Toilet bronchoscopy in respiratory ICU: a randomized controlled clinical trial

Effect of Modified Ultrafiltration on Pulmonary Function After Cardiopulmonary Bypass

ObjectiveThe primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.MethodsIn this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.ResultsPatients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).ConclusionBased on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system’s effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.Trial registration: Chictr.org: ChiCTR1900021452LAY ABSTRACTThis study explored whether using virtual reality technology to help patients in the Respiratory Intensive Care Unit perform early limb exercises could improve their recovery compared to traditional exercise methods. Patients were divided into two groups: one used virtual reality to assist with exercises, while the other followed standard exercise routines. Over one week, the virtual reality group showed better results in terms of exercise time, muscle strength, grip strength, and overall recovery. The study found that virtual reality-based exercises were more engaging and effective, leading to higher patient compliance and faster improvements in physical health. This suggests that virtual reality could be a valuable tool in helping Respiratory Intensive Care Unit patients recover more quickly and efficiently.

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU.. Key words: Enteral nutrition; Parenteral nutrition; Elderly patients in respiratory intensive care unit; Respiratory muscle strength; clinical outcome

Background Prediction of weaning outcome is still challenging. Among the reported causes of weaning failure is the diaphragmatic dysfunction. Diaphragmatic ultrasound indices were endorsed for predicting weaning outcome but with conflicting results. Therefore, this study aimed to evaluate ultrasonographic diaphragmatic indices for predicting weaning outcome in respiratory intensive care unit (RICU) patients. Patients and methods The study enrolled 40 RICU patients who were considered eligible for spontaneous breathing trial (SBT). Ultrasound of the right hemidiaphragm was performed immediately after the start of SBT. Assessment of the diaphragmatic excursion using M-mode in semisitting position was done. Moreover, the diaphragmatic thickness at the end of inspiration (Tdi) and expiration (Tdex), with the patient in supine position, was assessed. Diaphragmatic thickness fraction was then calculated. During SBT, patients’ respiratory rate, heart rate, rapid shallow breathing index (RSBI), and minute ventilation were recorded. Tracheal airway occlusion pressure (P0.1) and negative inspiratory force were measured using the ventilator software. Results The diaphragmatic indices did not appear to have a significant role in predicting successful weaning with area under the curve less than 0.56 for all of them. Moreover, no statistically significant difference in Tdi, Tdexe, thickness fraction, and diaphragmatic excursion was observed between the success and failure weaning groups. However, the RSBI performed as the best parameter in predicting weaning success, with area under the curve of 0.831. A cutoff value of 78 had 91% sensitivity and 84% specificity. Conclusion Ultrasonographic diaphragmatic indices are not satisfactory tools to predict weaning outcome in RICU compared with RSBI and other reported traditional indices.

To determine the risk factors for respiratory intensive care unit (RICU)-acquired colonization of multidrug-resistant Acinetobacter baumannii (MDR-AB). From January 2010 to June 2011, active screening was performed to define patients with RICU-acquired colonization of MDR-AB. And environment surveillance was carried out and patient data were collected. Logistic regression was applied to identify the risk factors of RICU-acquired colonization of MDR-AB. Active screening for MDR-AB was performed for 110 patients in RICU and 50 patients turned out to be positive. After eliminating 3 input positive patients, the RICU-acquired colonization rate of MDR-AB was 43.9% (47/107). The environmental contaminated rate of MDR-AB was 66.0% (31/47) for 47 positive patients and 33.9% (19/56) for 56 negative ones (χ(2) = 10.494, P < 0.01). Five risk factors were associated with the colonization of MDR-AB through univariate analysis: consciousness disturbance, use of carbapenems, nasal feeding tube, endotracheal intubation and mechanical ventilation (all P < 0.05). The Logistic regression equation contained 3 risk factors of conscious disturbance, use of carbapenems and mechanical ventilation (OR = 3.412, 3.211, 3.002; 95% CI: 1.165 - 9.992, 1.117 - 9.233, 1.101 - 8.182). Three risk factors are independently associated with the RICU-acquired colonization of MDR-AB: consciousness disturbance, use of carbapenems and mechanical ventilation.

BackgroundCritically ill patients in intensive care unit (ICU) are at high risk of venous thromboembolism (VTE). The standardized prophylaxis of VTE in these patients and the appropriate prevention protocols are not very clear.MethodWe enrolled 426 patients admitted to respiratory intensive care unit (RICU), all of them underwent Padua risk scoring and patients at high risk of VTE also underwent bleeding risk scoring. We compared the VTE prevention methods that followed the guidelines between two different bleeding risk groups and the VTE incidence of these two groups. We also analyzed the risk factors for VTE in RICU patients.ResultsIn patients admitted to RICU, the rate of overall VTE prophylaxis was 71.3% (295/414), but the rate of standardized prophylaxis of VTE was only 32.6% (135/414). The standardized prophylaxis rate of VTE in high-risk bleeding patients was 40.3%, much higher than the 22.2% in low-risk bleeding patients (P < 0.001). There was also a significant difference in the incidence of VTE between the two groups (26.9%vs3.4%, P < 0.001). 70 (16.9%) patients in RICU developed VTE, the multivariable logistic regression analysis showed that immobilization time, pulmonary encephalopathy, oral or inject corticosteroids, trauma or surgery within 3 months were independent risk factors of VTE in patients admitted to RICU, while pharmacological prophylaxis was a protective factor for VTE. The receiver operating characteristic (ROC) curve showed that the above composite indicators had a higher predictive value for RICU patients with VTE, with a ROC area under the curve (AUC) of 0.925 (95%CI 0.894–0.956, P < 0.001).ConclusionAlthough the overall prophylaxis rate of VTE in patients admitted to RICU was high, the rate of standardized prevention was not ideal. Pharmacological prophylaxis may play an important role in preventing VTE in RICU patients and fruther studies are needed to explore the optimal thromboprophylaxis protocol for critically ill patients.

Background Dead space refers to the part of each tidal volume that does not contribute to gas exchange. It serves as an indicator of lung function efficiency. Aim To evaluate the end-tidal-to-arterial PCO2 ratio and Acute Physiological and Chronic Health Assessment (APACHE IV) scoring system as prognostic values in mechanically ventilated patients at the respiratory intensive care unit (ICU). Patients and methods This prospective cohort research was done on 40 mechanically ventilated patients due to different respiratory causes who were admitted at the respiratory ICU at Ain Shams University hospitals. Results This study found that decreasing end tidal PCO2 (PETCO2)/arterial carbon dioxide (PaCO2) is associated with higher mortality amongst mechanically ventilated cases in respiratory ICU. A significant negative association between APACHE IV score and end-tidal to arterial PCO2 ratio following 1 h and after 24 h of mechanical ventilation. APACHE IV score showed a significant relation with mortality, being higher in survivors than nonsurvivors. Conclusion PETCO2/PaCO2 is a relevant prognostic value that reflects dead space ventilation among mechanically ventilated patients in respiratory ICU. APACHE IV score is a good mortality predictor in respiratory ICU.

ABSTRACTObjectiveThis retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).MethodsWe enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile‐negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.ResultsThe incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO2/FiO2 (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25–13.26; p = 0.02). The CDI group had a nonsignificantly higher 60‐day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).ConclusionIn this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60‐day mortality, it was linked to prolonged RICU hospitalization.

Patterns of admitted cases to Respiratory Intensive Care Unit at Zagazig University Hospitals, Egypt

EARLY INFECTIOUS PULMONARY COMPLICATIONS IN AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) RECIPIENTS

BackgroundThe evolving pathogen spectrum and prognosis of severe pulmonary infections in the respiratory intensive care unit (RICU) during the coronavirus disease 2019 (COVID-19) pandemic remain unclear. This study aimed to investigate shifts in the pathogen landscape of pulmonary infections among intensive care unit (ICU) patients following the regular prevention and control of COVID-19.MethodsA total of 132 patients with pulmonary infections admitted to the RICU of the First Affiliated Hospital of Anhui Medical University between January 2022 and March 2023 were included in the study. Patients were categorized into two cohorts: pre-strategy (n=65, Jan to Nov 2022) and post-strategy (n=67, Dec 2022 to Mar 2023), based on the implementation of regular COVID-19 prevention and control measures. Metagenomic next-generation sequencing (mNGS), and conventional tests using bronchoalveolar lavage fluid (BALF) and blood samples were used to detect pathogens. Retrospective data were obtained from the patients’ medical records. The spectrum of pathogens was analyzed. Additionally, univariate and multivariate logistic regression models were employed to analyze the risk factors associated with adverse outcomes.ResultsAfter the regular prevention and control of COVID-19 in December 2022, there was a significant shift in the pathogen landscape. The proportion of patients with severe acute respiratory coronavirus 2 (SARS-CoV-2) increased dramatically from 0% to 74.6%. This was accompanied by a significant rise in the incidence of Staphylococcus aureus (S. aureus) infections. Among the COVID-19 patients, a slight decrease in Gram-negative (G−) bacterial co-infections and a corresponding increase in Gram-positive (G+) bacterial co-infections was observed. The overall mortality rate among all enrolled patients was 30.3%, with 24.6% in the pre-strategy group and 35.8% in the post-strategy group. Additionally, there was a marked increase in the detection rates of Candida and herpes simplex virus 1 (HSV-1) in COVID-19 patients following the strategy change. The analysis of risk factors revealed that a poor prognosis was strongly associated with co-infections of SARS-CoV-2 with Candida [odds ratio (OR) =2.91, 95% confidence interval (CI): 1.01–8.41] or Aspergillus (OR =3.08, 95% CI: 0.89–10.66) species. Further, bacterial and fungal co-infections (OR =3.92, 95% CI: 1.41–10.86) were identified as significant risk factors for a poor prognosis in patients without COVID-19.ConclusionsOur findings highlight the pathogen spectrum in RICU patients changed significantly after the shift in COVID-19 policy. Co-infections with fungi and G+ bacteria require increased clinical vigilance and early intervention to improve outcomes.

Objective To investigate the state of β-lactamase genes and disinfectant resistance gene qacE/△ 1-sul1 in multi-drug resistant Acinetobacter baumannii clinically isolated in respiratory intensive care unit (RICU) of the hospital. Methods 16 strains of multi-drug resistant Acinetobacter baumannii were isolated from hospitalized patients in RICU. β-lactamase genes including TEM, SHV, PER, DHA,IMP,VIM, OXA-23, OXA-24 and qacE/△1-sul1 were detected by PCR. The homology of multi-drug resistant strains was investigated by polygene cluster analysis. Results In 16 strains of multi-drug resistant Acinetobacter baumannii, the positive rates of blaOXA-23, blaTEM, blaDHA, blaOXA-24,blaPER and qacE/△1-sul1 were 31.25%, 12.50%, 12.50%, 6.25%, 6.25% and 100.00%, respectively,while blaSHV, blaIMP, blaVIM were all negative. Polygene cluster analysis result showed that there was a clone propagation phenomenon. Conclusions Multi-drug resistant Acinetobacter baumannii carries various β-lactamase genes in RICU of the hospital,the positive rate of qacE/△1-sul1 is high. The cluster analysis shows that there is a clone propagation phenomenon,which should be paid attention to. Key words: Multi-drug resistance; Acinetobacter baumannii; Drug-resistant gene; Cluster analysis

BackgroundPoint of care ultrasonography (POCUS) is a real time examination that can be used in the emergency room and intensive care unit (ICU). It can provide low-cost modality in short period of time that can help the clinician in better management the ICU patients. The aim of the current work was to evaluate the impact of POCUS (focused heart, lung, IVC and Doppler lower limb) in improving the outcome of deteriorating patients in the respiratory intensive care unit (RICU), via narrowing differential diagnosis and earlier start of target therapy.MethodsThis prospective study included 126 deteriorated patients in the RICU. The POCUS was performed to all included patients, together with the indicated laboratory and radiological investigations (Chest x-ray, computerized tomography, and conventional echocardiography) to detect the agreement between POCUS and the gold standard techniques to assess the POCUS effectiveness. The impact of applying POCUS on the outcome of the studied patients was evaluated regarding ICU and in hospital length of stay and the 30-day mortality.ResultsThe included patients were 51 males (40.5%) and 75 females (59.5%) with a mean ±SD of age 45.4 ± 15.7 years. POCUS showed a good agreement with the gold standard techniques. There was significant improvement in outcome of the studied patients as regard ICU and in hospital stay with early using of POCUS examination but no significant difference in 30 days mortality rate of the studied patients.ConclusionPOCUS is an effective modality in the management of deteriorating patients in the RICU with a good impact on the patient outcome.

Incidence of and risk factors for post–intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study

Nutritional risk assessment is often difficult in intensive care unit (ICU) patients. NUTRIC (NUTrition RIsk in Critically ill) and modified (m) NUTRIC scores (without IL-6), are ICU-specific nutritional risk assessment tools. The aim of this study was to evaluate whether mNUTRIC score is related with ICU prognosis in respiratory ICU patients. Methods: Prospective observational study was performed in a respiratory ICU in a university hospital. All adult patients admitted between October 2018- October 2019 were recruited. mNUTRIC score was calculated within 24 h of admission. Results: 101 patients (34.7% female, mean age 66 ±12 (23-90 years), mean body mass index 25± 6 kg/m2 (12-50) were enrolled. Main diagnoses were COPD acute exacerbation in 27.2 %, pneumonia in 24.3 % and interstitial lung disease in 15.5 %. Mean mNUTRIC score was 4±1.8 (0-10). High nutritional risk which was defined as m NUTRIC≥5 was observed in 39.6 % of the study group. When the two groups compared, patients with high nutrional risk (n=40) had longer mean mechanical ventilation (1.8±3.4 vs. 5.8±7 days), ICU (6.2±5 vs. 9.4±7.8 days) and hospital length of stay (15.1±8.8 vs. 21.8±13.4 days) than the patients with low nutrional risk (p Conclusion: Nearly 40 % of respiratory ICU patients are at high nutrional risk which was associated with increased morbidity and mortality.