Assisted Ventilation Research Articles

Long-term prognosis and clinical course of choking-induced cardiac arrest in patients without the return of spontaneous circulation at hospital arrival: a population-based community study from the Shizuoka Kokuho Database

BackgroundThe risk of choking increases with aging, and the number of cases of choking-induced cardiac arrest is increasing. However, few studies have examined the prognosis of choking-induced cardiac arrest. The aim of this study was to reveal the rates of survival and dependence on devices in the long term after choking-induced cardiac arrest.MethodsWe analyzed data from the Shizuoka Kokuho Database, which consists of claims data of approximately 2.2 million people, from April 2012 to September 2018. We selected patients with choking-induced cardiac arrest who received cardiopulmonary resuscitation in the hospital. Patients were excluded if they were less than 20 years old, had an upper airway tumor, received ventilation assistance, or received enteral nutrition in the month prior to cardiac arrest. The primary outcome was death, and the secondary outcomes were the rates of survival at 3-months and independence on devices. Descriptive statistics are presented and compared among age groups (20–64 years, 65–74 years, 75–84 years, 85 years and older), and survival time analysis (Kaplan-Meier method) was performed.ResultsIn total, 268 patients were analyzed, including 26 patients in the 20–64 age group, 33 patients in the 65–74 age group, 70 patients in the 75–84 age group, and 139 patients in the ≥85 age group. The overall 3-month survival rate was 5.6% (15/268). The 3-month survival rates were 3.8% (1/26) in the 20–64 age group, 15.2% (5/33) in the 65–74 age group, 8.6% (6/70) in the 75–84 age group, and 2.2% (3/139) in the ≥85 age group. The overall 12-month survival rate was 2.6% (7/268). Of the 7 patients who survived for 12 months, 3 received ventilation management and 5 received tube or intravenous feedings at 3 months. These survivors were still receiving ventilation assistance and tube feedings in the hospital and had not been discharged at 12 months.ConclusionsThe prognosis of choking-induced cardiac arrest was extremely poor when patients were not resuscitated before hospital arrival. Those who survived were mostly dependent on assistive devices. Additionally, none of the survivors dependent on assistive devices had discontinued the use of the devices at the long-term follow-up.

Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group.

BackgroundThere are several observations that the onset of coronavirus 19 (COVID‐19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country‐specific healthcare policies, more national‐level evidence is needed to provide generalizable conclusions.ObjectiveTo compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID‐19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020).MethodsReference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new‐onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily‐reported number of COVID‐19‐related deaths in each region.ResultsWe recorded 3062 cases of new‐onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre‐ and post‐COVID‐19 period, we observed a significant increase in the rate of DKA (37.5%–49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID‐19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080).ConclusionsThe clinical picture of new‐onset children T1D in Poland deteriorated over a 2‐year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID‐19 epidemic.

Successful use of dupilumab to treat eczema in a child with X-linked agammaglobulinemia

We describe here a child with X-linked agammaglobulinemia (XLA) who developed severe generalized eczema that was unresponsive to mid-potency topical corticosteroid but eventually responded to dupilumab. The patient is an 11-year-old boy who initially presented to our clinic at 11 months of age after he was discharged from an outside pediatric intensive care unit owing to respiratory distress needing intubation and assisted ventilation. He was treated with intravenous antibiotics and eventually recovered.

Comparative risk of pulmonary adverse events with transfusion of pathogen reduced and conventional platelet components.

BackgroundPlatelet transfusion carries risk of transfusion‐transmitted infection (TTI). Pathogen reduction of platelet components (PRPC) is designed to reduce TTI. Pulmonary adverse events (AEs), including transfusion‐related acute lung injury and acute respiratory distress syndrome (ARDS) occur with platelet transfusion.Study designAn open label, sequential cohort study of transfusion‐dependent hematology‐oncology patients was conducted to compare pulmonary safety of PRPC with conventional PC (CPC). The primary outcome was the incidence of treatment‐emergent assisted mechanical ventilation (TEAMV) by non‐inferiority. Secondary outcomes included: time to TEAMV, ARDS, pulmonary AEs, peri‐transfusion AE, hemorrhagic AE, transfusion reactions (TRs), PC and red blood cell (RBC) use, and mortality.ResultsBy modified intent‐to‐treat (mITT), 1068 patients received 5277 PRPC and 1223 patients received 5487 CPC. The cohorts had similar demographics, primary disease, and primary therapy. PRPC were non‐inferior to CPC for TEAMV (treatment difference −1.7%, 95% CI: (−3.3% to −0.1%); odds ratio = 0.53, 95% CI: (0.30, 0.94). The cumulative incidence of TEAMV for PRPC (2.9%) was significantly less than CPC (4.6%, p = .039). The incidence of ARDS was less, but not significantly different, for PRPC (1.0% vs. 1.8%, p = .151; odds ratio = 0.57, 95% CI: (0.27, 1.18). AE, pulmonary AE, and mortality were not different between cohorts. TRs were similar for PRPC and CPC (8.3% vs. 9.7%, p = .256); and allergic TR were significantly less with PRPC (p = .006). PC and RBC use were not increased with PRPC.DiscussionPRPC demonstrated reduced TEAMV with no excess treatment‐related pulmonary morbidity.

The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing

BackgroundLiberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study.MethodsThe algorithm included five steps: enrollment criteria, pressure support ventilation (PSV) tolerance trial, weaning criteria, continuous positive airway pressure (CPAP) tolerance trial (0 cmH2O during 2 min) and spontaneous breathing trial (SBT): on fraction of inspired oxygen (FiO2) 40% for 30–120 min. Patients who failed the weaning criteria, CPAP Zero trial, or SBT were randomized. We describe the characteristics of patients who were initially enrolled, but passed all steps in the algorithm and consequently were not randomized.ResultsAmong the 374 enrolled patients, 93 (25%) patients passed all five steps. At time of enrollment, most patients were on PSV (87%) with a mean (± standard deviation) FiO2 of 34 (± 6) %, PSV of 8.7 (± 2.9) cmH2O, and positive end-expiratory pressure of 6.1 (± 1.6) cmH2O. Minute ventilation was 9.0 (± 3.1) L/min with a respiratory rate of 17.4 (± 4.4) breaths/min. Patients were liberated from MV with a median [interquartile range] delay between initial screening and extubation of 5 [1–49] hours. Only 7 (8%) patients required reintubation.ConclusionThe trial algorithm permitted identification of 93 (25%) patients who were ready to extubate, while their clinicians predicted a duration of ventilation higher than 24 h.

The Role of Biochemical and Respiratory Markers in the Mortality of Patients With SARS-CoV-2 Infection in a Mexican Population.

Background: The SARS-CoV-2 pandemic has challenged the traditional perspectives of health care. The objective of our study was to analyze the association of different hematological biomarkers and respiratory assistance with the disease's severity and mortality in COVID-19.Materials and methods: A single reference center, cross-sectional, retrospective, descriptive and analytical, observational study was carried out on 362 SARS-CoV-2 positive adults from April to October 2020.Results: The mean age of the population was 55.92±13.12 years. A distribution by gender of n=227 (63.0%) men and n=135 women (37.0%) was found. Mortality occurred in 14% of the studied population. Comorbidities associated were hypertension n=128 (35.0%) and diabetes n=112 (31.0%). Of the 362 patients, 64 required advanced ventilatory support when taken to the intensive care unit, of these 39 (60.9%) died and only 25 (39.1%) survived (p<0.0001). On the other hand, biochemical indicators such as CRP, D-dimer, DHL, lymphocytes, leukocytes, neutrophils, and the neutrophil/lymphocyte ratio, showed a significant difference (p<0.0001) at admission and during the stay in the intensive care unit.Conclusions: Patients who required ventilatory assistance showed an increased risk of mortality, as did those who were admitted to the intensive care unit. Higher mortality was associated with higher values ​​of CRP, DHL, D-dimer, neutrophil/lymphocytes ratio, total leukocytes, and lower lymphocytes.

Outcomes of acute limb ischemia in COVID-19

ObjectiveThe inflammatory cascade caused by severe acute respiratory syndrome coronavirus 2 infection may result in arterial thrombosis and acute limb ischemia (ALI) with devastating consequences. The aims of this study were to compare outcomes of ALI in the lower extremities in patients with and without coronavirus disease 2019 (COVID-19), and to determine if ALI development in the context of COVID-19 portends a worse prognosis compared with COVID-19 without ALI. MethodsQueries were built on TriNetX, a federated network of health care organizations across the United States that provides de-identified patient data. International Classification of Diseases, 10th revision diagnostic codes were used to identify patients with acute limb ischemia of the lower extremities and COVID-19. The study timeframe was defined as January 20, 2020 to May 20, 2021. Statistical analyses, including propensity-score matching, were done through TriNetX’s internal software. Outcomes looked at are rates of mortality, stroke, myocardial infarction, major adverse limb events, re-intervention, respiratory failure, sepsis, mental health complications, and acute renal failure. Baseline cohort characteristics were also collected. ResultsPatients with ALI with COVID-19 (ALI C19+; n = 526) were significantly less likely than patients with ALI without COVID-19 (ALI; n = 14,131) to have baseline comorbidities, including nicotine dependence (18% vs 33%; P < .0001). In contrast, ALI C19+ patients had significantly more comorbidities than hospitalized patients with COVID-19 without ALI (n = 275,903), including nicotine dependence (18% vs 10%; P < .0001). After propensity matching was performed, ALI C19+ patients had significantly higher rates of mortality (24.9% vs 9.2%; P < .0001), major adverse limb events (5.8% vs 2.9%; P = .0223), and acute renal failure (22.2% vs 14.9%; P = .0025) than patients with ALI. Compared with hospitalized patients with COVID-19 without ALI, ALI C19+ patients had higher propensity-matched rates of respiratory failure and being placed on assisted ventilation (32.9% vs 27%; P = .0369), sepsis (16.9% vs 12.2%; P = .0288), acute renal failure (22.1% vs 14.6%; P = .0019), and mortality (24.7% vs 14.4%; P < .0001). ConclusionsPatients who developed ALI following COVID-19 present with significantly different demographics and comorbidities from those who develop ALI without COVID-19. After controlling for these variables, higher rates of major adverse limb events, acute renal failure, and mortality in patients with ALI with COVID-19 suggest that not only may COVID-19 precipitate ALI, but it may also exacerbate ALI sequelae. Furthermore, development of ALI in COVID-19 portends worse prognosis compared with patients with COVID-19 without ALI.

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial.

BackgroundEmergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia.ObjectiveThe study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications.MethodThis was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 μg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 μg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge.ResultsThe incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO2) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} −1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed.ConclusionsIntravenous infusion of 0.2 μg/kg/min and 0.4 μg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 μg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 μg/kg/min alfentanil dose.Trial registrationChinese Clinical Trial Registry (ChiCTR2100043320)Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-022-00510-5.

Implementation of a checklist improves adherence to evidence-based practices in a pediatric intensive therapy unit

Adherence to evidence-based practices (EBP) allows better management of the health-disease process in critical ill patients, with a close relationship between compliance and the quality achieved. We set out to improve adherence to EBP in patients admitted to a Pediatric Intensive Care Unit (PICU) and to improve the quality-of-care indicators. Controlled before-after study, developed at the PICU of the Pedro de Elizalde Children's General Hospital (PECGH), which involved all patients admitted in the period 12/01/2019 to 08/31/2020. The implementation consisted of a checklist (CL) that included 27 EBP, segmented into 10 improvement areas. Adherence to the CL was considered if it met 80% of EBP. During the study period, 153 patients were admitted to the PECGH PICU. The pre- and post-intervention groups were similar in mechanical ventilatory assistance (MVA) requirements and pre-established mortality. In the last stage, adherence to the CL increased 23% (p <0.001). The MVA usage rate experienced the greatest decrease (18%, p = 0.033). In relation to quality indicators, a decrease in episodes of MVA-associated pneumonia (p = 0.002) and bladder catheter-associated infection (p = 0.001) was evident. There were no differences in mortality or stay in the PICU. The implementation of a CL allowed to increase compliance with the different EBP studied, a lower rate of MVA use, and a reduction in the rate of device-associated infections.

CT psoas calculations on the prognosis prediction of emergency laparotomy: a single-center, retrospective cohort study in eastern Asian population

BackgroundEmergency laparotomy (EL) has a high mortality rate. Clinically, frail patients have a poor tolerance for EL. In recent years, sarcopenia has been used as an important indicator of frailty and has received much attention. There have been five different calculation methods of psoas for computed tomography (CT) to measure sarcopenia, but lack of assessment of these calculation methods in Eastern Asian EL patients.MethodsWe conducted a 2-year retrospective cohort study of patients over 18 years of age who underwent EL in our institution. Five CT measurement values (PMI: psoas muscle index, PML3: psoas muscle to L3 vertebral body ratio, PMD: psoas muscle density, TPG: total psoas gauge, PBSA: psoas muscle to body face area ratio) were calculated to define sarcopenia. Patients with sarcopenia defined by the sex-specific lowest quartile of each measurement were compared with the rest of the cohort. The primary outcome was "ideal outcome", defined as: (1) No postoperative complications of Clavien-Dindo Grade ≥ 4; (2) No mortality within 30 days; (3) When discharged, no need for fluid resuscitation and assisted ventilation, semi-liquid diet tolerated, and able to mobilize independently. The second outcome was mortality at 30-days. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used.ResultsTwo hundred and twenty-eight patients underwent EL met the inclusion criteria, 192 (84.2%) patients had an ideal outcome after surgery; 32 (14%) patients died within 30 days. Multivariate analysis showed that, except PMD, each calculation method of psoas was independently related to clinical outcome (ideal outcome: PML3, P < 0.001; PMI, P = 0.001; PMD, P = 0.157; TPG, P = 0.006; PBSA, P < 0.001; mortality at 30-days: PML3, P < 0.001; PMI, P = 0.002; PMD, P = 0.088; TPG, P = 0.002; PBSA, P = 0.001). In ROC analysis, the prediction model containing PML3 had the largest area under the curve (AUC) value (AUC value = 0.922 and 0.920, respectively).ConclusionThe sarcopenia determined by CT psoas measurements is significantly related to the clinical outcome of EL. The calculation of CT psoas measurement is suitable for application in outcome prediction of EL. In the future, it is necessary to develop a scoring tool that includes sarcopenia to evaluate the risk of EL better.

Outcome prediction during an ICU surge using a purely data-driven approach: A supervised machine learning case-study in critically ill patients from COVID-19 Lombardy outbreak

PurposeCOVID-19 disease frequently affects the lungs leading to bilateral viral pneumonia, progressing in some cases to severe respiratory failure requiring ICU admission and mechanical ventilation. Risk stratification at ICU admission is fundamental for resource allocation and decision making. We assessed performances of three machine learning approaches to predict mortality in COVID-19 patients admitted to ICU using early operative data from the Lombardy ICU Network. MethodsThis is a secondary analysis of prospectively collected data from Lombardy ICU network. A logistic regression, balanced logistic regression and random forest were built to predict survival on two datasets: dataset A included patient demographics, medications before admission and comorbidities, and dataset B included respiratory data the first day in ICU. ResultsModels were trained on 1484 patients on four outcomes (7/14/21/28 days) and reached the greatest predictive performance at 28 days (F1-score: 0.75 and AUC: 0.80). Age, number of comorbidities and male gender were strongly associated with mortality. On dataset B, mode of ventilatory assistance at ICU admission and fraction of inspired oxygen were associated with an increase in prediction performances. ConclusionsMachine learning techniques might be useful in emergency phases to reach good predictive performances maintaining interpretability to gain knowledge on complex situations and enhance patient management and resources.

1049-P: Outcomes for Macrosomic Births by Maternal Diabetes Status

Objective: To determine obstetric outcomes by birthweight (BW) among individuals with and without diabetes mellitus (gestational or pre-existing diabetes) in pregnancy. Study Design: Retrospective cohort study of singleton, non-anomalous, live births in the U.S. from 2012-2018 registered in the National Vital Statistics System. Infants weighing &amp;gt; 3,000g at 37-42 week gestation were included. BW was stratified into four categories: 3,000-3,999g, 4,000-4,499g, 4,500-4,999g and ≥5,000g. Association of BW with outcomes was examined among women with and without diabetes mellitus (DM) . Chi-squared and multivariable logistic regression analyses were performed for statistical comparisons. Results: Of 18,397,3deliveries included in this analysis, 6.3% had DM. Higher BW were associated with higher odds of cesarean delivery, maternal blood transfusion, anal sphincter injury, APGAR &amp;lt;7 at 5 minutes, NICU admission, and assisted ventilation. At ≥5,000g, there were higher odds of neonatal seizures and death. Although findings among pregnant persons without DM were similar, the strength of association for most adverse perinatal outcomes was greater among persons with DM. Conclusion: Fetal macrosomia is associated with significant adverse perinatal outcomes, with even greater odds among deliveries impacted by maternal DM. Prenatal intervention studies to optimize pregnancy health are necessary to improve perinatal outcomes. Disclosure K.Fitch: None. A.R.Hersh: None. B.Garg: None. A.M.Valent: None.

WITHDRAWN

TYPE: Abstract TOPIC: Biotechnology PURPOSE: Development of diaphragmatic paralysis/paresis may lead to dyspnea, respiratory distress, and even respiratory failure.In prolonged cases, the diaphragm atrophies, which renders surgical palliation or pacemaker ineffective.To address this pervasive issue, we have designed and pilot-tested an artificial diaphragm. METHODS: We embedded nano-electromagnetic coils in an elastic polymeric non-immunogenic resin plate.Two plates were superimposed: the top plate is superiorly convex and mobile; the lower plate is flat, and the edges are sutured to adjacent tissues.The device is inserted into the deficiency left by the paralyzed diaphragm.Passing current through the coils, activates the magnetic fields of the plates: if they are charged opposingly, the top mobile plate moves towards the inferior fix plate, pulling the convex portion down, increasing the lung volume(i.e., inspiration).When the currents are reversed (similar magnetic fields), the plates repel each other: the convex plate moves upward, compressing the lung(i.e., expiration).This two-plate package is connected to and controlled by a rechargeable microchip and synchronized with stimulations of the phrenic nerve, to adjust with the respiration rate. RESULTS: We built and surgically affixed the artificial diaphragm double-set to the resected diaphragm of a sheep cadaver model.The sheep was intubated and attached to a mechanical ventilator, set on spontaneous (CPAP) mode with zero pressure support or PEEP.The diaphragm-model generated volumes of up to 850 ML/breath, with MIP=18cmH2O and MEP=14cmH2O. CONCLUSIONS: This device was pilot tested to mimic the inspiratory/expiratory motions of the diaphragm when tested on a cadaveric animal model.It must now be tested on a live animal model. CLINICAL IMPLICATIONS: Assist ventilation, improving patients' QOL. DISCLOSURE: Nothing to declare. KEYWORD: diaphragmatic assist device

Usefulness of a lead-acrylic shield for reducing lens dose of assistant in x-ray CT examination

In computed tomography (CT) examinations, the usefulness of protective glasses for reducing lens exposure to assistants has been reported. The present study aimed to compare the dose reduction effect for assistants with lead-acrylic shields and protective glasses (0.07 mm Pb, 0.5 mm Pb) during CT examination. The air dose distribution in a CT examination room with and without a lead-acrylic shield was compared. It was found that the amount of scattered radiation was significantly reduced by installing a lead-acrylic shield at the CT gantry aperture. Moreover, the reduction rate of air kerma at the assistant’s lens was higher using the lead acrylic shield than with the protective glasses—95.7% during head holding and 76.1% during assisted ventilation.

The Effect of Incompletely Administered Antenatal Corticosteroids on Neonatal Pulmonary Outcomes in Late Preterm Infants

Purpose: Recent obstetric guidelines recommend the administration of antenatal corticosteroids in pregnant women at risk of delivering infants at a gestational age between 34 and 36 weeks. We examined the effect of incompletely administered antenatal corticosteroids on the neonatal pulmonary outcomes in late preterm infants.Methods: Late preterm infants (34&lt;sup&gt;+0&lt;/sup&gt; to 36&lt;sup&gt;+6&lt;/sup&gt; weeks gestational age) born at the Seoul National University Bundang Hospital from January 2019 to June 2020 were retrospectively enrolled. We excluded multiple births except twins, those with major congenital anomalies, deaths, or transfers to other hospitals. An incomplete course of antenatal corticosteroids was defined as one in which the first or the second dose of betamethasone was administered within 24 hours before delivery. The rates of neonatal pulmonary morbidities were compared between late preterm infants given incomplete courses antenatal corticosteroids and their peers who not given antenatal corticosteroids; these morbidities included respiratory distress syndrome and transient tachypnea of the newborn, assisted ventilation including invasive mechanical ventilation, nasal continuous positive airway pressure and high-flow nasal cannula, and admission to neonatal intensive care unit.Results: Logistic regression models were constructed while adjusting for factors which were significant in bivariate models. After adjusting for baseline maternal and neonatal characteristics, we found no significant differences in the rates of neonatal pulmonary morbidities, assisted ventilation, or admission to the neonatal intensive care unit between late preterm infants who received incomplete antenatal corticosteroid therapy and their peers who were not given any antenatal corticosteroids.Conclusion: Incompletely administered antenatal corticosteroids did not significantly alter the neonatal pulmonary outcomes in late preterm infants.

Factors Associated with Receiving No Maternal or Neonatal Interventions among Periviable Deliveries.

The aim of this study was to quantify the influence of maternal sociodemographic, medical, and pregnancy characteristics on not receiving maternal and neonatal interventions with deliveries occurring at 22 to 23 weeks of gestation. This was a case-control study of U.S. live births at 220/6 to 236/7 weeks of gestation using vital statistics birth records from 2012 to 2016. We analyzed births that received no interventions for periviable delivery. Births were defined as having no interventions if they did not receive maternal (cesarean delivery, maternal hospital transfer, or antenatal corticosteroid administration) or neonatal interventions (neonatal intensive care unit admission, surfactant administration, antibiotic administration, or assisted ventilation). Logistic regression estimated the influence of maternal and pregnancy factors on the receipt of no interventions when delivery occurred at 22 to 23 weeks. Of 19,844,580 U.S. live births in 2012-2016, 24,379 (0.12%) occurred at 22 to 23 weeks; 54.3% of 22-week deliveries and 15.7% of 23-week deliveries received no interventions. Non-Hispanic Black maternal race was associated with no maternal interventions at 22 and 23 weeks. Private insurance, singleton pregnancy, and small for gestational age were associated with receiving no neonatal interventions at 22 and 23 weeks of gestation. Withholding or refusing maternal and neonatal interventions occurs frequently at the threshold of viability. Our data highlight various sociodemographic, pregnancy, and medical factors associated with decisions to not offer or receive maternal or neonatal interventions when birth occurs at the threshold of viability. The data elucidate observed practices and may assist in the development of further research. · Non-Hispanic Black race was associated with receiving no maternal interventions.. · Indicators of high socioeconomic status were associated with no neonatal inventions.. · Patient-level factors influence the receipt of no interventions for periviable birth..

Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease.

Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease.

Improving Helmet CPAP Use During COVID-19 Pandemic: A Multidisciplinary Approach in the Emergency Department.

The aim of this article is to describe the importance of a multidisciplinary team dedicated to noninvasive ventilation training of the emergency department's staff. In our experience, the presence of a medical and nursing “noninvasive ventilation group” made it possible to quickly teach expertise on the management of noninvasive ventilation of COVID-19 patients among emergency department doctors and nurses. This allowed improving a standardized approach regarding the identification and ventilatory assistance of patients with SARS-CoV-2 pneumonia needing ventilatory support, the correct use of the devices, and quick identification and reduction of the complications associated with noninvasive ventilation.In this article, we would like to encourage the formation of similar working groups in all situations where this is not yet present.

US Incidence of Late-Preterm Steroid Use and Associated Neonatal Respiratory Morbidity After Publication of the Antenatal Late Preterm Steroids Trial, 2015-2017

The Antenatal Late Preterm Steroids (ALPS) trial demonstrated a 20% reduction in the risk of respiratory complications in neonates at risk for a late-preterm birth who were exposed to antenatal corticosteroids compared with those who were not. To assess whether new evidence of steroid administration for neonatal respiratory benefit in the late-preterm period is associated with changes in obstetric practice and the use of assisted ventilation for the neonate after delivery. This cross-sectional study of US births from February 1, 2015, to October 31, 2017, as ascertained from US natality data, included live-born, singleton neonates born between 34 and 36 completed weeks of gestation to people without pregestational diabetes. An interrupted time series analysis using Poisson regression models was conducted. Data were analyzed from July 11, 2022, to November 9, 2022. Public dissemination of the ALPS trial results, which occurred during a 9-month period from February 1, 2016 (first published online), to October 31, 2016 (time of the last major professional society's guideline update in the months after the trial's publication). Steroid use, any assisted ventilation use, and assisted ventilation use for more than 6 hours immediately after the dissemination period. A total of 707 862 births were included, divided among the 12-month predissemination period (n = 250 643), dissemination period (n = 195 736), and 12-month postdissemination period (n = 261 493). Most births were at 36 weeks of gestation (53.9% in the predissemination and postdissemination period; P = .10). Small but significant differences were found between the predissemination and postdissemination period cohorts: there were more individuals 35 years or older (19.5% vs 17.9%), fewer White individuals (67.8% vs 69.8%), and more publicly insured individuals (50.5% vs 50.1%) in the postdissemination period compared with the predissemination period, respectively (P < .001 for all). Compared with what rates were expected based on the predissemination trends, the adjusted rate of steroid use increased from 5.0% to 11.7% (adjusted incidence rate ratio [IRR], 2.34; 95% CI, 2.13-2.57), and assisted ventilation use decreased from 8.9% to 8.2% (adjusted IRR, 0.91; 95% CI, 0.85-0.98) after the dissemination period. No change was observed in assisted ventilation use for more than 6 hours (adjusted IRR, 0.98; 95% CI, 0.87-1.10). These findings suggest that there was an immediate change in practice of administering antenatal steroids and a reduction in neonatal morbidity among late-preterm births associated with the dissemination of the ALPS trial, suggesting that this evidence may be translating into a reduction in immediate respiratory morbidity outside the context of a clinical trial.

C45 LATE CARDIAC OUTCOMES IN PATIENTS AFTER COVID–19: A CARDIAC MAGNETIC RESONANCE STUDY

BackgroundMyocardial injury can occur in patients with coronavirus disease (COVID)–19. Cardiac magnetic resonance (CMR) provides information on functional and morphological cardiac parameters, as well myocardial tissue characterization. Actually, there are few data on late cardiac outcomes in patients after COVID–19.Aim of the StudyTo assess late functional, morphological and myocardial tissue parameters in patients positive to COVID–19 Methods 55 patients (age 50±16 yrs, Female n = 17) with a prior diagnosis of COVID 19, without a previous history of cardiac disease were enrolled in the study. Of these, 35 were hospitalized. The time interval between COVID–19 diagnosis and CMR was 418±28 days. Cardiac function and myocardial tissue characterization have been evaluated with the current CMR techniques. In particular, the presence of late gadolinium enhancement (LGE), as a sign of myocarditis outcome has been evaluated.ResultsLGE was present in 19 patients (34.5%). In all cases, LGE was localized at the level of lateral wall of left ventricle within the myocardium or at the subepicardial level (non–ischemic pattern). Left and right ventricular (LV, RV) ejection fraction were within normal values (mean±SD 65±5% and 65±7%, respectively), as well as volumes (LV endiastolic and endsystolic volumes 71±15 and 27±8 ml/m2; RV endiastolic and endsystolic volumes 72±15 and 25±9 ml/m2). In one case, LGE was associated to regional wall hypokinesia. Among the hospitalized patients, the following factors were associated to the presence of LGE: prone position during assisted ventilation, duration of hospitalization. LGE was present in 67% of patients put in prone position, against 33% of patients not pronated (p = 0.009 Fisher‘s exact test). Duration of hospitalization was 9±5 and 16±7 respectively in patients without and with LGE (p = 0.007)ConclusionLGE, as an outcome of myocarditis, is present in a significant number of patients with a history of COVID–19, but it is not associated with dilatation or global and regional dysfunction of left ventricle. LGE is mainly present in pts with more severe clinical presentation of COVID–19