Ventilation Therapy Research Articles

Changes in neonatal morbidity, neonatal care practices, and length of hospital stay of surviving infants born very preterm in the Netherlands in the 1980s and in the 2000s: a comparison analysis with identical characteristics definitions

BackgroundThis study evaluates changes in the neonatal morbidity, the neonatal care practices, and the length of hospital stay of surviving very preterm (VP) infants born in the Netherlands in the 1980s and in the 2000s; a period over which historical improvements were introduced into neonatal care. We, herein, also study whether these changes in neonatal morbidity, neonatal care practices and length of hospital stay are associated with sociodemographic, prenatal, and infant characteristics.MethodsTwo community-based cohorts from 1983 (POPS) and 2002−03 (LOLLIPOP) have provided the perinatal data for our study. The analysis enrolled 1,228 participants born VP (before the 32nd week of gestation) and surviving to 2 years of age without any severe congenital malformation. A rigorous harmonisation protocol ensured a precise comparison of the cohorts by using identical definitions of the perinatal characteristics.ResultsIn 2003, mothers were older when giving birth, had higher multiple birth rates, and significantly more parents had received higher education. In 2003, less VP infants had severe intraventricular haemorrhage and sepsis and relatively more received continuous positive airway pressure, mechanical ventilation and caffeine therapy than in 1983. Antenatal corticosteroids and surfactant therapy were provided only in 2003. The length of the stay in the neonatal intensive care unit and in hospital had decreased in 2003 by 22 and 11 days, respectively. Differences persisted after adjustment for sociodemographic, prenatal, and infant characteristics.ConclusionsNeonatal morbidities of the surviving VP infants in this study have not increased, and exhibit improvements for various characteristics in two cohorts born 20 years apart with comparable gestational age and birth weight. Our data suggest that the improvements found are associated with more advanced therapeutic approaches and new national protocols in place, and less so with sociodemographic changes. This analysis provides a basis for further comparative analyses of the health and the development of VP children, particularly with regard to long-term outcomes.

Machine learning modeling of lung mechanics: Assessing the variability and propagation of uncertainty in respiratory-system compliance and airway resistance

Background and ObjectiveTraditional assessment of patient response in mechanical ventilation relies on respiratory-system compliance and airway resistance. Clinical evidence has shown high variability in these parameters, highlighting the difficulty of predicting them before the start of ventilation therapy. This motivates the creation of computational models that can connect structural and tissue features with lung mechanics. In this work, we leverage machine learning (ML) techniques to construct predictive lung function models informed by non-linear finite element simulations, and use them to investigate the propagation of uncertainty in the lung mechanical response. MethodsWe revisit a continuum poromechanical formulation of the lungs suitable for determining patient response. Based on this framework, we create high-fidelity finite element models of human lungs from medical images. We also develop a low-fidelity model based on an idealized sphere geometry. We then use these models to train and validate three ML architectures: single-fidelity and multi-fidelity Gaussian process regression, and artificial neural networks. We use the best predictive ML model to further study the sensitivity of lung response to variations in tissue structural parameters and boundary conditions via sensitivity analysis and forward uncertainty quantification. Codes are available for download at https://github.com/comp-medicine-uc/ML-lung-mechanics-UQ ResultsThe low-fidelity model delivers a lung response very close to that predicted by high-fidelity simulations and at a fraction of the computational time. Regarding the trained ML models, the multi-fidelity GP model consistently delivers better accuracy than the single-fidelity GP and neural network models in estimating respiratory-system compliance and resistance (R2∼0.99). In terms of computational efficiency, our ML model delivers a massive speed-up of ∼970,000× with respect to high-fidelity simulations. Regarding lung function, we observed an almost matched and non-linear behavior between specific structural parameters and chest wall stiffness with compliance. Also, we observed a strong modulation of airways resistance with tissue permeability. ConclusionsOur findings unveil the relevance of specific lung tissue parameters and boundary conditions in the respiratory-system response. Furthermore, we highlight the advantages of adopting a multi-fidelity ML approach that combines data from different levels to yield accurate and efficient estimates of clinical mechanical markers. We envision that the methods presented here can open the way to the development of predictive ML models of the lung response that can inform clinical decisions.

Indications, safety, and outcomes of therapeutic plasma exchange in critically ill children admitted to a multidisciplinary tertiary care pediatric intensive care unit

Background: Therapeutic plasma exchange (TPE) can be technically challenging in critically ill children in pediatric intensive care unit (PICU). This study was done to characterize the indications, technical aspects, safety, and outcomes of TPE in critically ill children admitted to PICU. Subjects and Methods: This was a retrospective study by analyzing the electronic medical records of 33 critically ill children (1 month–18 years of age) who underwent TPE in PICU. Results: A total of 33 patients underwent 122 TPE sessions. The most common diagnosis for TPE was acute liver failure (48.48%). Invasive mechanical ventilator (MV) and renal replacement therapy (RRT-continuous RRT [CRRT]/intermittent hemodialysis) were needed in 72.7%. Vasoactive support was needed in 63.6%, of whom 76% needed ≥2 vasoactive medications. Organ dysfunction of ≥3 organs was seen in 66.6%. One patient was also on extracorporeal membrane oxygenation (ECMO) support. Survival to intensive care unit discharge was 59.3%. Mortality was highest for liver failure (9/16: 56%), followed by sepsis with multiple organ dysfunction syndrome (40%). TPE without needing dialysis had a survival rate of 75%, while TPE with CRRT had a survival rate of 45%. Survival with ≥3 organ dysfunction was 36.3%. Factors associated with increased mortality were MV (P = 0.0115), need for vasoactive medications (P = 0.0002), organ dysfunction (P = 0.005), and specific indications (P = 0.0458). Complications were noted in 2.4%. Conclusions: TPE can be performed safely in critically ill children in combination with RRT and ECMO. The need for MV, multiple vasoactive medications, liver failure, sepsis, and higher number of organ failures were significantly associated with mortality.

Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit

ObjectivesPatients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.MethodsThis is...

Effect of nasal high-flow oxygen humidification on patients after cardiac surgery

BackgroundAlthough high-flow humidified oxygen therapy (HFNC) has emerged as an important treatment for respiratory failure, few studies have reported on whether HFNC is appropriate for patients with hypoxemia after cardiac surgery, and the clinical efficacy of HFNC in patients undergoing cardiac surgery is unclear. ObjectiveTo investigate the clinical effect of HFNC after cardiac surgery. MethodsConvenience sampling was used to select 76 patients who underwent invasive mechanical ventilation and oxygen therapy after valve replacement or coronary artery bypass grafting from July 2019 to June 2021. The patients were divided into the routine group and the HFNC group according to the oxygen therapy provided after the operation. The patients in the routine group (N = 38) were treated with oxygen inhalation by face mask after the operation, while those in the HFNC group (N = 38) were treated with HFNC via nasal cavity. The arterial partial pressure of oxygen (PaO2), the arterial partial pressure of carbon dioxide (PaCO2) and the oxygenation index (OI) were observed and compared between the two groups at 6 h, 12 h and 24 h after treatment. The sputum viscosity, incidence of second intubation and the intensive care unit (ICU) stay time were evaluated. ResultsThe difference in PaCO2 between the two groups was statistically significant at 24 h after treatment (p < 0.05). The PaO2 in the HFNC group was significantly higher than in the routine group at 24 h after treatment, and the OI of the routine group was lower than in the HFNC group at 6 h, 12 h and 24 h after treatment (p < 0.05). The sputum viscosity in the HFNC group was better than in the routine group at 12 h and 24 h after treatment. The second intubation rate and ICU stay time in the HFNC group were lower than in the routine group (p < 0.05). ConclusionCompared with conventional mask oxygen inhalation, HFNC can effectively reduce sputum viscosity, improve oxygenation, reduce the incidence of repeated intubation and meet patients’ comfort needs. It is an advantageous respiratory support strategy for patients after cardiac surgery compared with invasive mechanical ventilation to oxygen therapy and is beneficial to the recovery of cardiopulmonary function.

Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study

BackgroundPatients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA). MethodsThis retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS. ResultsThe study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0–77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01–1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335–8.073; P = 0.01), development of wound infection (2.653 1.285–5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388–2.116, P < 0.001) were significant predictors. ConclusionsIncreased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients’ LOS provides a reliable reference for clinical treatment.

Palliative Care as a Component of High Value and Cost-Saving Care During Hospitalization for Metastatic Cancer

Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs. This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with high charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care. Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P <.001) and costs (OR, 0.59; 95% CI, 0.58-0.61; P<.001). Factors associated with high charges were receipt of invasive medical ventilation (P<.001) or systemic therapy (P<.001), Hispanic patients (P<.001), and young age (18-49 years, P<.001). For-profit hospitals were more likely to bill high charges (OR, 5.05; 95% CI, 4.78-5.33, P<.001) but less likely to incur high hospital costs (OR, 0.51; 95% CI, 0.48-0.54, P<.001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P<.001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019). Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.

Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study.

The clinical characteristics and diagnosis of ten cases with severe Chlamydia psittaci pneumonia were analyzed. Ten patients had high fever, cough, or diarrhea, and all had a history of contact with birds or poultry. The white blood cell count of the patients was normal or slightly increased. The percentage of neutrophils (N%) and C reactive protein of the patients were significantly increased. Chest computer tomography showed patchy consolidation of both lungs, with one-sided lung lobes prominent, and bronchial inflation signs. All the patients were admitted to the intensive care unit due to respiratory failure. Nine patients needed ventilator-assisted ventilation therapy, and one patient needed high-flow oxygen therapy. All patients had sepsis, and five patients developed septic shock. The patients were diagnosed with severe C. psittaci pneumonia by clinical manifestations and contact history. After timely adjustment of tetracycline-based treatment, eight patients recovered and were discharged, and two patients died of septic shock and respiratory failure. Patients with poultry contact should be cautious toward C. psittaci pneumonia. A better method for the detection of C. psittaci is metagenomic next-generation sequencing. Its examination can shorten the diagnosis time. In a later stage, large-sample research is needed to guide clinical diagnosis and treatment.

Correlation between comorbidities and thoracic CT manifestations of COVID-19 pneumonia

Pulmonary manifestation of coronavirus disease 2019 (COVID-19) is described using standardized computed tomography (CT) morphologic criteria. In this study, we investigated possible associations between thoracic CT manifestations in COVID-19 pneumonia and typical comorbidities, as well as clinical course. We analyzed clinical data and pulmonary imaging of 61patients with positive PCR test. Pulmonary changes were categorized and reviewed for associations with pre-existing comorbidities and clinical course. Compared to patients with atypical infiltrate patterns (2/19, 10.5%), 25patients with typical infiltrate patterns (25/42, 59.5%) were significantly more likely to receive intensive care (p<0.001). In addition, patients with typical infiltrate patterns were more likely to receive non-invasive ventilation (12/42, 28.6%, p=0.040) and high-flow therapy (8/42, 19%, p=0.041) compared to patients with atypical infiltrate patterns. Mortality was also higher in patients with typical infiltrate patterns, with 15patients (15/42, 35.7%) dying during follow-up compared to only 1patient with atypical infiltrate pattern (1/19, 10.5%, p=0.012). No significant association between specific comorbidities and the resulting infiltrate pattern could be demonstrated. Patients with a typical COVID-19 infiltrate pattern are more likely to receive intensive care and show higher mortality rates. Further analysis with larger patient collectives is needed to identify specific risk factors for typical COVID-19 pneumonia.

Evaluating the Effectiveness of Emergency Ventilator Treatment for Severe Acute Left Ventricular Heart Failure

Objective: To evaluate the efficacy of emergency ventilator therapy in severe acute left heart failure. Methods: A total of 75 patients with severe acute left ventricular heart failure who were admitted to the hospital from July 2020 to July 2023 were randomly divided into two groups. Group A received additional emergency ventilator treatment, and group B received conventional treatment. The efficacy was compared. Results: The curative effect of patients with severe acute left heart failure in group A was higher than that in group B (P &lt; 0.05); all blood gas indicators in group A were better than those in group B (P &lt; 0.05); all vital signs indicators in group A were better than those in group B (P &lt; 0.05); group A was more satisfied with the treatment of severe acute left ventricular heart failure than group B (P &lt; 0.05). Conclusion: Patients with severe acute left heart failure who receive emergency ventilator treatment can stabilize vital signs, improve blood oxygen supply, and enhance curative effect.

Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score.

During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.

Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review

ObjectiveThis study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth...

Prevalence and impact of chronic dysglycaemia among patients with COVID-19 in Swedish intensive care units: a multicentre, retrospective cohort study

ObjectiveUsing glycated haemoglobin A1c (HbA1c) screening, we aimed to determine the prevalence of chronic dysglycaemia among patients with COVID-19 admitted to the intensive care unit (ICU). Additionally, we aimed to...

Abstract P156: IMPACT OF CHRONIC KIDNEY DISEASE ON HYPERTENSIVE EMERGENCY OUTCOMES

Introduction: In patients suffering from hypertension, the presence of concurrent chronic kidney disease (CKD) tends to escalate the risk of severe conditions and hospitalizations compared to those without such complications. This study, aimed to delve into the impact that a simultaneous diagnosis of CKD can have on patients admitted for hypertensive emergencies during the initial year of the COVID-19 pandemic. Methods: We examined data from the 2020 National Inpatient Sample to identify patients who were primarily admitted due to a hypertensive emergency. We used ICD-10 codes to distinguish between those with and without a concurrent CKD diagnosis. We employed logistic and linear regression analyses and accounted for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was less than 0.05. Results: During the calendar year of 2020, there were a total of 1,221,535 admissions, primarily for hypertensive emergencies. Notably, a significant proportion of these cases, amounting to 475,380 (38.9%), involved patients concurrently diagnosed with CKD. After adjusting for confounding variables, patients hospitalized for hypertensive emergencies, who were also diagnosed with CKD, demonstrated an elevated risk of in-hospital mortality (aOR 1.46, 95% CI 1.38-1.55), mechanical ventilation (aOR 1.12, 95% CI 1.09-1.15) and vasopressor therapy (aOR 1.27, 95% CI 1.15-1.40) Conclusion: Our findings suggest that CKD significantly impacts the hospital outcomes of patients admitted with hypertensive emergencies, often leading to less favorable results. As CKD prevalence is likely to rise in an aging population, the need to understand its pathophysiology and influence on severe hypertension cases is vital for future research.

Liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019.

Liver dysfunction was common in coronavirus disease 2019 (COVID-19), but its association with clinical features and poor prognosis has not been fully delineated. Our study aimed to determine the role of liver dysfunction in COVID-19 and understand the predictors for worse outcomes in patients with liver injury. We conducted this multicenter, retrospective study in five designated hospitals for COVID-19 management. Laboratory-confirmed COVID-19 patients were enrolled and classified into the normal live function group and liver dysfunction group according to liver enzymes, bilirubin, and albumin on admission, respectively. Data of baseline, clinical manifestations, and outcomes were collected and compared in the paired groups. Of the 649 included COVID-19 patients, 200 (30.8%), 69 (10.6%), and 267 (41.1%) patients had elevated liver enzymes, increased bilirubin, and low-level albumin, respectively. Fever, cough, and dyspnea were the most common symptoms and showed an increased proportion in the liver dysfunction group. Compared with patients in the normal liver function group, patients with liver dysfunction manifested decreased lymphocytes, higher level of leukocytes, neutrophils, inflammatory indicators, and cytokines, as well as more severe impairment in kidney function and myocardium. They were more likely to show bilateral involvement and more pulmonary lobes involved according to chest images. With increased proportion of patients who developed severe/critical conditions and needed mechanical ventilation and systemic glucocorticoid therapy, patients with liver dysfunction on admission showed significantly higher in-hospital mortality. Moreover, cardiac troponin I ≥1.5ng/mL was identified as an independent mortality predictor in the elevated liver enzymes group. Patients with liver dysfunction on admission had worse clinical manifestation, and resulted in higher rate of severe/critical type, receiving mechanical ventilation and in-hospital mortality.

Diagnosis, Prognostic Factors and Therapeutic Management of Invasive Fungal Infections. The Results of a Cross-Sectional Study in a Tunisian Hospital

Introduction: Invasive fungal infection (IFI) is associated to a high morbidity, mortality and healthcare costs. Patients and Methods: Our cross-sectional study focuses on patients who developed an IFI and treated with systemic antifungals, over a period of 14 months in a tunisian hospital. Clinico-biological data, risk factors, and therapeutic management were collected and analyzed. Results and Discussion: We report 51 cases with IFI, aged between 15 and 85 years. 56.9% were hospitalized in intensive care units and nearly 80% already suffer from other pathologies. Based on the EORTC/MSGERC criteria and clinical, radiological and biological data, IFIs were classified as follows : 49.3% cases of “proven infection”, 10.1% cases of “probable infection” and 17.4% cases of “possible infection”. Two risk factors revealed to correlate with a poor prognosis: intubation or invasive ventilation and long-term corticosteroid therapy. C.glabrata was the most common isolated species, agent responsible for invasive candidiasis. Resistances for fluconazole were not noticed. The anti-fungals prescribed for management of the IFI were: caspofungin, anidulafungin, voriconazole, amphotericin B and fluconzaole (following de-escalation). Conclusion: A close multidisciplinary collaboration between clinicians, radiologists, mycologists and pharmacists can improve the prognosis of these infections.

Non-Invasive Positive Pressure Ventilation or Standard Oxygen Therapy as Initial Treatment of Acute Cardiogenic Pulmonary Edema in ICU Patients

Abstract Background Continuous positive airway pressure ventilation (CPAP) through face mask has been widely used especially in North America, Europe and Australasia to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. Continuous positive airway pressure ventilation (CPAP) is ventilatory support that is given without establishing endotracheal intubation. CPAP avoid complication of endotracheal tube and invasive mechanical ventilation, preserving the patient’s ability to speak, eat, and cough reflex, reduces the need for sedation, potential airway trauma, and the risk of ventilator associated pneumonia. Objective: Patients and Methods In our study, 62 patients admitted at critical care unit of the Ain Shams University Hospitals with acute cardiogenic pulmonary edema. Patients divided into two groups. Group I: included 31 patients with acute cardiogenic pulmonary edema receive CPAP with (PS 10 cm h2o, PEEP 5 cm h2o). Group II: included 31 patients with acute cardiogenic pulmonary edema receive Oxygen therapy by face mask. Both groups are compared regarding the following parameter: Pao2, Pco2, respiratory rate and Spo2 on admission, 1-hour and 2-hours, post intervention and after discontinuation of treatment. Both groups were compared regarding the rate of endotracheal intubation, ICU length of stay and hospital mortality. Results Our study showed that the respiratory distress was markedly improved in CPAP group compared to oxygen therapy group by face mask as shown in respiratory rate after institution of CPAP (48.31±4.29, 35.84±5.30). In our study, as regarding to ICU length of stay, there was reduction in the intensive care unit length of stay in patient received CPAP compared to length of stay in standard oxygen treatment received group (2.48 ± 0.51 vs. 4.03± 0.65). Our study show that there is reduction in rate of intubation in group I with CPAP compared with group II with oxygen therapy by face mask. Conclusion Continuous positive air way pressure CPAP is widely used in North America, Europe and Australasia for patients with severe ACPE. There are clear mechanistic reasons why these interventions work in acute pulmonary edema. In conclusion, patients with acute cardiogenic pulmonary edema, CPAP safely provides earlier improvement of dyspnea, respiratory distress and oxygen saturation, and decrease ICU length of stay, improved endotracheal intubation and survival rate than does oxygen therapy.

Biological age as a predictor of unplanned intensive care readmission during the same hospitalization

BackgroundBiological age is increasingly being recognized as an important predictor of health but its utility in acute care setting remains uncertain. ObjectiveWe assessed whether biological age on intensive care unit (ICU) admission can predict unplanned ICU readmission during the same hospitalization. MethodsThe Levine PhenoAge model based on biomarkers of DNA methylation was used to determine each patient's biological age. The difference between PhenoAge and chronological age was indexed to the local context by regressing PhenoAge on chronological age using linear regression. A positive residual implied one's biological age was older than the corresponding chronological age compared to other patients — defined as PhenoAgeAccel. ResultsOf the 2950 patients included, 153 (5.2%) had unplanned ICU readmission. Chronological age, Acute Physiology and Chronic Health Evaluation II score, the use of mechanical ventilation, vasopressor, or renal replacement therapy were not significantly different between those with and without readmission. PhenoAgeAccel was, however, more common among those who had unplanned ICU readmission (52% vs 43%, p =0.031). Quantitatively, the degree of phenotypical age above chronological age exhibited a ‘dose-related’ relationship with the risk of readmission (odds ratio 1.12, 95% confidence interval 1.01-1.24; p=0.040) after adjusting for chronological age, comorbidities, and severity of acute illness in the index (first) ICU admission. ConclusionBiological age was predictive of unplanned ICU readmission during the same hospitalization.

Sodium-glucose Cotransporter-2 Inhibitors induced euglycemic diabetic ketoacidosis: A meta summary of case reports.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are commonly prescribed to manage patients with diabetes mellitus. These agents may rarely lead to the development of euglycemic diabetic ketoacidosis (EDKA), which may complicate the disease course of these patients. To analyze the demographic profile, predisposing factors, symptomology, clinical interventions and outcomes of patients presenting with EDKA secondary to SGLT2i use by reviewing the published case reports and series. We performed a systematic search of PubMed, Science Direct, Google Scholar and Reference Citation Analysis databases using the terms "canagliflozin" OR "empagliflozin" OR "dapagliflozin" OR "SGLT2 inhibitors" OR "Sodium-glucose cotransporter-2" AND "euglycemia" OR "euglycemic diabetic ketoacidosis" OR "metabolic acidosis". The inclusion criteria were: (1) Case reports or case series with individual patient details; and (2) Reported EDKA secondary to SGLT2i. Furthermore, the data were filtered from the literature published in the English language and on adults (> 18 years). We excluded: (1) Conference abstracts; and (2) Case reports or series which did not have individual biochemical data. All the case reports and case series were evaluated. The data extracted included patient demographics, clinical symptomatology, clinical interventions, intensive care unit course, need for organ support and outcomes. Overall, 108 case reports and 17 cases series with 169 unique patients that met all the inclusion criteria were included. The majority of patients were females (54.4%, n = 92), and the commonly reported symptoms were gastrointestinal (nausea/vomiting 65.1%, abdominal pain 37.3%) and respiratory (breathlessness 30.8%). One hundred and forty-nine (88.2%) patients had underlying type II diabetes, and the most commonly involved SGLT-2 inhibitor reported was empagliflozin (46.8%). A triggering factor was reported in most patients (78.7%), the commonest being acute severe infection (37.9%), which included patients with sepsis, coronavirus disease 2019, other viral illnesses, and acute pancreatitis. 61.5% were reported to require intensive unit care, but only a minority of patients required organ support in the form of invasive mechanical ventilation (13%), vasopressors (6.5%) or renal replacement therapy (5.9%). The overall mortality rate was only 2.4%. Patients on SGLT2i may rarely develop EDKA, especially in the presence of certain predisposing factors, including severe acute infections and following major surgery. The signs and symptoms of EDKA may be similar to that of DKA but with normal blood sugar levels, which may make the diagnosis challenging. Outcomes of EDKA are good if recognized early and corrective actions are taken. Hence, physicians managing such patients must be aware of this potential complication and must educate their patients accordingly to ensure early diagnosis and management.

Electrical Impedance Tomography Identifies Evolution of Regional Perfusion in a Porcine Model of Acute Respiratory Distress Syndrome.

Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast-enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position. Eleven mechanically ventilated (VT 8 ml · kg-1) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.5 ml · kg-1) to invoke lung injury. Electrical impedance tomography and computed tomography perfusion images were obtained at 2 h (early injury) and 24 h (late injury) after injury in supine position with PEEP 5 and 10 cm H2O. In eight animals, electrical impedance tomography and computed tomography perfusion imaging were also conducted in the prone position. Electrical impedance tomography perfusion (QEIT) and computed tomography perfusion (QCT) values (as percentages of image total) were compared in eight vertical regions across injury stages, levels of PEEP, and body positions using mixed-effects linear regression. The primary outcome was agreement between QEIT and QCT, defined using limits of agreement and Pearson correlation coefficient. Pao2/Fio2 decreased over the course of the experiment (healthy to early injury, -253 [95% CI, -317 to -189]; early to late injury, -88 [95% CI, -151 to -24]). The limits of agreement between QEIT and QCT were -4.66% and 4.73% for the middle 50% quantile of average regional perfusion, and the correlation coefficient was 0.88 (95% CI, 0.86 to 0.90]; P < 0.001). Electrical impedance tomography and computed tomography showed similar perfusion redistributions over injury stages and in response to increased PEEP. QEIT redistributions after positional therapy underestimated QCT in ventral regions and overestimated QCT in dorsal regions. Electrical impedance tomography closely approximated computed tomography perfusion measures in experimental acute respiratory distress syndrome, in the supine position, over injury progression and with increased PEEP. Further validation is needed to determine the accuracy of electrical impedance tomography in measuring perfusion redistributions after positional changes.