The effect of short-term discontinuation of high-level PEEP in patients with acute respiratory failure

Background: There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days. Methods: Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups. Results: A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4–20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses. Conclusions: Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.

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Controlled ventilation with best positive end-expiratory pressure (PEEP) and high level PEEP in acute respiratory failure (ARF)

Intensive Care Medicine ◽

10.1007/bf01724837 ◽

1981 ◽

Vol 7 (4) ◽

pp. 171-176 ◽

Cited By ~ 8

Author(s):

F. Jardin ◽

P. Desfond ◽

M. Bazin ◽

M. Sportiche ◽

A. Margairaz

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Positive End Expiratory Pressure ◽

Controlled Ventilation ◽

High Level

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Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

Critical Care ◽

10.1186/s13054-021-03550-4 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Hideto Yasuda ◽

Hiromu Okano ◽

Takuya Mayumi ◽

Chihiro Narita ◽

Yu Onodera ◽

...

Keyword(s):

Respiratory Failure ◽

Relative Risk ◽

Confidence Interval ◽

Acute Respiratory Failure ◽

Meta Analysis ◽

Positive Pressure ◽

Cochrane Central Register ◽

Short Term ◽

Short Term Mortality ◽

Registration Number

Abstract Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

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Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

10.21203/rs.3.rs-270103/v1 ◽

2021 ◽

Author(s):

Hideto Yasuda ◽

Hiromu Okano ◽

Takuya Mayumi ◽

Chihiro Narita ◽

Yu Onodera ◽

...

Keyword(s):

Respiratory Failure ◽

Relative Risk ◽

Confidence Interval ◽

Acute Respiratory Failure ◽

Mortality Risk ◽

Meta Analysis ◽

Positive Pressure ◽

Short Term ◽

Short Term Mortality ◽

Registration Number

Abstract Background: High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, COT) in reducing the mortality and reintubation risk.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients aged ≥16 years who underwent invasive mechanical ventilation for >12 hours for acute respiratory failure and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effects meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results: After evaluating 4,631 records, 15 studies and 2,600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval], 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared with COT use. The associations of mortality with NPPV and HFNC in either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval], 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).Conclusion: NPPV or HFNC use may reduce endotracheal reintubation risk, but not short-term mortality risk.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).

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A Novel Prediction Prognosis Model of sepsis with acute respiratory failure: A cohort study from the MIMIC-IV database

10.21203/rs.3.rs-449660/v1 ◽

2021 ◽

Author(s):

Lina Zhao ◽

Jing Yang ◽

Yunying Wang ◽

Zheng Ge. Zeng ◽

Tao Liu ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Medical Information ◽

Cox Regression ◽

Abdominal Cavity ◽

Simplified Acute Physiology Score ◽

Hospital Death ◽

Short Term ◽

Short Term Mortality ◽

Prognosis Model

Abstract Objectives: Acute respiratory failure is significantly related to increased short-term mortality in sepsis patients. We aimed to develop a novel prognosis model for predicting the risk for hospital mortality in sepsis patients with acute respiratory failure.Methods: We researched the Medical Information Mart for Intensive Care (MIMIC)-IV database, and developed a matched cohort of adult sepsis with acute respiratory failure. After applying multivariate Cox regression, a nomogram was developed based on identified risk factors of the mortality in the cohort. Besides, the discrimination of the nomogram in predicting individual hospital death was evaluated by the area under o the characteristic operating curve (ROC).Results: A total of 663 sepsis patients with acute respiratory failure were included in this study. Systolic blood pressure, white blood cell count, neutrophils, mechanical ventilation, PaO2 < 60mmHg, abdominal cavity infection, Klebsiella pneumoniae, Acinetobacter baumannii, and immunosuppressive disease were the independent risk predictors of the mortality in sepsis patients with acute respiratory failure. The area under curve of the nomogram in the ROC was 0.880 (95% CI: 0.851-0.908) that provided significantly higher discrimination compared with simplified acute physiology score II [0.656 (95% CI: 0.612-0.701)].Conclusion: The model has good performance in predicting the mortality risk of sepsis patients with acute respiratory failure, and it can be clinically useful to evaluate the short-term prognosis in critically ill patients with sepsis and acute respiratory failure.

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Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619895126 ◽

2020 ◽

Vol 9 (4_suppl) ◽

pp. S110-S121

Author(s):

Katarzyna Czerwińska-Jelonkiewicz ◽

Johannes Grand ◽

Guido Tavazzi ◽

Jordi Sans-Rosello ◽

Alice Wood ◽

...

Keyword(s):

Cardiac Arrest ◽

Respiratory Failure ◽

Inflammatory Response ◽

Acute Respiratory Failure ◽

White Blood Cells ◽

Short Term ◽

Reactive Protein ◽

Short Term Mortality ◽

Post Cardiac Arrest Syndrome ◽

Hospital Cardiac Arrest

Background: Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality. Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay. Results: Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001–1.070); 0.043, white blood cells 1.086 (1.039–1.136); 0.001, platelets 1.004 (1.001–1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496–6.725; 0.002) and to short-term mortality (3.335 (1.815–6.129); 0.0001). Conclusions: An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.

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