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Zhang W, He Y, Gu Q, Zhang Y, Zha Q, Feng Q, Zhang S, He Y, Kang L, Xue M, Jing F, Li J, Mao Y, Zhu W. Optimal timing for awake prone positioning in Covid-19 patients: Insights from an observational study from two centers. Int J Nurs Stud 2024; 152:104707. [PMID: 38368846 DOI: 10.1016/j.ijnurstu.2024.104707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The widespread application and interest in awake prone positioning stems from its ease and availability and its ability to enhance patients' oxygenation. Nevertheless, due to the absence of consensus over the regimen of awake prone positioning, the efficacy of awake prone positioning remains uncertain. OBJECTIVE To explore the optimal regimen for awake prone positioning, including the timing of initiation, ideal daily duration, and strategies for improving patient comfort and encouraging adherence. DESIGN Retrospective observational study. SETTING(S) Two university-affiliated hospitals in Shanghai. PARTICIPANTS Between December 2022 and February 2023, a total of 475 patients with COVID-19-related pneumonia who received awake prone positioning were observed. METHODS The data were collected from the hospital's electronic medical record system. The differentiation efficiency of peripheral blood oxygen saturation [SpO2]:fractional oxygen concentration in inspired air [FiO2] ratio at first awake prone positioning for different outcomes was tested by the area under the receiver operating characteristic curve. The Cox proportional hazard regression model was used to analyze the relationship between time to occurrence of 28-day outcomes and collected variables. Kaplan-Meier curves were plotted with the percentage of 28-day outcomes according to the SpO2:FiO2 ratio at first awake prone positioning after controlling covariates through Cox regression. RESULTS The best efficiency in predicting patient outcomes was achieved when the cutoff SpO2:FiO2 ratio at first awake prone positioning was 200. Patients with a reduced SpO2:FiO2 ratio (≤200) experienced more adverse respiratory outcomes (RR = 5.42, 95%CI [3.35, 8.76], p < 0·001) and higher mortality (RR = 16.64, 95%CI [5.53, 50.13], p < 0.001). Patients with a SpO2:FiO2 ratio of ≥200 at first awake prone positioning, longer duration between first awake prone positioning and admission, more awake prone positioning days, and better awake prone positioning completion were significantly protected from 28-day adverse respiratory outcomes and mortality. CONCLUSIONS Initiating awake prone positioning with a SpO2:FiO2 ratio exceeding 200, increasing the number of awake prone positioning days, prolonging the time between first awake prone positioning and admission, and achieving better completion of awake prone positioning were found to be significantly associated with reduced adverse respiratory outcomes and mortality. REGISTRATION ClinicalTrials.gov; No.: NCT05795751; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Weiqing Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Yan He
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Qiuying Gu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinghua Zha
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Feng
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyu Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang He
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Kang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xue
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jing
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinling Li
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Shanghai, China
| | - Yanjun Mao
- Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, China.
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Luján M, Cinesi Gómez C, Peñuelas O, Ferrando C, Heili-Frades SB, Carratalá Perales JM, Mas A, Sayas Catalán J, Mediano O, Roca O, García Fernández J, González Varela A, Sempere Montes G, Rialp Cervera G, Hernández G, Millán T, Ferrer Monreal M, Egea Santaolalla C. Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient. Arch Bronconeumol 2024:S0300-2896(24)00057-7. [PMID: 38521646 DOI: 10.1016/j.arbres.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation. Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered. While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.
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Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Anesthesia and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Sarah Béatrice Heili-Frades
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
| | | | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | - Olga Mediano
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
| | - Oriol Roca
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier García Fernández
- Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
| | | | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Teresa Millán
- Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
| | - Miquel Ferrer Monreal
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
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Santini A, Protti A, Pennati F, Dalla Corte F, Martinetti N, Pugliese L, Picardo G, Chiurazzi C, Ferrari M, Costantini E, Aliverti A, Cecconi M. Effect of decreasing PEEP on hyperinflation and collapse in COVID-19: A computed tomography study. Acta Anaesthesiol Scand 2024. [PMID: 38425207 DOI: 10.1111/aas.14401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND High positive end-expiratory pressure (PEEP>10 cmH2 O) is commonly used in mechanically ventilated hypoxemic patients with COVID-19. However, some epidemiological and physiological studies indirectly suggest that using a lower PEEP may primarily and beneficially decrease lung hyperinflation in this population. Herein we directly quantified the effect of decreasing PEEP from 15 to 10 cmH2 O on lung hyperinflation and collapse in mechanically ventilated patients with COVID-19. METHODS Twenty mechanically ventilated patients with COVID-19 underwent a lung computed tomography (CT) at PEEP of 15 and 10 cmH2 O. The effect of decreasing PEEP on lung hyperinflation and collapse was directly quantified as the change in the over-aerated (density below -900 HU) and non-aerated (density above -100 HU) lung volumes. The net response to decreasing PEEP was computed as the sum of the change in those two compartments and expressed as the change in the "pathologic" lung volume. If the pathologic lung volume decreased (i.e., hyperinflation decreased more than collapse increased) when PEEP was decreased, the net response was considered positive; otherwise, it was considered negative. RESULTS On average, the ratio of arterial tension to inspiratory fraction of oxygen (PaO2 :FiO2 ) in the overall study population was 137 (119-162) mmHg. In 11 (55%) patients, the net response to decreasing PEEP was positive. Their over-aerated lung volume decreased by 159 (98-186) mL, while the non-aerated lung volume increased by only 58 (31-91) mL. In nine (45%) patients, the net response was negative. Their over-aerated lung volume decreased by 46 (18-72) mL, but their non-aerated lung volume increased by 107 (44-121) mL. CONCLUSION In 20 patients with COVID-19 the net response to decreasing PEEP, as assessed with lung CT, was variable. In approximately half of them it was positive (and possibly beneficial), with a decrease in hyperinflation larger than the increase in collapse.
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Affiliation(s)
- Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Francesca Dalla Corte
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Martinetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Pugliese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Picardo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara Chiurazzi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michele Ferrari
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
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Wei N, Chen JS, Hu BS, Cao Y, Dai ZP. Effects of driving pressure-guided ventilation on postoperative pulmonary complications in patients with COVID-19 undergoing abdominal surgery: A post-hoc propensity score-matched analysis. Heliyon 2024; 10:e25533. [PMID: 38333813 PMCID: PMC10850964 DOI: 10.1016/j.heliyon.2024.e25533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
Background Application of individualized positive end-expiratory pressure (PEEP) based on minimum driving pressure facilitates to prevent from postoperative pulmonary complications (PPCs). Whether lung protective ventilation strategy can reduce the risk of PPCs in COVID-19 patients remains unclear. In this study, we compared the effects of driving pressure-guided ventilation with conventional mechanical ventilation on PPCs in patients with COVID-19. Methods Patients infected COVID-19 within 30-day before surgery were retrospectively enrolled consecutively. Patients were divided into two group: driving pressure-guided lung protective ventilation strategy group (LPVS group) and conventional mechanical ventilation group (Control group). Propensity score matching for variables selected was used by logistic regression with the nearest-neighbor method. The outcomes were the incidence of PPCs and hypoxemia in post-anesthesia care unit. Results There was no significant difference in the baseline data between both groups (P > 0.05). The incidence of PPCs (12.73 % vs 36.36 %, χ2 = 7.068, P = 0.008) and hypoxemia [18.18 % vs 38.18 %, χ2 = 4.492, P = 0.034], and lung ultrasound scores [4.68 ± 1.60 vs 8.39 ± 1.87, t = 8.383, P < 0.001] in LPVS group were lower than control group. The PEEP, airway pressure and plateau pressure in LPVS group were higher than control group, but driving pressure and tidal volume was lower than control group, the difference was statistically significant (P < 0.05). Conclusion Individualized PEEP ventilation strategy guided by minimum driving pressure could improve oxygenation and reduce the incidence of PPCs in surgical patients with COVID-19.
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Affiliation(s)
- Na Wei
- Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jun-Sheng Chen
- Department of Anaesthesia, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Bang-Sheng Hu
- Department of Anaesthesia, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Ya Cao
- Department of Anaesthesia, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Ze-Ping Dai
- Department of Anaesthesia, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
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Li Y, Zhao G, Ma Y, Wang L, Liu Y, Zhang H. Effectiveness and safety of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure: an overview of systematic reviews. BMC Pulm Med 2024; 24:5. [PMID: 38166818 PMCID: PMC10759512 DOI: 10.1186/s12890-023-02829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To evaluate and summarize systematic reviews of the effects and safety of awake prone positioning for COVID-19-related acute hypoxaemic respiratory failure. METHODS A comprehensive search was conducted on PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CSPD, CCD and CBM from their inception to March 28, 2023. Systematic reviews (SRs) of awake prone positioning (APP) for COVID-19-related acute hypoxaemic respiratory failure in adults were included. Two reviewers screened the eligible articles, and four reviewers in pairs extracted data and assessed the methodological quality/certainty of the evidence of all included SRs by AMSTAR 2 and GRADE tools. The overlap of primary studies was measured by calculating corrected covered areas. Data from the included reviews were synthesized with a narrative description. RESULTS A total of 11 SRs were included. The methodological quality of SRs included 1 "High", 4 "Moderate", 2 "Low" and 4 "Critically low" by AMSTAR 2. With the GRADE system, no high-quality evidence was found, and only 14 outcomes provided moderate-quality evidence. Data synthesis of the included SR outcomes showed that APP reduced the risk of requiring intubation (11 SRs) and improving oxygenation (3 SRs), whereas reduced significant mortality was not found in RCT-based SRs. No significant difference was observed in the incidence of adverse events between groups (8 SRs). The corrected covered area index was 27%, which shows very high overlap among studies. CONCLUSION The available SRs suggest that APP has benefits in terms of reducing intubation rates and improving oxygenation for COVID-19-related acute hypoxemic respiratory failure, without an increased risk of adverse events. The conclusion should be treated with caution because of the generally low quality of methodology and evidence. TRIAL REGISTRATION The protocol for this review was registered with PROSPERO: CRD42023400986. Registered 15 April 2023.
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Affiliation(s)
- Ya Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Guixiang Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Yizhao Ma
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Lu Wang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Ying Liu
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Hailong Zhang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, China.
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, China.
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
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Chan OW, Lee EP, Chou CC, Lai SH, Chung HT, Lee J, Lin JJ, Hsieh KS, Hsia SH. In-hospital care of children with COVID-19. Pediatr Neonatol 2024; 65:2-10. [PMID: 37989708 DOI: 10.1016/j.pedneo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 11/23/2023] Open
Abstract
Children have been reported to be less affected and to have milder severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than adults during the coronavirus disease 2019 (COVID-19) pandemic. However, children, and particularly those with underlying disorders, are still likely to develop critical illnesses. In the case of SARS-CoV-2 infection, most previous studies have focused on adult patients. To aid in the knowledge of in-hospital care of children with COVID-19, this study presents an expert review of the literature, including the management of respiratory distress or failure, extracorporeal membrane oxygenation (ECMO), multisystem inflammatory syndrome in children (MIS-C), hemodynamic and other organ support, pharmaceutical therapies (anti-viral drugs, anti-inflammatory or antithrombotic therapies) and management of cardiopulmonary arrest.
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Affiliation(s)
- Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Che Chou
- Division of Paediatric Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Shen-Hao Lai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Cardiovascular Internal Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, China
| | - Jung Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, ROC
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Sheng Hsieh
- Center of Structure and Congenital Heart Disease/Ultrasound and Department of Cardiology, Children's Hospital, China Medical University, Taichung, Taiwan; Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan.
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Jacquier M, Labruyère M, Ecarnot F, Roudaut JB, Andreu P, Voizeux P, Save Q, Pedri R, Rigaud JP, Quenot JP. Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2. J Clin Med 2023; 12:7509. [PMID: 38137578 PMCID: PMC10743400 DOI: 10.3390/jcm12247509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance.
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Affiliation(s)
- Marine Jacquier
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
| | - Marie Labruyère
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, 25030 Besançon, France;
- EA3920, University of Franche-Comté, 25000 Besançon, France
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pierre Voizeux
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Quentin Save
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Romain Pedri
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, 76202 Dieppe, France;
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, 14000 Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, 21000 Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), University of Burgundy, 21000 Dijon, France
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Montgomery AJ, Litell J, Dang J, Flurin L, Gajic O, Lal A. Gaining consensus on expert rule statements for acute respiratory failure digital twin patient model in intensive care unit using a Delphi method. Biomol Biomed 2023; 23:1108-1117. [PMID: 37431943 PMCID: PMC10655890 DOI: 10.17305/bb.2023.9344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Digital twin technology is a virtual depiction of a physical product and has been utilized in many fields. Digital twin patient model in healthcare is a virtual patient that provides opportunities to test the outcomes of various interventions virtually without subjecting an actual patient to possible harm. This can serve as a decision aid in the complex environment of the intensive care unit (ICU). Our objective is to develop consensus among a multidisciplinary expert panel on statements regarding respiratory pathophysiology contributing to respiratory failure in the medical ICU. We convened a panel of 34 international critical care experts. Our group modeled elements of respiratory failure pathophysiology using directed acyclic graphs (DAGs) and derived expert statements describing associated ICU clinical practices. The experts participated in three rounds of modified Delphi to gauge agreement on 78 final questions (13 statements with 6 substatements for each) using a Likert scale. A modified Delphi process achieved agreement for 62 of the final expert rule statements. Statements with the highest degree of agreement included the physiology, and management of airway obstruction decreasing alveolar ventilation and ventilation-perfusion matching. The lowest agreement statements involved the relationship between shock and hypoxemic respiratory failure due to heightened oxygen consumption and dead space. Our study proves the utility of a modified Delphi method to generate consensus to create expert rule statements for further development of a digital twin-patient model with acute respiratory failure. A substantial majority of expert rule statements used in the digital twin design align with expert knowledge of respiratory failure in critically ill patients.
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Affiliation(s)
| | - John Litell
- Department of Emergency Critical Care, Abbott Northwestern, Minneapolis, USA
| | - Johnny Dang
- Department of Neurology, Cleveland Clinic, Cleveland, USA
| | - Laure Flurin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Ognjen Gajic
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Amos Lal
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
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9
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Dushianthan A, Bracegirdle L, Cusack R, Cumpstey AF, Postle AD, Grocott MPW. Alveolar Hyperoxia and Exacerbation of Lung Injury in Critically Ill SARS-CoV-2 Pneumonia. Med Sci (Basel) 2023; 11:70. [PMID: 37987325 PMCID: PMC10660857 DOI: 10.3390/medsci11040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Acute hypoxic respiratory failure (AHRF) is a prominent feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) critical illness. The severity of gas exchange impairment correlates with worse prognosis, and AHRF requiring mechanical ventilation is associated with substantial mortality. Persistent impaired gas exchange leading to hypoxemia often warrants the prolonged administration of a high fraction of inspired oxygen (FiO2). In SARS-CoV-2 AHRF, systemic vasculopathy with lung microthrombosis and microangiopathy further exacerbates poor gas exchange due to alveolar inflammation and oedema. Capillary congestion with microthrombosis is a common autopsy finding in the lungs of patients who die with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome. The need for a high FiO2 to normalise arterial hypoxemia and tissue hypoxia can result in alveolar hyperoxia. This in turn can lead to local alveolar oxidative stress with associated inflammation, alveolar epithelial cell apoptosis, surfactant dysfunction, pulmonary vascular abnormalities, resorption atelectasis, and impairment of innate immunity predisposing to secondary bacterial infections. While oxygen is a life-saving treatment, alveolar hyperoxia may exacerbate pre-existing lung injury. In this review, we provide a summary of oxygen toxicity mechanisms, evaluating the consequences of alveolar hyperoxia in COVID-19 and propose established and potential exploratory treatment pathways to minimise alveolar hyperoxia.
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Affiliation(s)
- Ahilanandan Dushianthan
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Luke Bracegirdle
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Rebecca Cusack
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Andrew F Cumpstey
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Anthony D Postle
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Michael P W Grocott
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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10
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Al Duhailib Z, Parhar KKS, Solverson K, Alhazzani W, Weatherald J. Awake prone position in patients with acute hypoxic respiratory failure: A narrative review. Respir Med Res 2023; 84:101037. [PMID: 37625375 DOI: 10.1016/j.resmer.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Kevin Solverson
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Department of Medicine, Division of Respirology, University of Calgary, Calgary, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
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11
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Kruit N, Burrell A, Tian D, Barrett N, Bělohlávek J, Bernard S, Braude D, Buscher H, Chen YS, Donker DW, Finney S, Forrest P, Fowles JA, Hifumi T, Hodgson C, Hutin A, Inoue A, Jung JS, Kruse JM, Lamhaut L, Ming-Hui Lin R, Reis Miranda D, Müller T, Bhagyalakshmi Nanjayya V, Nickson C, Pellegrino V, Plunkett B, Richardson C, Alexander Richardson S, Shekar K, Shinar Z, Singer B, Stub D, Totaro RJ, Vuylsteke A, Yannopoulos D, Zakhary B, Dennis M. Expert consensus on training and accreditation for extracorporeal cardiopulmonary resuscitation an international, multidisciplinary modified Delphi Study. Resuscitation 2023; 192:109989. [PMID: 37805061 DOI: 10.1016/j.resuscitation.2023.109989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program. METHODS A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale. A diverse, representative group was targeted. Consensus was achieved when greater than 70% respondents rated a domain as critical (> or = 7 on the 9 point Likert scale). RESULTS 35 international ECPR experts from 9 countries formed the expert panel, with a median number of 14 years of ECMO practice (interquartile range 11-38). Participant response rates were 97% (survey round one), 63% (virtual meeting) and 100% (survey round two). After the second round of the survey, 47 consensus statements were formed outlining a core set of competencies required for ECPR provision. We identified key elements required to safely train and perform ECPR including skill pre-requisites, surrogate skill identification, the importance of competency-based assessment over volume of practice and competency requirements for successful ECPR practice and skill maintenance. CONCLUSIONS We present a series of core competencies, training requirements and ongoing governance protocols to guide safe ECPR implementation. These findings can be used to develop training syllabus and guide minimum standards for competency as the growth of ECPR practitioners continues.
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Affiliation(s)
- Natalie Kruit
- Department of Perioperative Medicine, Westmead Hospital, Hawksbury Rd, Westmead, NSW 2145, Australia.
| | - Aidan Burrell
- The Alfred Hospital, Melbourne, Victoria, Australia.
| | | | | | - Jan Bělohlávek
- Chair EuroELSO Working Group on ECPR, Deputy Head, 2(nd) Dept. of Internal Medicine, Cardiovascular Medicine U Nemocnice 2, Prague 2 128 00, Czech Republic.
| | | | - Darren Braude
- Division of Prehospital, Austere and Disaster Medicine, NM, United States.
| | | | | | | | | | - Paul Forrest
- RPAH and Sydney University Medical School, Australia.
| | - Jo-Anne Fowles
- Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus l Cambridge, UK.
| | - Toru Hifumi
- St. Luke's International Hospital, Tokyo, Japan.
| | | | - Alice Hutin
- Assistance Publique-Hôpitaux de Paris, Paris, France.
| | | | - Jae-Seung Jung
- Korea University Anam Hospital, Seoul, Republic of Korea.
| | - J M Kruse
- Charité - Universitätsmedizin Berlin, Germany.
| | | | - Richard Ming-Hui Lin
- Director of Emergency and Critical Care Services, Lin Shin Hospital, Taichung, Taiwan.
| | | | | | | | | | | | | | | | | | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, QLD, Australia.
| | | | - Ben Singer
- St Bartholomew's Hospital, London, UK London's Air Ambulance, London, UK.
| | - Dion Stub
- The Alfred Hosptial, Victoria, Australia.
| | | | | | | | | | - Mark Dennis
- Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Australia.
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12
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Xu Y, Xi Y, Cai S, Yu Y, Chen S, Guan W, Liang W, Wu H, He W, Deng X, Xu Y, Zhang R, Li M, Pan J, Liang Z, Wang Y, Kong S, Liu X, Lv Z, Li Y. Venovenous extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: A comparative cohort study in China. J Intensive Med 2023; 3:326-334. [PMID: 38028638 PMCID: PMC10658037 DOI: 10.1016/j.jointm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 12/01/2023]
Abstract
Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome (ARDS). However, whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019 (COVID-19)-associated ARDS patients remains unknown. Methods This is a retrospective cohort study. We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Eighth People's Hospital, and Wuhan Union Hospital West Campus between January 23 and March 31, 2020. We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS. Clinical characteristics, respiratory mechanics including plateau pressure, driving pressure, mechanical power, ventilatory ratio (VR) and lung compliance, and outcomes were compared. Results Data from 25 patients with COVID-19 (n=12) and H1N1 (n=13) associated ARDS who had received ECMO support were analyzed. COVID-19 patients were older than H1N1 influenza patients (P=0.004). The partial pressure of arterial carbon dioxide (PaCO2) and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients (P <0.001 and P=0.004, respectively). COVID-19 patients showed increased plateau and driving pressure compared with H1N1 subjects (P=0.013 and P=0.018, respectively). Patients with COVID-19 remained longer on ECMO support than did H1N1 influenza patients (P=0.015). COVID-19 patients who required ECMO support also had fewer intensive care unit and ventilator-free days than H1N1. Conclusions Compared with H1N1 influenza patients, COVID-19 patients were older and presented with increased PaCO2 and VR values before ECMO initiation. The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.
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Affiliation(s)
- Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Yin Xi
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuijiang Cai
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuheng Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sibei Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weijie Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weibo Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Hongkai Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weiqun He
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xilong Deng
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanda Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Manshu Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Jieyi Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Zhenting Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Ya Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Shaofeng Kong
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Zheng Lv
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
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13
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Misset B, Piagnerelli M, Hoste E, Dardenne N, Grimaldi D, Michaux I, De Waele E, Dumoulin A, Jorens PG, van der Hauwaert E, Vallot F, Lamote S, Swinnen W, De Schryver N, Fraipont V, de Mey N, Dauby N, Layios N, Mesland JB, Meyfroidt G, Moutschen M, Compernolle V, Gothot A, Desmecht D, Taveira da Silva Pereira MI, Garigliany M, Najdovski T, Bertrand A, Donneau AF, Laterre PF. Convalescent Plasma for Covid-19-Induced ARDS in Mechanically Ventilated Patients. N Engl J Med 2023; 389:1590-1600. [PMID: 37889107 PMCID: PMC10755833 DOI: 10.1056/nejmoa2209502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19-induced acute respiratory distress syndrome (ARDS). METHODS In this open-label trial, we randomly assigned adult patients with Covid-19-induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28. RESULTS A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P = 0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups. CONCLUSIONS The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19-induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowledge Center; ClinicalTrials.gov number, NCT04558476.).
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Affiliation(s)
- Benoît Misset
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Michael Piagnerelli
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Eric Hoste
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nadia Dardenne
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - David Grimaldi
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Isabelle Michaux
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Elisabeth De Waele
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Alexander Dumoulin
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Philippe G Jorens
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Emmanuel van der Hauwaert
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Frédéric Vallot
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Stoffel Lamote
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Walter Swinnen
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nicolas De Schryver
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Vincent Fraipont
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nathalie de Mey
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nicolas Dauby
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nathalie Layios
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Jean-Baptiste Mesland
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Geert Meyfroidt
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Michel Moutschen
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Veerle Compernolle
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - André Gothot
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Daniel Desmecht
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Maria I Taveira da Silva Pereira
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Mutien Garigliany
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Tome Najdovski
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Axelle Bertrand
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Anne-Françoise Donneau
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Pierre-François Laterre
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
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14
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Pérez J, Accoce M, Dorado JH, Gilgado DI, Navarro E, Cardoso GP, Telias I, Rodriguez PO, Brochard L. Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19. Crit Care Explor 2023; 5:e0968. [PMID: 37644972 PMCID: PMC10461949 DOI: 10.1097/cce.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes. DESIGN Retrospective cohort study. SETTING Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina). PATIENTS Subjects with arterial pressure of oxygen (AHRF to Fio2 [Pao2/Fio2] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15-4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15-4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05-1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91-0.99]; p = 0.029), Pao2/Fio2 (OR: 0.87; 95% CI [0.78-0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38-0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083). CONCLUSIONS In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes.
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Affiliation(s)
- Joaquin Pérez
- Intensive Care Unit, Sanatorio Anchorena, San Martín, Buenos Aires, Argentina
- Intensive Care Unit, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - Matías Accoce
- Intensive Care Unit, Sanatorio Anchorena, San Martín, Buenos Aires, Argentina
- Intensive Care Unit, Hospital de Quemados "Dr. Arturo Humberto Illia," Ciudad Autónoma de Buenos Aires, Argentina
- Faculta de Medicina y Ciencias de la Salud, Universidad Abierta Interamericana, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier H Dorado
- Intensive Care Unit, Sanatorio Anchorena, San Martín, Buenos Aires, Argentina
| | - Daniela I Gilgado
- Intensive Care Unit, Sanatorio Anchorena, San Martín, Buenos Aires, Argentina
- Intensive Care Unit, Hospital Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
| | - Emiliano Navarro
- Respiratory and physical therapy department, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gimena P Cardoso
- Intensive Care Unit, Sanatorio Anchorena, San Martín, Buenos Aires, Argentina
- Intensive Care Unit, Hospital Donación Francisco Santojanni, Ciudad Autónoma de Buenos Aires, Argentina
| | - Irene Telias
- Department of Critical Care, Keenan Research Center, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Pablo O Rodriguez
- Intensive Care Unit, Hospital Universitario Sede Pombo (Instituto Universitario CEMIC, Centro de Educación Médica e Investigaciones Clínicas), Ciudad Autónoma de Buenos Aires, Argentina
- Pneumonology section, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Laurent Brochard
- Department of Critical Care, Keenan Research Center, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Schultz MJ, van Oosten PJ, Hol L. Mortality among elderly patients with COVID-19 ARDS-age still does matter. Pulmonology 2023; 29:353-355. [PMID: 37012090 PMCID: PMC10015089 DOI: 10.1016/j.pulmoe.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- M J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, 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.
| | - P J van Oosten
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - L Hol
- Department of Anesthesiology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
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16
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Ismail KB, Essafi F, Talik I, Slimene NB, Sdiri I, Dhia BB, Merhbene T. Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia. Acute Crit Care 2023; 38:271-277. [PMID: 37652857 PMCID: PMC10497894 DOI: 10.4266/acc.2023.00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients. METHODS This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data. RESULTS Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4-19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02). CONCLUSIONS Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.
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Affiliation(s)
- Khaoula Ben Ismail
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Fatma Essafi
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Imen Talik
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
| | - Najla Ben Slimene
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Ines Sdiri
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
| | - Boudour Ben Dhia
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
| | - Takoua Merhbene
- Medical Intensive Care Unit, Regional Hospital of Zaghouan and Faculty of Medicine of Tunis, University of Tunis El Manar, Zaghouan, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
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17
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Kwizera A, Kabatooro D, Atumanya P, Tumukunde J, Kalungi J, Mwanje AK, Obua D, Agaba P, Sendagire C, Nakibuuka J, Owachi D, Dünser MW, Alenyo-Ngabirano A, Olaro C, Kyobe-Bosa H, Kirenga BJ, Nakiyingi L, Kiwanuka N, Kateete DP, Joloba M, Sewankambo N, Summers C. Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study. Chest 2023; 164:369-380. [PMID: 36773933 PMCID: PMC9911971 DOI: 10.1016/j.chest.2023.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS. RESEARCH QUESTION Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda? STUDY DESIGN AND METHODS A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses. RESULTS Four hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59 of 79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio2 ratio (OR, 0.99; 95% CI, 0.98-0.99; P < .001) and respiratory rate (OR, 1.07; 95% CI, 1.03-1.12; P = .002) at admission and NIV (OR, 6.31; 95% CI, 2.29-17.37; P < .001) or IMV (OR, 8.08; 95% CI, 3.52-18.57; P < .001) use were independent risk factors for death. INTERPRETATION SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Daphne Kabatooro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patience Atumanya
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joyce Kalungi
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Arthur Kavuma Mwanje
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Obua
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Agaba
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cornelius Sendagire
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda; Uganda Heart Institute, Kampala, Uganda
| | - Jane Nakibuuka
- Department of Medicine and Intensive Care Unit, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Martin W Dünser
- Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | | | | | - Henry Kyobe-Bosa
- Ministry of Health, Kampala, Uganda; Uganda Peoples Defence Forces, Kampala, Uganda; Kellogg College, University of Oxford, Oxford, England
| | - Bruce J Kirenga
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University Lung Institute, Kampala, Uganda
| | - Lydia Nakiyingi
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Joloba
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Kjellberg A, Douglas J, Hassler A, Al-Ezerjawi S, Boström E, Abdel-Halim L, Liwenborg L, Hetting E, Jonasdottir Njåstad AD, Kowalski J, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO). J Clin Med 2023; 12:4850. [PMID: 37510965 PMCID: PMC10381696 DOI: 10.3390/jcm12144850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND A few prospective trials and case series have suggested that hyperbaric oxygen therapy (HBOT) may be efficacious for the treatment of severe COVID-19, but safety is a concern for critically ill patients. We present an interim analysis of the safety of HBOT via a randomized controlled trial (COVID-19-HBO). METHODS A randomized controlled, open-label, clinical trial was conducted in compliance with good clinical practice to explore the safety and efficacy of HBOT for severe COVID-19 in critically ill patients with moderate acute respiratory distress syndrome (ARDS). Between 3 June 2020, and 17 May 2021, 31 patients with severe COVID-19 and moderate-to-severe ARDS, a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) < 26.7 kPa (200 mmHg), and at least two defined risk factors for intensive care unit (ICU) admission and/or mortality were enrolled in the trial and randomized 1:1 to best practice, or HBOT in addition to best practice. The subjects allocated to HBOT received a maximum of five treatments at 2.4 atmospheres absolute (ATA) for 80 min over seven days. The subjects were followed up for 30 days. The safety endpoints were analyzed. RESULTS Adverse events (AEs) were common. Hypoxia was the most common adverse event reported. There was no statistically significant difference between the groups. Numerically, serious adverse events (SAEs) and barotrauma were more frequent in the control group, and the differences between groups were in favor of the HBOT in PaO2/FiO2 (PFI) and the national early warning score (NEWS); statistically, however, the differences were not significant at day 7, and no difference was observed for the total oxygen burden and cumulative pulmonary oxygen toxicity dose (CPTD). CONCLUSION HBOT appears to be safe as an intervention for critically ill patients with moderate-to-severe ARDS induced by COVID-19. CLINICAL TRIAL REGISTRATION NCT04327505 (31 March 2020) and EudraCT 2020-001349-37 (24 April 2020).
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Affiliation(s)
- Anders Kjellberg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Johan Douglas
- Department of Anaesthesia and Intensive Care, Blekingesjukhuset, 371 85 Karlskrona, Sweden
| | - Adrian Hassler
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Sarah Al-Ezerjawi
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emil Boström
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lina Abdel-Halim
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lovisa Liwenborg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eric Hetting
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | | | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Academic Specialist Center, Center for Diabetes, 113 65 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynaecology and Reproduction, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Emergency Medicine, Division of Hyperbaric Medicine, University of California San Diego, La Jolla, CA 92093, USA
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19
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Hol L, Schultz MJ, Martin-Loeches I, van Meenen DMP, Serpa Neto A, Paulus F. Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic-A Comparison between Two Nationwide Observational Studies in The Netherlands. J Clin Med 2023; 12:4507. [PMID: 37445542 DOI: 10.3390/jcm12134507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this analysis was to compare ventilation management and outcomes in invasively ventilated patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) between the first and second wave in the Netherlands. This is a post hoc analysis of two nationwide observational COVID-19 studies conducted in quick succession. The primary endpoint was ventilation management. Secondary endpoints were tracheostomy use, duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), and mortality. We used propensity score matching to control for observed confounding factors. This analysis included 1122 patients from the first and 568 patients from the second wave. Patients in the second wave were sicker, had more comorbidities, and had worse oxygenation parameters. They were ventilated with lower positive end-expiratory pressure and higher fraction inspired oxygen, had a lower oxygen saturation, received neuromuscular blockade more often, and were less often tracheostomized. Duration of ventilation was shorter, but mortality rates were similar. After matching, the fraction of inspired oxygen was lower in the second wave. In patients with acute hypoxemic respiratory failure due to COVID-19, aspects of respiratory care and outcomes rapidly changed over the successive waves.
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Affiliation(s)
- Liselotte Hol
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Street, Leinster, D08 NYH1 Dublin, Ireland
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - David M P van Meenen
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Critical Care Medicine, Hospital Israelite Albert Einstein, Sao Paolo 05652-900, Brazil
- Department of Critical Care Medicine, Austin Hospital and University of Melbourne, Melbourne 3084, Australia
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
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Swenson KE, Hardin CC. Pathophysiology of Hypoxemia in COVID-19 Lung Disease. Clin Chest Med 2023; 44:239-248. [PMID: 37085217 PMCID: PMC9682047 DOI: 10.1016/j.ccm.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As the pandemic has progressed, our understanding of hypoxemia in coronavirus disease 2019 (COVID-19) lung disease has become more nuanced, although much remains to be understood. In this article, we review ventilation-perfusion mismatching in COVID-19 and the evidence to support various biologic theories offered in explanation. In addition, the relationship between hypoxemia and other features of severe COVID-19 lung disease such as respiratory symptoms, radiographic abnormalities, and pulmonary mechanics is explored. Recognizing and understanding hypoxemia in COVID-19 lung disease remains essential for risk stratification, prognostication, and choice of appropriate treatments in severe COVID-19.
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Affiliation(s)
- Kai E Swenson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA.
| | - Charles C Hardin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA
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21
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Farinha I, da Cunha AT, Nogueira AR, Ribeiro A, Silva C, Rua J, Trêpa J, Mateus JE, Costa F. Factors associated with non-invasive positive pressure ventilation failure in a COVID-19 intermediate care unit. Int J Emerg Med 2023; 16:36. [PMID: 37173632 PMCID: PMC10175901 DOI: 10.1186/s12245-023-00510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure. METHODS Patients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model. RESULTS A total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56-75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036-1.308) and morphine use (OR 24.771; 95%CI 1.809-339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960-0.994) were associated with a favorable outcome. CONCLUSIONS NIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.
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Affiliation(s)
- Inês Farinha
- Pulmonology Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Alexandra Tenda da Cunha
- Pulmonology Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ana Rita Nogueira
- Intensive Care Medicine Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - André Ribeiro
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- Haematology Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Carlos Silva
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- Internal Medicine Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - João Rua
- Intensive Care Medicine Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - João Trêpa
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- Infectious Diseases Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - José Eduardo Mateus
- Intensive Care Medicine Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Filipa Costa
- Pulmonology Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
- COVID-19 Intermediate Care Unit, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
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22
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Reid J, Daya R, Zingoni ZM, Jassat W, Bayat Z, Nel J. COVID-19 in-hospital mortality during the first two pandemic waves, at Helen Joseph Hospital, South Africa. Pan Afr Med J 2023; 45:5. [PMID: 37346915 PMCID: PMC10280698 DOI: 10.11604/pamj.2023.45.5.39222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/19/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction there has been significant global variation in Coronavirus Disease (COVID-19) mortality at different time points in the pandemic. Contributing factors include population demographics, comorbidities, health system capacity, prior infection with COVID-19, vaccinations, and viral variants. The study aims to describe COVID-19-related mortality of inpatients at Helen Joseph Hospital (HJH), over 12 months, during the first two waves of the COVID-19 pandemic in South Africa. The primary objectives were to describe the socio-demographic details, clinical characteristics, and hospital outcomes during the first and second waves of COVID-19. This included an assessment of the in-hospital case fatality ratio (CFR) of patients admitted with COVID-19. The secondary objectives were to compare the socio-demographic details, clinical characteristics, and outcomes between the two waves, and to determine risk factors associated with COVID-19-related mortality. Methods this is a retrospective cohort study of all inpatient laboratory-confirmed COVID-19 cases at HJH from 1st May 2020 to 31st April 2021. Data were collected by the National Institute for Communicable Diseases (NICD). Bivariate analysis was performed to describe and compare the socio-demographic characteristics, clinical characteristics, and hospital admission outcomes between the two waves. Multivariate logistic regression was used to determine risk factors for COVID-19-related mortality. Results overall, 1359 patients were admitted, 595 in wave one, and 764 in wave two. Patients were predominantly male (52.4%), of Black African race (75.1%) with a mean age of 54.6 (standard deviation 15.4) years. The median length of stay was 8 days (interquartile range 5-14 days). In total, 73.2% (995) of patients required oxygen, 5.2% (71) of patients received mechanical ventilation, and 7.1% (96) were admitted to the high care and Intensive Care Unit (ICU). The most common comorbid illnesses were hypertension (36.7%, n=499), diabetes mellitus (26.6%, n=362), Human Immunodeficiency Virus (HIV) (10.8%, n=147), and obesity (11.0%, n=149). The in-hospital CFR during the first wave was 30.4% (181/595) and 25.5% (195/764) (p<0.001) in the second wave, and overall, in-hospital CFR was 27.7% (376/1359). The adjusted odds of death were 79% higher among patients admitted during wave one compared to wave two (aOR=1.79; 95% CI: 1.35-2.38). A one-year increase in age increased the odds of death by 4% (aOR=1.04; 95% CI: 1.03-1.05). The need for oxygen (aOR=2.17, 95%CI: 1.56-3.01) and ventilation (aOR=7.23, 95% CI: 4.02-13.01) were significant risk factors for mortality. Conclusion prior to the availability of vaccines, COVID-19-related mortality was high and risk factors for mortality were consistent with national and international findings. This study reflects the impact of the pandemic on the South African public sector with limited resources and minimal ICU capacity.
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Affiliation(s)
- Joanna Reid
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reyna Daya
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Waasila Jassat
- National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), South Africa
- Right to Care, Centurion, South Africa
| | - Zaheer Bayat
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremy Nel
- Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Qin S, Chang W, Peng F, Hu Z, Yang Y. Awake prone position in COVID-19-related acute respiratory failure: a meta-analysis of randomized controlled trials. BMC Pulm Med 2023; 23:145. [PMID: 37101160 PMCID: PMC10131466 DOI: 10.1186/s12890-023-02442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND We aimed to investigate the effects of awake prone positioning (APP) in nonintubated adult patients with acute hypoxemic respiratory failure due to COVID-19. METHODS The PubMed, Embase, Web of Science and Cochrane Central Register databases were searched up to June 1, 2022. All randomized trials investigating the effects of APP were included in the present meta-analysis. The primary outcome was intubation rate, and the secondary outcomes included the length of intensive care unit (ICU) stay, hospital stay, and mortality. Prescribed subgroup analysis was also conducted. RESULTS A total of 10 randomized trials enrolling 2324 patients were ultimately included in the present study. The results indicated that APP was associated with a significant reduction in the intubation rate (OR 0.77, 95% CI 0.63 to 0.93, P = 0.007). However, no differences could be observed in the length of ICU stay or hospitalization or mortality. Subgroup analysis suggested that patients in the ICU settings (OR 0.74, 95% CI 0.60 to 0.91, P = 0.004), patients whose median APP time was more than 4 h (OR 0.77, 95% CI 0.63 to 0.93, P = 0.008), and patients with an average baseline SpO2 to FiO2 ratio less than 200 (OR 0.75, 95% CI 0.61 to 0.92) were more likely to benefit from APP, indicated a significantly reduced intubation rate. CONCLUSION Based on the current evidence, nonintubated adult patients with hypoxemic respiratory failure due to COVID-19 infection who underwent APP were shown to have a significantly reduced intubation rate. However, no differences in ICU or hospital length of stay or mortality could be observed between APP and usual care. REGISTRATION NUMBER CRD42022337846.
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Affiliation(s)
- Sun Qin
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Wei Chang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Fei Peng
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Zihan Hu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
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Dang J, Lal A, Montgomery A, Flurin L, Litell J, Gajic O, Rabinstein A. Developing DELPHI expert consensus rules for a digital twin model of acute stroke care in the neuro critical care unit. BMC Neurol 2023; 23:161. [PMID: 37085850 PMCID: PMC10121414 DOI: 10.1186/s12883-023-03192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Digital twins, a form of artificial intelligence, are virtual representations of the physical world. In the past 20 years, digital twins have been utilized to track wind turbines' operations, monitor spacecraft's status, and even create a model of the Earth for climate research. While digital twins hold much promise for the neurocritical care unit, the question remains on how to best establish the rules that govern these models. This model will expand on our group's existing digital twin model for the treatment of sepsis. METHODS The authors of this project collaborated to create a Direct Acyclic Graph (DAG) and an initial series of 20 DELPHI statements, each with six accompanying sub-statements that captured the pathophysiology surrounding the management of acute ischemic strokes in the practice of Neurocritical Care (NCC). Agreement from a panel of 18 experts in the field of NCC was collected through a 7-point Likert scale with consensus defined a-priori by ≥ 80% selection of a 6 ("agree") or 7 ("strongly agree"). The endpoint of the study was defined as the completion of three separate rounds of DELPHI consensus. DELPHI statements that had met consensus would not be included in subsequent rounds of DELPHI consensus. The authors refined DELPHI statements that did not reach consensus with the guidance of de-identified expert comments for subsequent rounds of DELPHI. All DELPHI statements that reached consensus by the end of three rounds of DELPHI consensus would go on to be used to inform the construction of the digital twin model. RESULTS After the completion of three rounds of DELPHI, 93 (77.5%) statements reached consensus, 11 (9.2%) statements were excluded, and 16 (13.3%) statements did not reach a consensus of the original 120 DELPHI statements. CONCLUSION This descriptive study demonstrates the use of the DELPHI process to generate consensus among experts and establish a set of rules for the development of a digital twin model for use in the neurologic ICU. Compared to associative models of AI, which develop rules based on finding associations in datasets, digital twin AI created by the DELPHI process are easily interpretable models based on a current understanding of underlying physiology.
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Affiliation(s)
- Johnny Dang
- Department of Neurology, Cleveland Clinic, Cleveland, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA.
| | | | - Laure Flurin
- Infectious Diseases Research Laboratory, Mayo Clinic, Rochester, USA
- Department of Critical Care, University Hospital of Guadeloupe, Guadeloupe, France
| | - John Litell
- Abbott Northwestern Emergency Critical Care, Minneapolis, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
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Janković R, Stojanović M, Božov H, Domi R, Ivančan V, Karišik M, Mojsova Mijovska M, Jakupović Smajić J, Šoštarič M. PROCALCITONIN GUIDED ANTIBIOTIC STEWARDSHIP: A BALKAN EXPERT CONSENSUS STATEMENT. Acta Clin Croat 2023; 62:36-44. [PMID: 38304372 PMCID: PMC10829966 DOI: 10.20471/acc.2023.62.01.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/22/2023] [Indexed: 02/03/2024] Open
Abstract
Sepsis as a consequence of infection is a frequent cause of death among critically ill patients. The most common sites of infection are lover respiratory tract, abdominal, urinary tract and catheter-associated blood stream infections. Early empiric, broad-spectrum therapy in those with severe sepsis and/or shock with the aim of reducing mortality may lead to antibiotic overuse, resistance and increased costs. Among numerous serum biomarkers, procalcitonin (PCT) has proved to be one of the most reliable ones in the diagnosis of sepsis. An important means of limiting antibiotic resistance is the antibiotic stewardship program, especially in intensive care units with critically ill patients and prevalence of multiple drug-resistant pathogens. The PCT-guided antibiotic stewardship was first started in Western Europe and Asia-Pacific countries, as well as in the United States. Considering that this method has proven to be effective in reducing antibiotic consumption while improving clinical outcome, a group of experts from the Balkan region decided to make their own recommendations and PCT protocol. When creating this protocol for initiation and duration of antibiotic treatment, they especially reviewed the literature for lower respiratory tract infection and sepsis. In the protocol, they have included the severity of illness, clinical assessment, and PCT levels. Developing a consensus on the clinical algorithm by eminent experts/specialists in various fields of medicine should enable clinicians to use PCT for initiation of antibiotic therapy and monitoring PCT to stop antibiotics earlier. It is crucial that the PCT-guided algorithm becomes an integral part of institutional stewardship program.
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Affiliation(s)
- Radmilo Janković
- University Clinical Center Niš, Department of Anesthesia and Intensive Therapy, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Milena Stojanović
- University Clinical Center Niš, Department of Anesthesia and Intensive Therapy, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Hristo Božov
- Department of Anesthesiology, Maritime and Intensive Medicine, Naval Hospital, Varna, Bulgaria
| | - Rudin Domi
- University of Medicine, Tirana Faculty of Medicine, Tirana, Albania
| | | | - Marijana Karišik
- Department of Anesthesiology and Intensive Care, Institute for Children’s Disease, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Maja Mojsova Mijovska
- Department of Anesthesia, Resuscitation and Intensive Care (KARIL), Skopje, North Macedonia
| | - Jasmina Jakupović Smajić
- Tuzla University Clinical Center, Tuzla University, Medical Faculty, Tuzla, Bosnia and Herzegovina
| | - Maja Šoštarič
- Ljubljana University Medical Center, University of Ljubljana, Ljubljana, Slovenia
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26
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Khanna AK, De Jong A, Myatra SN. High-Flow Nasal Cannula and Outcomes in COVID-19: Reading Between the Lines. Anesth Analg 2023; 136:689-691. [PMID: 36928155 PMCID: PMC9990477 DOI: 10.1213/ane.0000000000006409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Ashish K. Khanna
- From the Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Cedex 5, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Boselli E, Fatah A, Ledochowski S, Allaouchiche B. Variations of qCON and qNOX during tracheal suction in ICU patients on sedation and curarization for SARS-CoV2 pneumonia: a retrospective study. J Clin Monit Comput 2023:10.1007/s10877-023-00998-3. [PMID: 37004662 PMCID: PMC10067008 DOI: 10.1007/s10877-023-00998-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Emmanuel Boselli
- Department of Anesthesiology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France.
- University of Lyon, University Lyon I Claude Bernard, APCSe VetAgro Sup UP, 2021.A10, Marcy L'Étoile, France.
| | - Abdelhamid Fatah
- Department of Intensive Care, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Stanislas Ledochowski
- Department of Intensive Care, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Bernard Allaouchiche
- University of Lyon, University Lyon I Claude Bernard, APCSe VetAgro Sup UP, 2021.A10, Marcy L'Étoile, France
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Crimi C, Murphy P, Patout M, Sayas J, Winck JC. Lessons from COVID-19 in the management of acute respiratory failure. Breathe (Sheff) 2023; 19:230035. [PMID: 37378059 PMCID: PMC10292773 DOI: 10.1183/20734735.0035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Patrick Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
| | - Joao Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Centro De Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal
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Khokher W, Iftikhar S, Abrahamian A, Beran A, Abuhelwa Z, Rashid R, Ali H, Khuder S, Assaly R. Association between Body Mass Index and Hospital Outcomes for COVID-19 Patients: A Nationwide Study. J Clin Med 2023; 12. [PMID: 36836153 DOI: 10.3390/jcm12041617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused significant morbidity and mortality worldwide. There is limited information describing the hospital outcomes of COVID-19 patients in regard to specific body mass index (BMI) categories. METHODS We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult patients (≥18 years of age) with a primary hospitalization for COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization, and compare the outcomes among patients categorized according to BMI. RESULTS A total of 305,284 patients were included in this study. Of them, 248,490 had underlying obesity, defined as BMI ≥ 30. The oldest patients were observed to have BMI < 19, while youngest patients were in the BMI > 50 category. BMI < 19 category had the highest crude in-hospital mortality rate. However, after adjusted regression, patients with BMI > 50 (adjusted odds ratio (aOR) 1.63, 95% CI 1.48-1.79, p-value < 0.001) had the highest increased odds, at 63%, of in-hospital mortality compared to all other patients in the study. Patients with BMI > 50 also had the highest increased odds of needing invasive mechanical ventilation (IMV) and mortality associated with IMV compared to all other patient, by 37% and 61%, respectively. Obese patients were noted to have shorter average hospital length of stay (LOS), by 1.07 days, compared to non-obese patients, but there was no significant difference in average hospitalization charges. CONCLUSION Among obese patients primarily hospitalized with COVID-19, those with BMI ≥ 40 had significantly increased rates of all-cause in-hospital mortality, need for IMV, mortality associated with IMV, and septic shock. Overall, obese patients had shorter average hospital LOS, however, did not have significantly higher hospitalization charges.
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Dillard JA, Martinez SA, Dearing JJ, Montgomery SA, Baxter AK. Animal Models for the Study of SARS-CoV-2-Induced Respiratory Disease and Pathology. Comp Med 2023; 73:72-90. [PMID: 36229170 PMCID: PMC9948904 DOI: 10.30802/aalas-cm-22-000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Emergence of the betacoronavirus SARS-CoV-2 has resulted in a historic pandemic, with millions of deaths worldwide. An unprecedented effort has been made by the medical, scientific, and public health communities to rapidly develop and implement vaccines and therapeutics to prevent and reduce hospitalizations and deaths. Although SARS-CoV-2 infection can lead to disease in many organ systems, the respiratory system is its main target, with pneumonia and acute respiratory distress syndrome as the hallmark features of severe disease. The large number of patients who have contracted COVID-19 infections since 2019 has permitted a detailed characterization of the clinical and pathologic features of the disease in humans. However, continued progress in the development of effective preventatives and therapies requires a deeper understanding of the pathogenesis of infection. Studies using animal models are necessary to complement in vitro findings and human clinical data. Multiple animal species have been evaluated as potential models for studying the respiratory disease caused by SARSCoV-2 infection. Knowing the similarities and differences between animal and human responses to infection is critical for effective translation of animal data into human medicine. This review provides a detailed summary of the respiratory disease and associated pathology induced by SARS-CoV-2 infection in humans and compares them with the disease that develops in 3 commonly used models: NHP, hamsters, and mice. The effective use of animals to study SARS-CoV-2-induced respiratory disease will enhance our understanding of SARS-CoV-2 pathogenesis, allow the development of novel preventatives and therapeutics, and aid in the preparation for the next emerging virus with pandemic potential.
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Key Words
- ace2, angiotensin-converting enzyme 2
- agm, african green monkey
- ali, acute lung injury
- ards, acute respiratory distress syndrome
- balf, bronchoalveolar lavage fluid
- cards, covid-19-associated acute respiratory distress syndrome
- dad, diffuse alveolar damage
- dpi, days postinfection
- ggo, ground glass opacities
- s, spike glycoprotein
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Affiliation(s)
- Jacob A Dillard
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sabian A Martinez
- Division of Comparative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin J Dearing
- Biological and Biomedical Sciences Program, Office of Graduate Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie A Montgomery
- Division of Comparative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andvictoria K Baxter
- Division of Comparative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,
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Dandel M. Letter to the editor "Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients". J Crit Care 2023; 73:154217. [PMID: 36379138 PMCID: PMC9653088 DOI: 10.1016/j.jcrc.2022.154217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin, Germany.
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Killough N, Patterson L, The Covid-Genomics Uk Cog-Uk Consortium, Peacock SJ, Bradley DT. How public health authorities can use pathogen genomics in health protection practice: a consensus-building Delphi study conducted in the United Kingdom. Microb Genom 2023; 9:mgen000912. [PMID: 36745548 PMCID: PMC9997744 DOI: 10.1099/mgen.0.000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pathogen sequencing guided understanding of SARS-CoV-2 evolution during the COVID-19 pandemic. Many health systems developed pathogen genomics services to monitor SARS-CoV-2. There are no agreed guidelines about how pathogen genomic information should be used in public health practice. We undertook a modified Delphi study in three rounds to develop expert consensus statements about how genomic information should be used. Our aim was to inform health protection policy, planning and practice. Participants were from organisations that produced or used pathogen genomics information in the United Kingdom. The first round posed questions derived from a rapid literature review. Responses informed statements for the subsequent rounds. Consensus was accepted when 70 % or more of the responses were strongly agree/agree, or 70 % were disagree/strongly disagree on the five-point Likert scale. Consensus was achieved in 26 (96 %) of 27 statements. We grouped the statements into six categories: monitoring the emergence of new variants; understanding the epidemiological context of genomic data; using genomic data in outbreak risk assessment and risk management; prioritising the use of limited sequencing capacity; sequencing service performance; and sequencing service capability. The expert consensus statements will help guide public health authorities and policymakers to integrate pathogen genomics in health protection practice.
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Affiliation(s)
| | - Lynsey Patterson
- Public Health Agency, Belfast, UK.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | | | - Declan T Bradley
- Public Health Agency, Belfast, UK.,Centre for Public Health, Queen's University Belfast, Belfast, UK
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Garnier M, Constantin JM, Heming N, Camous L, Ferré A, Razazi K, Lapidus N. Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units. Anaesth Crit Care Pain Med 2023; 42:101184. [PMID: 36509387 PMCID: PMC9731925 DOI: 10.1016/j.accpm.2022.101184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 patients requiring mechanical ventilation are particularly at risk of developing ventilator-associated pneumonia (VAP). Risk factors and the prognostic impact of developing VAP during critical COVID-19 have not been fully documented. METHODS Patients invasively ventilated for at least 48 h from the prospective multicentre COVID-ICU database were included in the analyses. Cause-specific Cox regression models were used to determine factors associated with the occurrence of VAP. Cox-regression multivariable models were used to determine VAP prognosis. Risk factors and the prognostic impact of early vs. late VAP, and Pseudomonas-related vs. non-Pseudomonas-related VAP were also determined. MAIN FINDINGS 3388 patients were analysed (63 [55-70] years, 75.8% males). VAP occurred in 1523/3388 (45.5%) patients after 7 [5-9] days of ventilation. Identified bacteria were mainly Enterobacteriaceae followed by Staphylococcus aureus and Pseudomonas aeruginosa. VAP risk factors were male gender (Hazard Ratio (HR) 1.26, 95% Confidence Interval [1.09-1.46]), concomitant bacterial pneumonia at ICU admission (HR 1.36 [1.10-1.67]), PaO2/FiO2 ratio at intubation (HR 0.99 [0.98-0.99] per 10 mmHg increase), neuromuscular-blocking agents (HR 0.89 [0.76-0.998]), and corticosteroids (HR 1.27 [1.09-1.47]). VAP was associated with 90-mortality (HR 1.34 [1.16-1.55]), predominantly due to late VAP (HR 1.51 [1.26-1.81]). The impact of Pseudomonas-related and non-Pseudomonas-related VAP on mortality was similar. CONCLUSION VAP affected almost half of mechanically ventilated COVID-19 patients. Several risk factors have been identified, among which modifiable risk factors deserve further investigation. VAP had a specific negative impact on 90-day mortality, particularly when it occurred between the end of the first week and the third week of ventilation.
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Affiliation(s)
- Marc Garnier
- Sorbonne University, GRC29, Assistance Publique-Hôpitaux de Paris (APHP), DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon Hospital, Paris, France,Corresponding author at: Anesthesiology and Critical Care Department, Tenon University Hospital, 4 Rue de la Chine, 75020 Paris, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC29, Assistance Publique-Hôpitaux de Paris (APHP), DMU DREAM, Anesthesiology and Critical Care Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin — University Paris Saclay, France,Laboratory of Infection & Inflammation — U1173, School of Medicine Simone Veil, University Versailles Saint Quentin — University Paris Saclay, INSERM, Garches, France,FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) & RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Garches, France
| | - Laurent Camous
- Antilles-Guyane University, Medical and Surgical Intensive Care Unit, Guadeloupe Teaching Hospital, Les Abymes, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Keyvan Razazi
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France,Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, Créteil 94010, France
| | - Nathanaël Lapidus
- Sorbonne University, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, F75012 Paris, France
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Bowdish ME, Barkauskas CE, Overbey JR, Gottlieb RL, Osman K, Duggal A, Marks ME, Hupf J, Fernandes E, Leshnower BG, Golob JL, Iribarne A, Rassias AJ, Moquete EG, O’Sullivan K, Chang HL, Williams JB, Parnia S, Patel NC, Desai ND, Vekstein AM, Hollister BA, Possemato T, Romero C, Hou PC, Burke E, Hayes J, Grossman F, Itescu S, Gillinov M, Pagani FD, O’Gara PT, Mack MJ, Smith PK, Bagiella E, Moskowitz AJ, Gelijns AC. A Randomized Trial of Mesenchymal Stromal Cells for Moderate to Severe Acute Respiratory Distress Syndrome from COVID-19. Am J Respir Crit Care Med 2023; 207:261-270. [PMID: 36099435 PMCID: PMC9896641 DOI: 10.1164/rccm.202201-0157oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rationale: There are limited therapeutic options for patients with coronavirus disease (COVID-19)-related acute respiratory distress syndrome with inflammation-mediated lung injury. Mesenchymal stromal cells offer promise as immunomodulatory agents. Objectives: Evaluation of efficacy and safety of allogeneic mesenchymal cells in mechanically-ventilated patients with moderate or severe COVID-19-induced respiratory failure. Methods: Patients were randomized to two infusions of 2 million cells/kg or sham infusions, in addition to the standard of care. We hypothesized that cell therapy would be superior to sham control for the primary endpoint of 30-day mortality. The key secondary endpoint was ventilator-free survival within 60 days, accounting for deaths and withdrawals in a ranked analysis. Measurements and Main Results: At the third interim analysis, the data and safety monitoring board recommended that the trial halt enrollment as the prespecified mortality reduction from 40% to 23% was unlikely to be achieved (n = 222 out of planned 300). Thirty-day mortality was 37.5% (42/112) in cell recipients versus 42.7% (47/110) in control patients (relative risk [RR], 0.88; 95% confidence interval, 0.64-1.21; P = 0.43). There were no significant differences in days alive off ventilation within 60 days (median rank, 117.3 [interquartile range, 60.0-169.5] in cell patients and 102.0 [interquartile range, 54.0-162.5] in control subjects; higher is better). Resolution or improvement of acute respiratory distress syndrome at 30 days was observed in 51/104 (49.0%) cell recipients and 46/106 (43.4%) control patients (odds ratio, 1.36; 95% confidence interval, 0.57-3.21). There were no infusion-related toxicities and overall serious adverse events over 30 days were similar. Conclusions: Mesenchymal cells, while safe, did not improve 30-day survival or 60-day ventilator-free days in patients with moderate and/or severe COVID-19-related acute respiratory distress syndrome.
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Affiliation(s)
- Michael E. Bowdish
- Department of Surgery and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | | | - Keren Osman
- The Tisch Cancer Institute, Icahn School of Medicine, New York, New York
| | | | | | | | | | | | | | - Alexander Iribarne
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Athos J. Rassias
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | - Judson B. Williams
- Cardiovascular Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Sam Parnia
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Nirav C. Patel
- Department of Cardiothoracic Surgery, Northwell Health, Manhasset, New York
| | - Nimesh D. Desai
- Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew M. Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Beth A. Hollister
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Tammie Possemato
- Department of Surgery and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christian Romero
- Department of Surgery and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Peter C. Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine and
| | | | | | | | | | - Marc Gillinov
- Department of Thoracic & Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Patrick T. O’Gara
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; and
| | - Michael J. Mack
- Cardiac and Thoracic Surgery, Baylor Scott & White Health, Dallas, Texas
| | - Peter K. Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
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Peng Q, Yang S, Zhang Y, Zhao W, Hu M, Meng B, Ni H, Min L, Yu J, Wang Y, Zhang L. Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1120837. [PMID: 37081841 PMCID: PMC10111056 DOI: 10.3389/fmed.2023.1120837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 04/22/2023] Open
Abstract
Background Previous studies have shown that an awake prone position may be beneficial for the treatment of acute respiratory distress syndrome (ARDS) or acute hypoxic respiratory failure (AHRF) in patients with COVID-19, but the results are not consistent, especially in terms of oxygenation outcomes and intubation rate. This systematic review and meta-analysis assessed the effects of the awake prone position on AHRF in patients with COVID-19 with all randomized controlled trials (RCTs). Methods An extensive search of online databases, including MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials from 1 December 2019 to 30 October 2022, with no language restrictions was performed. This systematic review and meta-analysis are based on the PRISMA statement. We only included RCTs and used the Cochrane risk assessment tool for quality assessment. Results Fourteen RCTs fulfilled the selection criteria, and 3,290 patients were included. A meta-analysis found that patients in the awake prone position group had more significant improvement in the SpO2/FiO2 ratio [mean difference (MD): 29.76; 95% confidence interval (CI): 1.39-48.13; P = 0.001] compared with the usual care. The prone position also reduced the need for intubation [odd ratio (OR): 0.72; 95% CI: 0.61 to 0.84; P < 0.0001; I 2 = 0%]. There was no significant difference in mortality, hospital length of stay, incidence of intensive care unit (ICU) admission, and adverse events between the two groups. Conclusion The awake prone position was a promising intervention method, which is beneficial to improve the oxygenation of patients with ARDS or AHRF caused by COVID-19 and reduce the need for intubation. However, the awake prone position showed no obvious advantage in mortality, hospital length of stay, incidence of ICU admission, and adverse events. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42022367885.
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Affiliation(s)
- Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng Yang
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Zhao
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Man Hu
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Bo Meng
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Huanhuan Ni
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lingfeng Min
- Department of Respiratory, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jiangquan Yu
- Department of Critical Care Medicine, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Jiangquan Yu
| | - Yongxiang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
- Yongxiang Wang
| | - Liang Zhang
- Department of Orthopedics, Regenerative Medicine Engineering Technology Research Center of Yangzhou, Yangzhou, China
- Liang Zhang
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Zbiral M, Weber M, König S, Kraft F, Ullrich R, Krenn K. Usefulness and limitations of the acute respiratory distress syndrome definitions in non-intubated patients. A narrative review. Front Med (Lausanne) 2023; 10:1088709. [PMID: 36910485 PMCID: PMC9995400 DOI: 10.3389/fmed.2023.1088709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
According to the Berlin Definition of acute respiratory distress syndrome (ARDS), a positive end-expiratory pressure (PEEP) of at least 5 cmH2O is required to diagnose and grade ARDS. While the Berlin consensus statement specifically acknowledges the role of non-invasive ventilation (NIV) in mild ARDS, this stratification has traditionally presumed a mechanically ventilated patient in the context of moderate to severe ARDS. This may not accurately reflect today's reality of clinical respiratory care. NIV and high-flow nasal cannula oxygen therapy (HFNO) have been used for managing of severe forms of acute hypoxemic respiratory failure with growing frequency, including in patients showing pathophysiological signs of ARDS. This became especially relevant during the COVID-19 pandemic. The levels of PEEP achieved with HFNO have been particularly controversial, and the exact FiO2 it achieves is subject to variability. Pinpointing the presence of ARDS in patients receiving HNFO and the severity in those receiving NIV therefore remains methodically problematic. This narrative review highlights the evolution of the ARDS definition in the context of non-invasive ventilatory support and provides an overview of the parallel development of definitions and ventilatory management of ARDS. It summarizes the methodology applied in clinical trials to classify ARDS in non-intubated patients and the respective consequences on treatment. As ARDS severity has significant therapeutic and prognostic consequences, and earlier treatment in non-intubated patients may be beneficial, closing this knowledge gap may ultimately be a relevant step to improve comparability in clinical trial design and outcomes.
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Affiliation(s)
- Martin Zbiral
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maximilian Weber
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian König
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix Kraft
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Center Vienna, Vienna, Austria
| | - Katharina Krenn
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Busco C, González F, Aránguiz M. Factors that favor or hinder the acquisition of a digital culture in large organizations in Chile. Front Psychol 2023; 14:1153031. [PMID: 36968717 PMCID: PMC10033523 DOI: 10.3389/fpsyg.2023.1153031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Organizational culture is often perceived as a valuable strategic asset supporting business transformation and the exploitation of digital technologies. Still, it can also be the source of inertia that impedes change. The research question proposed is What factors favor or hinder the acquisition of digital culture in large organizations in Chile? The aim is to rank factors that promote a digital culture based on the perception of executives using the Delphi method. The expert panel was selected with strategic criteria, considering practical knowledge, up-to-date experience on the subject, and having high decision-making positions in large companies in Chile. The main statistics used are media, maximum, minimum, and average range, along with the search for consensus determined by the interquartile range and Kendall's W concordance coefficient. Results show a high level of agreement on the importance of digital strategy and digital leadership factors when favoring a digital culture in large companies in Chile. However, large companies in Chile must pay attention to the conservative triad of elements that characterize Chilean work culture that considers the belief that changes are exclusively possible when commanded by the strategic apex, a hierarchical work culture that prevents collaborative work, and the rejection of disruptive change. These factors and cultural characteristics will likely hinder any attempt to succeed in a digital transformation plan.
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Didriksson I, Leffler M, Spångfors M, Lindberg S, Reepalu A, Nilsson A, Cronqvist J, Andertun S, Nelderup M, Jungner M, Johnsson P, Lilja G, Frigyesi A, Friberg H. Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients. Acta Anaesthesiol Scand 2022; 67:329-338. [PMID: 36537243 PMCID: PMC9878196 DOI: 10.1111/aas.14184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19. METHODS In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days. RESULTS Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, Pa CO2 >7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU. CONCLUSION In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.
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Affiliation(s)
- Ingrid Didriksson
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareMalmöSweden
| | - Märta Leffler
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareMalmöSweden
| | - Martin Spångfors
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Kristianstad HospitalAnaesthesia and Intensive CareKristianstadSweden
| | - Sarah Lindberg
- Skåne University HospitalResearch and EducationLundSweden
| | - Anton Reepalu
- Department of Translational MedicineLund UniversityMalmöSweden,Department of Infectious DiseasesSkåne University HospitalMalmöSweden
| | - Anna Nilsson
- Department of Translational MedicineLund UniversityMalmöSweden,Department of Infectious DiseasesSkåne University HospitalMalmöSweden
| | - Jonas Cronqvist
- Department of Translational MedicineLund UniversityMalmöSweden,Department of Infectious DiseasesSkåne University HospitalMalmöSweden
| | - Sara Andertun
- Helsingborg HospitalAnaesthesia, and Intensive CareHelsingborgSweden
| | - Maria Nelderup
- Helsingborg HospitalAnaesthesia, and Intensive CareHelsingborgSweden
| | - Mårten Jungner
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareMalmöSweden
| | - Patrik Johnsson
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareMalmöSweden
| | - Gisela Lilja
- Skåne University HospitalDepartment of NeurologyLundSweden
| | - Attila Frigyesi
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareLundSweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesiology and Intensive CareLund UniversityLundSweden,Skåne University HospitalIntensive and Perioperative CareMalmöSweden
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Bambi S, Parente E, Bardacci Y, Baldassini Rodriguez S, Forciniti C, Ballerini L, Caruso C, El Aoufy K, Poggianti M, Bonacaro A, Rona R, Rasero L, Lucchini A. The Effectiveness of NIV and CPAP Training on the Job in COVID-19 Acute Care Wards: A Nurses' Self-Assessment of Skills. Nurs Rep 2022; 13:17-28. [PMID: 36648976 PMCID: PMC9844455 DOI: 10.3390/nursrep13010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) in COVID-19 patients outside of intensive care unit (ICU) settings was a feasible support during the pandemic outbreak. The aim of this study was to assess the effectiveness of an “on the job” NIV training program provided to 66 nurses working in 3 COVID-19 wards in an Italian university hospital. Methods: A quasi-experimental longitudinal before−after study was designed. The NIV Team education program, provided by expert ICU nurses, included: 3 h sessions of training on the job during work-shifts about the management of helmet-continuous positive airway pressure (CPAP) Venturi systems, and NIV with oronasal and full-face masks. An eleven-item “brief skills self-report tool” was administered before and after the program to explore the perception of NIV education program attendees about their level of skills. Results: In total, 59 nurses responded to the questionnaire. There was an improvement in the skill levels of the management of Helmet-CPAP (median before training 2, inter-quartile range (IQR) 0−6; median after training 8, IQR 3−9; p < 0.0001), and mask-NIV (median before training 2, IQR 0−6; median after training 8, IQR 3−9; p < 0.0001). Conclusions: Training on the job performed by expert ICU nurses can be a valuable and fast means to implement new Helmet-CPAP and mask-NIV skills outside of ICUs.
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Affiliation(s)
- Stefano Bambi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Eustachio Parente
- Neuroscience—Neurosurgery, Meyer Children’s Hospital, 50139 Florence, Italy
| | - Yari Bardacci
- Emergency and Trauma Intensive Care Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Carolina Forciniti
- Medical and Surgical Intensive Care Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Ballerini
- Emergency Department, Careggi University Hospital, 50134 Florence, Italy
| | - Christian Caruso
- Emergency Medical System—AUSL Toscana Centro, 50122 Florence, Italy
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Marta Poggianti
- Hospital Healthcare Management, Careggi University Hospital, 50134 Florence, Italy
| | - Antonio Bonacaro
- School of Health and Sports Sciences, University of Suffolk, Ipswich IP4 1QJ, UK
| | - Roberto Rona
- General Intensive Care Unit, San Gerardo Hospital—ASST Monza, Milano Bicocca University, 20900 Monza, Italy
| | - Laura Rasero
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Alberto Lucchini
- General Intensive Care Unit, San Gerardo Hospital—ASST Monza, Milano Bicocca University, 20900 Monza, Italy
- Correspondence: or
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Gopalakrishnan M, Khichar S, Saurabh S, Vijayvergia P, Thangaraju K, Tripathi S, Devarakonda HV, Kumar A, Kumar PS, Garg MK. Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: an open-labelled randomized clinical trial from Jodhpur, India. Monaldi Arch Chest Dis 2022; 93. [PMID: 36524853 DOI: 10.4081/monaldi.2022.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Awake self-proning is being used widely as respiratory support in COVID-19 hypoxemia, in resource-limited settings. We aimed to investigate the effectiveness of early awake self-proning in preventing mortality and the need for intubation in adults with moderate COVID-19 hypoxemia. In this randomized clinical trial with inten-tion-to-treat analysis, we enrolled eligible adults with COVID-19 hypoxemia (SpO2 <94%), requiring supplemental oxygen via nasal prongs or facemask from a tertiary-care setting in Jodhpur, India between June 15 to December 24, 2020. Awake proning comprised of 4-hour cycles with prone position maintained 2 h per cycle. The control group did not maintain any specific position. All participants received standard care. The primary outcomes were 30-day mortal-ity and requirement for mechanical ventilation. Of 502 participants included, mean (SD) age was 59.7 (12.7) years with 124 women (24.6%); 257 were randomized to awake-proning, 245 to control group and all 502 were included for follow-up mortality analysis. Mortality at follow-up was 16.3% in the awake-prone and 15.1% in the control group [OR:1.10 (0.68-1.78), p=0.703). The requirement of mechanical ventilation was 10% in both groups (p=0.974). Survival time (in days) was not significantly different between the groups [Log-rank test, HR: 1.08 (95% CI, 0.70-1.68), p=0.726]. Likewise, time to intubation was comparable (Log-rank test, HR: 0.93 (95% CI, 0.56-1.70), p=0.974). Hence, awake self-proning did not improve survival or requirement of mechanical-ventilation in non-intubated patients with mild to moderate COVID-19 hypox-emia. Trial Registration: Clinical trial registry of India, ID: CTRI/2020/06/025804. The trial is accessible from WHO's International Clinical Trials Registry Platform (ICTRP) at https://trialsearch.who.int *************************************************************** *Appendix Authors list Deepak Kumar1, Gopal Krishna Bohra1, Nishant Kumar Chauhan2, Nikhil Kothari3, Vijaya Lakshmi Nag4 Sanjeev Misra5 1Department of Internal Medicine; 2Department of Pulmonary Medicine; 3Department of Anaesthesiology and Critical Care; 4Department of Microbiology; 5Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.
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Affiliation(s)
- Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Suman Saurabh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Parag Vijayvergia
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Karthikeyan Thangaraju
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Swapnil Tripathi
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | | | - Akhilesh Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Pranav S Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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Allardet-Servent J, Ait Belkacem I, Miloud T, Benarous L, Galland F, Halfon P, Mège JL, Penaranda G, Busnel JM, Malergue F. The Association of Low CD4 Expression on Monocytes and Low CD8+ T-Cell Count at Hospital Admission Predicts the Need for Mechanical Ventilation in Patients With COVID-19 Pneumonia: A Prospective Monocentric Cohort Study. Crit Care Explor 2022; 4:e0810. [PMID: 36518218 DOI: 10.1097/CCE.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To identify COVID-19-associated immunophenotyping patterns at hospital admission and to determine if some patterns could predict the need for mechanical ventilation (MV). DESIGN Prospective observational monocentric cohort study. SETTING A university-affiliated hospital in Marseille, France. PATIENTS Thirty patients presenting with laboratory-confirmed COVID-19 pneumonia were enrolled within the first 48 hours of hospital admission and compared with 18 healthy controls. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Whole-blood leukocytes were immunophenotyped with a rapid and simplified one-step flow cytometry method. Thirty-eight immune and five laboratory parameters were compared first between COVID-19 patients and controls and then between the COVID-19 patients who received or not MV during their stays. The variables that significantly discriminated MV from non-MV patients in univariate analysis were entered into a multiple stepwise logistic regression analysis. The COVID-19 patients were predominantly male (87%), aged 61 years (50-71 yr), and 93% received early corticosteroid therapy. Sixteen patients (53%) were managed with noninvasive respiratory support, and 14 (47%) required MV. Compared with controls, COVID-19 patients were characterized by an immune signature featuring: 1) decreased HLA-DR expression on monocytes; 2) reduced basophils, eosinophils, T-cells, NK cells, and nonclassical monocyte count; and 3) up regulation of CD169 on monocytes, CD64 on neutrophils, the adhesion/migration markers (CD62L and CD11b), and the checkpoint inhibitor CD274 on myeloid cells. Among the COVID-19 patients, those who received MV had lower level of CD4 and HLA-DR on monocytes, lower CD8+ T-cell count, and higher lactate dehydrogenase at hospital admission. In multivariate analysis, only CD4 on monocytes (p = 0.032) and CD8+ T-cell count (p = 0.026) were associated with MV requirement. The model combining these two variables provided an area under curve of 0.97 (95% CI, 0.83-0.99). CONCLUSIONS The association of low CD4 on monocytes and low CD8+ T-cell count at hospital admission was highly predictive of the need for MV in hospitalized patients with COVID-19 pneumonia.
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Giammarioli B, Burns KEA, Patel BK, Sklar MC. Providing respiratory and ventilation care in the face of shifting evidence: current opinion in critical care. Curr Opin Crit Care 2022; 28:660-6. [PMID: 36302195 DOI: 10.1097/MCC.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review the clinical problem and noninvasive treatments of hypoxemia in critically-ill patients with coronavirus disease 2019 pneumonia and describe recent advances in evidence supporting bedside decision making. RECENT FINDINGS High-flow nasal oxygen and noninvasive ventilation, along with awake prone positioning are potentially helpful therapies for acute hypoxemic respiratory failure. High-flow nasal oxygen therapy has been widely implemented as a form of oxygen support supported by prepandemic randomized controlled trials showing possible benefit over noninvasive ventilation. Given the sheer volume of patients, noninvasive ventilation was often required, and based on a well conducted randomized controlled trial there was a developing role for helmet-interface noninvasive. Coupled with noninvasive supports, the use of awake prone positioning demonstrated physiological benefits, but randomized controlled trial data did not demonstrate clear outcome superiority. SUMMARY The use of noninvasive oxygen strategies and our understanding of the proposed mechanisms are evolving. Variability in patient severity and physiology may dictate a personalized approach to care. High-flow nasal oxygen may be paired with awake and spontaneously breathing prone-positioning to optimize oxygen and lung mechanics but requires further insight before widely applying to clinical practice.
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Quach S, Veitch A, Zaccagnini M, West A, Nonoyama ML. Underrepresentation of Respiratory Therapists as Experts in Delphi Studies on Respiratory Practices and Research Priorities. Respir Care 2022; 67:1609-1632. [PMID: 36442987 PMCID: PMC9994035 DOI: 10.4187/respcare.10012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Delphi survey techniques are a common consensus method used to collect feedback from an expert panel to inform practices, establish guidelines, and identify research priorities. Collecting respiratory therapists' (RT) expertise and experiences as part of consensus-building methodologies is one way to ensure that they align with RT practices and to better influence respiratory care practice. This narrative review aimed to report the RT representation in expert panels of Delphi studies focused on respiratory therapy practices and research priorities. The research question that guided this review is: to what extent are RTs included as expert participants among published Delphi studies relate to respiratory therapy and research topics? We conducted a structured search of the literature and identified 23 papers that reported Delphi studies related to respiratory care practices and 15 that reported on respiratory-related research priorities. Delphi studies that focused on reporting consensus on respiratory care practices included the following: (1) mechanical ventilation, (2) high-flow nasal cannula therapy, (3) COVID-19 respiratory management, (4) home oxygen therapy, (5) cardiopulmonary monitoring, and (6) disease-specific guidelines. Delphi studies that focused on establishing respiratory research priorities included the following: (1) theory and practice-orientated knowledge gaps, and (2) priority research topics for empirical investigation. The results of this review suggest that RTs were rarely included as expert participants and, when involved, were minimally represented (5% to 33%). Given RTs' diverse and relevant experience in respiratory care, incorporating their perspectives to inform future education, respiratory care practices, and research priorities would allow evidence to better align with knowledge gaps deemed important for the respiratory therapy profession.
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Affiliation(s)
- Shirley Quach
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
| | - Alanna Veitch
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada
- Department Respiratory Therapy, McGill University Health Centre, Montréal, Quebec, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, New Brunswick, Canada
| | - Mika L Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
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Schulz L, Stewart A, O’Regan W, McCanny P, Austin D, Hallback M, Wallin M, Aneman A. Capnodynamic monitoring of lung volume and blood flow in response to increased positive end-expiratory pressure in moderate to severe COVID-19 pneumonia: an observational study. Crit Care 2022; 26:232. [PMID: 35909174 PMCID: PMC9340710 DOI: 10.1186/s13054-022-04110-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The optimal level of positive end-expiratory pressure (PEEP) during mechanical ventilation for COVID-19 pneumonia remains debated and should ideally be guided by responses in both lung volume and perfusion. Capnodynamic monitoring allows both end-expiratory lung volume (\documentclass[12pt]{minimal}
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\begin{document}$${\text{EELV}}_{{{\text{CO}}_{2} }}$$\end{document}EELVCO2) and effective pulmonary blood flow (EPBF) to be determined at the bedside with ongoing ventilation. Methods Patients with COVID-19-related moderate to severe respiratory failure underwent capnodynamic monitoring of \documentclass[12pt]{minimal}
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\begin{document}$${\text{EELV}}_{{{\text{CO}}_{2} }}$$\end{document}EELVCO2 and EPBF during a step increase in PEEP by 50% above the baseline (PEEPlow to PEEPhigh). The primary outcome was a > 20 mm Hg increase in arterial oxygen tension to inspired fraction of oxygen (P/F) ratio to define responders versus non-responders. Secondary outcomes included changes in physiological dead space and correlations with independently determined recruited lung volume and the recruitment-to-inflation ratio at an instantaneous, single breath decrease in PEEP. Mixed factor ANOVA for group mean differences and correlations by Pearson’s correlation coefficient are reported including their 95% confidence intervals. Results Of 27 patients studied, 15 responders increased the P/F ratio by 55 [24–86] mm Hg compared to 12 non-responders (p < 0.01) as PEEPlow (11 ± 2.7 cm H2O) was increased to PEEPhigh (18 ± 3.0 cm H2O). The \documentclass[12pt]{minimal}
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\begin{document}$${\text{EELV}}_{{{\text{CO}}_{2} }}$$\end{document}EELVCO2 was 461 [82–839] ml less in responders at PEEPlow (p = 0.02) but not statistically different between groups at PEEPhigh. Responders increased both \documentclass[12pt]{minimal}
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\begin{document}$${\text{EELV}}_{{{\text{CO}}_{2} }}$$\end{document}EELVCO2 and EPBF at PEEPhigh (r = 0.56 [0.18–0.83], p = 0.03). In contrast, non-responders demonstrated a negative correlation (r = − 0.65 [− 0.12 to − 0.89], p = 0.02) with increased lung volume associated with decreased pulmonary perfusion. Decreased (− 0.06 [− 0.02 to − 0.09] %, p < 0.01) dead space was observed in responders. The change in \documentclass[12pt]{minimal}
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\begin{document}$${\text{EELV}}_{{{\text{CO}}_{2} }}$$\end{document}EELVCO2 correlated with both the recruited lung volume (r = 0.85 [0.69–0.93], p < 0.01) and the recruitment-to-inflation ratio (r = 0.87 [0.74–0.94], p < 0.01). Conclusions In mechanically ventilated patients with moderate to severe COVID-19 respiratory failure, improved oxygenation in response to increased PEEP was associated with increased end-expiratory lung volume and pulmonary perfusion. The change in end-expiratory lung volume was positively correlated with the lung volume recruited and the recruitment-to-inflation ratio. This study demonstrates the feasibility of capnodynamic monitoring to assess physiological responses to PEEP at the bedside to facilitate an individualised setting of PEEP. Trial registration: NCT05082168 (18th October 2021). Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04110-0.
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Stilma W, Valk CMA, van Meenen DMP, Morales L, Remmelzwaal D, Myatra SN, Artigas A, Neto AS, Paulus F, Schultz MJ. Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients-Insights from the PRoAcT-COVID Study. J Clin Med 2022; 11:jcm11236988. [PMID: 36498564 PMCID: PMC9739110 DOI: 10.3390/jcm11236988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT−COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4−14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41−2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87−1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation.
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Affiliation(s)
- Willemke Stilma
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
- Correspondence:
| | - Christel M. A. Valk
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - David M. P. van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Luis Morales
- Servei de Medicina Intensiva, Hospital Universitari Sant Pau, 08025 Barcelona, Spain
- Translational Research Laboratory, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona Sabadell, 08208 Barcelona, Spain
| | - Daantje Remmelzwaal
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
| | - Sheila N. Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - Antonio Artigas
- Intensive Care Department, CIBER Enfermedades Respiratorias, Parc Tauli University Hospital, 08208 Sabadell, Spain
- Autonomous University of Barcelona, 08193 Sabadell, Spain
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care, Research Center (ANZIC-RC), Monash University, Melbourne 3800, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Boffi A, Ravenel M, Lupieri E, Schneider A, Liaudet L, Gonzalez M, Chiche JD, Piquilloud L. Physiological response to prone positioning in intubated adults with COVID-19 acute respiratory distress syndrome: a retrospective study. Respir Res 2022; 23:320. [DOI: 10.1186/s12931-022-02247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
COVID-19 related acute respiratory distress syndrome (ARDS) has specific characteristics compared to ARDS in other populations. Proning is recommended by analogy with other forms of ARDS, but few data are available regarding its physiological effects in this population. This study aimed to assess the effects of proning on oxygenation parameters (PaO2/FiO2 and alveolo-arterial gradient (Aa-gradient)), blood gas analysis, ventilatory ratio (VR), respiratory system compliance (CRS) and estimated dead space fraction (VD/VT HB). We also looked for variables associated with treatment failure.
Methods
Retrospective monocentric study of intubated COVID-19 ARDS patients managed with an early intubation, low to moderate positive end-expiratory pressure and early proning strategy hospitalized from March 6 to April 30 2020. Blood gas analysis, PaO2/FiO2, Aa-gradient, VR, CRS and VD/VT HB were compared before and at the end of each proning session with paired t-tests or Wilcoxon tests (p < 0.05 considered as significant). Proportions were assessed using Fischer exact test or Chi square test.
Results
Forty-two patients were included for a total of 191 proning sessions, median duration of 16 (5–36) hours. Considering all sessions, PaO2/FiO2 increased (180 [148–210] vs 107 [90–129] mmHg, p < 0.001) and Aa-gradient decreased (127 [92–176] vs 275 [211–334] mmHg, p < 0.001) with proning. CRS (36.2 [30.0–41.8] vs 32.2 [27.5–40.9] ml/cmH2O, p = 0.003), VR (2.4 [2.0–2.9] vs 2.3 [1.9–2.8], p = 0.028) and VD/VT HB (0.72 [0.67–0.76] vs 0.71 [0.65–0.76], p = 0.022) slightly increased. Considering the first proning session, PaO2/FiO2 increased (186 [165–215] vs 104 [94–126] mmHg, p < 0.001) and Aa-gradient decreased (121 [89–160] vs 276 [238–321] mmHg, p < 0.001), while CRS, VR and VD/VT HB were unchanged. Similar variations were observed during the subsequent proning sessions. Among the patients who experienced treatment failure (defined as ICU death or need for extracorporeal membrane oxygenation), fewer expressed a positive response in terms of oxygenation (defined as increase of more than 20% in PaO2/FiO2) to the first proning (67 vs 97%, p = 0.020).
Conclusion
Proning in COVID-19 ARDS intubated patients led to an increase in PaO2/FiO2 and a decrease in Aa-gradient if we consider all the sessions together, the first one or the 4 subsequent sessions independently. When considering all sessions, CRS increased and VR and VD/VT HB only slightly increased.
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47
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Bedford JP, Garside T, Darbyshire JL, Betts TR, Young JD, Watkinson PJ. Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study. J Intensive Care Soc 2022; 23:414-424. [PMID: 36751347 PMCID: PMC9679893 DOI: 10.1177/17511437211022132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study. Methods We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness. Results Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables. Conclusions We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.
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Affiliation(s)
- Jonathan P Bedford
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,Jonathan P Bedford, Kadoorie Centre for
Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley
Way, Headington, Oxford OX3 9DU, UK.
| | - Tessa Garside
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Julie L Darbyshire
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Timothy R Betts
- Radcliffe Department of Medicine, University of Oxford, Oxford,
UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, Oxford, UK
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Perkins EJ, Begley JL, Brewster FM, Hanegbi ND, Ilancheran AA, Brewster DJ. The use of video laryngoscopy outside the operating room: A systematic review. PLoS One 2022; 17:e0276420. [PMID: 36264980 PMCID: PMC9584394 DOI: 10.1371/journal.pone.0276420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
This study aimed to describe how video laryngoscopy is used outside the operating room within the hospital setting. Specifically, we aimed to summarise the evidence for the use of video laryngoscopy outside the operating room, and detail how it appears in current clinical practice guidelines. A literature search was conducted across two databases (MEDLINE and Embase), and all articles underwent screening for relevance to our aims and pre-determined exclusion criteria. Our results include 14 clinical practice guidelines, 12 interventional studies, 38 observational studies. Our results show that video laryngoscopy is likely to improve glottic view and decrease the incidence of oesophageal intubations; however, it remains unclear as to how this contributes to first-pass success, overall intubation success and clinical outcomes such as mortality outside the operating room. Furthermore, our results indicate that the appearance of video laryngoscopy in clinical practice guidelines has increased in recent years, and particularly through the COVID-19 pandemic. Current COVID-19 airway management guidelines unanimously introduce video laryngoscopy as a first-line (rather than rescue) device.
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Affiliation(s)
| | - Jonathan L. Begley
- Alfred Health, Melbourne, VIC, Australia
- Intensive Care Unit, Cabrini Hospital, Malvern, VIC, Australia
| | - Fiona M. Brewster
- Department of Anaesthesia, Royal Women’s Hospital, Parkville, VIC, Australia
| | | | | | - David J. Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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Otáhal M, Mlček M, Borges JB, Alcala GC, Hladík D, Kuriščák E, Tejkl L, Amato M, Kittnar O. Prone positioning may increase lung overdistension in COVID-19-induced ARDS. Sci Rep 2022; 12:16528. [PMID: 36192569 DOI: 10.1038/s41598-022-20881-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022] Open
Abstract
Real-time effects of changing body position and positive end-expiratory pressure (PEEP) on regional lung overdistension and collapse in individual patients remain largely unknown and not timely monitored. The aim of this study was to individualize PEEP in supine and prone body positions seeking to reduce lung collapse and overdistension in mechanically ventilated patients with coronavirus disease (COVID-19)-induced acute respiratory distress syndrome (ARDS). We hypothesized that prone positioning with bedside titrated PEEP would provide attenuation of both overdistension and collapse. In this prospective observational study, patients with COVID-19-induced ARDS under mechanical ventilation were included. We used electrical impedance tomography (EIT) with decremental PEEP titration algorithm (PEEPEIT-titration), which provides information on regional lung overdistension and collapse, along with global respiratory system compliance, to individualize PEEP and body position. PEEPEIT-titration in supine position followed by PEEPEIT-titration in prone position were performed. Immediately before each PEEPEIT-titration, the same lung recruitment maneuver was performed: 2 min of PEEP 24 cmH2O and driving pressure of 15 cmH2O. Forty-two PEEPEIT-titration were performed in ten patients (21 pairs supine and prone positions). We have found larger % of overdistension along the PEEP titration in prone than supine position (P = 0.042). A larger % of collapse along the PEEP titration was found in supine than prone position (P = 0.037). A smaller respiratory system compliance was found in prone than supine position (P < 0.0005). In patients with COVID-19-induced ARDS, prone body position, when compared with supine body position, decreased lung collapse at low PEEP levels, but increased lung overdistension at PEEP levels greater than 10 cm H2O. Trial registration number: NCT04460859.
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50
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Hamazaki N, Koike T, Kariya H, Kobayashi S, Miida K, Fukuda M. Adverse Events During Early Mobility Are Not Associated With Poor Prognosis in COVID-19-Related Acute Respiratory Failure. Respir Care 2022; 67:1327-1331. [PMID: 35443966 PMCID: PMC9994312 DOI: 10.4187/respcare.09872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
| | - Tomotaka Koike
- Department of Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan
| | - Hidenori Kariya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shuken Kobayashi
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kazumasa Miida
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Michinari Fukuda
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; and Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
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