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Schneider CJ, Both CP, Fries D, Wendel-Garcia PD, Buehler PK, Grass B, Cannizzaro V, Escher C, Schmitz A, Thomas J. The in-vitro performance of a modern portable respirator in different lung models and as an alternative intensive care respirator: A simulation based cohort study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY AND INTENSIVE CARE 2025; 4:e0069. [PMID: 40206343 PMCID: PMC11977734 DOI: 10.1097/ea9.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 11/28/2024] [Indexed: 04/11/2025]
Abstract
BACKGROUND Transporting ventilated patients safely and without loss of efficacy is a challenge. Portable ventilators are generally used to transport critically ill patients, but their performance is often limited. OBJECTIVE This study aimed to compare the in-vitro performance of a modern portable respirator with a modern intensive care respirator for different lung settings. DESIGN An in-vitro testing of a portable and an intensive care respirator. SETTINGS Anaesthesia Department at the University Children's Hospital Zurich. MAIN OUTCOME MEASURES The portable respirator Hamilton T1 was compared with the established intensive care respirator bellavista1000 (BV) while applying different settings with the ASL 5000 (ASL) device. The ASL can simulate neonatal, paediatric, and adult lung settings with normal or impaired lung function. Accuracy of delivered tidal volumes, proximal and distal airway pressures and mechanical lung properties were assessed. RESULTS Bland-Altman analyses showed higher accuracy for applied tidal volumes delivered by the portable respirator, 12.6% [95% confidence interval (CI) -8.9 to 34.2], compared with the intensive care respirator, 15.9% (95% CI -18.5 to 50.3). In neonatal and infant lung models particularly, the accuracy of delivered tidal volumes by the portable respirator, 13.2% (95% CI -8.9 to 35.3) was superior to those delivered by the intensive care respirator, 20.9% (95%CI -15.9 to 57.7). Lung compliance estimation was performed more accurately by the intensive care respirator, whereas the portable respirator measured airway resistance more accurately. However, both respirators showed only moderate overall accuracy when assessing lung mechanics. CONCLUSION The tested portable respirator proved to be a useful device for invasive ventilation of critically ill patients. The overall performance is non-inferior to a conventional intensive care respirator.
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Affiliation(s)
- Celine Josianne Schneider
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Christian Peter Both
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Daniel Fries
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Pedro David Wendel-Garcia
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Philipp Karl Buehler
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Beate Grass
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Vincenzo Cannizzaro
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Christian Escher
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Achim Schmitz
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
| | - Jörg Thomas
- From the Department of Anesthesiology, Children's University Hospital Zurich, Zurich, Switzerland (CJS, CPB, DF, PKB, AS, JT), Department of Anesthesiology, Children Hospital St. Gallen, St. Gallen/Switzerland (CPB), Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (CJS, CPB, PKB, BG, VC, AS, JT), Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (DF, PDW-G), Institut of Intensive Care, University Hospital Zurich, Zurich, Switzerland (PDW-G), Department of Intensive Care, Hospital Winterthur, Winterthur, Switzerland (PKB), Department of Neonatal Intensive Care, University Hospital Zurich, Zurich, Switzerland (BG, VC), Department of Anesthesiology, Hospital Aarau, Aargau, Switzerland (CE), and Department of Anesthesiology, Hospital Winterthur, Winterthur, Switzerland (CJS)
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Chen L, Xia S, Zuo Y, Lin Y, Qiu X, Chen Q, Feng T, Xia X, Shao Q, Wang S. Systemic immune inflammation index and peripheral blood carbon dioxide concentration at admission predict poor prognosis in patients with severe traumatic brain injury. Front Immunol 2023; 13:1034916. [PMID: 36700228 PMCID: PMC9868584 DOI: 10.3389/fimmu.2022.1034916] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Background Recent studies have shown that systemic inflammation responses and hyperventilation are associated with poor outcomes in patients with severe traumatic brain injury (TBI). The aim of this retrospective study was to investigate the relationships between the systemic immune inflammation index (SII = platelet × neutrophil/lymphocyte) and peripheral blood CO2 concentration at admission with the Glasgow Outcome Score (GOS) at 6 months after discharge in patients with severe TBI. Methods We retrospectively analyzed the clinical data for 1266 patients with severe TBI at three large medical centers from January 2016 to December 2021, and recorded the GOS 6 months after discharge. The receiver operating characteristic (ROC) curve was used to determine the best cutoff values for SII, CO2, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR), and chi-square tests were used to evaluate the relationships among SII, CO2 and the basic clinical characteristics of patients with TBI. Multivariate logistic regression analysis was used to determine the independent prognostic factors for GOS in patients with severe TBI. Finally, ROC curve, nomogram, calibration curve and decision curve analyses were used to evaluate the value of SII and coSII-CO2 in predicting the prognosis of patients with severe TBI. And we used the multifactor regression analysis method to build the CRASH model and the IMPACT model. The CRASH model included age, GCS score (GCS, Glasgow Coma Scale) and Pupillary reflex to light: one, both, none. The IMPACT model includes age, motor score and Pupillary reflex to light: one, both, none. Results The ROC curves indicated that the best cutoff values of SII, CO2, PLR, NLR and LMR were 2651.43×109, 22.15mmol/L, 190.98×109, 9.66×109 and 1.5×109, respectively. The GOS at 6 months after discharge of patients with high SII and low CO2 were significantly poorer than those with low SII and high CO2. Multivariate logistic regression analysis revealed that age, systolic blood pressure (SBP), pupil size, subarachnoid hemorrhage (SAH), SII, PLR, serum potassium concentration [K+], serum calcium concentration [Ca2+], international normalized ratio (INR), C-reactive protein (CRP) and co-systemic immune inflammation index combined with carbon dioxide (coSII-CO2) (P < 0.001) were independent prognostic factors for GOS in patients with severe TBI. In the training group, the C-index was 0.837 with SII and 0.860 with coSII-CO2. In the external validation group, the C-index was 0.907 with SII and 0.916 with coSII-CO2. Decision curve analysis confirmed a superior net clinical benefit with coSII-CO2 rather than SII in most cases. Furthermore, the calibration curve for the probability of GOS 6 months after discharge showed better agreement with the observed results when based on the coSII-CO2 rather than the SII nomogram. According to machine learning, coSII-CO2 ranked first in importance and was followed by pupil size, then SII. Conclusions SII and CO2 have better predictive performance than NLR, PLR and LMR. SII and CO2 can be used as new, accurate and objective clinical predictors, and coSII-CO2, based on combining SII with CO2, can be used to improve the accuracy of GOS prediction in patients with TBI 6 months after discharge.
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Affiliation(s)
- Li Chen
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shaohuai Xia
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Yi Zuo
- Department of Geriatrics, Affiliated Huai’an No.2 People’s Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Yinghong Lin
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xianshen Qiu
- Department of Neurosurgery, Ganzhou People's Hospital, No.16 Meiguan Avenue, Zhanggong District, Ganzhou, Jiangxi, China
| | - Qizuan Chen
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Tianshun Feng
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xuewei Xia
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China,*Correspondence: Xuewei Xia, ; Qixiang Shao, ; Shousen Wang,
| | - Qixiang Shao
- Institute of Medical Genetics and Reproductive Immunity, School of Medical Science and Laboratory Medicine, Jiangsu College of Nursing, No.2 the Yellow River West Road Huai'an, Jiangsu, China,*Correspondence: Xuewei Xia, ; Qixiang Shao, ; Shousen Wang,
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China,Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China,*Correspondence: Xuewei Xia, ; Qixiang Shao, ; Shousen Wang,
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Wolf MS, Rakkar J, Horvat CM, Simon DW, Kochanek PM, Clermont G, Clark RSB. Assessment of Dynamic Intracranial Compliance in Children with Severe Traumatic Brain Injury: Proof-of-Concept. Neurocrit Care 2020; 34:209-217. [PMID: 32556856 PMCID: PMC7299131 DOI: 10.1007/s12028-020-01004-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background and Aims Intracranial compliance refers to the relationship between a change in intracranial volume and the resultant change in intracranial pressure (ICP). Measurement of compliance is useful in managing cardiovascular and respiratory failure; however, there are no contemporary means to assess intracranial compliance. Knowledge of intracranial compliance could complement ICP and cerebral perfusion pressure (CPP) monitoring in patients with severe traumatic brain injury (TBI) and may enable a proactive approach to ICP management. In this proof-of-concept study, we aimed to capitalize on the physiologic principles of intracranial compliance and vascular reactivity to CO2, and standard-of-care neurocritical care monitoring, to develop a method to assess dynamic intracranial compliance. Methods Continuous ICP and end-tidal CO2 (ETCO2) data from children with severe TBI were collected after obtaining informed consent in this Institutional Review Board-approved study. An intracranial pressure-PCO2 Compliance Index (PCI) was derived by calculating the moment-to-moment correlation between change in ICP and change in ETCO2. As such, “good” compliance may be reflected by a lack of correlation between time-synched changes in ICP in response to changes in ETCO2, and “poor” compliance may be reflected by a positive correlation between changes in ICP in response to changes in ETCO2. Results A total of 978 h of ICP and ETCO2 data were collected and analyzed from eight patients with severe TBI. Demographic and clinical characteristics included patient age 7.1 ± 5.8 years (mean ± SD); 6/8 male; initial Glasgow Coma Scale score 3 [3–7] (median [IQR]); 6/8 had decompressive surgery; 7.1 ± 1.4 ICP monitor days; ICU length of stay (LOS) 16.1 ± 6.8 days; hospital LOS 25.9 ± 8.4 days; and survival 100%. The mean PCI for all patients throughout the monitoring period was 0.18 ± 0.04, where mean ICP was 13.7 ± 2.1 mmHg. In this cohort, PCI was observed to be consistently above 0.18 by 12 h after monitor placement. Percent time spent with PCI thresholds > 0.1, 0.2, and 0.3 were 62% [24], 38% [14], and 23% [15], respectively. The percentage of time spent with an ICP threshold > 20 mmHg was 5.1% [14.6]. Conclusions Indirect assessment of dynamic intracranial compliance in TBI patients using standard-of-care monitoring appears feasible and suggests a prolonged period of derangement out to 5 days post-injury. Further study is ongoing to determine if the PCI—a new physiologic index, complements utility of ICP and/or CPP in guiding management of patients with severe TBI. Electronic supplementary material The online version of this article (10.1007/s12028-020-01004-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael S Wolf
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jaskaran Rakkar
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher M Horvat
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Faculty Pavilion, Suite 2000, Brain Care Institute, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
| | - Dennis W Simon
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Faculty Pavilion, Suite 2000, Brain Care Institute, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Faculty Pavilion, Suite 2000, Brain Care Institute, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
| | - Robert S B Clark
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Faculty Pavilion, Suite 2000, Brain Care Institute, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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