Mechanical Ventilation In Patients Research Articles

Incidence, outcomes, and predictors of Acinetobacter infection in Saudi Arabian critical care units.

Acinetobacter is an increasingly-problematic organism, especially in intensive care units (ICUs). In this study, we compared its incidence, outcomes, and predictors spanning eight ICUs in five geographically and climatologically-diverse cities in Saudi Arabia. Geographic, climatologic, hospital-related, and patient-related factors were collected prospectively on 3179 patients admitted to eight Saudi ICUs from June 2018 through June 2019. These data then underwent both bivariable and multivariable analysis, the latter vis hierarchical logistic regression to identify predictors of clinically-manifest Acinetobacter infection. Overall incidence of Acinetobacter infection was 3.9% (n=124). Of these 124 infections, 122 (98.4%) were cultured as A. baumannii. Incidence ranged from 1.0 to 7.9% across the eight ICUs. On bivariable analysis, incident Acinetobacter infection was more common in university and military hospitals, in hospitals with more total beds and ICU isolation rooms, and in 2018 versus 2019, incidence steadily declining over the 13 study months. Mechanically-ventilated patients had ten-fold increased odds of infection. Adjusted (multivariable) analysis revealed the risk of clinically-manifest Acinetobacter infection to increase the longer patients were on mechanical ventilation. Increased risk also existed at certain hospitals over others, especially in university-affiliated and military hospitals, larger hospitals with more isolation rooms, and hospitals with fewer ICU beds. In our study of eight ICUs across Saudi Arabia, inter-hospital differences did appear to account for inter-hospital differences in Acinetobacter incidence rates. Patients requiring mechanical ventilation for longer periods of time were particularly at risk.

A 48-Year-Old Previously Healthy Man Presenting with Acute Respiratory Distress Syndrome (ARDS), Negative Tests for SARS-CoV-2, and Positive Serology for Parainfluenza Virus Type 3 (PIV-3)

Patient: Male, 48-year-old Final Diagnosis: Acute respiratory distress syndrome (ARDS) • parainfluenza virus infection Symptoms: Dyspnea Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Pulmonology Objective: Rare disease Background:Human parainfluenza viruses (PIVs) belong to the Paramyxoviridae family. PIVs cause lower respiratory tract infections in children and the elderly. In addition, severe pneumonia due to PIVs has been reported in immunocompromised adults. However, no reports have described PIV infections leading to acute respiratory distress syndrome (ARDS) in immunocompetent hosts.Case Report:A 48-year-old otherwise healthy man was transported to our hospital due to worsening dyspnea. On arrival, strong effortful breathing was observed and results of arterial blood gas analysis revealed severe hypoxia. On the basis of the clinical presentation, we intubated the patient for mechanical ventilation. However, mechanical ventilation provided inadequate oxygenation. Finally, veno-venous extracorporeal membrane oxygenation was initiated. Pneumonia was considered to be a cause of the ARDS, based on the patient’s history and blood examination. Repeated reverse transcription-polymerase chain reaction tests for the novel coronavirus were performed, and endotracheal aspirate specimens were cultured for bacteria and fungus; however, the results were all negative. On day 2, the PIV-3-specific antibody titer was elevated. Two weeks later, the PIV-3-specific antibody titer had increased 4-fold. On the basis of these results, we diagnosed pneumonia induced by PIV-3 infection.Conclusions:ARDS can occur because of severe pneumonia induced by PIV-3. In cases of unexplained severe pneumonia or ARDS, PIV infection should be included in the differential diagnosis.

Tools Are Needed to Promote Sedation Practices for Mechanically Ventilated Patients.

Suboptimal sedation practices continue to be frequent, although the updated guidelines for management of pain, agitation, and delirium in mechanically ventilated (MV) patients have been published for several years. Causes of low adherence to the recommended minimal sedation protocol are multifactorial. However, the barriers to translation of these protocols into standard care for MV patients have yet to be analyzed. In our view, it is necessary to develop fresh insights into the interaction between the patients' responses to nociceptive stimuli and individualized regulation of patients' tolerance when using analgesics and sedatives. By better understanding this interaction, development of novel tools to assess patient pain tolerance and to define and predict oversedation or delirium may promote better sedation practices in the future.

Isolated liver trauma: A clinical perspective in a non-emergency center for liver surgery.

The management of liver trauma is, currently, still heterogeneous ranging from conservative to major invasive liver resections. When appropriate, these cases should be referred to a regional care center. The objective of this study was to analyze the expertise of a non-emergency center for liver surgery from Romania after initial stabilization in county hospitals. This study is a monocentric, retrospective, observational study, including 12 patients with hepatic trauma after a car accident, admitted between 2015 and 2019. We analyzed various clinical and biochemical data as independent variables, and the main outcome was considered the intensive care unit (ICU) length of stay. Our results revealed that intubation status at admission, norepinephrine infusion during surgery, hyperfibrinogenemia and duration of mechanical ventilation in patients with isolated liver trauma were correlated with prolonged ICU length of stay. Further prospective, more comprehensive studies are needed in order to evaluate the exact prognostic factors in terms of short- and long-term mortality.

A randomized controlled clinical trial on efficacy and safety of anakinra in patients with severe COVID-19.

IntroductionHyperinflammatory state has a role in the pathogenesis of COVID‐19. Anakinra could reduce inflammation and help to combat the condition. In this study, we aimed to assess the safety and efficacy of anakinra (PerkinRA®) in severe COVID‐19.MethodThe study was an open‐label, randomized, controlled trial conducted in Imam Hossein Medical Center from May to July 2020. Patients with a confirmed diagnosis of COVID‐19 were included in this study. We administered anakinra 100 mg daily intravenously. All patients received COVID‐19 pharmacotherapy based on the represented national guideline. The need for invasive mechanical ventilation is considered the primary outcome.ResultsThirty patients were included in this study, and 15 of them received Anakinra. Nineteen patients were male (63.3%), and 11 were female (36.7%). The mean age of patients was 55.77 ± 15.89 years. In the intervention group, the need for invasive mechanical ventilation was significantly reduced compared to the control group (20.0% vs. 66.7%, p = .010). Also, these patients had a significantly lower length of hospital stay (p = .043). No significant higher rate of infection was recorded.ConclusionAnakinra as an immunomodulatory agent has been associated with the reduced need for mechanical ventilation in patients admitted to intensive care units because of severe COVID‐19. The medication reduced the hospital length of stay. Furthermore, no increased risk of infection was observed. Further randomized placebo‐controlled trials with a larger sample size are needed to confirm these findings.

Over-distension prediction via hysteresis loop analysis and patient-specific basis functions in a virtual patient model

Background and objectiveRecruitment maneuvers (RMs) with subsequent positive-end-expiratory-pressure (PEEP) have proven effective in recruiting lung volume and preventing alveolar collapse. However, a suboptimal PEEP could induce undesired injury in lungs by insufficient or excessive breath support. Thus, a predictive model for patient response under PEEP changes could improve clinical care and lower risks. MethodsThis research adds novel elements to a virtual patient model to identify and predict patient-specific lung distension to optimise and personalise care. Model validity and accuracy are validated using data from 18 volume-controlled ventilation (VCV) patients at 7 different baseline PEEP levels (0–12cmH2O), yielding 623 prediction cases. Predictions were made up to ΔPEEP = 12cmH2O ahead covering 6x2cmH2O PEEP steps. ResultsUsing the proposed lung distension model, 90% of absolute peak inspiratory pressure (PIP) prediction errors compared to clinical measurement are within 3.95cmH2O, compared with 4.76cmH2O without this distension term. Comparing model-predicted and clinically measured distension had high correlation increasing to R2 = 0.93–0.95 if maximum ΔPEEP ≤ 6cmH2O. Predicted dynamic functional residual capacity (Vfrc) changes as PEEP rises yield 0.013L median prediction error for both prediction groups and overall R2 of 0.84. ConclusionsOverall results demonstrate nonlinear distension mechanics are accurately captured in virtual lung mechanics patients for mechanical ventilation, for the first time. This result can minimise the risk of lung injury by predicting its potential occurrence of distension before changing ventilator settings. The overall outcomes significantly extend and more fully validate this virtual mechanical ventilation patient model.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Application of bundle management strategy in early mobility of mechanically ventilated patients

To explore the effect of bundle management strategy in early mobility of patients with mechanical ventilation. Seventy-two mechanically ventilated patients admitted to the respiratory intensive care unit (RICU) of Fenyang Hospital of Shanxi Province from December 2019 to June 2020 were enrolled. The patients were divided into routine nursing control group (routine control group) and early mobility bundle management group (bundle group), with 36 cases in each group. The routine control group received regular nursing, including monitoring vital signs, raising the head of the bed, turning over and buttoning the back every 2 hours, daily awakening, airway humidification, prevention of digestive tract ulcer, analgesia and sedation management, prevention of deep vein embolism, pipeline management, regular monitoring of blood gas analysis and electrolytes according to the changes of the condition, prevention of aspiration, prevention of bacterial colonization, correct hand hygiene, and so on. The bundle group implemented the cluster early mobility strategy based on routine nursing. Firstly, set up a professional team to execute the standards. The team determined the plan and implemented the 4-level mobility plan, companied with psychological intervention, decided the termination standard and quality control. The incidence of intensive care unit acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, the duration of mechanical ventilation and the length of intensive care unit (ICU) stay were evaluated. Compared with the routine control group, the incidences of ICU-AW, VAP, and delirium in the bundle group were significantly lower (the incidence of ICU-AW: 36.11% vs. 69.44%, χ2 = 8.025, P = 0.005; the incidence of VAP: 8.33% vs. 30.56%, χ2 = 5.675, P = 0.017; the incidence of delirium: 5.56% vs. 36.11%, χ2 = 10.180, P = 0.001), the duration of mechanical ventilation was significantly shorter (days: 7.13±1.34 vs. 10.46±1.48, t = -10.145, P < 0.001), and the length of ICU stay was also significantly decreased (days: 9.03±2.43 vs. 13.06±3.63, t = -5.535, P < 0.001). The implementation of bundle management strategy of early mobility can promote the rehabilitation of mechanical ventilated patients, improve the prognosis and the quality of life. The effect is noticeable and it is worth popularizing.

Effect of early off-bed mobility on delirium in mechanical ventilated patients in intensive care unit: a prospective randomized controlled study

To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit (ICU). Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected. The patients were randomly divided into two groups. The experimental group conducted early off-bed mobility, such as using the shift machine off-bed sitting and walking aids to assist standing and walking, and the off-bed mobility is based on patient tolerance. The control group was given early bed activities, including conducting the joint range activity, limb movement, bed sitting, upper limb elastic belt movement, and lower limb cycling, once a day. Each joint moved 15-20 times, a total of 30 minutes. Both groups were treated with anti-infection, mechanical ventilation, analgesia and sedation, and nutrition therapy. After intervention, confusion assessment method for the ICU (CAM-ICU) was used to assess the onset and duration of delirium, physical restraint rate and duration of physical restraint, mechanical ventilation time, and the length of ICU stay. After excluding patients who died or gave up treatment during the intervention period, 266 patients were included, with 133 patients in the experimental group and 133 patients in the control group. There were no significant differences in gender, age, diagnosis, degree of illness, sedative drugs between the two groups. The incidence of the delirium in intervention group was significantly lower than that in control group [26.3% (35/133) vs. 42.1% (56/133), χ2 = 7.366, P = 0.007], the duration of delirium was shorter than that in control group (hours: 11.26±4.11 vs. 17.00±3.29, t = -4.157, P = 0.000), the rate of physical restraint was lower than that in control group [19.5% (26/133) vs. 45.1% (60/133), χ2 = 19.864, P = 0.000], the duration of physical restraint was shorter than that in control group (hours: 9.71±4.07 vs. 13.55±7.40, t = -5.234, P = 0.000), the mechanical ventilation time and the length of ICU stay were shorter than those in control group [mechanical ventilation time (hours) : 106.23±42.25 vs. 133.10±41.88, t = -3.363, P = 0.001; length of ICU stay (days) : 8.35±6.21 vs. 13.25±9.98, t =-4.190, P = 0.000]. Early off-bed mobility can reduce physical restraint rate and the incidence of delirium, and thus can accelerate rehabilitation in critically ill patients. Early off-bed mobility is safe and effective for patients with mechanical ventilation in ICU.

Transfusion-related respiratory complications in intensive care: A diagnosis challenge.

Transfusion-related respiratory complications can be challenging to diagnose especially in mechanically-ventilated patients in the intensive care unit (ICU) due to the concurrent respiratory symptoms associated with the patients' primary diagnoses. In this narrative review, transfusion-related respiratory complications, including transfusion-associated dyspnea (TAD), transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and transfusion-related allergic reaction (TRAR), are briefly presented in light of the recent consensus or experts' definitions; and the diagnosis issues for ICU patients are discussed. Acute respiratory failure occurring during, or within 6 to 24hours, of transfusion might be a transfusion-related respiratory complication. The recent updated definitions for TRALI and TACO should assist clinicians to differentiate between possible diagnoses. The issues for ICU clinicians are first to recognize the acute respiratory deterioration and the possible causality between the deterioration and blood transfusion and secondly to make the proper diagnosis. This remains challenging for mechanically-ventilated patients. Clinical assessment to identify ICU patients at particular risk of transfusion-related respiratory complications and non-invasive investigation tools could be beneficial and may help to remind clinicians to be alert to the link between transfusion and worsening of respiratory symptoms in these vulnerable critically ill patients.

Mechanical ventilation in patients with severe traumatic brain injury: modern guidelines review

Traumatic brain injury is the most common group of injuries among victims admitted to the emergency departments. Up to 20 % of individuals with brain damage require endotracheal intubation and mechanical ventilation, the duration of which is significantly longer than in non-neurological patients. Such patients have a higher incidence of acute respiratory distress syndrome and ventilator-associated pneumonia, and weaning and extubation are associated with significant difficulties. However, patients with traumatic brain injury are often excluded from randomized trials, and international guidelines for the treatment of severe traumatic brain injury do not provide clear ventilation strategies. Analysis of the literature allowed us to identify modern principles of respiratory support in severe traumatic brain injury, which include: tracheal intubation in Glasgow coma scale score of ≤ 8 points; early mechanical ventilation; PaO2 in the range of 80–120 mm Hg (SaO2 ≥ 95 %), PaCO2 — 35–45 mm Hg; tidal volume ≤ 8 ml/kg; respiratory rate ≈ 20/min; PEEP ≥ 5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning from the respirator through the use of support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheostomy in predicted extubation failure.

Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: An observational cohort study.

Classical clinical characteristics associated with successful or unsuccessful extubation are unreliable in neurocritically ill patients, and attempts to predict successful extubation in this context have failed. We aimed to investigate the frequency of mechanical ventilation (MV) in adult patients in status epilepticus (SE) and its clinical associations, to identify predictors at SE onset of prolonged postictal MV, and to determine the associated outcomes with prolonged MV. From 2012 to 2018, SE patients treated in intensive care units at a Swiss academic care center were included. Multivariable Poisson regression adjusting for potential confounders, such as continuously administered anesthetics, was performed to identify risks for postictal MV for >24h after SE and its association with no return to neurologic function and death. Linear regression was performed to identify correlations between the durations of administered specific anesthetics and postictal MV. Of 262 patients, 42% were ventilated, with 24% being on ventilators for >24h after SE. Patients with prolonged postictal MV were extubated at a median of 7days, with 56% not being extubated on the day of successful weaning from MV because of altered consciousness and/or lack of airway-protective reflexes. After extubation, noninvasive ventilation and reintubation were rarely needed. Prolonged postictal MV was associated with increased risk for death independent of potential confounders, including fatal etiology of SE, age, SE severity, and use of anesthetics (relative risk for every additional day = 2.7, p=.024). At SE onset, decreased consciousness and presumed fatal etiology predicted prolonged postictal MV. Anesthetics were associated with prolonged MV, but linear regression could not identify significant correlations. Our data reveal that prolonged postictal MV is frequent and an independent risk factor for death. Extubation is often delayed for days despite sufficient weaning from the ventilator and altered airway-protective reflexes in only few patients. Studies need to investigate whether more rigorous extubation strategies improve outcome.

All-cause mortality in COVID-19 patients receiving statin therapy: analysis of veterans affairs database cohort study.

Statins have been advocated as a potential treatment for coronavirus disease-2019 (COVID-19) due to its pleotropic properties. The aim of the study was to elucidate the association between antecedent statin exposure and 30-day all-cause mortality, intensive care unit (ICU) admission and hypoxic respiratory failure requiring mechanical ventilation in patients diagnosed with COVID-19. Observational cohort study derived from the VA Corporate Data Warehouse of all veterans tested positive for COVID-19 between January 1st and May 31st, 2020. Antecedent use of statins was defined as a redeemed drug prescription in the 6 months prior to COVID-19 diagnosis. Propensity-matched mixed-effects logistic regression was performed, stratified by statin use. The study population comprised 14,268 patients with COVID-19 (median age 66 years (25th–75th percentile, 53–74), 90.7% men), of whom 7,168 were receiving a prescription for statins. Patients with statin exposure had a greater prevalence of comorbidities and a higher risk of mortality (Odd ratio [OR] 1.52; 95% confidence interval [CI] 1.37–1.68). After adjusting for covariates, statin exposure was not associated with a decreased mortality in the overall cohort by either Cox proportional hazards stratified model (HR 0.99; 95% CI 0.88–1.12) or propensity matching (HR .86; 95% CI 0.74–1.01). Similarly, there was no demonstrated advantage of statins in reducing the risk of ICU admission (HR 0.92; 95% CI 0.74–1.31) or hypoxic respiratory failure requiring mechanical ventilation (HR 1.02; 95% CI 0.81–1.29). Antecedent statin exposure in patients with COVID-19 was not associated with a decreased risk of 30-day all-cause mortality or need for mechanical ventilation.

Frontal QRS/T angle can predict mortality in COVID-19 patients

Abstract Aims fQRS-T angle was investigated from general population including healthy people to patients who has hearth failure. It can predict mortality of myocarditis, ischemic cardiomyopathy, non-ischemic cardiomyopathy, idiopathic dilated cardiomyopathy and chronic heart failure in general population. There is no study in the literature that has been investigated for COVID-19 patients. The purpose of this retrospective multi-center study is to evaluate fQRS angle of COVID-19 patients for in-hospital mortality and need mechanical ventilation. Methods and results ECG was enrolled in 327 COVID-19 patients during admission and the fQRS angle calculated. Mechanical ventilation was needed for 119 patients and 110 of them died in hospital. Patients were divided into two groups according to their fQRS angle as fQRs&amp;gt;90° and fQRS≤90°. Percentages of mortality and need of MV according to fQRS angle were found 67.8% and 66.1% respectively in fQRs&amp;gt;90° group and 26.1%, 29.9% in fQRS≤90°group. Heart rate, SO2, fQRS, eGFR and CRP only were predictors for mortality in multivariable analysis. Mortality risk was increased 2.9-fold in univariate analysis and 1.6-fold in multivariate analysis for fQRS&amp;gt;90 patient group in respect to fQRS≤90 group. Conclusion In conclusion, a wide fQRS angle (&amp;gt;90°) was found as a predictor for mortality in-hospital and associated with the need for mechanical ventilation in COVID-19 patients. Funding Acknowledgement Type of funding sources: None. Mortality, need mechanical ventilationUnivariable and multivariable predictors

Evaluation of Effectiveness of Comprehensive Oral Hygiene Management in Mechanical Ventilation Patients in Chinese Intensive Care Unit

Objective: To investigate the effect of toothbrushes and oral care solution in oral hygiene management on the prevention of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) in the critically ill patients. Methods: The patients were divided into 5 groups according to the time of admission of ICU. Toothbrush and oral care solution were used as intervention for oral care. By comparing halitosis, dental plaque, oral mucosa status, and secretion bacteriological analysis, the changes of oral status were observed and evaluated, and VAE was evaluated and diagnosed according to the corresponding standards. ICU and hospital length of stay, duration of MV were calculated from the medical records. Bacterial count and VAP pathogens of oral secretion were also evaluated. Results: The incidence rate of VAE, duration of MV and ICU stays and mortality rate in each group of neurosurgical and general ICU did not show a significant difference. VAE developed later in the intervention group using 0.1% cetylpyridinium chloride solution. The evaluation of halitosis and dental plaque in general and neurosurgical ICU on the 7th day after intubation were significantly improved compared with those on admission (P < 0.05). However, the bleeding in the patients diagnosed as cerebral hemorrhage increased in the intervention group. The number of S.pneumoniae in oral secretion of each group was different. The bacterial count of intervention groups in general ICU began to decrease on the third day, while that of control group did not decrease significantly or even increased. Conclusions: The oral care incorporating toothbrush brushing was effective to reduce the bacterial count in the oral cavity and eliminate halitosis and dental plaque in mechanically ventilated patients.

Hemogram parameters can predict in-hospital mortality of patients with Myasthenic crisis

BackgroundMyasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Myasthenic crisis (MC), which is characterized by respiratory failure and the requirement of mechanical ventilation in patients with MG, is still a medical emergency despite the decrease in mortality with the advances in acute management. Hemogram is a cost-effective test for evaluating hematological complications and systemic inflammation, and hemogram data have been used to predict various clinical outcomes of several diseases. The relationship between hemogram and MG has been discussed, but the role of hemogram data in predicting the prognosis of MC patients has not been established.MethodsTo identify whether hemogram data can predict in-hospital mortality in patients with MC, we retrospectively investigated 188 myasthenic crisis events from the Chang Gung Research Database between April 2001 and March 2019. Demographic and clinical characteristics were collected, as well as hemogram data before intubation and extubation. The endpoints were mortality during mechanical ventilation and mortality after extubation.ResultsThe overall in-hospital mortality rate was 22%. Multivariate logistic regression analysis for predicting mortality during mechanical ventilation showed that old age at MC onset (OR = 1.039, p = 0.022), moderate-to-severe anemia (OR = 5.851, p = 0.001), and extreme leukocytosis (OR = 5.659, p = 0.022) before intubation were strong predictors of mortality, while acute management with plasma exchange or double-filtration plasmapheresis (PE/DFPP) significantly decreased mortality (OR = 0.236, p = 0.012). For predicting mortality after extubation, moderate-to-severe anemia before extubation (OR = 8.452, p = 0.017) and non-treated with disease-modifying therapy before MC (OR = 5.459, p = 0.031) were crucial predictive factors.ConclusionThis study demonstrated that both old age at MC onset and moderate-to-severe anemia are important predictors of in-hospital mortality in patients with MC, and extreme leukocytosis is another crucial predictor of mortality during mechanical ventilation. The suggested mechanism is that anemia-induced hypoxia may enhance the release of proinflammatory cytokines, exacerbate systemic inflammation, and lead to multiple organ dysfunction syndrome and, finally, mortality.

Evaluation of airway inflammation in mechanically ventilated patients using cell count and protein concentration

Mechanically ventilated (MV) patients may present airway inflammation and elevated secretion production. However, it is unknown whether cell and/or protein counts in bronchial samples may be useful to evaluate their clinical condition. Our aim was to standardize sampling and propose a new mechanical mucus dissolution in Tracheal-Bronchial secretions. In all patients, bronchial lining fluid aspiration (BLF), Bronchoalveolar lavage (BAL) and Bronchial Washings (BW40, BW5) were performed, while visible bronchial secretions were obtained via bronchoscopy (VBS) and blinded, via a common catheter for tracheobronchial aspiration (AC). Mucus was mechanically or DTT dissolved and cell number was count. Protein, albumin and TNF-α levels were measured, in mucus dissolved samples from control and MV patients. Cell number and protein levels were elevated in mucus dissolved compared to non-dissolved, or DTT dissolved. Cell number and TNF-α levels were elevated in MV patients compared to controls, while protein levels were lower in MV patients. Differences in cell and protein levels were observed in samples acquired using different sampling technics. Therefore, mechanical mucus dissolution provides a proper sample for evaluation, and the sampling technic used can influence the sample’s characteristics.

Тривалість штучної вентиляції легень та функціонування діафрагми у дітей з гострою дихальною недостатністю

Актуальність. Пацієнти з комбінованими формами дихальної недостатності часто мають довготривале чи навіть невдале відлучення від штучної вентиляції легень (ШВЛ). Мета дослідження: порівняти тривалість проведення ШВЛ, а також показники функціонування діафрагми при використанні технологій P-SIMV та BIPAP у пацієнтів на етапі відлучення від ШВЛ. Матеріали та методи. Проведено проспективне обсерваційне нерандомізоване когортне дослідження серед 27 пацієнтів з гострою дихальною недостатністю. До І (режим P-SIMV) та ІІ груп пацієнтів (режим BIPAP ) увійшло по 10 пацієнтів. Первинними точками оцінювання результатів лікування були тривалість проведення інвазивної ШВЛ; вторинними точками — амплітуда рухів обох куполів діафрагми, фракція стоншення діафрагми, виникнення декомпенсованого респіраторного чи змішаного ацидозу. Результати. Середня тривалість проведення ШВЛ у пацієнтів першої групи становила 14,14 ± 1,83 доби, у пацієнтів другої групи — 13,2 ± 2,56 доби (p = 0,32). Амплітуда рухів куполів діафрагми в першу добу дослідження становила в І групі пацієнтів 7,2 ± 1,8 мм, у ІІ групі — 6,8 ± 1,5 (p = 0,42); на 5-ту добу лікування цей показник вірогідно не відрізнявся між групами та в І групі зростав до 8,1 ± 2,1 мм, у ІІ — до 8,4 ± 1,9 мм (p = 0,12 та p = 0,89). Вже на 9-ту добу лікування амплітуда рухів правого купола діафрагми вірогідно (р = 0,04) відрізнялася у І групі пацієнтів щодо ІІ групи (9,0 ± 2,1 мм та 10,0 ± 1,3 мм відповідно) та щодо попереднього етапу обстеження (p = 0,05 та p = 0,04). Амплітуда рухів правого купола діафрагми залишалася на рівні понад 10 мм у ІІ групі пацієнтів і на 13-ту та 17-ту добу спостереження за пацієнтами. Висновки. Тривалість проведення ШВЛ у дітей з поєднанням обструктивного та рестриктивного типів дихальної недостатності в І та ІІ групах вірогідно не відрізнялася. Спонтанні дихальні зусилля були вірогідно вищими у пацієнтів ІІ групи починаючи з 9-ї доби порівняно з пацієнтами І групи.

CLINICAL ATTRIBUTES AND RISK FACTORS FOR MECHANICAL VENTILATION AMONG PATIENTS WITH COVID-19 IN A COMMUNITY HOSPITAL SETTING: A PROPENSITY-MATCHED ANALYSIS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Covid-19 caused by the novel SARS-CoV-2 has emerged as a global health crisis with various clinical complications. Covid-19 related respiratory manifestations have been reported as mild, moderate to severe including acute lung injury and acute respiratory distress syndrome necessitating non-invasive forms of oxygenation to mechanical ventilation (MV). MV patients frequently undergo prolonged hospitalizations with substantial morbidity and mortality. We sought to evaluate risk factors for MV in our cohort. METHODS: We conducted a retrospective cohort study of patients admitted in our institution from March 1st to June 21st2020, to assess risk factors for Covid-19 related respiratory failure requiring MV. The original cohort encompassed 166 MV and 503 non MV patients. Information from our hospital medical records was extracted, which included demographics, presenting symptoms, past medical history, vital signals, and laboratory data and need for MV. We propensity matched 166 MV with a concurrent cohort of non MV patients in our institution. Covariates applied in matching included age, gender, race, and body mass index (BMI). The admission clinical attributes and laboratory parameters were analyzed, along with outcomes. RESULTS: The mean age of our matched cohort was 63.8 years. Mechanically Ventilated patients had a higher incidence of tachycardia (heart rate > 125) (p <.001), elevated respiratory rate > 24 cycles per minute (p <.001), fever > 97.8 F (Temperature > (p = .037), shortness of breath (p = .001), and headaches (p = .005). In addition, mechanically ventilated patients had a lower serum albumin (g/dl) ≤ 3 units (p <. 001), elevated serum creatinine (mg/dl) ≥ 1.135 units (p = .02), elevated serum CRP-HS ≥ 123 units (p = .005), HbA1C (%) > 6.6 units (p = .004), serum lactic acid (mmol/L) > 1.7 units (p = .003), serum LDH U/L > 465 U/L (p <.001), Procalcitonin (ng/ml) > .305 units (p <0.001), SGOT IU/L or AST IU/L ≥ 54 units (p < 0.001), SGPT or ALT IU/L ≥ 41 units (p = .021), and WBC count > 8.4 k/ul (p <.001). Furthermore, tachycardia (OR = 3.98, p = .001), HbA1C (OR = 2.36, p = .008), serum LDH (OR = 1.9, p = .041), and absolute lymphocyte percent ≤ 12 (OR = 1.98, p = .022) predicted mechanical ventilation in all matched patients in our institutional cohort. CONCLUSIONS: Our case series provides clinical characteristics, laboratory parameters, and predictors for mechanical ventilation in matched patients with Covid-19. Elevated heart rate, HbA1C, serum LDH and decreased lymphocyte percentage were predictors for mechanical ventilation. Tachycardia had the highest odds of 3.98. CLINICAL IMPLICATIONS: Several clinical and laboratory parameters can be utilized for evaluating and stratifying Covid-19 patients’ risk for mechanical ventilation. These risk factors will need further validation in other similar cohorts. DISCLOSURES: No relevant relationships by Olawale Akande, source=Web Response No relevant relationships by Olga Badem, source=Web Response No relevant relationships by Premila Bhat, source=Web Response No relevant relationships by Utpal Bhatt, source=Web Response No relevant relationships by Diego Castellon, source=Web Response No relevant relationships by Bhargav Desai, source=Web Response No relevant relationships by Basilides Fermin, source=Web Response No relevant relationships by Shurovi Jafar, source=Web Response No relevant relationships by KELASH KUMAR, source=Web Response No relevant relationships by Juan Martinez Zegarra, source=Web Response No relevant relationships by Tanveer Mir, source=Web Response No relevant relationships by Parvez Mir, source=Web Response No relevant relationships by Luis Morón Mercado, source=Web Response No relevant relationships by Beatriz Omeragic, source=Web Response No relevant relationships by Maxine Orris, source=Web Response No relevant relationships by Priyank Patel, source=Web Response No relevant relationships by Giovanna Ramirez-Barbieri, source=Web Response No relevant relationships by Luis Santana Alcantara, source=Web Response No relevant relationships by Karthik Seetharam, source=Web Response No relevant relationships by Jilan Shah, source=Web Response No relevant relationships by Phanthira Tamsukhin, source=Web Response No relevant relationships by Zeyar Thet, source=Web Response No relevant relationships by Elbia Toribio, source=Web Response No relevant relationships by Thinzar Wai, source=Web Response No relevant relationships by Vamsi Yenugadhati, source=Web Response

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.