Exacerbations of COPD: The Role of Invasive Mechanical Ventilation

Abstract Background Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality. Results During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1–4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7–51] days, median ECMO duration was 16.4 [IQR 8.7–27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6–12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0). Conclusions The role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis.

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Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review

Indian Journal of Critical Care Medicine ◽

10.5005/jp-journals-10071-23870 ◽

2021 ◽

Vol 25 (6) ◽

pp. 690-697

Author(s):

Sanjana Nagraj ◽

Rutu Karia ◽

Sahar Hassanain ◽

Prithwish Ghosh ◽

Viraj R Shah ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Invasive Mechanical Ventilation

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Spontaneous pneumothorax, with or without pulmonary cysts, in patients with COVID-19 pneumonia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.15054 ◽

2021 ◽

Vol 15 (10) ◽

pp. 1404-1407

Author(s):

Javier Leonardo Galindo ◽

Luisa Fernanda Jiménez ◽

Juan Ricardo Lutz ◽

María Alejandra Izquierdo ◽

Viviana Lucía Rivillas ◽

...

Keyword(s):

Mechanical Ventilation ◽

Medical Records ◽

Spontaneous Pneumothorax ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Ventilator Weaning ◽

Radiologic Findings ◽

Pulmonary Cysts ◽

Rare Manifestation

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Pneumothorax is a rare manifestation of the disease. This report is a description of a series of patients with COVID-19 and spontaneous pneumothorax, some of them with associated pulmonary cysts. Methodology: Cases were collected retrospectively. We included clinical data from medical records and described radiologic findings. Patients that developed pneumothorax during mechanical ventilation were excluded. Results: Ten cases were included in this report, nine of them were male. The median age of our series was 62 years (IQR = 57-68). The median days since the onset of symptoms until the development of pneumothorax was 27 (IQR = 17-31), most cases developed after the second week of the diagnosis of pneumonia. Two cases required invasive mechanical ventilation, but pneumothorax occurred after ventilator weaning. Three cases showed subpleural pulmonary cysts. Conclusions: Cysts and pneumothorax are rare manifestations of SARS-CoV-2 pneumonia with mechanisms not completely understood. This report highlights the role of CT scan in diagnosis of COVID-19 complications.

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Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

Global Journal of Health Science ◽

10.5539/gjhs.v11n6p111 ◽

2019 ◽

Vol 11 (6) ◽

pp. 111

Author(s):

Iyad Abbas Salman ◽

Waleed Ibraheem Ali ◽

Amir Ibrahim Moushib ◽

Hayder Adnan Fawzi

Keyword(s):

Mechanical Ventilation ◽

Endotracheal Tube ◽

Invasive Mechanical Ventilation ◽

Tracheal Aspirate ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Subglottic Secretion ◽

Radiological Features ◽

Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &lrm;to decrease the incidence of VAP and thereby assisting in &lrm;the decrease of morbidity associated with invasive mechanical ventilation.&lrm; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&lrm; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &lrm;hospital for surgical specialties in medical city complex, 30 patients who &lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &lrm;clinical and radiological data to detect features of VAP was &lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &lrm;to confirm diagnosis.&lrm; RESULTS: &lrm;Patient’s age was 37.1 ± &lrm;&lrm;15.39 years, the highest proportion of study patients was found in &lrm;age group < 30 and &lrm;&lrm;30–49 years (40% in &lrm;each group), most of the patients were males (70%) with a male to female ratio of &lrm;&lrm;2.33:1&lrm;&rlm;, &rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &rlm;&lrm;0.167 (0.045–0.559)&lrm;&rlm;, p-&rlm;value = 0.001. &rlm;Twenty eight patients didn’t show any sign, symptoms &lrm;or radiological features suggesting a &lrm;diagnosis of pneumonia while two patients developed &lrm;features of pneumonia (suggestive signs and &lrm;symptoms, radiological features and &lrm;positive culture of tracheal aspirate).&lrm; CONCLUSION: the use of endotracheal tube with subglottic &lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&lrm;

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