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Gómez CA, Brochard L, Goligher EC, Rozenberg D, Reid WD, Roblyer D. Combined frequency domain near-infrared spectroscopy and diffuse correlation spectroscopy system for comprehensive metabolic monitoring of inspiratory muscles during loading. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:035002. [PMID: 38532926 PMCID: PMC10965138 DOI: 10.1117/1.jbo.29.3.035002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
Significance Mechanical ventilation (MV) is a cornerstone technology in the intensive care unit as it assists with the delivery of oxygen in critically ill patients. The process of weaning patients from MV can be long and arduous and can lead to serious complications for many patients. Despite the known importance of inspiratory muscle function in the success of weaning, current clinical standards do not include direct monitoring of these muscles. Aim The goal of this project was to develop and validate a combined frequency domain near-infrared spectroscopy (FD-NIRS) and diffuse correlation spectroscopy (DCS) system for the noninvasive characterization of inspiratory muscle response to a load. Approach The system was fabricated by combining a custom digital FD-NIRS and DCS system. It was validated via liquid phantom titrations and a healthy volunteer study. The sternocleidomastoid (SCM), an accessory muscle of inspiration, was monitored during a short loading period in fourteen young, healthy volunteers. Volunteers performed two different respiratory exercises, a moderate load and a high load, which consisted of a one-minute baseline, a one-minute load, and a six-minute recovery period. Results The system has low crosstalk between absorption, reduced scattering, and flow when tested in a set of liquid titrations. Faster dynamics were observed for changes in blood flow index (BF i ), and metabolic rate of oxygen (MRO 2 ) compared with hemoglobin + myoglobin (Hb+Mb) based parameters after the onset of loads in males. Additionally, larger percent changes in BF i , and MRO 2 were observed compared with Hb+Mb parameters in both males and females. There were also sex differences in baseline values of oxygenated Hb+Mb, total Hb+Mb, and tissue saturation. Conclusions The dynamic characteristics of Hb+Mb concentration and blood flow were distinct during loading of the SCM, suggesting that the combination of FD-NIRS and DCS may provide a more complete picture of inspiratory muscle dynamics.
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Affiliation(s)
- Carlos A. Gómez
- Boston University, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Laurent Brochard
- St. Michael’s Hospital, Unity Health Toronto, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada
- St. Michael’s Hospital, Department of Critical Care, Toronto, Ontario, Canada
- University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
| | - Ewan C. Goligher
- University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
- University Health Network, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- University of Toronto, Department of Physiology, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- University Health Network, Toronto General Hospital Research Institute, Ajmera Transplant Center, Toronto, Ontario, Canada
- University of Toronto, Division of Respirology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - W. Darlene Reid
- University of Toronto, Department of Physical Therapy, Toronto, Ontario, Canada
- University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
- University Health Network, KITE – Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Darren Roblyer
- Boston University, Department of Biomedical Engineering, Boston, Massachusetts, United States
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von Wedel D, Redaelli S, Suleiman A, Wachtendorf LJ, Fosset M, Santer P, Shay D, Munoz-Acuna R, Chen G, Talmor D, Jung B, Baedorf-Kassis EN, Schaefer MS. Adjustments of Ventilator Parameters during Operating Room-to-ICU Transition and 28-Day Mortality. Am J Respir Crit Care Med 2024; 209:553-562. [PMID: 38190707 DOI: 10.1164/rccm.202307-1168oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024] Open
Abstract
Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (-1.1 ml/kg predicted body weight [IQR, -2.0 to -0.2]; P < 0.001; and -4.3 cm H2O [-8.2 to -1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [-1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4-1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.
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Affiliation(s)
- Dario von Wedel
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Maxime Fosset
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Elias N Baedorf-Kassis
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesiology, Düsseldorf University Hospital, Dusseldorf, Germany
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Mekontso Dessap A, Bagate F, Repesse X, Blayau C, Fartoukh M, Canoui-Poitrine F, de Prost N, Vieillard-Baron A. Low-flow ECCO 2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS. Heliyon 2024; 10:e23878. [PMID: 38226285 PMCID: PMC10788508 DOI: 10.1016/j.heliyon.2023.e23878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Background Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia. Methods We planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h. Results Only eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases. Conclusions This pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials. Trial registration Registered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807.
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Affiliation(s)
- Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - François Bagate
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - Xavier Repesse
- AP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, France
| | - Clarisse Blayau
- AP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France
| | - Muriel Fartoukh
- AP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France
| | - Florence Canoui-Poitrine
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Nicolas de Prost
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - Antoine Vieillard-Baron
- AP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, France
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Gómez CA, Brochard L, Goligher EC, Rozenberg D, Reid WD, Roblyer D. A combined frequency domain near infrared spectroscopy and diffuse correlation spectroscopy system for comprehensive metabolic monitoring of inspiratory muscles during loading. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.30.569133. [PMID: 38076980 PMCID: PMC10705398 DOI: 10.1101/2023.11.30.569133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Significance Mechanical ventilation (MV) is a cornerstone technology in the intensive care unit as it assists with the delivery of oxygen in critical ill patients. The process of weaning patients from MV can be long, and arduous and can lead to serious complications for many patients. Despite the known importance of inspiratory muscle function in the success of weaning, current clinical standards do not include direct monitoring of these muscles. Aim The goal of this project was to develop and validate a combined frequency domain near infrared spectroscopy (FD-NIRS) and diffuse correlation spectroscopy (DCS) system for the noninvasive characterization of inspiratory muscle response to a load. Approach The system was fabricated by combining a custom digital FD-NIRS and DCS system. It was validated via liquid phantom titrations and a healthy volunteer study. The sternocleidomastoid (SCM), an accessory muscle of inspiration, was monitored during a short loading period in fourteen young healthy volunteer. Volunteers performed two different respiratory exercises, a moderate and high load, which consisted of a one-minute baseline, a one-minute load, and a six-minute recovery period. Results The system has low crosstalk between absorption, reduced scattering, and flow when tested in a set of liquid titrations. Faster dynamics were observed for changes in blood flow index (BFi), and metabolic rate of oxygen (MRO2) compared to hemoglobin + myoglobin (Hb+Mb) based parameters after the onset of loads in males. Additionally, larger percent changes in BFi, and MRO2 were observed compared to Hb+Mb parameters in both males and females. There were also sex differences in baseline values of oxygenated Hb+Mb, total Hb+Mb, and tissue saturation. Conclusion The dynamic characteristics of Hb+Mb concentration and blood flow were distinct during loading of the SCM, suggesting that the combination of FD-NIRS and DCS may provide a more complete picture of inspiratory muscle dynamics.
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Affiliation(s)
- Carlos A Gómez
- Department of Biomedical Engineering, Boston University, Boston, MA 02125, USA
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Darren Roblyer
- Department of Biomedical Engineering, Boston University, Boston, MA 02125, USA
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Shi X, Shi Y, Fan L, Yang J, Chen H, Ni K, Yang J. Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study. J Intensive Care 2023; 11:59. [PMID: 38031107 PMCID: PMC10685672 DOI: 10.1186/s40560-023-00707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Heterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians' ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective. METHODS A group-based trajectory model was used to identify the OSI-trajectory phenotypes. Associations between the OSI-trajectory phenotypes and ICU mortality were analyzed using doubly robust analyses. Then, a predictive model was constructed to distinguish patients with poor prognosis phenotypes. RESULTS Four OSI-trajectory phenotypes were identified in 3378 patients: low-level stable, ascending, descending, and high-level stable. Patients with the high-level stable phenotype had the highest mortality and fewest VFDs. The doubly robust estimation, after adjusting for unbalanced covariates in a model using the XGBoost method for generating propensity scores, revealed that both high-level stable and ascending phenotypes were associated with higher mortality rates (odds ratio [OR]: 1.422, 95% confidence interval [CI] 1.246-1.623; OR: 1.097, 95% CI 1.027-1.172, respectively), while the descending phenotype showed similar ICU mortality rates to the low-level stable phenotype (odds ratio [OR] 0.986, 95% confidence interval [CI] 0.940-1.035). The predictive model could help identify patients with ascending or high-level stable phenotypes at an early stage (area under the curve [AUC] in the training dataset: 0.851 [0.827-0.875]; AUC in the validation dataset: 0.743 [0.709-0.777]). CONCLUSIONS Dynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients.
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Affiliation(s)
- Xiawei Shi
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Yangyang Shi
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Liming Fan
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia Yang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Hao Chen
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaiwen Ni
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Junchao Yang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.
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Tejerina EE, Gonçalves G, Gómez-Mediavilla K, Jaramillo C, Jiménez J, Frutos-Vivar F, Lorente JÁ, Thuissard IJ, Andreu-Vázquez C. The effect of age on clinical outcomes in critically ill brain-injured patients. Acta Neurol Belg 2023; 123:1709-1715. [PMID: 35737277 DOI: 10.1007/s13760-022-01987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE We studied the impact of age on survival and functional recovery in brain-injured patients. METHODS We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3-6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes. RESULTS We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3-6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73-7.74, p < 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95-7.08, p < 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70-11.28, p < 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34-6.42, p < 0.001]. CONCLUSION Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
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Affiliation(s)
- Eva E Tejerina
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain.
| | | | | | | | | | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain
| | - José Ángel Lorente
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain
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7
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King AJ, Angus DC, Cooper GF, Mowery DL, Seaman JB, Potter KM, Bukowski LA, Al-Khafaji A, Gunn SR, Kahn JM. A voice-based digital assistant for intelligent prompting of evidence-based practices during ICU rounds. J Biomed Inform 2023; 146:104483. [PMID: 37657712 PMCID: PMC10591951 DOI: 10.1016/j.jbi.2023.104483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the technical feasibility and potential value of a digital assistant that prompts intensive care unit (ICU) rounding teams to use evidence-based practices based on analysis of their real-time discussions. METHODS We evaluated a novel voice-based digital assistant which audio records and processes the ICU care team's rounding discussions to determine which evidence-based practices are applicable to the patient but have yet to be addressed by the team. The system would then prompt the team to consider indicated but not yet delivered practices, thereby reducing cognitive burden compared to traditional rigid rounding checklists. In a retrospective analysis, we applied automatic transcription, natural language processing, and a rule-based expert system to generate personalized prompts for each patient in 106 audio-recorded ICU rounding discussions. To assess technical feasibility, we compared the system's prompts to those created by experienced critical care nurses who directly observed rounds. To assess potential value, we also compared the system's prompts to a hypothetical paper checklist containing all evidence-based practices. RESULTS The positive predictive value, negative predictive value, true positive rate, and true negative rate of the system's prompts were 0.45 ± 0.06, 0.83 ± 0.04, 0.68 ± 0.07, and 0.66 ± 0.04, respectively. If implemented in lieu of a paper checklist, the system would generate 56% fewer prompts per patient, with 50%±17% greater precision. CONCLUSION A voice-based digital assistant can reduce prompts per patient compared to traditional approaches for improving evidence uptake on ICU rounds. Additional work is needed to evaluate field performance and team acceptance.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Gregory F Cooper
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Offices at Baum 4th Floor, 5607 Baum Blvd, Pittsburgh, PA 15206, USA.
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Blockley Hall 8th Floor, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Jennifer B Seaman
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Kelly M Potter
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Leigh A Bukowski
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Ali Al-Khafaji
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Scott R Gunn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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8
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Olsen GH, Gee PM, Wolfe D, Winberg C, Carpenter L, Jones C, Jacobs JR, Leither L, Peltan ID, Singer SJ, Asch SM, Grissom CK, Srivastava R, Knighton AJ. Awakening and Breathing Coordination: A Mixed-Methods Analysis of Determinants of Implementation. Ann Am Thorac Soc 2023; 20:1483-1490. [PMID: 37413692 PMCID: PMC10559139 DOI: 10.1513/annalsats.202212-1048oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/06/2023] [Indexed: 07/08/2023] Open
Abstract
Rationale: Routine spontaneous awakening and breathing trial coordination (SAT/SBT) improves outcomes for mechanically ventilated patients, but adherence varies. Understanding barriers to and facilitators of consistent daily use of SAT/SBT (implementation determinants) can guide the development of implementation strategies to increase adherence to these evidence-based interventions. Objectives: We conducted an explanatory, sequential mixed-methods study to measure variation in the routine daily use of SAT/SBT and to identify implementation determinants that might explain variation in SAT/SBT use across 15 intensive care units (ICUs) in urban and rural locations within an integrated, community-based health system. Methods: We described the patient population and measured adherence to daily use of coordinated SAT/SBT from January to June 2021, selecting four sites with varied adherence levels for semistructured field interviews. We conducted key informant interviews with critical care nurses, respiratory therapists, and physicians/advanced practice clinicians (n = 55) from these four sites between October and December 2021 and performed content analysis to identify implementation determinants of SAT/SBT use. Results: The 15 sites had 1,901 ICU admissions receiving invasive mechanical ventilation (IMV) for ⩾24 hours during the measurement period. The mean IMV patient age was 58 years, and the median IMV duration was 5.3 days (interquartile range, 2.5-11.9). Coordinated SAT/SBT adherence (within 2 h) was estimated at 21% systemwide (site range, 9-68%). ICU clinicians were generally familiar with SAT/SBT but varied in their knowledge and beliefs about what constituted an evidence-based SAT/SBT. Clinicians reported that SAT/SBT coordination was difficult in the context of existing ICU workflows, and existing protocols did not explicitly define how coordination should be performed. The lack of an agreed-upon system-level measure for tracking daily use of SAT/SBT led to uncertainty regarding what constituted adherence. The effects of the COVID-19 pandemic increased clinician workloads, impacting performance. Conclusions: Coordinated SAT/SBT adherence varied substantially across 15 ICUs within an integrated, community-based health system. Implementation strategies that address barriers identified by this study, including knowledge deficits, challenges regarding workflow coordination, and the lack of performance measurement, should be tested in future hybrid implementation-effectiveness trials to increase adherence to daily use of coordinated SAT/SBT and minimize harm related to the prolonged use of mechanical ventilation and sedation.
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Affiliation(s)
| | - Perry M. Gee
- Nursing Research and Evidence Based Practice, Intermountain Health, Salt Lake City, Utah
| | - Doug Wolfe
- Intermountain Healthcare Delivery Institute and
| | - Carrie Winberg
- Critical Care Operations, Intermountain Health, Murray, Utah
| | - Lori Carpenter
- Critical Care Operations, Intermountain Health, Murray, Utah
| | - Chris Jones
- Critical Care Operations, Intermountain Health, Murray, Utah
| | - Jason R. Jacobs
- Critical Care Operations, Intermountain Health, Murray, Utah
| | - Lindsay Leither
- Critical Care Operations, Intermountain Health, Murray, Utah
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Ithan D. Peltan
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, California; and
| | - Steven M. Asch
- Department of Medicine, Stanford University School of Medicine, Stanford, California; and
| | - Colin K. Grissom
- Critical Care Operations, Intermountain Health, Murray, Utah
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Rajendu Srivastava
- Intermountain Healthcare Delivery Institute and
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
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9
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Schwager E, Liu X, Nabian M, Feng T, French RM, Amelung P, Atallah L, Badawi O. Machine learning prediction of the total duration of invasive and non-invasive ventilation During ICU Stay. PLOS DIGITAL HEALTH 2023; 2:e0000289. [PMID: 37703526 PMCID: PMC10499394 DOI: 10.1371/journal.pdig.0000289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/30/2023] [Indexed: 09/15/2023]
Abstract
Predicting the duration of ventilation in the ICU helps in assessing the risk of ventilator-induced lung injury, ensuring sufficient oxygenation, and optimizing resource allocation. Prior models provided a prediction of total duration without distinguishing between invasive and non-invasive ventilation. This work proposes two independent gradient boosting regression models for predicting the duration of invasive and non-invasive ventilation based on commonly available ICU features. These models are trained on 2.6 million patient stays across 350 US hospitals between 2010 to 2019. The mean absolute error (MAE) for the prediction of duration was 2.08 days for invasive ventilation and 0.36 days for non-invasive ventilation. The total ventilation duration predicted by our model had MAE of 2.38 days, which outperformed the gold standard (APACHE) with MAE of 3.02 days. The feature importance analysis of the trained models showed that, for invasive ventilation, high average heart rate, diagnosis of respiratory infection and admissions from locations other than the operating room were associated with longer ventilation durations. For non-invasive ventilation, higher respiratory rates and having any GCS measurement were associated with longer durations.
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Affiliation(s)
- Emma Schwager
- Philips, Cambridge, Massachusetts, United States of America
| | - Xinggang Liu
- Johnson and Johnson, Rockville, Maryland, United States of America
| | - Mohsen Nabian
- Philips, Cambridge, Massachusetts, United States of America
| | - Ting Feng
- Philips, Cambridge, Massachusetts, United States of America
| | | | - Pam Amelung
- Philips, Cambridge, Massachusetts, United States of America
| | - Louis Atallah
- Philips, Cambridge, Massachusetts, United States of America
| | - Omar Badawi
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States of America
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10
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Magdy DM, Metwally A. Effect of high-flow nasal cannula versus non-invasive ventilation in preventing re-intubation in high-risk chronic obstructive pulmonary disease patients: A randomised controlled trial. Lung India 2023; 40:312-320. [PMID: 37417083 PMCID: PMC10401978 DOI: 10.4103/lungindia.lungindia_338_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 07/08/2023] Open
Abstract
Background Currently, a high-flow nasal cannula (HFNC) has been shown to improve extubation outcomes. However, there is a lack of evidence on the utilisation of HFNC in high-risk chronic obstructive pulmonary disease (COPD) patients. This study aimed to compare the effectiveness of HFNC versus non-invasive ventilation (NIV) in preventing re-intubation following planned extubation in high-risk COPD patients. Patients and Methods In this prospective, randomised, controlled trial, 230 mechanically ventilated COPD patients at high risk for re-intubation who fulfilled the criteria for planned extubation were enrolled. Post-extubation blood gases and vital signs at 1, 24, and 48 hours were recorded. The primary outcome was the re-intubation rate within 72 hours. Secondary outcomes included post-extubation respiratory failure, respiratory infection, intensive care unit and hospital length of stay, and mortality rate at 60 days. Results 230 patients after planned extubation were randomly allocated to receive either HFNC (n = 120) or NIV (n = 110). Re-intubation within 72 hours was significantly lower in the high-flow group: 8 patients (6.6%) versus 23 patients (20.9%) in the NIV group {absolute difference, 14.3% [95% confidence interval (CI), 10.9-16.3]; P = 0.001}. The frequency of post-extubation respiratory failure was less in patients assigned to HFNC than in those allocated NIV (25% vs. 35.4%) [absolute difference, 10.4% (95% CI, 2.4-14.3); P = 0.001]. There was no significant difference between the two groups regarding reasons for respiratory failure after extubation. It was observed that the 60-day mortality rate was lower in patients who received HFNC than in those assigned to NIV (5% vs. 13.6%) [absolute difference, 8.6 (95% CI, 4.3 to 9.10); P = 0.001]. Conclusion The use of HFNC after extubation appears to be superior to NIV in reducing the risk of re-intubation within 72 hours and 60-day mortality in high-risk COPD patients.
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Affiliation(s)
- Doaa M. Magdy
- Department of Chest Diseases, Faculty of Medicine, Assuit University, Egypt
| | - Ahmed Metwally
- Department of Chest Diseases, Faculty of Medicine, Assuit University, Egypt
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11
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Asehnoune K, Rooze P, Robba C, Bouras M, Mascia L, Cinotti R, Pelosi P, Roquilly A. Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis. Crit Care 2023; 27:221. [PMID: 37280579 PMCID: PMC10242967 DOI: 10.1186/s13054-023-04509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To describe the potential effects of ventilatory strategies on the outcome of acute brain-injured patients undergoing invasive mechanical ventilation. DESIGN Systematic review with an individual data meta-analysis. SETTING Observational and interventional (before/after) studies published up to August 22nd, 2022, were considered for inclusion. We investigated the effects of low tidal volume Vt < 8 ml/Kg of IBW versus Vt > = 8 ml/Kg of IBW, positive end-expiratory pressure (PEEP) < or > = 5 cmH2O and protective ventilation (association of both) on relevant clinical outcomes. POPULATION Patients with acute brain injury (trauma or haemorrhagic stroke) with invasive mechanical ventilation for ≥ 24 h. MAIN OUTCOME MEASURES The primary outcome was mortality at 28 days or in-hospital mortality. Secondary outcomes were the incidence of acute respiratory distress syndrome (ARDS), the duration of mechanical ventilation and the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio. RESULTS The meta-analysis included eight studies with a total of 5639 patients. There was no difference in mortality between low and high tidal volume [Odds Ratio, OR 0.88 (95%Confidence Interval, CI 0.74 to 1.05), p = 0.16, I2 = 20%], low and moderate to high PEEP [OR 0.8 (95% CI 0.59 to 1.07), p = 0.13, I2 = 80%] or protective and non-protective ventilation [OR 1.03 (95% CI 0.93 to 1.15), p = 0.6, I2 = 11]. Low tidal volume [OR 0.74 (95% CI 0.45 to 1.21, p = 0.23, I2 = 88%], moderate PEEP [OR 0.98 (95% CI 0.76 to 1.26), p = 0.9, I2 = 21%] or protective ventilation [OR 1.22 (95% CI 0.94 to 1.58), p = 0.13, I2 = 22%] did not affect the incidence of acute respiratory distress syndrome. Protective ventilation improved the PaO2/FiO2 ratio in the first five days of mechanical ventilation (p < 0.01). CONCLUSIONS Low tidal volume, moderate to high PEEP, or protective ventilation were not associated with mortality and lower incidence of ARDS in patients with acute brain injury undergoing invasive mechanical ventilation. However, protective ventilation improved oxygenation and could be safely considered in this setting. The exact role of ventilatory management on the outcome of patients with a severe brain injury needs to be more accurately delineated.
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Affiliation(s)
- Karim Asehnoune
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France.
- Department of Anaesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Paul Rooze
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France
| | - Chiara Robba
- Anesthesia and Critical Care, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Marwan Bouras
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France
| | - Luciana Mascia
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Raphaël Cinotti
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, 44000, Nantes, France
| | - Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
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12
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Aswanetmanee P, Limsuwat C, Maneechotesuwan K, Wongsurakiat P. Noninvasive ventilation in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2023; 13:8283. [PMID: 37217643 DOI: 10.1038/s41598-023-35323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
The clinical benefits of noninvasive ventilation (NIV) for patients with acute hypoxemic respiratory failure (AHRF) is still inconclusive. We aimed to evaluate the effect of NIV compared with conventional oxygen therapy (COT)/high-flow nasal cannula (HFNC) in this patient population. We searched for relevant studies from PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CINHAL, Web of Science up to August 2019 for randomized controlled trials (RCTs) that compared NIV with COT/HFNC in AHRF. The primary outcome was the tracheal intubation rate. Secondary outcomes were intensive care unit (ICU) mortality, and hospital mortality. We applied the GRADE approach to grade the strength of the evidence. Seventeen RCTs that recruited 1738 patients were included in our meta-analysis. When comparing NIV versus COT/HFNC, the pooled risk ratio (RR) for the tracheal intubation rate was 0.68, 95% confidence interval (CI) 0.52-0.89, p = 0.005, I2 = 72.4%, low certainty of evidence. There were no significant differences in ICU mortality (pooled RR = 0.87, 95% CI 0.60-1.26), p = 0.45, I2 = 64.6%) and hospital mortality (pooled RR = 0.71, 95% CI 0.51-1.00, p = 0.05, I2 = 27.4%). Subgroup analysis revealed that NIV application with helmet was significantly associated with a lower intubation rate than NIV with face mask. NIV did not show a significant reduction in intubation rate compared to HFNC. In conclusion, NIV application in patients with medical illness and AHRF was associated with a lower risk of tracheal intubation compared to COT. NIV with helmet and HFNC are promising strategies to avoid tracheal intubation in this patient population and warrant further studies. NIV application had no effect on mortality.The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087342).
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Affiliation(s)
- Pantaree Aswanetmanee
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Chok Limsuwat
- Pulmonary and Critical Care Department, Bumrungrad International Hospital, Khet Watthana, Bangkok, 10110, Thailand
| | - Kittipong Maneechotesuwan
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Phunsup Wongsurakiat
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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13
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Zeng P, Lin Y, Chen Y, Tan G. Effects of incentive spirometry respiratory trainer device on lung recruitment in non-intubated mechanical ventilation moderate ARDS patients: A retrospective study. Heliyon 2023; 9:e16073. [PMID: 37206014 PMCID: PMC10189391 DOI: 10.1016/j.heliyon.2023.e16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives A retrospective study was performed to investigate the effects of incentive spirometry (IS)respiratory trainer device on lung recruitment in non-intubated moderate ARDS patients. Method Moderate ARDS patients who non-intubated from January 2019 to October 2022 were enrolled to the lung recruitment group and the control group. Compared the PaO2/FiO2 (P/F)ratio, lung ultrasound (LUS) score, APACHE-II score, Maximum inspiratory volume during three days (baseline, Day1, Day2, Day3) and the rate of intubation, mean hospital stay, the 28-day in-hospital mortality and the 90-days in-hospital mortality between the two groups. Results The lung recruitment group 118 patients (73 males, 47.6 ± 16.5y) and the control group 103 patients (62 males, 50.2 ± 14.8y) were included. The P/F ratios, APACHE-II scores, LUS scores, and the maximum inspiratory volume (ml) were significantly different between the two groups (P = 0.000, P = 0.014, P = 0.013 and P = 0.001, respectively).The P/F ratios were higher (252.6 ± 55.6 v.s, 166.96.9re, p = 0.035, day2), (269.8 ± 75.7 v.s 183.9 ± 68.6, p = 0.027, day3), the APACHE-II scores were lower (10.0 ± 2.4 v.s 15.3 1e l p = 0.025, day2), (8.0 ± 1.4 v.s 14.1 ± 2.7, p = 0.000, day3), the LUS scores were higher (16.2res wv.s 21.61.6w, p = 0.043, day2), (11.4 ± 5.9 v.s 20.3 ± 6.9, p = 0.004, day3), the maximum inspiratory volumes were higher (1722.3 ± 432.2 v.s 1310.70.732., p = 0.044, day2), (1913.5467.2 v.s 1299.79452.5, p = 0.018, day3) in Lung Recruitment group than that in Control group. These data at day1, day2, and day3 were significantly improvement than baseline in Lung Recruitment group. Only 36 patients (30.5%) in Lung Recruitment group needed to intubation, while 48 patients (46.6%) in Control group (p = 0.014). The mean hospital stay in lung recruitment group was lower (12.6 ± 4.6 v.s, 18.4 ± 5.3, P = 0.018). The 28-days and the 90-days in-hospital mortality were no statistical significance between the two groups (P = 0.414 and P = 0.418, respectively). Conclusions Using IS to perform lung recruitment in moderate ARDS patients can improve maximum inspiratory volume, PaO2/FiO2 ratio, LUS scores, and APACHE-II score and reduce the rate of intubation and the mean hospital stay, but the 28 days and the 90-days in-hospital mortality were not improved.
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Affiliation(s)
| | | | | | - Guoliang Tan
- Corresponding author. Department ICU of the Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, 362000, China.
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14
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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. THE LANCET. RESPIRATORY MEDICINE 2023; 11:465-476. [PMID: 36693401 DOI: 10.1016/s2213-2600(22)00449-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [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.
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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.
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Girard M, Deschamps J, Razzaq S, Lavoie N, Denault A, Beaubien-Souligny W. Emerging Applications of Extracardiac Ultrasound in Critically Ill Cardiac Patients. Can J Cardiol 2023; 39:444-457. [PMID: 36509177 DOI: 10.1016/j.cjca.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Point-of-care ultrasound has evolved as an invaluable diagnostic modality and procedural guidance tool in the care of critically ill cardiac patients. Beyond focused cardiac ultrasound, additional extracardiac ultrasound modalities may provide important information at the bedside. In addition to new uses of existing modalities, such as pulsed-wave Doppler ultrasound, the development of new applications is fostered by the implementation of additional features in mid-range ultrasound machines commonly acquired for intensive care units, such as tissue elastography, speckle tracking, and contrast-enhanced ultrasound quantification software. This review explores several areas in which ultrasound imaging technology may transform care in the future. First, we review how lung ultrasound in mechanically ventilated patients can enable the personalization of ventilator parameters and help to liberate them from mechanical ventilation. Second, we review the role of venous Doppler in the assessment of organ congestion and how tissue elastography may complement this application. Finally, we explore how contrast-enhanced ultrasound could be used to assess changes in organ perfusion.
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Affiliation(s)
- Martin Girard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jean Deschamps
- Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - André Denault
- Department of Anaesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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Soták M, Tyll T, Roubík K. Temporary phrenic nerve stimulated patients: What is the role of ultrasound examination? Artif Organs 2023; 47:464-469. [PMID: 36398921 DOI: 10.1111/aor.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prolonged mechanical ventilation caused by ventilator-induced diaphragm dysfunction (VIDD) is a serious problem in critically ill patients. Identification of patients who will have difficulty weaning from ventilation along with attempts to reduce total time on mechanical ventilation is some of the aims of intensive care medicine. OBSERVATIONS This article briefly summarizes current options for temporary phrenic nerve stimulation therapy in an effort to keep the diaphragm active as direct prevention and treatment of ventilator-associated diaphragmatic dysfunction in patients on mechanical ventilation. The results of feasibility studies using different approaches are promising but so far, the clinical relevance is low. One important question is which tool would reliably identify early signs of diaphragmatic dysfunction and also be useful in guiding therapy. The authors present a brief overview of the current options considering the advantages and disadvantages of the available examination modalities. Despite the fact that current data point out some limitations of ultrasound examination, we believe that it still has a unique position in the bedside examination of critically ill patients on mechanical ventilation. CONCLUSION Temporary phrenic nerve stimulation, regardless of the specific approach used, has the potential to directly treat or reverse VIDD, and ultrasound examination plays an important role in the comprehensive care of critically ill patients.
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Affiliation(s)
- Michal Soták
- Military University Hospital Prague, Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic.,Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tomáš Tyll
- Military University Hospital Prague, Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Karel Roubík
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Application of Neuromuscular Blockers in Patients with ARDS in ICU: A Retrospective Study Based on the MIMIC-III Database. J Clin Med 2023; 12:jcm12051878. [PMID: 36902664 PMCID: PMC10003530 DOI: 10.3390/jcm12051878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Although neuromuscular blocker agents (NMBAs) are recommended by guidelines as a treatment for ARDS patients, the efficacy of NMBAs is still controversial. Our study aimed to investigate the association between cisatracurium infusion and the medium- and long-term outcomes of critically ill patients with moderate and severe ARDS. METHODS We performed a single-center, retrospective study of 485 critically ill adult patients with ARDS based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching (PSM) was used to match patients receiving NMBA administration with those not receiving NMBAs. The Cox proportional hazards model, Kaplan-Meier method, and subgroup analysis were used to evaluate the relationship between NMBA therapy and 28-day mortality. RESULTS A total of 485 moderate and severe patients with ARDS were reviewed and 86 pairs of patients were matched after PSM. NMBAs were not associated with reduced 28-day mortality (hazard ratio (HR) 1.44; 95% CI: 0.85~2.46; p = 0.20), 90-day mortality (HR = 1.49; 95% CI: 0.92~2.41; p = 0.10), 1-year mortality (HR = 1.34; 95% CI: 0.86~2.09; p = 0.20), or hospital mortality (HR = 1.34; 95% CI: 0.81~2.24; p = 0.30). However, NMBAs were associated with a prolonged duration of ventilation and the length of ICU stay. CONCLUSIONS NMBAs were not associated with improved medium- and long-term survival and may result in some adverse clinical outcomes.
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Maggiore SM, Jaber S, Grieco DL, Mancebo J, Zakynthinos S, Demoule A, Ricard JD, Navalesi P, Vaschetto R, Hraiech S, Klouche K, Frat JP, Lemiale V, Fanelli V, Chanques G, Natalini D, Ischaki E, Reuter D, Morán I, La Combe B, Longhini F, De Gaetano A, Ranieri VM, Brochard LJ, Antonelli M. High-Flow Versus VenturiMask Oxygen Therapy to Prevent Reintubation in Hypoxemic Patients after Extubation: A Multicenter Randomized Clinical Trial. Am J Respir Crit Care Med 2022; 206:1452-1462. [PMID: 35849787 DOI: 10.1164/rccm.202201-0065oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. Objectives: To establish whether high-flow oxygen prevents endotracheal reintubation in hypoxemic patients after extubation, compared with VenturiMask. Methods: In this multicenter randomized trial, 494 patients exhibiting PaO2:FiO2 ratio ⩽ 300 mm Hg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before reintubation. High-flow use in the VenturiMask group was not permitted. Measurements and Main Results: The primary outcome was the rate of reintubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included reintubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n = 492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required reintubation at 72 hours (unadjusted odds ratio, 1.26 [95% confidence interval (CI), 0.70-2.26]; P = 0.49). At 28 days, the rate of reintubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio, 0.89 [95% CI, 0.60-1.31]; P = 0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% versus 17% (adjusted hazard ratio, 0.39 [95% CI, 0.22-0.71]; P = 0.002) and at 28 days, 12% versus 21% (adjusted hazard ratio, 0.52 [95% CI, 0.32-0.83]; P = 0.007). Conclusions: Reintubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded less frequent use of rescue noninvasive ventilation. Clinical trial registered with www.clinicaltrials.gov (NCT02107183).
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Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier; France
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of The Sacred Heart, Rome, Italy
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Spyros Zakynthinos
- Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece
| | - Alexandre Demoule
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Jean-Damien Ricard
- Service de Médecine Intensive-Réanimatio, DMU ESPRIT, Hôpital Louis Mourier, AP-HP, Université de Paris, Colombes, France
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Rosanna Vaschetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU Poitiers, INSERM, CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
- INSERM, CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | | | - Vito Fanelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anaesthesia, Critical Care, and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gerald Chanques
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier; France
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Daniele Natalini
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Eleni Ischaki
- Servei de Medicina Intensiva, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Danielle Reuter
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Indalecio Morán
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of The Sacred Heart, Rome, Italy
| | - Béatrice La Combe
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Graecia" University, Catanzaro, Italy
| | | | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anestesia e Rianimazione, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Laurent J Brochard
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Massimo Antonelli
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
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19
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Garegnani LI, Giménez ML, Escobar Liquitay CM, Franco JVA. Oral hygiene interventions to prevent ventilator‐associated pneumonia: A network meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Ageel M. Pandemic Critical Care Research during the COVID-19 (2020-2022): A Bibliometric Analysis Using VOSviewer. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8564649. [PMID: 36452061 PMCID: PMC9705102 DOI: 10.1155/2022/8564649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/15/2022] [Accepted: 11/02/2022] [Indexed: 12/01/2023]
Abstract
This paper has reviewed the global research on the pandemic critical care research during the COVID-19 from 2020 to 2022. To this end, a bibliometric and cluster analysis by full counting has been carried out using VOSviewer software and bibliographic data extracted from the Scopus database. The research found and studied 2778 documents. The types of research documents were limited to an article (81.46%), a letter (9.43%), an editorial (3.92%), a note (3.92%), a conference paper (0.90), and a short survey (0.04%). The results show an incessant increase in the number of research documents published and citations received during the COVID-19 pandemic. The U.S., U.K., Italy, and France have been shown to be the most productive countries, and there is a predominance of European institutions supporting and fostering research on pandemic critical care. Cecconi, M. (Italy) and Shankar-Hari, M. (U.K.) produced the highest number of research documents. Mapping of citation, co-citation, co-authorship, and keyword cooccurrence highlighted the hotspot, knowledge structure, and important themes. Citation dynamics for the top-cited research documents revealed static discourse. By reviewing the evolutionary trends of pandemic critical care research investigated factors, such as the influential works, main research topics, and the research frontiers, this paper reveals the scientific literature production's main research objectives and directions that could be addressed and explored in future studies. This paper reveals the scientific literature production's main research objectives and directions that could be addressed and explored in future studies after reviewing the evolutionary trends of pandemic critical care research during the COVID-19 and the investigated factors, such as influential works, main research topics, and research frontiers.
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Affiliation(s)
- Mohammed Ageel
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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21
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Villelabeitia-Jaureguizar K, Calvo-Lobo C, Rodríguez-Sanz D, Vicente-Campos D, Castro-Portal JA, López-Cañadas M, Becerro-de-Bengoa-Vallejo R, Chicharro JL. Low Intensity Respiratory Muscle Training in COVID-19 Patients after Invasive Mechanical Ventilation: A Retrospective Case-Series Study. Biomedicines 2022; 10:2807. [PMID: 36359327 PMCID: PMC9687222 DOI: 10.3390/biomedicines10112807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Worldwide, healthcare systems had to respond to an exponential increase in COVID-19 patients with a noteworthy increment in intensive care units (ICU) admissions and invasive mechanical ventilation (IMV). The aim was to determine low intensity respiratory muscle training (RMT) effects in COVID-19 patients upon medical discharge and after an ICU stay with IMV. A retrospective case-series study was performed. Forty COVID-19 patients were enrolled and divided into twenty participants who received IMV during ICU stay (IMV group) and 20 participants who did not receive IMV nor an ICU stay (non-IMV group). Maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), COPD assessment test (CAT) and Medical Research Council (MRC) dyspnea scale were collected at baseline and after 12 weeks of low intensity RMT. A greater MRC dyspnea score and lower PImax were shown at baseline in the IMV group versus the non-IMV group (p < 0.01). RMT effects on the total sample improved all outcome measurements (p < 0.05; d = 0.38−0.98). Intragroup comparisons after RMT improved PImax, CAT and MRC scores in the IMV group (p = 0.001; d = 0.94−1.09), but not for PImax in the non-IMV group (p > 0.05). Between-groups comparison after RMT only showed MRC dyspnea improvements (p = 0.020; d = 0.74) in the IMV group versus non-IMV group. Furthermore, PImax decrease was only predicted by the IMV presence (R2 = 0.378). Low intensity RMT may improve respiratory muscle strength, health related quality of life and dyspnea in COVID-19 patients. Especially, low intensity RMT could improve dyspnea level and maybe PImax in COVID-19 patients who received IMV in ICU.
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Affiliation(s)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | | | | | | | - José López Chicharro
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
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22
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Weaning Outcomes in Patients with Brain Injury. Neurocrit Care 2022; 37:649-659. [PMID: 36050534 DOI: 10.1007/s12028-022-01584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Despite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons. METHODS We performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h. We collected data on baseline characteristics, variables related to management ventilator settings, and complications while patients were ventilated or until day 28. RESULTS Among the 20,929 patients enrolled, we included 12,618 (60%) who started the weaning from MV, of whom 1722 (14%) were patients with acute brain injury. In the acutely brain-injured cohort, 538 patients (31%) did not undergo planned extubation, defined as the need for a tracheostomy without an attempt of extubation, accidental extubation, and death. Among the 1184 planned extubated patients with acute brain injury, 202 required reintubation (17%). Patients with acute brain injury had a higher odds for unplanned extubation (odds ratio [OR] 1.35, confidence interval for 95% [CI 95%] 1.19-1.54; p < 0.001), a higher odds of failure after the first attempt of weaning (spontaneous breathing trial or gradual reduction of ventilatory support; OR 1.14 [CI 95% 1.01-1.30; p = 0.03]), and a higher odds for reintubation (OR 1.41 [CI 95% 1.20-1.66; p < 0.001]) than patients without brain injury. Patients with hemorrhagic stroke had the highest odds for unplanned extubation (OR 1.47 [CI 95% 1.22-1.77; p < 0.001]), of failed extubation after the first attempt of weaning (OR 1.28 [CI 95% 1.06-1.55; p = 0.009]), and for reintubation (OR 1.49 [CI 95% 1.17-1.88; p < 0.001]). In relation to weaning evolution over time in patients with acute brain injury, the risk for unplanned extubation showed a downward trend; the risk for reintubation was not associated to time; and there was a significant increase in the percentage of patients who underwent extubation after the first attempt of weaning from MV. CONCLUSIONS Patients with acute brain injury, compared with patients without brain injury, present higher odds of undergoing unplanned extubated after weaning was started, lower odds of being extubated after the first attempt, and a higher risk of reintubation.
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23
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Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, Frutos-Vivar F, Pen Uelas O, Esteban AS, Anzueto AR, Raymondos K, Rios F, Thille AW, Gonza Lez M, Du B, Maggiore SM, Matamis D, Abroug F, Amin P, Zeggwagh AA, Ely EW, Vasilevskis EE, Patel MB. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg 2022; 276:e114-e119. [PMID: 33201122 PMCID: PMC10573707 DOI: 10.1097/sla.0000000000004484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Failure Assessment (SOFA). SUMMARY BACKGROUND DATA The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. METHODS Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 ventilated patients with daily RASS and GCS assessments (20,023 patient-days, 32 countries). We estimated GCS from RASS via a proportional odds model without adjustment. ICU mortality logistic regression models and c-statistics were constructed using SOFA (measured GCS) and mSOFA (measured RASS-estimated GCS), adjusted for age, sex, body-mass index, region (Europe, USA-Canada, Latin America, Africa, Asia, Australia-New Zealand), and postoperative status (medical/surgical). RESULTS Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769-0.799; mSOFA: AUC = 0.778, 95% CI = 0.763-0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). CONCLUSIONS We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA.
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Affiliation(s)
- Shayan Rakhit
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Morgan A Hosay
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Baylor University, Waco, TX
| | - James W Stewart
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Meharry Medical College, Nashville, TN
| | - Gary D Owen
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Fernando Frutos-Vivar
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Oscar Pen Uelas
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Andre S Esteban
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Antonio R Anzueto
- Department of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
- Pulmonary Section, Audie L Murphy VA Hospital, South Texas Veterans Healthcare System, US Department of Veterans Affairs, San Antonio, TX
| | | | - Fernando Rios
- Alejandro Posadas National Hospital, El Palomar, Buenos Aires, Argentina
| | | | - Marco Gonza Lez
- Medellin Clinic and Pontifical Bolivaran University, Medellin, Colombia
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | | | | | - Fekri Abroug
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Ibn Sina University Hospital Center & Mohammed V University of Rabat, Rabat, Morocco
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Surgical Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs Nashville, TN
- Departments of Neurosurgery and Hearing and Speech Sciences, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
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24
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Yamamoto R, Sugimura S, Kikuyama K, Takayama C, Fujimoto J, Yamashita K, Norisue Y, Narita C. Efficacy of Higher Positive End-Expiratory Pressure Ventilation Strategy in Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e26957. [PMID: 35989808 PMCID: PMC9382348 DOI: 10.7759/cureus.26957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 12/16/2022] Open
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25
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition management of critically ill adult patients requiring non-invasive ventilation: a scoping review protocol. JBI Evid Synth 2022; 20:1814-1820. [PMID: 36164714 DOI: 10.11124/jbies-21-00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This scoping review will identify the current available literature and key concepts in the nutrition management of critically ill adult patients requiring non-invasive ventilation. INTRODUCTION Current international nutrition guidelines include recommendations for the nutrition management of critically ill patients who are receiving invasive mechanical ventilation; however, these guidelines do not address nutrition management of patients receiving non-invasive ventilation. This scoping review aims to explore and describe the existing available literature on the nutrition management of critically ill adults requiring non-invasive ventilation. INCLUSION CRITERIA This review will consider original research (qualitative, quantitative, or mixed methods studies) reporting on any nutrition parameter for critically ill adult patients (≥16 years) requiring non-invasive ventilation in the intensive care unit. Concepts of interest based on the general intensive care nutrition literature include route of nutrition, recommendations related to macro- or micro-nutrients, nutrition provision, barriers to nutrition provision, and strategies for nutrition management. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews using a three-step search strategy. MEDLINE, Embase, Scopus, and Web of Science will be searched to obtain original research available in English and published after 1990. Google Scholar will be searched for gray literature. Duplicates will be removed and studies will be selected by two independent reviewers based on the inclusion criteria. The same two reviewers will extract data in duplicate using a data extraction tool. Any disagreements will be resolved via consensus with a third reviewer. Data extraction will be synthesized in tabular and diagrammatic format.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia.,Nutrition Department, Alfred Health, Melbourne, Vic, Australia
| | - Christopher K Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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26
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Plotnikow GA, Gogniat E, Accoce M, Navarro E, Dorado JH. Epidemiology of mechanical ventilation in Argentina. The EpVAr multicenter observational study. Med Intensiva 2022; 46:372-382. [PMID: 35660286 DOI: 10.1016/j.medine.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 06/15/2023]
Abstract
OBJETIVE To describe mechanical ventilation (MV) practices in Argentina, and to explore factors associated with ICU mortality in this population. DESIGN A prospective, multicenter, observational study was carried out. SETTING Intensive Care. PATIENTS We enrolled patients above 18 years old admitted to any of the participating ICUs requiring invasive MV for at least 12 h since the admission to the healthcare institution, including MV initiation in emergency department, operating room or other hospitals. INTERVENTIONS None. VARIABLES All variables were classified into three categories: variables related to demographic and clinical factors before the MV, factors related to the first day on MV, and factors related to events happening during the MV (complications and weaning from MV). Mechanical ventilation weaning and mortality were classified according to WIND. RESULTS The primary analysis included 950 patients. The main indication for MV was acute respiratory failure (58% of patients). Initial ventilation mode was volume control-continuous mandatory ventilation in 75% of cases. ICU and hospital mortality were 44.6% and 47.9% respectively. The variables identified as independent predictors of mortality in ICU were age (OR 3.48 IC 95% 1.22-11.66; p = 0.028), failure to implement NIV before MV (OR 2.76 IC 95% 1.02-7.10; p = 0.038), diagnosis of sepsis (OR 2.46 IC 95% 1.09-5.47; p = 0.027) and extubation failure (OR 4.50 IC 95% 2.05-9.90; p < 0.001). CONCLUSIONS The present study allowed us to describe the characteristics and clinical course of the patients who received mechanical ventilation in Argentina, finding as the main result that mortality was higher than that reported in international studies.
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Affiliation(s)
- G A Plotnikow
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, CABA, Argentina; Hospital Británico de Buenos Aires, CABA, Argentina; Docente Adjunto de Cátedra de Kinesfisiatría Cardiorrespiratoria de la Carrera de Kinesiología y Fisiatría, Universidad Abierta Interamericana, CABA, Argentina; Director del Grupo de Estudios Especializados en VM, Universidad Abierta Interamericana, CABA, Argentina.
| | - E Gogniat
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, CABA, Argentina
| | - M Accoce
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, CABA, Argentina; Docente Adjunto de Cátedra de Kinesfisiatría Cardiorrespiratoria de la Carrera de Kinesiología y Fisiatría, Universidad Abierta Interamericana, CABA, Argentina; Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - E Navarro
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, CABA, Argentina; Sanatorio Anchorena San Martín, Buenos Aires, Argentina; Centro del Parque, CABA, Argentina
| | - J H Dorado
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, CABA, Argentina; Sanatorio Anchorena San Martín, Buenos Aires, Argentina
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Mechanical ventilation in Spain, 1998-2016: Changes in the disconnection of mechanical ventilation. Med Intensiva 2022; 46:363-371. [PMID: 35570188 DOI: 10.1016/j.medine.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 04/15/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN Post-hoc analysis of four cohort studies. AMBIT 138 Spanish ICUs. PATIENTS 2141 patients scheduled extubated. INTERVENTIONS None. VARIABLES OF INTEREST Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS There was a significant increase (p < 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435). CONCLUSIONS There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
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Burns KEA, Agarwal A, Bosma KJ, Chaudhuri D, Girard TD. Liberation from Mechanical Ventilation: Established and New Insights. Semin Respir Crit Care Med 2022; 43:461-470. [PMID: 35760299 DOI: 10.1055/s-0042-1747929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. We also discuss the roles for (4) extubation to noninvasive ventilation and (5) newer modes of mechanical ventilation during liberation from mechanical ventilation. We conclude that, though substantial progress has been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation, and early mobilization), many important questions regarding liberation from mechanical ventilation in clinical practice remain unanswered.
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Affiliation(s)
- Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Departments of Critical Care and Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen J Bosma
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, and London Health Sciences Centre, London, Ontario, Canada
| | - Dipayan Chaudhuri
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Departments of Critical Care Medicine and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Timothy D Girard
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Tsonas AM, Botta M, Horn J, Morales-Quinteros L, Artigas A, Schultz MJ, Paulus F, Neto AS. Clinical characteristics, physiological features, and outcomes associated with hypercapnia in patients with acute hypoxemic respiratory failure due to COVID-19---insights from the PRoVENT-COVID study. J Crit Care 2022; 69:154022. [PMID: 35339900 PMCID: PMC8947815 DOI: 10.1016/j.jcrc.2022.154022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We determined the incidence of hypercapnia and associations with outcome in invasively ventilated COVID-19 patients. METHODS Posthoc analysis of a national, multicenter, observational study in 22 ICUs. Patients were classified as 'hypercapnic' or 'normocapnic' in the first three days of invasive ventilation. Primary endpoint was prevalence of hypercapnia. Secondary endpoints were ventilator parameters, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, at day 28 and 90. RESULTS Of 824 patients, 485 (58.9%) were hypercapnic. Hypercapnic patients had a higher BMI and had COPD, severe ARDS and venous thromboembolic events more often. Hypercapnic patients were ventilated with lower tidal volumes, higher respiratory rates, higher driving pressures, and with more mechanical power of ventilation. Hypercapnic patients had comparable minute volumes but higher ventilatory ratios than normocapnic patients. In hypercapnic patients, ventilation and LOS in ICU and hospital was longer, but mortality was comparable to normocapnic patients. CONCLUSION Hypercapnia occurs often in invasively ventilated COVID-19 patients. Main differences between hypercapnic and normocapnic patients are severity of ARDS, occurrence of venous thromboembolic events, and a higher ventilation ratio. Hypercapnia has an association with duration of ventilation and LOS in ICU and hospital, but not with mortality.
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Affiliation(s)
- Anissa M. Tsonas
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands,Corresponding author at: Department of Intensive Care, G3–228, Amsterdam UMC, location ‘AMC’, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Michela Botta
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands
| | - Luis Morales-Quinteros
- Intensive Care Unit, University General Hospital of Catalonia, Barcelona, Spain,Servei de Medicina Intensive, Hospital Universitari Sant Pau, Barcelona, Spain,The Autonomous University of Barcelona, Barcelona, Spain,The Parc Taulí Research and Innovation Institute (I3PT), Sabadell, Spain
| | - Antonio Artigas
- The Autonomous University of Barcelona, Barcelona, Spain,The Parc Taulí Research and Innovation Institute (I3PT), Sabadell, Spain,Critical Care Center, University Hospital Parc Tauli, Sabadell, Spain,CIBER Enfermedades Respiratorias (ISCiii), Madrid, Spain
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands,Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands,ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam UMC, location ‘AMC’, Amsterdam, the Netherlands,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil,Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC–RC), Monash University, Melbourne, Australia,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Australia,Department of Critical Care, Melbourne Medical School, Austin Hospital and University of Melbourne, Melbourne, Australia
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30
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Jibaja M, Roldan-Vasquez E, Rello J, Shen H, Maldonado N, Grunauer M, Díaz AM, García F, Ramírez V, Sánchez H, Barberán JL, Paredes JP, Cevallos M, Montenegro F, Puertas S, Briones K, Martínez M, Vélez-Páez J, Montalvo-Villagómez M, Herrera L, Garrido S, Sisa I. Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study. J Intensive Care Med 2022; 37:1265-1273. [PMID: 35532089 PMCID: PMC9095997 DOI: 10.1177/08850666221099827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
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Affiliation(s)
- Manuel Jibaja
- Escuela de Medicina, Universidad Internacional del Ecuador UIDE, Quito, Ecuador
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Estefania Roldan-Vasquez
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Jordi Rello
- Vall d’Hebrón Institute of Research (VHIR), Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- CHRU Nîmes, Nîmes, France
| | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nelson Maldonado
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Michelle Grunauer
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Ana María Díaz
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Fernanda García
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Vanessa Ramírez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Hernán Sánchez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - José Luis Barberán
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Juan Pablo Paredes
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Mónica Cevallos
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Francisco Montenegro
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Soraya Puertas
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Killen Briones
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Marlon Martínez
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Jorge Vélez-Páez
- Unidad de Cuidados Intensivos, Hospital General Pablo Arturo Suárez, Quito, Ecuador
| | | | - Luis Herrera
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Santiago Garrido
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Ivan Sisa
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
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Sim JK, Lee SM, Kang HK, Kim KC, Kim YS, Kim YS, Lee WY, Park S, Park SY, Park JH, Sim YS, Lee K, Lee YJ, Lee JH, Lee HB, Lim CM, Choi WI, Hong JY, Song WJ, Suh GY. Change in management and outcome of mechanical ventilation in Korea: a prospective observational study. Korean J Intern Med 2022; 37:618-630. [PMID: 32872728 PMCID: PMC9082445 DOI: 10.3904/kjim.2020.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. METHODS International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. RESULTS Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. CONCLUSION There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.
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Affiliation(s)
- Jae Kyeom Sim
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang,
Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu,
Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Yun Seong Kim
- Divison of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan,
Korea
| | - Won-Yeon Lee
- Divison of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - So Young Park
- Department of Pulmonary and Critical Care Medicine, Department of Medicine, Kyung Hee University Medical Center, Seoul,
Korea
| | - Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Yun Su Sim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul,
Korea
| | - Kwangha Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Busan,
Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul,
Korea
| | - Heung Bum Lee
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Won-Il Choi
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu,
Korea
| | - Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon,
Korea
| | - Won Jun Song
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Divison of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Divison of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
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The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era. Crit Care Explor 2022; 4:e0684. [PMID: 35510152 PMCID: PMC9061169 DOI: 10.1097/cce.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN: A 6-month prospective, epidemiological, observational study. SETTING: A network of 22 multidisciplinary ICUs in Spain. PATIENTS: Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS: AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.
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Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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34
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Liang M, Chen X. Differential Prognostic Analysis of Higher and Lower PEEP in ARDS Patients: Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5399416. [PMID: 35356616 PMCID: PMC8959975 DOI: 10.1155/2022/5399416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/30/2022]
Abstract
Background Positive end-expiratory pressure (PEEP) refers to the positive pressure in the respiratory tract at the end of the exhalation when we use a ventilator. The differences of higher PEEP and lower PEEP on clinical outcomes in acute respiratory distress syndrome (ARDS) patients are less well known. Methods A comprehensive literature search of all randomized control trials (RCTs) was conducted using PubMed, Embase, World Health Organization (WHO) Global Index Medicus, WHO clinical trial registry, and Clinicaltrials.gov. Inclusion criteria included RCTs comparing the clinical outcomes of higher and lower PEEP in ARDS patients. Results Eleven studies were included in the final analysis. In the higher PEEP group, the hospital mortality, 28-day mortality, and ICU mortality showed no significantly lower risk compared to the lower PEEP group (RR = 0.92, 95% CI 0.80-1.05, p = 0.22; RR = 0.88, 95% CI 0.73-1.05, p = 0.15; RR = 0.84, 95% CI 0.67-1.05, p = 0.12; respectively). High certainty could be obtained that there is no significant difference between the clinical outcomes of higher PEEP and lower PEEP in ARDS patients. Conclusions There is no significant difference of the hospital mortality, 28-day mortality, and ICU mortality between higher and lower PEEP in ARDS patients.
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Affiliation(s)
- Min Liang
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Affiliated to School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Department of Intensive Care Unit, Hangzhou Tumor Hospital, Affiliated to School of Medicine, Zhejiang University, Hangzhou, China
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He Y, Liu N, Zhuang X, Wang X, Ma W. High-flow nasal cannula versus noninvasive ventilation in patients with COVID-19: a systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221087847. [PMID: 35318888 PMCID: PMC8972939 DOI: 10.1177/17534666221087847] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: During the novel coronavirus disease 2019 (COVID-19) pandemic raging around
the world, the effectiveness of respiratory support treatment has dominated
people’s field of vision. This study aimed to compare the effectiveness and
value of high-flow nasal cannula (HFNC) with noninvasive ventilation (NIV)
for COVID-19 patients. Methods: A comprehensive systematic review via PubMed, Web of
Science, Cochrane, Scopus, WHO database, China Biology Medicine Disc
(SINOMED), and China National Knowledge Infrastructure (CNKI) databases was
conducted, followed by meta-analysis. RevMan 5.4 was used to analyze the
results and risk of bias. The primary outcome is the number of deaths at day
28. The secondary outcomes are the occurrence of invasive mechanical
ventilation (IMV), the number of deaths (no time-limited), length of
intensive care unit (ICU) and hospital stay, ventilator-free days, and
oxygenation index [partial pressure of arterial oxygen
(PaO2)/fraction of inhaled oxygen (FiO2)] at 24 h. Results: In total, nine studies [one randomized controlled trial (RCT), seven
retrospective studies, and one prospective study] totaling 1582 patients
were enrolled in the meta-analysis. The results showed that the incidence of
IMV, number of deaths (no time-limited), and length of ICU stay were not
statistically significant in the HFNC group compared with the NIV group
(ps = 0.71, 0.31, and 0.33, respectively). Whereas the
HFNC group performed significant advantages in terms of the number of deaths
at day 28, length of hospital stay and oxygenation index
(p < 0.05). Only in the ventilator-free days did NIV
show advantages over the HFNC group (p < 0.0001). Conclusion: For COVID-19 patients, the use of HFNC therapy is associated with the
reduction of the number of deaths at day 28 and length of hospital stay, and
can significantly improve oxygenation index
(PaO2/FiO2) at 24 h. However, there was no favorable
between the HFNC and NIV groups in the occurrence of IMV. NIV group was
superior only in terms of ventilator-free days.
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Affiliation(s)
- Yuewen He
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Na Liu
- Weihai Municipal Affiliated Hospital of Shandong University, Weihai, China
| | - Xuhui Zhuang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Xia Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, Guangdong 510405, P.R. China
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Bureau C, Decavèle M, Campion S, Nierat MC, Mayaux J, Morawiec E, Raux M, Similowski T, Demoule A. Proportional assist ventilation relieves clinically significant dyspnea in critically ill ventilated patients. Ann Intensive Care 2021; 11:177. [PMID: 34919178 PMCID: PMC8683518 DOI: 10.1186/s13613-021-00958-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Dyspnea is common and often severe symptom in mechanically ventilated patients. Proportional assist ventilation (PAV) is an assist ventilatory mode that adjusts the level of assistance to the activity of respiratory muscles. We hypothesized that PAV reduce dyspnea compared to pressure support ventilation (PSV). PATIENTS AND METHODS Mechanically ventilated patients with clinically significant dyspnea were included. Dyspnea intensity was assessed by the Dyspnea-Visual Analog Scale (D-VAS) and the Intensive Care-Respiratory Distress Observation Scale (IC-RDOS) at inclusion (PSV-Baseline), after personalization of ventilator settings in order to minimize dyspnea (PSV-Personalization), and after switch to PAV. Respiratory drive was assessed by record of electromyographic activity of inspiratory muscles, the proportion of asynchrony was analyzed. RESULTS Thirty-four patients were included (73% males, median age of 66 [57-77] years). The D-VAS score was lower with PSV-Personalization (37 mm [20‒55]) and PAV (31 mm [14‒45]) than with PSV-Baseline (62 mm [28‒76]) (p < 0.05). The IC-RDOS score was lower with PAV (4.2 [2.4‒4.7]) and PSV-Personalization (4.4 [2.4‒4.9]) than with PSV-Baseline (4.8 [4.1‒6.5]) (p < 0.05). The electromyographic activity of parasternal intercostal muscles was lower with PAV and PSV-Personalization than with PSV-Baseline. The asynchrony index was lower with PAV (0% [0‒0.55]) than with PSV-Baseline and PSV-Personalization (0.68% [0‒2.28] and 0.60% [0.31‒1.41], respectively) (p < 0.05). CONCLUSION In mechanically ventilated patients exhibiting clinically significant dyspnea with PSV, personalization of PSV settings and PAV results in not different decreased dyspnea and activity of muscles to a similar degree, even though PAV was able to reduce asynchrony more effectively.
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Affiliation(s)
- Côme Bureau
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France. .,AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France.
| | - Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.,AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France
| | - Sébastien Campion
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 75013, Paris, France
| | - Marie-Cécile Nierat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
| | - Julien Mayaux
- AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France
| | - Elise Morawiec
- AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 75013, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.,AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.,AP-HP 6 Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, 47-83 bld de l'hôpital, 75651, Paris cedex 13, France
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Smith JA, Secombe P, Aromataris E. Conservative management of occult pneumothorax in mechanically ventilated patients: A systematic review and meta-analysis. J Trauma Acute Care Surg 2021; 91:1025-1040. [PMID: 34225346 DOI: 10.1097/ta.0000000000003322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this systematic review was to investigate the safety and effectiveness of conservative management versus prophylactic intercostal catheter (ICC) insertion for the management of occult pneumothoraces in mechanically ventilated patients. METHODS PubMed, Embase, CINAHL, Web of Science, Cochrane Central, and other trial registries were searched. Eligible studies were critically appraised using standardized instruments. Meta-analysis was performed with mixed-methods logistic regression where appropriate and sensitivity analyses were performed with alternative statistical methods (Stata™ 15 or RevMan 5.3) or summarized in narrative. Randomized controlled trials (RCTs) and cohort studies were analyzed separately. RESULTS Twelve studies with a total of 354 participants were included; three RCTs (178 participants) and nine cohort studies (176 participants). The majority of the included studies, particularly the cohort studies, were well conducted. Two of the RCTs were rated as low quality. Statistically significant differences were observed in the RCT analysis: ICC insertion (any reason) (odds ratio, 2.86; 95% confidence interval, 1.26-6.43, 2 RCTs) in favor of prophylactic ICC; ICC complications (odds ratio, 0.12; 95% confidence interval, 0.02-0.62, 2 RCTs) in favor of conservative management. Nonstatistically significant differences were observed for progression of pneumothorax, ICC insertion (progression to simple pneumothorax), and ICC insertion (nonpneumothorax reasons). Results of analyses showed high imprecision (wide confidence limits). Conservative management showed a low rate of tension pneumothorax (2.8%). Complications were higher in the ICC group (19.5% vs. 5.8%). CONCLUSION Available evidence suggests that conservative management is safe for the management of occult pneumothoraces in mechanically ventilated patients, especially when undergoing short-term (<4 days) ventilation. We recommend that patients undergoing mechanical ventilation for a procedure alone and patients suspected to be ventilated less than 4 days can be conservatively managed. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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Affiliation(s)
- Jeremy Adam Smith
- From the JBI, Faculty of Health and Medical Sciences (J.A.S., E.A.), The University of Adelaide, SA; Intensive Care Unit (J.A.S.), The Alfred Hospital, Melbourne, VIC; Intensive Care Unit (P.S.), Alice Springs Hospital, Alice Springs, NT; School of Medicine (P.S.), Flinders University, Bedford Park, SA; and Australian and New Zealand Intensive Care Research Centre (P.S.), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Lorente JA, Nin N, Villa P, Vasco D, Miguel-Coello AB, Rodriguez I, Herrero R, Peñuelas O, Ruiz-Cabello J, Izquierdo-Garcia JL. Metabolomic diferences between COVID-19 and H1N1 influenza induced ARDS. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:390. [PMID: 34781986 PMCID: PMC8591432 DOI: 10.1186/s13054-021-03810-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by lung inflammation and pulmonary edema. Coronavirus disease 2019 (COVID-19) is associated with ARDS in the more severe cases. This study aimed to compare the specificity of the metabolic alterations induced by COVID-19 or Influenza A pneumonia (IAP) in ARDS. METHODS Eighteen patients with ARDS due to COVID-19 and twenty patients with ARDS due to IAP, admitted to the intensive care unit. ARDS was defined as in the American-European Consensus Conference. As compared with patients with COVID-19, patients with IAP were younger and received more often noradrenaline to maintain a mean arterial pressure > 65 mm Hg. Serum samples were analyzed by Nuclear Magnetic Resonance Spectroscopy. Multivariate Statistical Analyses were used to identify metabolic differences between groups. Metabolic pathway analysis was performed to identify the most relevant pathways involved in ARDS development. RESULTS ARDS due to COVID-19 or to IAP induces a different regulation of amino acids metabolism, lipid metabolism, glycolysis, and anaplerotic metabolism. COVID-19 causes a significant energy supply deficit that induces supplementary energy-generating pathways. In contrast, IAP patients suffer more marked inflammatory and oxidative stress responses. The classificatory model discriminated against the cause of pneumonia with a success rate of 100%. CONCLUSIONS Our findings support the concept that ARDS is associated with a characteristic metabolomic profile that may discriminate patients with ARDS of different etiologies, being a potential biomarker for the diagnosis, prognosis, and management of this condition.
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Affiliation(s)
- Jose Angel Lorente
- CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Department of Critical Care, Hospital Universitario de Getafe, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | | | - Palmira Villa
- Centro de Asistencia a La Investigación Bioimagen Complutense, Universidad Complutense de Madrid, Madrid, Spain
| | - Dovami Vasco
- Department of Critical Care, Hospital Universitario de Getafe, Madrid, Spain
| | - Ana B Miguel-Coello
- CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 182, 20014, Donostia San Sebastián, Spain
| | - Ignacio Rodriguez
- CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Química en CC. Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Herrero
- Department of Critical Care, Hospital Universitario de Getafe, Madrid, Spain
| | - Oscar Peñuelas
- Department of Critical Care, Hospital Universitario de Getafe, Madrid, Spain
| | - Jesús Ruiz-Cabello
- CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 182, 20014, Donostia San Sebastián, Spain.,Departamento de Química en CC. Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose L Izquierdo-Garcia
- CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain. .,Instituto Pluridisciplinar, Universidad Complutense de Madrid, Paseo Juan XXIII, 1, Madrid, Spain. .,Departamento de Química en CC. Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
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Plotnikow G, Gogniat E, Accoce M, Navarro E, Dorado J. Epidemiología de la ventilación mecánica en Argentina. Estudio observacional multicéntrico EpVAr. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning. J Pers Med 2021; 11:jpm11111109. [PMID: 34834461 PMCID: PMC8618434 DOI: 10.3390/jpm11111109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical characteristics and respiratory system mechanics with ARDS of other origins. Therefore, mechanical ventilation in these patients should be based on strategies aiming to mitigate ventilator-induced lung injury. Assisted mechanical ventilation should be applied early in the course of mechanical ventilation by considering evaluation and minimizing factors associated with patient-inflicted lung injury. Extracorporeal membrane oxygenation should be considered in selected patients with refractory hypoxia not responding to conventional ventilation strategies. This review highlights the current and evolving practice in managing mechanically ventilated patients with ARDS related to COVID-19.
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Chiumello D, Meli A, Pozzi T, Lucenteforte M, Simili P, Sterchele E, Coppola S. Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients. J Clin Med 2021; 10:jcm10204756. [PMID: 34682881 PMCID: PMC8540057 DOI: 10.3390/jcm10204756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
The most used types of mechanical ventilation are volume- and pressure-controlled ventilation, respectively characterized by a square and a decelerating flow waveform. Nowadays, the clinical utility of different inspiratory flow waveforms remains unclear. The aim of this study was to assess the effects of four different inspiratory flow waveforms in ARDS patients. Twenty-eight ARDS patients (PaO2/FiO2 182 ± 40 and PEEP 11.3 ± 2.5 cmH2O) were ventilated in volume-controlled ventilation with four inspiratory flow waveforms: square (SQ), decelerating (DE), sinusoidal (SIN), and trunk descending (TDE). After 30 min in each condition, partitioned respiratory mechanics and gas exchange were collected. The inspiratory peak flow was higher in the DE waveform compared to the other three waveforms, and in SIN compared to the SQ and TDE waveforms, respectively. The mean inspiratory flow was higher in the DE and SIN waveforms compared with TDE and SQ. The inspiratory peak pressure was higher in the SIN and SQ compared to the TDE waveform. Partitioned elastance was similar in the four groups; mechanical power was lower in the TDE waveform, while PaCO2 in DE. No major effect on oxygenation was found. The explored flow waveforms did not provide relevant changes in oxygenation and respiratory mechanics.
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Affiliation(s)
- Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, 20142 Milan, Italy;
- Department of Health Sciences, University of Milan, 20142 Milan, Italy; (T.P.); (M.L.); (P.S.); (E.S.)
- Coordinated Research Center on Respiratory Failure, University of Milan, 20142 Milan, Italy
- Correspondence:
| | - Andrea Meli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Hospital Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy;
| | - Tommaso Pozzi
- Department of Health Sciences, University of Milan, 20142 Milan, Italy; (T.P.); (M.L.); (P.S.); (E.S.)
| | - Manuela Lucenteforte
- Department of Health Sciences, University of Milan, 20142 Milan, Italy; (T.P.); (M.L.); (P.S.); (E.S.)
| | - Paolo Simili
- Department of Health Sciences, University of Milan, 20142 Milan, Italy; (T.P.); (M.L.); (P.S.); (E.S.)
| | - Elda Sterchele
- Department of Health Sciences, University of Milan, 20142 Milan, Italy; (T.P.); (M.L.); (P.S.); (E.S.)
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, 20142 Milan, Italy;
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Phrenic nerve stimulation prevents diaphragm atrophy in patients with respiratory failure on mechanical ventilation. BMC Pulm Med 2021; 21:314. [PMID: 34625059 PMCID: PMC8500254 DOI: 10.1186/s12890-021-01677-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness. METHODS A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared. RESULTS The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001). CONCLUSIONS Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness - the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933 ).
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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] [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.
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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
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Robba C, Citerio G, Taccone FS, Galimberti S, Rebora P, Vargiolu A, Pelosi P. Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol. BMJ Open 2021; 11:e047100. [PMID: 34380722 PMCID: PMC8359464 DOI: 10.1136/bmjopen-2020-047100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Mechanical ventilatory is a crucial element of acute brain injured patients' management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting. METHODS AND ANALYSIS This is an international multicentre prospective observational cohort study. The aim of the 'multicentre observational study on practice of ventilation in brain injured patients'-the VENTIBRAIN study-is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up. ETHICS AND DISSEMINATION The study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04459884.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genoa, Genova, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, Università Miano - Bicocca, Milano, Italy
- Neuroscience Department, NeuroIntensive Care Unit, Hospital San Gerardo, ASST Monza, Monza, Italy
| | - Fabio S Taccone
- Dpt of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Stefania Galimberti
- School of Medicine and Surgery, Università Miano - Bicocca, Milano, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Paola Rebora
- School of Medicine and Surgery, Università Miano - Bicocca, Milano, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alessia Vargiolu
- School of Medicine and Surgery, Università Miano - Bicocca, Milano, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genoa, Genova, Italy
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Armañac-Julián P, Hernando D, Lázaro J, de Haro C, Magrans R, Morales J, Moeyersons J, Sarlabous L, López-Aguilar J, Subirà C, Fernández R, Orini M, Laguna P, Varon C, Gil E, Bailón R, Blanch L. Cardiopulmonary coupling indices to assess weaning readiness from mechanical ventilation. Sci Rep 2021; 11:16014. [PMID: 34362950 PMCID: PMC8346488 DOI: 10.1038/s41598-021-95282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients' readiness, there is still around 15-20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation -being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness.
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Affiliation(s)
- Pablo Armañac-Julián
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain.
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - David Hernando
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Lázaro
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Candelaria de Haro
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - John Morales
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Jonathan Moeyersons
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Leonardo Sarlabous
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
| | - Josefina López-Aguilar
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
| | - Carles Subirà
- Department of Intensive Care, Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | - Rafael Fernández
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Intensive Care, Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomews Hospital, University College London, London, UK
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Varon
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Circuits and Systems (CAS) group, Delft University of Technology, Delft, The Netherlands
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluís Blanch
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
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46
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Esophageal pressure monitoring during mechanical ventilation in critically ill adult patients: A systematic review and meta-analysis. Med Intensiva 2021; 45:387-394. [PMID: 34312095 DOI: 10.1016/j.medine.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effects of esophageal pressure monitoring in adult patients with mechanical ventilation requirements in the Intensive Care Unit. DESIGN A systematic review (PROSPERO Register CRD42018118583) was carried out. SETTING Intensive therapy. Critical care. PATIENTS OR PARTICIPANTS Adults with mechanical ventilation requirement in the Intensive Care Unit. INTERVENTIONS Esophageal pressure monitoring. OUTCOMES OF INTEREST Intensive Care Unit mortality and length of stay, mechanical ventilation days, adverse events. RESULTS Four studies with 301 participants were included. Esophageal pressure monitoring during mechanical ventilation had little or no effect on mortality in intensive care at 28 days (RR 0.74; 95% CI 0.31-1.76; participants 261; studies 2; I2: 68%), with little or no differences in ICU length of stay (MD 0.48; 95% CI -1.90 to 2.85; participants 284; studies 3; I2: 7%) or impact upon adverse events (RR 0.74; 95% CI 0.50-1.09; participants 261; studies 2; I2: 0%). There is uncertainty about whether esophageal pressure monitoring reduces the duration of mechanical ventilation. CONCLUSIONS Evidence of low or very low certainty indicates that esophageal pressure monitoring during mechanical ventilation would produce little or no effect on Intensive Care Unit mortality, Intensive Care Unit length of stay, days on mechanical ventilation or adverse events.
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47
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Hasanloei MAV, Zeinaly A, Rahimlou M, Houshyar H, Moonesirad S, Hashemi R. Effect of coenzyme Q10 supplementation on oxidative stress and clinical outcomes in patients with low levels of coenzyme Q10 admitted to the intensive care unit. J Nutr Sci 2021; 10:e48. [PMID: 34290862 PMCID: PMC8278158 DOI: 10.1017/jns.2021.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/09/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022] Open
Abstract
Today, trauma is known to be the third leading cause of death in most countries. Studies have demonstrated below-normal plasma levels of antioxidants in trauma patients. The present study aimed to assess the efficacy of Coenzyme Q10 (CoQ10) on oxidative stress, clinical outcomes and anthropometrical parameters in traumatic mechanical ventilated patients admitted to the intensive care unit. Patients were randomised to receive sublingual CoQ10 (400 mg/d) or placebo for 7 d. Primary and secondary outcomes were measured at the baseline and end of the study. We enrolled forty patients for this trial: twenty in the CoQ10 group and twenty in the placebo group. There was not any significant difference in the baseline variables (P > 0⋅05). At the end of the study, CoQ10 administration caused a considerable reduction in the Malondialdehyde (MDA) and Interleukin 6 (IL-6) concentrations (P < 0⋅001), Glasgow Coma Score (GCS; P = 0⋅02), ICU and hospital length of stay and mechanical ventilation (MV) duration (P < 0⋅001). We found that CoQ10 administration could increase Fat-Free Mass (P < 0⋅001) (FFM; P = 0⋅04), Skeletal Muscle Mass (SMM; P = 0⋅04) and Body Cell Mass (BCM) percent (P = 0⋅03). There was not any significant difference in other factors between the two groups (P > 0⋅05). CoQ10 administration has beneficial effects on patients with traumatic injury and has no side effects. However, since the possibility of the type II error was high, the outcomes on the duration of MV, ICU stay and hospital stay, and GCS may very well be false positives.
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Affiliation(s)
- Mohammad Amin Valizade Hasanloei
- Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Ershad Ave, 5756151818Urmia, West Azerbaijan Province, Iran
| | - Aidin Zeinaly
- Department of Anesthesiology, Urmia University of Medical Sciences, 11 km SERO Road, 5756151818Urmia, West Azerbaijan Province, Iran
| | - Mehran Rahimlou
- Department of Nutrition, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hadi Houshyar
- Department of Anesthesiology, Imam Khomeini Hospital, Faculty of Medicine, Urmia University of Medical Sciences, Imam Khomeini Avenue, 5756151818Urmia, West Azerbaijan Province, Iran
| | - Solma Moonesirad
- Urmia University of Medical Sciences, 11 km SERO Road, 5756151818Urmia, West Azerbaijan Province, Iran
| | - Reza Hashemi
- Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Ershad Ave, 5756151818Urmia, West Azerbaijan Province, Iran
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48
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Frutos-Vivar F, Peñuelas O, Muriel A, Mancebo J, García-Jiménez A, de Pablo R, Valledor M, Ferrer M, León M, Quiroga JM, Temprano S, Vallverdú I, Fernández R, Gordo F, Anzueto A, Esteban A. Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation. Med Intensiva 2021; 46:S0210-5691(21)00079-6. [PMID: 34092422 DOI: 10.1016/j.medin.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 04/15/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN Post-hoc analysis of four cohort studies. AMBIT 138 Spanish ICUs. PATIENTS 2141 patients scheduled extubated. INTERVENTIONS None. VARIABLES OF INTEREST Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
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Affiliation(s)
| | - O Peñuelas
- Hospital Universitario de Getafe, Madrid, España
| | - A Muriel
- Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - J Mancebo
- Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - M Ferrer
- Hospital Clinic-IDIBAPS, Barcelona, España
| | - M León
- Hospital Arnau de Vilanova, Lleida, España
| | | | | | - I Vallverdú
- Hospital Universitari San Juan, Reus, España
| | - R Fernández
- Hospital Sant Joan de Déu, Fundació Althaia, Manresa, España
| | - F Gordo
- Grupo de Investigación en Patología Crítica. Universidad Francisco de Vitoria, Pozuelo de Alarcón. Hospital Universitario del Henares, Coslada, España
| | - A Anzueto
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, Estados Unidos
| | - A Esteban
- Hospital Universitario de Getafe, Madrid, España
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49
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Initial Assessment of the Percutaneous Electrical Phrenic Nerve Stimulation System in Patients on Mechanical Ventilation. Crit Care Med 2021; 48:e362-e370. [PMID: 32191413 PMCID: PMC7161723 DOI: 10.1097/ccm.0000000000004256] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Maintaining diaphragm work using electrical stimulation during mechanical ventilation has been proposed to attenuate ventilator-induced diaphragm dysfunction. This study assessed the safety and feasibility of temporary percutaneous electrical phrenic nerve stimulation on user-specified inspiratory breaths while on mechanical ventilation.
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50
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Mamandipoor B, Frutos-Vivar F, Peñuelas O, Rezar R, Raymondos K, Muriel A, Du B, Thille AW, Ríos F, González M, del-Sorbo L, del Carmen Marín M, Pinheiro BV, Soares MA, Nin N, Maggiore SM, Bersten A, Kelm M, Bruno RR, Amin P, Cakar N, Suh GY, Abroug F, Jibaja M, Matamis D, Zeggwagh AA, Sutherasan Y, Anzueto A, Wernly B, Esteban A, Jung C, Osmani V. Machine learning predicts mortality based on analysis of ventilation parameters of critically ill patients: multi-centre validation. BMC Med Inform Decis Mak 2021; 21:152. [PMID: 33962603 PMCID: PMC8102841 DOI: 10.1186/s12911-021-01506-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mechanical Ventilation (MV) is a complex and central treatment process in the care of critically ill patients. It influences acid-base balance and can also cause prognostically relevant biotrauma by generating forces and liberating reactive oxygen species, negatively affecting outcomes. In this work we evaluate the use of a Recurrent Neural Network (RNN) modelling to predict outcomes of mechanically ventilated patients, using standard mechanical ventilation parameters. METHODS We performed our analysis on VENTILA dataset, an observational, prospective, international, multi-centre study, performed to investigate the effect of baseline characteristics and management changes over time on the all-cause mortality rate in mechanically ventilated patients in ICU. Our cohort includes 12,596 adult patients older than 18, associated with 12,755 distinct admissions in ICUs across 37 countries and receiving invasive and non-invasive mechanical ventilation. We carry out four different analysis. Initially we select typical mechanical ventilation parameters and evaluate the machine learning model on both, the overall cohort and a subgroup of patients admitted with respiratory disorders. Furthermore, we carry out sensitivity analysis to evaluate whether inclusion of variables related to the function of other organs, improve the predictive performance of the model for both the overall cohort as well as the subgroup of patients with respiratory disorders. RESULTS Predictive performance of RNN-based model was higher with Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.72 (± 0.01) and Average Precision (AP) of 0.57 (± 0.01) in comparison to RF and LR for the overall patient dataset. Higher predictive performance was recorded in the subgroup of patients admitted with respiratory disorders with AUC of 0.75 (± 0.02) and AP of 0.65 (± 0.03). Inclusion of function of other organs further improved the performance to AUC of 0.79 (± 0.01) and AP 0.68 (± 0.02) for the overall patient dataset and AUC of 0.79 (± 0.01) and AP 0.72 (± 0.02) for the subgroup with respiratory disorders. CONCLUSION The RNN-based model demonstrated better performance than RF and LR in patients in mechanical ventilation and its subgroup admitted with respiratory disorders. Clinical studies are needed to evaluate whether it impacts decision-making and patient outcomes. TRIAL REGISTRATION NCT02731898 ( https://clinicaltrials.gov/ct2/show/NCT02731898 ), prospectively registered on April 8, 2016.
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Affiliation(s)
| | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Oscar Peñuelas
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | | | - Alfonso Muriel
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | | | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Marco González
- Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lorenzo del-Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto, ON Canada
| | - Maria del Carmen Marín
- Hospital Regional 1° de Octubre, Instituto de Seguridad Y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), México, DF México
| | - Bruno Valle Pinheiro
- Pulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | - Andrew Bersten
- Department of Critical Care Medicine, Flinders University, Adelaide, South Australia Australia
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Nahit Cakar
- Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Manuel Jibaja
- Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | | | - Amine Ali Zeggwagh
- Centre Hospitalier Universitarie Ibn Sina - Mohammed V University, Rabat, Morocco
| | - Yuda Sutherasan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Anzueto
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX USA
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Andrés Esteban
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
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