, another 728 patients were enrolled in the external validation cohort.

Results

Before NIV, the presence of pneumonia, cardiogenic pulmonary edema, pulmonary ARDS, immunosuppression, or septic shock and the SOFA score were strongly associated with NIV failure. These six variables as baseline data were added to the original HACOR score. The AUCs for predicting NIV failure were 0.85 (95% CI 0.84–0.87) and 0.78 (0.75–0.81) tested with the updated HACOR score assessed after 1–2 h of NIV in the training and validation cohorts, respectively. A higher AUC was observed when it was tested with the updated HACOR score compared to the original HACOR score in the training cohort (0.85 vs. 0.80, 0.86 vs. 0.81, and 0.85 vs. 0.82 after 1–2, 12, and 24 h of NIV, respectively; all p values < 0.01). Similar results were found in the validation cohort (0.78 vs. 0.71, 0.79 vs. 0.74, and 0.81 vs. 0.76, respectively; all p values < 0.01). When 7, 10.5, and 14 points of the updated HACOR score were used as cutoff values, the probability of NIV failure was 25%, 50%, and 75%, respectively. Among patients with updated HACOR scores of ≤ 7, 7.5–10.5, 11–14, and > 14 after 1–2 h of NIV, the rate of NIV failure was 12.4%, 38.2%, 67.1%, and 83.7%, respectively.

Conclusions

The updated HACOR score has high predictive power for NIV failure in patients with hypoxemic respiratory failure. It can be used to help in decision-making when NIV is used.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-04060-7.

“Tracheostomy healing time after decannulation”: can we improve it?

Dear Editor, We read with great interest the article “Tracheostomy healing time after decannulation” by Christiansen et al. The authors aimed to determine the tracheostomy wound healing time after decannulation...