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Arabi Y, Al Dorzi H, Ghanem A, Hegazy M, AlMatrood A, Alchin J, Mutairi M, Aqeil A. Humidification during mechanical ventilation to prevent endotracheal tube occlusion in critically ill patients: A case control study. Ann Thorac Med 2022; 17:37-43. [PMID: 35198047 PMCID: PMC8809127 DOI: 10.4103/atm.atm_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND: Endotracheal tube (ETT) occlusion is a potentially life-threatening event. This study describes a quality improvement project to prevent ETT occlusion in critically ill patients. METHODS: After a cluster of clinically significant ETT occlusion incidents at a tertiary-care intensive care unit (ICU), the root cause analysis suggested that the universal use of heat moisture exchangers (HMEs) was a major cause. Then, we prospectively audited new ETT occlusion incidents after changing our practices to evidence-based active and passive humidification during mechanical ventilation (MV). We also compared the outcomes of affected patients with matched controls. RESULTS: During 100 weeks, 18 incidents of clinically significant ETT occlusion occurred on a median of 7 days after intubation (interquartile range, 4.8–9.5): 8 in the 10 weeks before and 10 in the 90 weeks after changing humidification practices (8.1 vs. 1.0 incidents per 1000 ventilator days, respectively). The incidents were not suspected in 94.4%, the peak airway pressure was >30 cm H2O in only 25%, and 55.6% were being treated for pneumonia when ETT occlusion occurred. Compared with 51 matched controls, ETT occlusion cases had significantly longer MV duration (median of 13.5 vs. 4.0 days; P = 0.002) and ICU stay (median of 26.5 vs. 11.0 days; P = 0.006) and more tracheostomy (55.6% vs. 9.8%; P < 0.001). The hospital mortality was similar in cases and controls. CONCLUSIONS: The rate of ETT occlusion decreased after changing humidification practices from universal HME use to evidence-based active and passive humidification. ETT occlusion was associated with more tracheostomy and a longer duration of MV and ICU stay.
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Lellouche F, Lavoie-Bérard CA, Rousseau E, Bouchard PA, Lefebvre JC, Branson R, Brochard L. How to avoid an epidemic of endotracheal tube occlusion. THE LANCET RESPIRATORY MEDICINE 2021; 9:1215-1216. [PMID: 34739886 PMCID: PMC8563017 DOI: 10.1016/s2213-2600(21)00404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada; Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada.
| | - Carole-Anne Lavoie-Bérard
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Emilie Rousseau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Pierre-Alexandre Bouchard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Jean-Claude Lefebvre
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Richard Branson
- Department of Surgery, Division of Trauma and Critical Care, University of Cincinnati, Cincinnati, OH, USA
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
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Vargas M, Chiumello D, Sutherasan Y, Ball L, Esquinas AM, Pelosi P, Servillo G. Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:123. [PMID: 28552074 PMCID: PMC5447307 DOI: 10.1186/s13054-017-1710-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients. METHODS Computerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I 2 were estimated for each outcome. Furthermore, weighted random-effect meta-regression analysis was performed to test the relationship between the effect size on each considered outcome and covariates. RESULTS Eighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792-4.338), pneumonia (RR = 932; 95% CI 0.730-1.190) and mortality (RR = 1.023; 95% CI 0.878-1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560-9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time). CONCLUSIONS In this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Davide Chiumello
- Dipartimento di Emergenza - Urgenza, ASST Santi Paolo e Carlo; Dipartimento di Scienze della salute, Università degli Studi di Milano, Milan, Italy
| | - Yuda Sutherasan
- Division of pulmonary and critical care medicine, Faculty of medicine Ramathibodi hospital, Mahidol University, 270 RAMA VI road, Bangkok, 10400, Thailand
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | | | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Ikeda T, Uchida K, Yamauchi Y, Nagase T, Oba K, Yamada Y. Relationship between pre-anesthetic and intra-anesthetic airway resistance in patients undergoing general anesthesia: A prospective observational study. PLoS One 2017; 12:e0172421. [PMID: 28212451 PMCID: PMC5315306 DOI: 10.1371/journal.pone.0172421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/04/2017] [Indexed: 12/31/2022] Open
Abstract
Surgery patients in Japan undergo routine spirometry testing prior to general anesthesia. The use of a flow sensor during general anesthesia has recently become common. However, it is not certain whether the information derived from flow-volume curves is being adequately used for mechanical ventilation management during general anesthesia. So far, there have been no attempts to calculate airway resistance using flow-volume curves. Therefore, we performed a prospective, observational study to investigate the relationship between pre-anesthetic and intra-anesthetic airway resistance in patients scheduled for surgery under general anesthesia. We calculated pre-anesthetic and intra-anesthetic airway resistance in each patient, based on the slopes of flow-volume curves obtained prior to and during general anesthesia. We also calculated endotracheal tube resistance to correct the intra-anesthetic airway resistance values calculated. A total of 526 patients were included in the study, and 98 patients had a forced expiratory volume in the first second/forced vital capacity ratio of < 70%. Pre-anesthetic airway resistance was significantly higher in patients with airflow obstruction than in those without airflow obstruction (p < 0.001), whereas no significant difference in intra-anesthetic airway resistance was found between patients with and without airflow obstruction during mechanical ventilation (p = 0.48). Pre-anesthetic and intra-anesthetic airway resistance values were closer to each other in patients without airflow obstruction, with a mean difference < 1.0 cmH2O L-1s-1, than in those with airflow obstruction, although these respiratory parameters were significantly different (p < 0.001). Intra-anesthetic airway resistance was not related to the FEV1/FVC ratio, regardless of the degree to which the FEV1/FVC ratio reflected pre-anesthetic airway resistance. As compared with patients with airflow obstruction, the mean difference between pre-anesthetic and intra-anesthetic airway resistance was small in patients without airflow obstruction.
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Affiliation(s)
- Takamitsu Ikeda
- Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Schenk P, Eber E, Funk GC, Fritz W, Hartl S, Heininger P, Kink E, Kühteubl G, Oberwaldner B, Pachernigg U, Pfleger A, Schandl P, Schmidt I, Stein M. [Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology]. Wien Klin Wochenschr 2016; 128 Suppl 1:S1-36. [PMID: 26837865 DOI: 10.1007/s00508-015-0899-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.
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Affiliation(s)
- Peter Schenk
- Abteilung für Pulmologie, Landesklinikum Hochegg, Hocheggerstraße 88, 2840, Grimmenstein, Österreich.
| | - Ernst Eber
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Georg-Christian Funk
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | - Wilfried Fritz
- Klinische Abteilung für Lungenkrankheiten, Universitätsklinik für Innere Medizin, Universitätsklinikum Graz, Graz, Österreich
| | - Sylvia Hartl
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | | | - Eveline Kink
- Abteilung für Lungenkrankheiten, Landeskrankenhaus Hörgas-Enzenbach, Eisbach, Österreich
| | - Gernot Kühteubl
- Abteilung für Pulmologie, Landesklinikum Hochegg, Hocheggerstraße 88, 2840, Grimmenstein, Österreich
| | | | - Ulrike Pachernigg
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Andreas Pfleger
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Petra Schandl
- 1. Allgemeine Intensivstation, Wilhelminenspital, Wien, Österreich
| | - Ingrid Schmidt
- I. Interne Lungenabteilung, Pulmologisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Wien, Österreich
| | - Markus Stein
- Abteilung für Pneumologie, Landeskrankenhaus Hochzirl-Natters, Standort Natters, Natters, Österreich
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Aguirre-Bermeo H, Morán I, Bottiroli M, Italiano S, Parrilla FJ, Plazolles E, Roche-Campo F, Mancebo J. End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics. Ann Intensive Care 2016; 6:81. [PMID: 27558174 PMCID: PMC4996808 DOI: 10.1186/s13613-016-0183-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022] Open
Abstract
Background End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO2. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. Methods The investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases. First phase, baseline measurements were taken. Second phase, the EIP was prolonged until one of the following was achieved: (1) EIP of 0.7 s; (2) intrinsic positive end-expiratory pressure ≥1 cmH2O; or (3) inspiratory–expiratory ratio 1:1. Third phase, the Vt was decreased (30 mL every 30 min) until PaCO2 equal to baseline was reached. FiO2, PEEP, airflow and respiratory rate were kept constant. Results EIP was prolonged from 0.12 ± 0.04 to 0.7 s in all patients. This decreased the Vd/Vt and PaCO2 (0.70 ± 0.07 to 0.64 ± 0.08, p < 0.001 and 54 ± 9 to 50 ± 8 mmHg, p = 0.001, respectively). In the third phase, the decrease in Vt (from 6.3 ± 0.8 to 5.6 ± 0.8 mL/Kg PBW, p < 0.001) allowed to decrease plateau pressure and driving pressure (24 ± 3 to 22 ± 3 cmH2O, p < 0.001 and 13.4 ± 3.6 to 10.9 ± 3.1 cmH2O, p < 0.001, respectively) and increased respiratory system compliance from 29 ± 9 to 32 ± 11 mL/cmH2O (p = 0.001). PaO2 did not significantly change. Conclusions Prolonging EIP allowed a significant decrease in Vt without changes in PaCO2 in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.
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Affiliation(s)
- Hernan Aguirre-Bermeo
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain
| | - Indalecio Morán
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain
| | | | - Stefano Italiano
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain
| | - Francisco José Parrilla
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain
| | - Eugenia Plazolles
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain
| | - Ferran Roche-Campo
- Servei de Medicina Intensiva, Hospital Verge de la Cinta, Tortosa, Spain
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona (UAB), Sant Quintí, 89, 08041, Barcelona, Spain.
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Lellouche F. Quelle technique d’humidification pour la ventilation invasive et non invasive ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Évaluation des ventilateurs. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea. Intensive Care Med 2012; 38:542-56. [PMID: 22349425 PMCID: PMC3308008 DOI: 10.1007/s00134-012-2508-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 12/17/2022]
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