Mechanical Ventilation Dependency Research Articles

Association Between Levodopa with Inotrope Prescription and Mechanical Ventilation Dependence in People with Parkinson’s Disease upon Septic Shock

Background/Objectives: People with Parkinson’s disease (PwP) face high risks of bacterial infections and septic shock, often requiring inotrope treatment and mechanical ventilation. The impact of levodopa on these critical care interventions remains unclear. Methods: This retrospective cohort study analyzed data from the Taipei Medical University Clinical Research Database to explore the relationship between levodopa prescription, inotrope treatment duration, and mechanical ventilation dependence in PwP who experienced septic shock. PwP aged 45 years and older who required intensive care for septic shock were categorized into levodopa and non-levodopa groups. Results: Outcomes included inotrope treatment duration, mechanical ventilation dependence, and 3-month mortality. Among 243 PwP (116 without levodopa, 127 with levodopa), no significant difference was observed in the duration of mechanical ventilation dependence. However, levodopa prescription was associated with a significantly extended inotrope treatment duration (estimate: 3.43 days, p = 0.027). Additionally, a nonsignificant trend was identified between levodopa prescription and reduced 3-month mortality (adjusted hazard ratio = 0.67, p = 0.068). Conclusions: These findings highlight the complex interplay between Parkinson’s disease management and critical care interventions during septic shock. While levodopa may prolong inotrope use, its potential to influence survival outcomes warrants further investigation.

Opportunities to Improve Care Processes for Ventilator-Dependent Children: A Single-Center Study.

Children with chronic ventilator dependence are a complex and heterogeneous population with unique needs. We sought input from parents, clinicians, and hospital staff to identify opportunities for process improvement during hospitalization and discharge preparation. We conducted a qualitative study at a large referral center for children with chronic ventilator dependence. Participants included parents of children with chronic ventilator dependence, physicians, nurses, respiratory therapists, and support staff. Two group-level assessment (GLA) sessions occurred, followed by one-on-one semistructured interviews. Thematic analysis identified areas for process improvements in the care of children with chronic ventilator dependence. A total of 27 individuals participated in 2 GLA sessions followed by 9 interviews. Potential areas for process improvements included (1) acknowledging and addressing limited resources for children with long-term mechanical ventilation dependence; (2) advancing beyond a "one-size-fits-most" care model; (3) placing the patient and family at the center of care; and (4) improving support for families and staff. Families persistently noted a traumatic component of their experiences through hospitalizations and learning to care for a child with chronic ventilator dependence. There are multiple opportunities for process improvement during the hospitalization of children with chronic ventilator dependence. Protocols and practices that support efficient and safe care, such as education before discharge, may require modifications to better meet family needs, address system shortcomings, and mitigate trauma.

Timeline of Weaning in Pediatric Long-Term Mechanical Ventilator Dependent Children: A Longitudinal Cohort Study.

Children with invasive long-term mechanical ventilation (LTMV) dependence are a complex, heterogeneous population with wide variability in respiratory outcomes. Limited data exist on their ventilator weaning trajectories and respiratory characteristics as they progress toward liberation from the ventilator. To describe a population of children with invasive LTMV dependence who have successfully liberated from ventilator support, focusing on ventilator parameters as potential early predictors of liberation. This was a retrospective study of children who initiated chronic ventilator support at < 12 months of age at our institution, received ventilator support through a tracheostomy tube, were followed through our outpatient clinic, and were fully liberated from mechanical ventilation. Our primary outcome was age at liberation from ventilator support. Multiple covariates were described, including baseline descriptors, health system utilization descriptors, disease markers, and care milestones. Seventy-eight patients were identified. The median age of tracheostomy was 3.8 [IQR: 3.0-4.8] months. The median age of first hospital discharge to home care was 9.3 months [IQR: 7.5-12], with a median of 44 hospital encounters after initial discharge. These patients were liberated at a median age of 23.9 [18.3-32.2] months. Age at liberation from the ventilator was highly variable within our institution. The most significant variation in outcome was introduced after hospital discharge and appears to be largely independent of lung disease severity as indicated by ventilatory support. No single covariate was strongly correlated with liberation outcome. Further studies are needed to identify underlying pathophysiology that may contribute to the varied weaning trajectories to better define objective weaning strategies.

Clinicoepidemiological Profile of Retinopathy of Prematurity.

Purpose In previously performed studies, retinopathy of prematurity (ROP) has been shown to occur postpartum. As a result, mechanical ventilation and oxygen dependence were eventually connected to the development of ROP in these preterm children, and ROP prevalence is on the rise globally. Despite various improvements in childcare, ROP still tends to arise due to various risk factors associated with the disease. So, clinically the research was performed to determine the clinical and epidemiological profile of ROP. Materials and methods A total of 268 participants were to be enrolled in the study. It was an observational, cross-sectional study carried out at Department of Ophthalmology and Neonatal Intensive Care Unit in Veer Surendra Sai Institute of Medical Sciences and Research Centre, Burla, Sambalpur, Odisha, India. Ethical approval was provided on 30 November 2019. Results Overall 123 (46%) infants out of 268 infants developed retinopathy of prematurity. Majorly, the infants had stage 1 and stage 2 ROP. Most of the infants were male. Birth weight in ROP patients was 1000 g or less in 54% of infants, 1000-1500 g in 46% of infants and >1500 g in 33% of infants. Gestational age was found to be a predictor of retinopathy of prematurity. The adverse events that were found to be associated with retinopathy of prematurity were sepsis (53%), respiratory distress syndrome (RDS) (54.6%), intraventricular haemorrhage (IVH) (60%), anaemia (61.5%). Conclusion It has been observed that babies with higher birth weights and older gestations are also susceptible to developing ROP. Therefore, the greater birth weight newborns up to 1750 g and older gestational age babies >34 weeks should also be included in the screening criteria, especially if they have risk factors such as oxygen supplementation, sepsis, RDS, and anaemia.

Comparison of supraglottic airway device and endotracheal tube in former preterm infants receiving general anesthesia: a randomized controlled trial

To date, endotracheal tube (ETT) remains the mainstream for preterm infants receiving general anesthesia. We aim to compare the perioperative respiratory adverse events between using supraglottic airway device (SAD) and ETT in former preterm infants receiving general anesthesia. Former preterm infants below 52 weeks of postmenstrual age scheduled for herniorrhaphy were randomized to receive SAD or ETT for general anesthesia. Infants with severe congenital cardiopulmonary disease, prolonged oxygen or mechanical ventilation dependence, and recent respiratory tract infection were excluded. Muscle relaxant agents and opioids were avoided in this study. 40 infants were assigned into SAD or ETT groups. Infants in the SAD group had a much lower rate of intraoperative desaturation than those in the ETT group (21.1% vs. 73.7%, p = 0.003). Incidences of other intraoperative and postoperative 24-h respiratory adverse events were similar between groups, including laryngospasm/bronchospasm, cough and stridor during anesthesia, and postoperative apnea, bradycardia, and supplemental oxygen use. All participants were extubated successfully in the operation room. SAD is recommended in former preterm infants receiving general anesthesia for herniorrhaphy in their early infancy as it much decreases the incidence of intraoperative desaturation compared to ETT.

Changing clinical practice and prognosis for severe respiratory failure over time: A nationwide inpatient database study

BackgroundSevere respiratory failure requires numerous interventions and its clinical implementation changes over time. We aimed to clarify the clinical practice and prognosis of severe respiratory failure and its changes over time. MethodsIn a nationwide Japanese administrative database from 2016 to 2019, we identified nonoperative patients with severe respiratory failure without congestive heart failure as the main diagnosis who received mechanical ventilation (MV) for more than four days. We examined trends in patient characteristics, adjunctive interventions, and prognosis. ResultsAmong 66,905 patients included in this study, patients received antibiotics (90%), high-dose corticosteroids (14%), low-dose corticosteroids (18%), and 51% were admitted to the critical care unit. Hospital mortality was 35%. Median mechanical ventilation lasted 10 days. Tracheostomy occurred in 23% of cases. Median critical care and hospital stays were 10 and 25 days, respectively. Among survivors, 23% had mechanical ventilation dependency at hospital discharge. Large relative changes in adjunctive therapies included fentanyl (30%–38%), rocuronium (4.4%–6.7%), vasopressin (3.8%–6.0%), early rehabilitation (27%–38%), extracorporeal membrane oxygenation (0.7%–1.2%), dopamine (15%–10%), and sivelestat (8.6%–3.5%). No notable changes were seen in mechanical ventilation duration, tracheostomy, critical care unit stay, hospital stay, or ventilator dependency at discharge, except for a slight reduction in hospital mortality (36%–34%). ConclusionsSeveral adjunctive therapies for severe respiratory failure changed from 2016 to 2019, with an increase in evidence-based practices and a slight decrease in hospital mortality.

Hemoperfusion with high-affinity polyethylene microbeads (Seraph-100®) for the removal of pathogens in chronic critically ill patients: Clinical experience.

Critically ill septic patients present variable clinical trajectories, with some succumbing to hyperinflammatory responses while others develop a chronic critical illness, characterized by a prolonged low-grade inflammation, muscle atrophy, and mechanical ventilation dependency and often develop secondary infections often caused by from low-virulence microorganisms or reactivated latent viruses. The Seraph-100® hemoperfusion cartridge takes advantage from heparin-coated ultra-high molecular weight polyethylene microbeads mimicking pathogen-binding cell receptors and can adsorb both pathogens and damage-associated molecular patterns released by injured tissues. We describe two chronic critically ill patients who developed secondary viral bloodstream infections successfully treated with this device.

Risk factors for mortality in brain injury patients who have severe hypernatremia and received continuous venovenous hemofiltration

Background and objectivesThe mortality rate for people with brain injuries is increased when hypernatremia is present. Patients with severe hypernatremia, who have a significant short-term mortality rate, were shown to benefit from continuous venovenous hemofiltration (CVVH), which has been indicated to be successful. Exploring the risk factors for short-term mortality in brain injury patients who underwent CVVH and had severe hypernatremia was the aim of the current study. Materials and methodsRetrospective screening was performed on patients with brain injuries who underwent CVVH at Xijing Hospital between 1 December 2010 and 31 December 2021 and who have a diagnosis of severe hypernatremia. The outcomes included 28-day patient mortality and hospital stay duration. The patient survival rate was examined using the Kaplan-Meier survival curve. To determine the risk factors for short-term death for patients, univariate and multivariate Cox regression analysis models were used. ResultsOur current study included a total of 83 individuals. The included patients had a median age of 49 (IQR 35–59) years. Of the included patients, 58 patients (69.9 %) died within 28 days. The median length of hospital stay for the patient was 13 (IQR 7–21) days. The APACHE II score, SOFA score, GCS, PLT count, INR, stroke, mechanical ventilation, and vasopressor reliance were related to 28-day mortality according to the univariate Cox analysis. INR (HR = 1.004, 95 % Cl: 1.001–1.006, P = 0.008), stroke (HR = 1.971, 95 % Cl: 1.031–3.768, P = 0.04), mechanical ventilation (HR = 3.948, 95 % Cl: 1.090–14.294, P = 0.036), and vasopressor dependency (HR = 2.262, 95 % Cl: 1.099–4.655, P = 0.027) were independently associated with the risk of 28-day death rates, according to multivariate Cox regression analysis. ConclusionsBrain injuries who have severe hypernatremia requires CVVH, which has high short-term patient mortality. Mechanical ventilation, INR increase, stroke, and vasopressor dependence are independently associated with increased patient mortality risk.

Safety and Efficacy of Selenium on Recovery of Hospitalized Patients with COVID-19: A Randomized Controlled Clinical Trial

Background: Various micronutrients have been used to manage patients affected by coronavirus disease 2019 (COVID-19). However, data on the potential benefits of selenium for COVID-19 patients are scarce. Objectives: This study was conducted to monitor the efficacy and safety of selenium supplementation in COVID-19 patients hospitalized at Shahid Mostafa Khomeini Hospital in Ilam, Iran, in 2021. Methods: In this randomized controlled trial, 100 COVID-19 cases were included and divided into two groups: The selenium group (n = 50) was prescribed the hospital treatment protocol as well as selenium supplementation in a daily dose of 200 µg, and the control group (n = 50) that received only the hospital treatment protocol. Laboratory tests, including platelet, white blood count (WBC), hemoglobin, ferritin, c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were performed before the trial and on the 14th day. Two groups were compared based on laboratory findings, duration of hospitalization, and dependency on mechanical ventilation. Results: In the selenium group, platelets, WBC, and hemoglobin rose remarkably compared to their pre-treatment concentrations (P &lt; 0.05), while a considerable drop was detected in levels of ESR, CRP, and ferritin (P &lt; 0.05). The mean length of stay in the selenium and control groups was 9.27 ± 13.50 and 11.45 ± 14.33 days, respectively (P = 0.401). The mean mechanical ventilation dependency days in the selenium and control groups were 9.65 ± 11.71 and 7.45 ± 4.93, respectively, implying no statistically significant difference (P = 0.307). Conclusions: Selenium supplement may reduce levels of inflammatory markers in COVID-19 patients. Nevertheless, further trials are required to monitor its clinical effectiveness.

Respiratory Musculature Evaluated by Computed Tomography in the Setting of Prolonged Mechanical Ventilation.

Diaphragm atrophy has been observed in subjects who undergo invasive mechanical ventilation. We propose a new method to assess for respiratory muscle (RM) changes in subjects who undergo invasive mechanical ventilation by assessing for changes in respiratory muscles through computed tomography (CT). A retrospective case series study was conducted on subjects who underwent invasive mechanical ventilation and received at least 2 chest CT scans during admission. Exclusion criteria included history of chronic mechanical ventilation dependence and neuromuscular disease. Respiratory muscle cross-sectional area (CSA) was measured at the T6 vertebrae. Fourteen subjects were included: mean (± SD) age, BMI, and admission APACHE II scores were 54.0 y (± 14.9), 32.6 kg/m2 (± 10.9), and 23.5 (± 6.0), respectively. Ten (71%) subjects were male. Mean length of time between CT chest scans was 7.5 d (± 3.3). Mean duration of invasive mechanical ventilation was 4.5 d (± 3.4). The percentage change in TM CSA among those who underwent invasive mechanical ventilation was 10.5% (± 6.1). We demonstrated that serial analysis of respiratory muscle CSA through CT chest scans can be a method to assess for respiratory muscle atrophy in subjects undergoing mechanical ventilation. Future prospective studies involving larger populations are needed to better understand how this method can be used to predict outcomes in mechanically ventilated patients.

(1180) A Case of Successful Lung Transplantation Following 10 Months of Mechanical Ventilator Dependence

(1180) A Case of Successful Lung Transplantation Following 10 Months of Mechanical Ventilator Dependence

Predictive factors for respiratory failure and in-hospital mortality after surgery for spinal metastasis

PurposeSpinal metastasis surgeries carry substantial risk of complications. PRF is among complications that significantly increase mortality rate and length of hospital stay. The risk factor of PRF after spinal metastasis surgery has not been investigated. This study aims to identify the predictors of postoperative respiratory failure (PRF) and in-hospital death after spinal metastasis surgery.MethodsWe retrospectively reviewed consecutive patients with spinal metastasis surgically treated between 2008 and 2018. PRF was defined as mechanical ventilator dependence > 48 h postoperatively (MVD) or unplanned postoperative intubation (UPI). Collected data include demographics, laboratory data, radiographic and operative data, and postoperative complications. Stepwise logistic regression analysis was used to determine predictors independently associated with PRFs and in-hospital death.ResultsThis study included 236 patients (average age 57 ± 14 years, 126 males). MVD and UPI occurred in 13 (5.5%) patients and 13 (5.5%) patients, respectively. During admission, 14 (5.9%) patients had died postoperatively. Multivariate logistic regression analysis revealed significant predictors of MVD included intraoperative blood loss > 2000 mL (odds ratio [OR] 12.28, 95% confidence interval [CI] 2.88–52.36), surgery involving cervical spine (OR 9.58, 95% CI 1.94–47.25), and ASA classification ≥ 4 (OR 6.59, 95% CI 1.85–23.42). The predictive factors of UPI included postoperative sepsis (OR 20.48, 95% CI 3.47–120.86), central nervous system (CNS) metastasis (OR 10.21, 95% CI 1.42–73.18), lung metastasis (OR 7.18, 95% CI 1.09–47.4), and postoperative pulmonary complications (OR 6.85, 95% CI 1.44–32.52). The predictive factors of in-hospital death included postoperative sepsis (OR 13.15, 95% CI 2.92–59.26), CNS metastasis (OR 10.55, 95% CI 1.54–72.05), and postoperative pulmonary complications (OR 9.87, 95% CI 2.35–41.45).ConclusionPRFs and in-hospital death are not uncommon after spinal metastasis surgery. Predictive factors for PRFs included preoperative comorbidities, intraoperative massive blood loss, and postoperative complications. Identification of risk factors may help guide therapeutic decision-making and patient counseling.

Direct Extracorporeal Membrane Oxygenation Bridged Heart Transplantation: The Importance of Multi-Organ Failure.

Recently, approximately 40% of all heart transplantation (HTx) in South Korea are performed using the direct extracorporeal membrane oxygenation (ECMO) bridging method. We conducted a study to examine the clinical outcome of direct ECMO-bridged HTx and to investigate the impact of multi-organ failure (MOF). From June 2014 to September 2022, a total of 96 adult patients who underwent isolated HTx at a single tertiary hospital were included in the study. The patients were sub-grouped into ECMO (n=48) and non-ECMO group (n=48), and the ECMO group was subdivided into awake (n=22) and non-awake (n=26) groups based on mechanical ventilator (MV) dependency. Baseline characteristics, 30-day, and 1-year mortality were analyzed retrospectively. The 1-year survival rate was significantly lower in the ECMO group (72.9% vs. 95.8%, p=0.002). There was a significant difference in the 30-day survival rate between the awake and non-awake ECMO groups (81.8% vs. 65.4%, p=0.032). In the univariate analysis of logistic regression for 1-year mortality, the odds ratio was 8.5 for ECMO bridged HTx compared to the non-ECMO group, 12.3 in patients who required MV (p=0.003), and 23 with additional hemodialysis (p<0.001). Patients who required MV in ECMO bridged HTx showed higher preoperative MOF rates and early mortality than those extubated. When considering ECMO bridged HTx, the severity of MOF should be thoroughly investigated, and careful patient selection is necessary.

Anaerobic Lung Abscess with Complex Empyema

A 51-year-old man with advanced ALS and home mechanical ventilator dependence presented with fever, tachycardia, hypotension and leukocytosis. Chest radiograph showed a large left pleural effusion (Figure 1) and an unenhanced chest CT confirmed a loculated effusion with gas bubbles (Figure 2) and large air-fluid level (Figure 3).

Outcomes Among Hospitalized Patients With COVID-19 and Acute Kidney Injury Requiring Renal Replacement Therapy.

IntroductionAcute kidney injury (AKI) occurs in up to 10%-30% of coronavirus disease 2019 (COVID-19) patients. AKI patients who require renal replacement therapy (RRT) often have concurrent respiratory failure and represent a high-mortality-risk population. The authors sought to describe outcomes in hospitalized COVID-19 patients with AKI requiring RRT and determine factors associated with poor outcomes. MethodsA retrospective cohort study of hospitalized COVID-19 patients with AKI requiring RRT during the period from March 14, 2020, to September 30, 2020, was performed at Kaiser Permanente Southern California. RRT was defined as conventional hemodialysis and/or continuous renal replacement therapy. The primary outcome was hospitalization mortality, and secondary outcomes were mechanical ventilation, vasopressor support, and dialysis dependence among discharged patients. Hospitalization mortality risk ratios were estimated up to 30 days from RRT initiation. ResultsA total of 167 hospitalized COVID-19 patients were identified with AKI requiring RRT. The study population had a mean age of 60.7 years and included 71.3% male patients and 60.5% Hispanic patients. Overall, 114 (68.3%) patients died during their hospitalization. Among patients with baseline estimated glomerular filtration rate (eGFR) values of ≥ 60, 30-59, and < 30 mL/min, the mortality rates were 76.8%, 78.1%, and 50.0%, respectively. Among the 53 patients who survived to hospital discharge, 29 (54.7%) continued to require RRT. Compared to patients with eGFR < 30 mL/min, the adjusted 30-day hospitalization mortality risk ratios (95% CI) were 1.38 (0.90-2.12) and 1.54 (1.06-2.25) for eGFR values of 30-59 and ≥ 60, respectively. ConclusionAmong a diverse cohort of hospitalized COVID-19 patients with AKI requiring RRT, survival to discharge was low. Greater mortality was observed among patients with higher baseline kidney function. Most of the patients discharged alive continued to be dialysis-dependent.

Efficacy and safety of fibrinogen administration in acute post-traumatic hypofibrinogenemia in isolated severe traumatic brain injury: A randomized clinical trial

AimThis study was conducted to evaluate clinical outcomes after fibrinogen administration in hypofibrinogenemia following severe traumatic brain injury. BackgroundPost traumatic coagulopathy (PTC) is a common but devastating medical condition in patients with severe head injury. Hypofibrinogenemia is considered as an indicator for poor clinical outcomes in traumatic brain injury (TBI). MethodsIn this randomized clinical trial (RCT), primarily 137 patients with severe traumatic brain injury (Glasgow coma scale score: GCS < 9) were enrolled. Thereafter, their plasma fibrinogen level was measured. The patients with primary hypofibrinogenemia (<200 mg/dL) with no concurrent coagulopathy were randomly allocated into fibrinogen-receiving (n = 50) and control (n = 54) groups. P-value < 0.05 was considered as statistically significant. ResultsSeventy-one patients were analyzed in the final step of the study. The mean value for age in fibrinogen and control groups was 25.64 ± 10.71 and 28.91 ± 12.25 years old, respectively. Male – female patients in both groups were equally distributed. In the fibrinogen receiving group, GCS scores were significantly higher after 24, 48, and 72 h compared to the control group (p = 0.000). Hematoma expansion was better controlled in the fibrinogen receiving group (p = 0.000). Notably, the number needed to treat (NNT) for fibrinogen infusion and hematoma expansion control was 2.3. Glasgow outcome scale-extended (GOSE) was significantly better in the fibrinogen group (p = 0.25). Multiple regression tests showed intracerebral hematoma (ICH) and severe brain edema had the most detrimental effect on GOSE outcomes. The need for cranial surgery, hospital stay duration, mechanical ventilator dependency, in hospital and 90-day post discharge mortality rates were similar in both study groups. ConclusionIn severe TBI, hypofibrinogenemia correction (>200 mg/dL) could improve GOSE, GCS score progression within 3 days after primary head injury and hematoma expansion controllability.

Abordagem fisioterapêutica e perfil dos pacientes assistidos na unidade cirúrgica do pronto-socorro de um hospital terciário do Distrito Federal

Abstract Introduction The emergency room (ER) is the main entry door for the care of critically ill patients. The inclusion of physiotherapists in these sectors is being consolidated in Brazil. Objective To characterize the physiotherapeutic approach and the clinical-functional profile of patients in the ER surgical unit of a tertiary hospital. Methods This was a retrospective cross-sectional study conducted from August to December of 2020. Clinical and functional data, and the main physiotherapeutic procedures performed, were collected. Analyses were conducted by means of the Friedman and Pearson Correlation tests, using SPSS software v.23. Results The sample included 98 patients, 68% male, mean age of 52 ± 19 years. The most common (64%) physiotherapeutic diagnosis was central nervous system (CNS) deficiency with mechanical ventilation (MV) dependence. The mean time of MV use was 4 ± 5 days. Association (p &lt; 0.05) between MV time and admission in the emergency department (r = 0.972) and between MV time and age (r = 0.330) was identified. The most used physiotherapeutic actions were: suction (69%), lung re-expansion therapy (51%), and bed kinesiotherapy (37%). Conclusion Adult men with CNS-related disabilities were the principal patient profile. The physiotherapeutic action in the surgical emergency unit was diverse, with application of motor and respiratory techniques, and the predominant activity was the management and maintenance of MV.

Presentation of SARS-CoV-2 in a Pediatric Heart Transplant Recipient with Multiple Underlying Comorbidities

A six-year-old heart transplant recipient with additional significant co-morbidities, including severe hypoxic-ischemic injury, gastrostomy, tracheostomy, and mechanical ventilation dependency, encountered SARS-CoV-2 infection. The patient received tacrolimus and mycophenolate to prevent graft rejection, presented initially with SARS-CoV-2 positive and presumed pseudomonas aeruginosa pneumonia. Twenty-three days later, the patient presented with fever recurrence with evidence for systemic inflammation, which resolved rapidly with high-dose methylprednisolone. Interestingly, while IgM to SARS-CoV-2 was present, IgG was not detected even three months after his first positive test for SARS-CoV-2. The author discusses potential immune mechanisms that might have affected the course of multi-system inflammatory syndrome children (MIS-C) in this patient.

Emergency surgical tracheotomy in the era of COVID-19 pandemic

At the beginning of 2020 a novel variant of coronavirus, named SARS-CoV-2, was identified as responsible for the development of severe pneumonia and acute respiratory distress syndrome (ARDS) with very high mortality, exceeding 30%. The disease caused by SARS-CoV-2, called Coronavirus Disease 2019 (COVID-19), was declared a pandemic by WHO on March 11th, 2020. Patients affected by COVID-19 may present with subtle, specific symptoms, but the sudden onset of life-threatening acute respiratory failure is not uncommon. The peculiarities of the disease combined with the single patient’s comorbidities, e.g. advanced age and cardiovascular diseases, plus hypoxia and hypotension secondary to ARDS, and multiorgan failure, may lead to unexpected difficulties in the case of tracheal intubation. The occurrence of the ‘Cannot-Intubate-Cannot-Oxygenate’ (CICO) scenario in COVID-19 patients represents a hazard not only for the patients but also for the assisting healthcare workers due to the high risk of aerosol-generating infected particles during conventional rescue airway procedures. While international consensus guidelines on the management of CICO scenario in COVID-19 patients are still lacking, there is evidence that both scalpel cricothyrotomy (CT) and open surgical tracheotomy (OST) represent valid alternatives for the establishment of a front-of-neck emergency airway. Primary CT requires a staged conversion to formal tracheotomy; conversely, OST represents a definitive mastery of the airway in COVID-19 patients in case of prolonged mechanical ventilation dependency, avoiding a second procedure and further exposure to aerosols. Furthermore, in patients with facial trauma and/or head and neck tumors, OST allows obtaining safe airway control. In the context of the current pandemic, emergency OST procedure in SARS-CoV-2 positives (or with unknown status) requires adequate arrangements and the use of proper personal protective equipment to limit risks for clinicians.

Impact of inhaled corticosteroids on the neurodevelopmental outcomes in chronically ventilated extremely low birth weight preterm infants

Few studies have assessed the long-term impact of inhaled corticosteroids (ICS) in preterm infants. This study evaluated the neurodevelopmental outcomes of chronically ventilated extremely low birth weight (ELBW) preterm infants exposed to ICS. The medical records of ELBW preterm infants admitted to two tertiary-level neonatal intensive care units from 2008 to 2014 were reviewed. Infants intubated for more than 28 days were included. The neurodevelopmental outcomes were compared at 24 months corrected age, between those with ICS exposure (inhaled group, IH) and those without it (non-inhaled group, NIH), by using the Bayley-Scale-of-Infant-and-Toddler Development-III (BSID-III). Out of the 115 infants included, 64 had an ICS exposure. The incidence of the morbidities at the time of discharge, was comparable between the two groups, except for the duration of oxygen and mechanical ventilation dependence (IH 124.8±40.3 days vs. NIH: 101.0±28.6 days, p<0.001 and IH 60.0±25.8 days vs. NIH: 42.3±14.2 days, p<0.001, respectively). Multiple logistic regression analysis at 24 months corrected age revealed no significant differences in the BSID-III scores and in the incidence of cerebral palsy and neurodevelopmental impairment. The late ICS exposure was not associated with neurodevelopmental impairment at 24 months corrected age in chronically ventilated ELBW infants; however, it did not reduce the duration of their dependence on oxygen and mechanical ventilation.