Noninvasive Ventilation Days Research Articles

Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak.

Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.

Case Report: Whole lung lavage therapy for pulmonary alveolar proteinosis: a double-edged sword

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by the excessive accumulation of lipoprotein material in the alveoli. No uniform treatment existed. However, whole lung lavage (WLL) remains the main treatment. We report the case of a 33-year-old non-smoking man, with no reported history of medical problems, who complained of dyspnea on exertion and cough for over 5 years. A CT scan revealed diffuse pulmonary interstitial infiltrates. Bronchoalveolar lavage was milky. WLL was planned, and the procedure was repeated 70 times and a total of 3,5 liters of saline serum was instilled and 2,8 liters of milky liquid was removed. The operation procedure was interrupted because of acute pulmonary edema. The patient was transferred to the intensive care unit for acute respiratory distress syndrome. He received 3 days of noninvasive ventilation and regression of supplemental oxygen. Faced with the seriousness of the complication it was decided not to perform a third wash and to monitor the patient functionally and radiologically. Currently, after one year of the lung wash the patient is stable functionally and radiologically. We presented a rare complication of a WLL in a patient with PAP. Physicians should evaluate the patient carefully before suggesting WLL, which is an invasive procedure requiring general anesthesia for a pathology that may evolve spontaneously favorably.

255: IMPACTS OF MECHANICAL VENTILATION ON PATIENTS AND FAMILIES TWO MONTHS AFTER CRITICAL ILLNESS

Introduction: The outcomes of mechanically ventilated children surviving a critical illness remain poorly characterized, and increased knowledge may lead to strategies improving post-PICU care. We compared the outcomes of PICU survivors who received invasive mechanical ventilation (IMV) vs. non-invasive ventilation (NIV) 2 months after PICU discharge. Methods: This is a retrospective cohort study of children admitted for ≥4 days with ≥2 days of IMV or ≥4 days of NIV to the PICU of CHU Sainte-Justine. Two months after PICU discharge, patients were evaluated at the follow-up clinic, and parents were asked to fill out questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety, and Depression Scale). Continuous and dichotomous data were compared using Mann-Whitney and Fisher’s exact tests. Results: From Oct 2018 to Dec 2021, 152 patients were included. 106 patients received IMV (+/-NIV), and 46 patients exclusively received NIV. Duration of respiratory support (11.8+/-2.3 vs. 8.2 +/-3.1 days, p=0.22) was similar between groups, while duration of PICU stay was longer (34.1+/-9.2 vs 13.0+/-4.2 days, p=0.008) and worst PELOD was higher (10.4+/-0.4 vs 3.2+/-0.4, p=0.001) in IMV patients. The diagnosis was a respiratory illness in 30.2% of IMV vs. 78.3% of NIV patients (p=0.04). Quality of life scores were similar between groups (physical score 77.3+/-21.1% vs. 79.7+/-17.4%, p=0.73 and psychological score 79.7+/-16.0% vs 80.3+/-18.3% p=0.68). At follow-up, more patients in the NIV group had persistent respiratory difficulties (26.7% vs. 10.4%, p=0.01). Reported rates of fatigue (19.0% vs. 8.0%, p= 0.18), voice change (10.4% vs. 6.6%, p=0.44), and sleep disorders (17.1% vs. 8.9%, p=0.11) were similar between groups. There was no difference in parental anxiety (28.9 vs. 35.0%, p=0.83) and depression symptoms (24.7% vs. 23.5%, p=0.94) between groups. Conclusions: PICU survivors and their family experienced physical and neurobehavioral morbidities 2 months after their critical illness, whether they received IMV or NIV. Patients’ quality of life and parental symptoms of anxiety and depression did not differ according to the respiratory support. Persistent respiratory difficulties were more common in the NIV group. These findings suggest that PICU follow-up clinics should include patients receiving NIV.

EXtreme Gradient Boosting-based method to classify patients with COVID-19

Different demographic, clinical and laboratory variables have been related to the severity and mortality following SARS-CoV-2 infection. Most studies applied traditional statistical methods and in some cases combined with a...

PICU Follow-Up Clinic: Patient and Family Outcomes 2 Months After Discharge.

Hospitalization in a PICU is a life-altering experience for children and their families. Yet, little is known about the well-being of these children after their discharge. We are describing the outcome of PICU survivors at a PICU clinic 2 months after discharge. Prospective cohort study. PICU and PICU clinic of CHU Sainte-Justine. Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, odds ratio greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine. Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, or greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine PICU. None. Patients were evaluated by a pediatric intensivist 2 months after discharge at the follow-up clinic. They were asked to fill out validated questionnaires. One hundred thirty-two patients were followed from October 2018 to September 2020. The PICU diagnoses were respiratory illness (40.9%), head trauma, and septic shock (7.6%). Average length of PICU stay was 28.5 ± 84.2 days (median 7 d). Sixty-one percent were intubated. Symptoms reported by families were as follows: fatigue (9.9%), sleep disturbances (20.5%), feeding difficulties (12.1%), and voice change and/or stridor (9.8%). Twenty-one percent of school-aged children reported school delays. Twenty-seven children demonstrated communication delays, 45% gross motor function delays, 41% fine motor delays, 37% delays in problem-solving, and 49% delays in personal-social functioning. Quality of Life scores were 78.1 ± 20.5 and 80.0 ± 17.5 for physical and psychosocial aspects, respectively. Fourteen percent of parents reported financial difficulties, 42% reported symptoms of anxiety, 29% symptoms of depression. PICU survivors and their families experience significant physical and psychosocial morbidities after their critical illness. PICU follow-up is crucial to determine the outcome of these children and develop interventions.

Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit.

Noninvasive ventilation (NIV) has become the preferable modality of respiratory support for spontaneously breathing premature infants in the neonatal ICU (NICU). Whereas NIV support contributes to the prevention of long-term respiratory sequelae from mechanical ventilation, the nasal interfaces used are well known for placing patients at risk for development of NIV device-related pressure injuries (PIs). After implementing clinical practice guidelines promoting the use of sealing NIV interfaces for respiratory support in a level IV NICU, an increase in the frequency of stage 2 or worse and deep tissue injury (DTI) PI was observed. We hypothesized that the implementation of a multifaceted skin care bundle (SCB) would reduce the incidence of NIV device-related PI. Quality improvement methodology was used to evaluate the impact of implementing an SCB for patients supported with NIV via a nasal interface. Incidence rate of stage 2 or worse and DTI PI was reported per 100 NIV days over 4 distinct time periods: (1) pre-NIV guideline, (2) post-NIV guideline, (3) post SCB, and (4) sustainability phase. Incidence comparisons were made using one-sided P values from the Farrington-Manning test of equal risks with a significance level of 0.05. The NICU experienced a notable rise in NIV device-related PI after implementation of NIV guidelines (0.01 vs 0.34 per 100 NIV days; P = .01). After application of an SCB, a decrease in NIV device-related skin PI was achieved (0.34 vs 0.07 per 100 NIV days; P = .04), representing a 79% reduction. A collaborative and multidisciplinary team approach was used to promote engagement with clinical staff to address a preventable harm. The implementation of a multifaceted PI prevention bundle contributed to reducing harm while permitting the continued use of appropriate respiratory support to a highly vulnerable patient population in the NICU.

Inhaled hypertonic saline after pediatric lung transplant-Caution required?

Management of pulmonary infection following lung transplant is multifaceted and includes respiratory physiotherapy. Inhaled hypertonic saline (HTS) has been introduced as an adjunct to physiotherapy in pediatric transplant patients. There are no published studies investigating the use of HTS in this population. This study aimed to evaluate the effect of inhaled HTS, in the acute post-operative period, in pediatric lung transplant patients. A retrospective case-note review was completed at a single UK pediatric transplant center. An intervention group who received HTS was compared to a historical control group. Participants were frequency matched for age, gender, and diagnosis (14 per group); median age in years was 13.7(IQR 12.7-15.3) in the controls and 14.8(IQR 12.4-16.1) in the intervention group. Primary outcome was the requirement of invasive and non-invasive ventilation. Secondary outcomes included oxygen use and length of stay. Median days of invasive ventilation were shorter in the control group (1, 95% CI 1-1) compared to the intervention group (2, 95% CI 1-2.5) (P<.05). Days of non-invasive ventilation and oxygen were higher in the HTS group, but this was not statistically significant. The controls displayed shorter median length of stay (23days, 95% CI 20-24) compared to the intervention group (31days, 95% CI 24.5-39) (P<.05). The results of this small study provide uncertainty regarding the safety of inhaled hypertonic saline after lung transplant. There was a trend of poorer acute outcomes in patients who received HTS. However, the findings should be interpreted with caution and further investigation using larger samples is required.

Application of acute physiology and chronic health evaluation II score in the timing of noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

To explore the application of acute physiology and chronic health evaluation II (APACHE II) score in the timing and nursing of noninvasive ventilation for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). 106 AECOPD patients admitted to Haikou People's Hospital from January 2018 to October 2019 were selected as the study objects. According to the method of random number table, the patients were divided into observation group and control group, with 53 patients in each group. The control group selected the timing of noninvasive ventilation treatment according to the standards of Mechanical ventilation (second edition), weaned according to Clinical practice of mechanical ventilation, and received routine nursing in intensive care unit (ICU), including creating comfortable indoor environment, reasonable diet, condition monitoring, psychological nursing and complications nursing. On the basis of the control group, the patients in the observation group were given noninvasive ventilation when APACHE II score was more than 10, and were weaned when APACHE II score was less than or equal to 10. According to APACHE II score < 10, 10-14, 15-19 and ≥ 20, the patients were given level-3 care, level-2 care, level-1 care and intensive care. The pulmonary function before and 3 days after the noninvasive ventilation treatment was monitored, and the duration of mechanical ventilation, the length of ICU stay, endotracheal intubation rate, incidence of complication [ventilator associated pneumonia (VAP)] and ICU mortality were recorded. The self-designed questionnaire of nursing satisfaction was used to evaluate the patients' nursing satisfaction. There was no significant difference in general data such as gender or age between the two groups. After 3 days of noninvasive ventilation, the forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio of the two groups were increased significantly as compared with those before treatment, especially in the observation group, with statistical significances as compared with the control group [FEV1 (L): 3.02±0.22 vs. 2.54±0.19, FVC (L): 3.01±0.32 vs. 2.13±0.28, FEV1/FVC ratio: 0.89±0.08 vs. 0.79±0.08, all P < 0.05]. Compared with the control group, the duration of mechanical ventilation and length of ICU stay in the observation group were significantly shortened [duration of mechanical ventilation (days): 4.32±0.73 vs. 8.42±1.94, length of ICU stay (hours): 32.23±10.22 vs. 38.52±9.85, both P < 0.01]. The intubation rate, incidence of VAP and ICU mortality in the observation group were significantly lower than those in the control group [intubation rate: 1.9% (1/53) vs. 13.2% (7/53), incidence of VAP: 1.9% (1/53) vs. 15.1% (8/53), ICU mortality: 1.9% (1/53) vs. 13.2% (7/53), all P < 0.05]. The nursing satisfaction of patients in the observation group was significantly higher than that in the control group [96.2% (51/53) vs. 75.5% (40/53), P < 0.01]. APACHE II score can be used to guide the choice of noninvasive ventilation treatment opportunity and nursing intervention measures for AECOPD patients. It can significantly improve the pulmonary function of patients, improve the treatment effect, reduce the incidence of complications, and improve the satisfaction of patients with nursing, which is effective in clinical application.

Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit

PurposeTo assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). Methods and materialsRetrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. ResultsThe study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81–0.84) for hospital death, compared with 0.79 for OASIS (P < .05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P < .001), APACHE IV predicted mortality (P = .007), Charlson Comorbidity Index (P < .001), noninvasive ventilation use (P < .001), and noninvasive ventilation days (P = .02). ConclusionsContemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.

Trends in Mortality and Morbidity in Infants Under 500 Grams Birthweight: Observations from Our Neonatal Intensive Care Unit (NICU).

BackgroundIn our previous study, some changes were presented in obstetric care and we studied the morbidity and mortality trends of infants with <500 grams birth weight. Several neonatal protocol changes occurred during the study period. The aim of this study was to analyze the changes in mortality and morbidity of premature infants in light of changing neonatal protocols.Material/MethodsWe performed a retrospective study of premature infants with <500 grams birth weight, born at our department between 2006 and 2015. We divided the study period into two 5-year epochs and compared mortality and morbidity rates. We calculated the duration of mechanical ventilation and non-invasive respiratory support, and also investigated the potential impact of the differences in clinical practice.ResultsThe survival rate was 30.8% during first epoch, which was significantly lower than the 70.4% survival rate during second epoch. There was no difference in the rate of complications between the 2 epochs. The total number of ventilator and non-invasive ventilation days was significantly lower in the second epoch.ConclusionsWe found significant differences in survival rates but no change in the incidence of morbidities between the 2 epochs. Therefore, although the number of neonates surviving with morbidities has increased, so did the number of those with intact survival. The increased survival of infants born with <500 grams birth weight is not associated with increased rate of morbidities. Protocol changes may have contributed to these findings; however, in a retrospective study it is not possible to separate the impact of individual changes.

Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study

BackgroundPatients starting noninvasive ventilation (NIV) to treat acute respiratory failure are often unable to eat and therefore remain in the fasting state or receive nutritional support. Maintaining a good nutritional status has been reported to improve patient outcomes. In the present study, our primary objective was to describe the nutritional management of patients starting first-line NIV, and our secondary objectives were to assess potential associations between nutritional management and outcomes.MethodsObservational retrospective cohort study of a prospective database fed by 20 French intensive care units. Adult medical patients receiving NIV for more than 2 consecutive days were included and divided into four groups on the basis of nutritional support received during the first 2 days of NIV: no nutrition, enteral nutrition, parenteral nutrition only, and oral nutrition only.ResultsOf the 16,594 patients admitted during the study period, 1075 met the inclusion criteria; of these, 622 (57.9%) received no nutrition, 28 (2.6%) received enteral nutrition, 74 (6.9%) received parenteral nutrition only, and 351 (32.7%) received oral nutrition only. After adjustment for confounders, enteral nutrition (vs. no nutrition) was associated with higher 28-day mortality (adjusted HR, 2.3; 95% CI, 1.2–4.4) and invasive mechanical ventilation needs (adjusted HR, 2.1; 95% CI, 1.1–4.2), as well as with fewer ventilator-free days by day 28 (adjusted relative risk, 0.7; 95% CI, 0.5–0.9).ConclusionsNearly three-fifths of patients receiving NIV fasted for the first 2 days. Lack of feeding or underfeeding was not associated with mortality. The optimal route of nutrition for these patients needs to be investigated.

Effect of hyponatremia on complications and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To observe the complications and mortality of hyponatremia in patients with acute exacerbation of chronic obstructive pulmonary disease. Methods The patients with acute exacerbation of chronic obstructive pulmonary disease were selected and divided into non-hyponatremia group(252 cases) and hyponatremia group(65 cases). The differences in the general status, serum ions, blood gas, APACHE Ⅱ score, complications during the hospitalization, using of ventilator and mortality between the two groups were compared, and drew the receiver operating characteristic(ROC) curve, to acquire higher serum sodium cut-off values. Results In the hyponatremia group, the body weight was (68.3±14.4)kg, BMI was (25.5±4.9)kg/m2, those in the non-hyponatremia group were (74.9±15.9)kg and (28.2±5.3)kg/m2 respectively, there were statistically significant differences(t=2.009, 8.494, all P<0.05). The incidence rate of pneumonia in the hyponatremia group was 23.1%, which was higher than 13.1% in the non-hyponatremia group(χ2=4.007, P=0.045). The hospital days of the hyponatremia group was (13.1±8.9)d, which was longer than (7.8±4.9)d of the non-hyponatremia group(t=15.638, P=0.000). The invasive ventilation days of the hyponatremia group was (1.1±0.4)d, which was longer than (0.9±0.1)d of the non-hyponatremia group(t=2.885, P=0.004). The non invasive ventilation days of the hyponatremia group was (3.1±0.8)d, which was longer than (0.8±0.3)d of the non-hyponatremia group (t=2.984, P=0.003). The hospital mortality rate of the hyponatremia group was 12.3%, which was higher than 3.1% of the non-hyponatremia group(χ2=7.189, P=0.007). The 90-day mortality rate of the hyponatremia group was 29.2%, which was higher than 15.1% of the non-hyponatremia group(χ2=7.017, P=0.008). When the serum sodium cut-off value was 128.8mmol/L by drawing ROC curve, the mortality rate in patients with lower than this value was 26.3%, while the mortality rate in patients with higher than the value was 3.7%. Conclusion Hyponatremia is related with the severity and prognosis of acute exacerbation of chronic obstructive pulmonary disease.It is most important to prevent and correct hyponatremia at early disease stage. Key words: Pulmonary disease, chronic obstructive; Hyponatremia; Mortality; ROC curves

Clinical characteristics of severe pneumocystis pneumonia in children without human immunodeficiency virus infection

Objective To investigate the clinical parameters, risk factors, treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective analysis was made for the clinical features, risk factors, treatment and prognoses of the non-HIV infected severe PCP patients hospitalized at Pediatric Intensive Care Unit(PICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics. Results During April of 2010 to April of 2014, there were 10 cases of non-HIV infected severe PCP in PICU of Children's Hospital Affiliated to Capital Institute of Pediatrics.All of the patients had predisposing diseases, in which 3 cases had connective tissue diseases, 2 cases had acute leukemia, 3 cases had severe pneumonia and 2 cases had congenital immunodeficiency.The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea.All patients developed respiratory failure.The median value of Pediatric Critical Illness Score was 79.The median arterial oxygen pressure was 58 mmHg(1 mmHg=0.133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43.8 mmHg. The median CD4+ T-lymphocytes counts was 169×106/L. Eight patients on admission had mixed infection.Acute respiratory distress syndrome(ARDS) occurred in all of the patients, and 7 cases of them had multiple organ dysfunctions.All of the patients required ventilation support.The median day for invasive mechanical ventilation days was 11 and the median day for noninvasive ventilation days was 6.The pneumothorax occurred in 5 patients.All patients received trimethoprim-Sulfamethoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients.Six patients had nosocomial infection. The median time of PICU stay was 15.5 days.Six patients survived and the mortality was 40%(4/10 cases). Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions.Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children. Key words: Pneumocystis pneumonia; Acute respiratory distress syndrome; Treatment; Child

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Introduction: Device related pressure ulcers (PUs) from non-invasive ventilation (NIV) masks result in skin integrity alterations and patient discomfort. NIV mask related PU rates in our ICUs were above national PU benchmarks The primary purpose of the study was to examine PU outcomes and comfort of patients using a nasal-oral (N-O) mask (Performatrak, Respironics, Philips Healthcare) compared to a full face (FF) mask (Performax, Philips Healthcare). Methods: A before-after study of a convenience sample of patients with NIV orders in 5 ICUs was conducted. Two groups of 100 subjects each received either the N-O mask (first group) or the FF mask. Skin was assessed prior to mask application and every 12 hours and with mask removal. Comfort levels were assessed every 12 hours on a 1-5 Likert Scale (1 most comfortable). Adherence time was recorded every 12 hours. Data on the following variables were also recorded: indication for NIV, reason for study exit, total NIV days, invasive mechanical ventilation (MV) requirements, and demographic information. Results: In the N-O group, 20% developed a facial PU (16 Stage I and 4 Stage II); in the FF mask group, 1% developed a facial PU (Stage II) and 1% developed a scalp PU under the mask strap (p < .001). Comfort scores were significantly lower (more comfortable) with the FF mask (mean 1.9 ± 1.1) compared to N-O mask (mean 2.7 ± 1.2, p < .001). There was no significant difference in mean hours worn or % adherence: 28.9 hours ± 27.2, 92% for FF and 25 ± 20.7, 92% for N-O. Total NIV days (p <.001) and need for subsequent NIV (p = .022) were significantly higher with N-O mask due to switch to FF mask upon PU identification. No subjects who developed a PU with the N-O mask developed a PU with the FF mask. No significant differences between groups were found for ICU or hospital LOS, MV use prior or after NIV and total MV days, age, APACHE II, gender, race or indication for NIV. Conclusions: The FF mask resulted in significantly less PUs and was more comfortable for patients. The FF mask is a reasonable alternative to traditional N-O masks to decrease NIV mask related PU incidence.

563 Case Report: Transverse Myelitis Caused by Enterovirus Infection

Background and AimsEnterovirus infections are most common in young children, and acute infection of the CNS occurs at all ages. Meningitis is by far the most common CNS manifestation. Certain...

Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database

Pneumonia associated with invasive mechanical ventilation (IMV) is one of the indicator infections of the German Nosocomial Infection Surveillance System. In 2005 surveillance was extended to include pneumonia associated with noninvasive ventilation (NIV). The aim of this study was to determine the utilization of IMV and NIV and the associated incidence densities (IDs) of pneumonia and to compare the characteristics of pneumonia cases and the spectrum of associated pathogens. We analyzed the pooled data of 400 intensive care units (ICUs) with respect to three categories of pneumonia: pneumonia associated with IMV and NIV and pneumonia not associated with ventilation. Pooled ventilation utilization rates and pneumonia IDs were calculated in total and stratified by hospital size, hospital type and ICU type. Four hundred ICUs with 779,500 admitted patients, 1,068,472 IMV days and 101,569 NIV days reported 6,869 cases of pneumonia between 2005 and 2007. Of these, 5,811 cases were associated with IMV, 160 with NIV and 898 were not associated with ventilation. The mean pneumonia IDs were 1.58 and 5.44 cases per 1,000 ventilator days for NIV and IMV, respectively. Pneumonia cases associated with IMV were younger, had a longer ICU stay before onset of pneumonia and were more often associated with gram-negative bacteria than cases associated with NIV; however, there were no differences in the proportion of secondary sepsis and death. This surveillance study including pneumonia associated with IMV and NIV and pneumonia not associated with ventilation shows significant differences of pneumonia IDs, patient characteristics and the spectrum of associated pathogens.

Time of non-invasive ventilation

Non-invasive ventilation (NIV) is a safe, versatile and effective technique that can avert side effects and complications associated with endotracheal intubation. The success of NIV relies on several factors, including the type and severity of acute respiratory failure, the underlying disease, the location of treatment, and the experience of the team. The time factor is also important. NIV is primarily used to avert the need for endotracheal intubation in patients with early-stage acute respiratory failure and post-extubation respiratory failure. It can also be used as an alternative to invasive ventilation at a more advanced stage of acute respiratory failure or to facilitate the process of weaning from mechanical ventilation. NIV has been used to prevent development of acute respiratory failure or post-extubation respiratory failure. The number of days of NIV and hours of daily use differ, depending on the severity and course of the acute respiratory failure and the timing of application. In this review article, we analyse, compare and discuss the results of studies in which NIV was applied at various times during the evolution of acute respiratory failure.

Amyotrophic Lateral Sclerosis Presenting During Pregnancy

Amyotrophic Lateral Sclerosis Presenting During Pregnancy