Respiratory Failure In Intensive Care Unit Research Articles

Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation.

In critically ill patients, risk scores are used; however, they do not provide information for nutritional intervention. This study combined the levels of phenylalanine and leucine amino acids (PLA) to improve 30-day mortality prediction in intensive care unit (ICU) patients and to see whether PLA could help interpret the nutritional phases of critical illness. We recruited 676 patients with APACHE II scores ≥ 15 or intubated due to respiratory failure in ICUs, including 537 and 139 patients in the initiation and validation (multicenter) cohorts, respectively. In the initiation cohort, phenylalanine ≥ 88.5 μM (indicating metabolic disturbance) and leucine < 68.9 μM (indicating malnutrition) were associated with higher mortality rate. Based on different levels of phenylalanine and leucine, we developed PLA scores. In different models of multivariable analyses, PLA scores predicted 30-day mortality independent of traditional risk scores (p < 0.001). PLA scores were then classified into low, intermediate, high, and very-high risk categories with observed mortality rates of 9.0%, 23.8%, 45.6%, and 81.8%, respectively. These findings were validated in the multicenter cohort. PLA scores predicted 30-day mortality better than APACHE II and NUTRIC scores and provide a basis for future studies to determine whether PLA-guided nutritional intervention improves the outcomes of patients in ICUs.

Stress cardiomyopathy in critical care: A case series of 109 patients.

BACKGROUNDCritically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized. AIMTo describe a case series of patients with SC admitted to critical care units.METHODSWe conducted a retrospective observational study at a tertiary care teaching hospital. All adult (≥ 18 years old) patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.RESULTSOf 24279 admissions to the critical care units [19139 to medical-surgical intensive care units (MSICUs) and 5140 in coronary care units (CCUs)], 109 patients with SC were identified. Sixty (55%) were admitted to the coronary care units (CCUs) and forty-nine (45%) to the medical-surgical units (MSICUs). The overall incidence of SC was 0.44%, incidence in CCU and MSICU was 1.16% and 0.25% respectively. Sixty-two (57%) had confirmed SC and underwent cardiac catheterization whereas 47 (43%) had clinical SC, and did not undergo cardiac catheterization. Forty-three (72%) patients in the CCUs were diagnosed with primary SC, whereas all (100%) patients in MSICUs developed secondary SC. Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine (59%) MSICU patients. There were no statistically significant differences in intensive care unit (ICU) mortality, in-hospital mortality, use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.CONCLUSIONStress cardiomyopathy can be under-recognized in the critical care setting. Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure in ICU.

Predictors of ICU Admission and Mortality in Patients with Coronavirus Disease – 2019 (COVID 19) in Community Hospitals

Background:&#x0D; Coronavirus Disease 2019 (COVID-19) is caused by novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The mortality of patients in the Intensive Care Unit (ICU) is variable and has been reported to be as high as 80%. Not much is known about the factors leading to the progression of hospitalized patients to requiring ICU care and the predictors of mortality among ICU patients. We performed univariate followed by multivariate logistic regression analysis to determine predictors of progression of the disease and factors associated with mortality.&#x0D; &#x0D; Method:&#x0D; Retrospective data were collected from 101 consecutive patients admitted from March, 2020 to June, 2020. Data were collected from five different community hospitals in eastern Virginia with varied demographics.&#x0D; &#x0D; Result:&#x0D; A total of 101 consecutive hospitalized patients in five community hospitals in eastern Virginia were enrolled in the study. Out of the 101 patients, 53 were admitted into the ICU for respiratory failure. Of these 53, 40 patients required intubation and mechanical ventilation. Altogether, 30 of the 53 patients admitted to the ICU died. Of these 30 patients, 25 required intubations. Of these 25 patients, one had mild, 6 moderate and 18 severe Adult Respiratory Distress Syndrome (ARDS). Patients aged 60 years and above accounted for &gt;2/3rd of the cases in ICU.&#x0D; &#x0D; Conclusion:&#x0D; Logistic regression analysis revealed multiple factors associated with progression of disease leading to transfer into the ICU from floor and unfavorable outcome.&#x0D;

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey.

This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.

Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial

BackgroundIn intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone.MethodsPost-hoc analysis of a multicenter, randomized, controlled trial focusing on patients who experienced post-extubation respiratory failure within the 7 days following extubation. Patients were classified in the NIV group or the high-flow nasal oxygen group according to oxygenation strategy used after the onset of post-extubation respiratory failure. Patients reintubated within the first hour after extubation and those promptly reintubated without prior treatment were excluded. The primary outcome was mortality at day 28 after the onset of post-extubation respiratory failure.ResultsAmong 651 extubated patients, 158 (25%) experienced respiratory failure and 146 were included in the analysis. Mortality at day 28 was 18% (15/84) using NIV alternating with high-flow nasal oxygen and 29% (18/62) with high flow nasal oxygen alone (difference, − 11% [95% CI, − 25 to 2]; p = 0.12). Among the 46 patients with hypercapnia at the onset of respiratory failure, mortality at day 28 was 3% (1/33) with NIV and 31% (4/13) with high-flow nasal oxygen alone (difference, − 28% [95% CI, − 54 to − 6]; p = 0.006). The proportion of patients reintubated 48 h after the onset of post-extubation respiratory failure was 44% (37/84) with NIV and 52% (32/62) with high-flow nasal oxygen alone (p = 0.21).ConclusionsIn patients with post-extubation respiratory failure, NIV alternating with high-flow nasal oxygen might not increase the risk of death.Trial registration numberThe trial was registered at http://www.clinicaltrials.gov with the registration number NCT03121482 the 20th April 2017.

What are the prognostic factors affecting 30-day mortality in geriatric patients with respiratory failure in the Intensive Care Unit?

Objective:We aimed to investigate the prognostic factors related to 30 day mortality of elderly patients with respiratory failure in the intensive care unit (ICU).Methods:We performed a single centre, retrospective study and analyzed the main variables and outcomes of 238 geriatric patients admitted to an ICU with ARF between December 2017- January 2019 in Chest Disease Hospital, were included and classified as survivors and nonsurvivors. Main characteristics, laboratory datas, severity and nutrition scores were evaluated and logistic regression analysis were used.Results:The nonsurvivor group included 110 cases (40% female,) with a median age of 79, had higher scores in the followings; Acute Physiology Chronic Health Evaluation II score (APACHE-II) (p < 0.001), Charlson Comorbidity Index (CCI) (p < 0.001), Sequential Organ Failure Assessment score (p < 0.001). The inotropic support requirement was also higher in the nonsurvivor group (48,2%). As a comorbidity, malignancy and Type-I respiratory failure were higher in the nonsurvivor group (p=0.03, p < 0.001). The overall 30-day mortality was 46%. Blood urea nitrogen, procalsitonin, C-reactive protein and creatinine levels were higher in the nonsurvivor group (p < 0.001). However, albumin (p < 0.001), BMI (p=0.03) and longer hospital stay (p < 0.001) were higher in the survivor group. Inotropic support, APACHE-II score and CCI were independently related to increased mortality risk, whereas albumin was associated with decreased mortality risk.Conclusion:High APACHE II score, low CCI, low albumin levels and the requirement for inotropic support were found to be independently risk factors of 30-day mortality in the geriatric patients with respiratory failure in ICU.

The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure

There are several screening tools used in the detection of malnutrition to facilitate nutritional support and predict prognosis in the elderly. We aimed to compare the prognostic predictive value of geriatric nutritional risk index (GNRI) with other nutritional indices on 1month survival in geriatric patients hospitalized for respiratory failure in intensive care unit (ICU). A total of 191 geriatric patients (> 65years) admitted to a specialized chest hospital with respiratory failure between January 2018 and January 2019 were analyzed. Patients were classified into two category according to 30-day survival: Survivors and Non-survivors. Nutritional assesment was done via GNRI, OPNI, NRS 2002, Nutric Scores in ICU. Using GNRI, 146 (76.3%) geriatric patients found to be at risk of malnutrition (GNRI score: ≤ 92). GNRI < 86.9 showed significantly higher 30-day mortality rate and patients with malnutrition risk were older, had significantly lower BMI, OPNI, and higher SOFA score. The Age, NRS 2002, Nutric and SOFA score had negative correlation with GNRI. Nutric score, prealbumin and GNRI were detected as significant independent risk factors of 30-day mortality. GNRI had higher sensitivity (76.7%) but lower specificity (57.1%) compared to Nutric score and OPNI for the prediction of 30-day hospital mortality. Compared to others, Geriatric Nutritional Risk Index (GNRI) seems to be a good predictor of 30-day mortality and having a score of less than 86.9 increase the malnutrition risk in geriatric patients hospitalized for respiratory failure in ICU.

Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other?

It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a first-line strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in post-operative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.

Preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy for intubation of patients with acute hypoxaemic respiratory failure in ICU: the prospective randomised controlled FLORALI-2 study protocol

IntroductionEndotracheal intubation in intensive care unit (ICU) is a procedure at high risk of life-threatening complications. Among them, severe oxygen desaturation, usually defined as a drop of pulse oxymetry (SpO2)...

Noninvasive ventilation in treatment of acute respiratory failure in ICU

In the last years noninvasive ventilation (NIV) is used increasingly worldwide in treatment of acute respiratory failure (ARF). The evidence strongly supports NIV use in patients with ARF, especially for chronic obstructive pulmonary disease (COPD) ex-acerbations and acute cardiogenic pulmo-nary edema. The efficacy of NIV depends on several factors like the experience of medical team, adequate selection of patient and inter-face and appropriate ventilator settings. This is a retrospective analysis of patients with ARF treated by NIV in the medical in-tensive care unit (ICU), University Hospital Sveti Duh, between January 2015 and Janu-ary 2016.Analysis of statistical hospital data showed steady increments in NIV utilization from year 2011 (7%) to 2015 (15.7%). The mean age of studied patients was 69.8 years, 58.3% were male and 41.7% female. Four ma-jor causes for applying NIV were: COPD (41.7%), pneumonia (25%), acute cardio-genic pulmonary edema (19.4%) and other reasons (13.9%). Of 108 patients 93 (86.1%) were successfully treated with NIV and 15 (13.9%) were intubated. A number of randomized clinical trials sup-port the use of NIV in patients with ARF and beside the beneficial role in reducing patients symptoms it showed reduction in morbidity, mortality and length of stay in ICU. Failure rates of NIV still range from 25% to 40%, and optimization of NIV success rates requires careful patient selection and knowledge of proper application and monitoring tech-niques. If a patient fails to improve sufficient-ly, prompt endotracheal intubation should be performed without delay.

Survival of bronchiectatic patients with respiratory failure in ICU

BackgroundThe outcome of patients with bronchiectasis during and after their stay in the intensive care unit (ICU) has seldom been reported in the literature. Managing these patients in the ICU can be challenging because of the complex nature of their disease. This study aims to identify the in-hospital and long-term outcome of patients with bronchiectasis and respiratory failure (RF) in ICU.MethodsA retrospective study was carried out by studying all bronchiectatic patients admitted to the medical ICU for RF over a 10-year period (1995–2004).ResultsThe mean (± standard deviation) age of 35 patients was 63.5 ± 11.7 years and APACHE score was 22.3 ± 7.3. The 4-year mortality was 60%. Among the variables observed, age > 65 years (hazard ratio (HR): 4.15; 95% confidence interval (CI): 3.2–5.1), APACHE II score > 24 (2.6, 95% CI 1.7–3.5), intubation (2.81, 95 %CI 1.9–3.7), inotropic support (2.9, 95% CI 2.0–3.7), Home-O2 (4.0, 95% CI 2.7–5.2) and activity index (4.0, 95% CI 2.8–5.3) were associated with diminished survival in univariate analysis by Cox regression. By long rank test, survival probabilities were significantly low at these strata. Multivariate analysis of Cox proportional hazard model showed that age > 65 years (HR: 5.4, 95% CI 1.9–15.7); activity index (HR: 4.8, 95% CI 1.4–16.6); and inotropic support (HR: 3.8, 95% CI 1.5–10.1) were independently associated with reduced survival.ConclusionThe decreased survival of ICU patients was associated with age > 65 years, activity index (bedridden or wheelchair-bound) and use of inotropic support.