scholarly journals Outcomes for Children Receiving Noninvasive Ventilation as the First-Line Mode of Mechanical Ventilation at Intensive Care Admission

2017 ◽  
Vol 45 (6) ◽  
pp. 1045-1053 ◽  
Author(s):  
Jenny V. Morris ◽  
Padmanabhan Ramnarayan ◽  
Roger C. Parslow ◽  
Sarah J. Fleming
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Noninvasive Ventilation ◽  
First Line ◽  
Intensive Care Admission ◽  
Outcomes For Children

Use of flexible intermediate and intensive care to reduce multiple transfers of patients

1999 ◽  
Vol 8 (3) ◽  
pp. 170-179 ◽  
Author(s):  
E Besserman ◽  
D Teres ◽  
A Logan ◽  
M Brennan ◽  
S Cleaves ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Noninvasive Ventilation ◽  
Cost Savings ◽  
Median Number ◽  
Nursing Unit ◽  
Teaching Community ◽  
Intermediate Unit

OBJECTIVE: To test an alternative flexible approach to traditional fixed intermediate and intensive care to minimize transfers of patients. METHODS: Patients admitted to a 28-bed nursing unit with intermediate care potential and a 12-bed intensive care unit at a 300-bed teaching community hospital were studied. The group included 524 patients with a discharge diagnosis code for mechanical ventilation. During eight 3-week cycles, 1073 transfers of patients were tabulated. A plan-do-study-act method was used to improve weaning from mechanical ventilation and reduce the number of inappropriate days in intensive care. Admissions and transfers to the 2 units for all patients during the eight 3-week cycles were compared over time. Length of stay and mortality were noted for all patients treated with conventional and noninvasive ventilation. RESULTS: Direct admissions to the flexible intermediate unit increased with no overall change in admissions to the intensive care unit. Fewer patients needed conventional ventilation, and more in both units were treated with noninvasive ventilation. The median number of transfers per patient treated with mechanical ventilation decreased from 1.94 to 1.20. Length of stay and mortality also decreased among such patients. Some cost savings were attributable to the decrease in the number of transfers. Transfers out of the hospital directly from the intensive care unit increased from 2.24% to 4.43%. CONCLUSIONS: In a community teaching hospital, flexible care policies decreased the number of in-hospital transfers of patients treated with mechanical ventilation.

scholarly journals Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea

2012 ◽  
Vol 38 (4) ◽  
pp. 542-556 ◽  
Author(s):  
Massimo Antonelli ◽  
Marc Bonten ◽  
Jean Chastre ◽  
Giuseppe Citerio ◽  
Giorgio Conti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Noninvasive Ventilation

scholarly journals Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience

2020 ◽  
Vol 31 (4) ◽  
pp. 540-543
Author(s):  
Azhar Hussain ◽  
Alia Noorani ◽  
Ranjit Deshpande ◽  
Lindsay John ◽  
Max Baghai ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Best Practice ◽  
Significant Proportion ◽  
Case Series ◽  
Chest Drain ◽  
The Novel ◽  
Intensive Care Admission ◽  
Mechanically Ventilated ◽  
Novel Coronavirus

Abstract A significant proportion of patients infected with the novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), require intensive care admission and subsequent mechanical ventilation. Pneumothorax, a potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. We present a case series and a suggested best-practice protocol for how to manage and treat pneumothoraces in COVID-19 patients in an intensive care unit setting.

Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit

2015 ◽  
Vol 42 (8) ◽  
pp. 1406-1412 ◽  
Author(s):  
Frédéric Pène ◽  
Tarik Hissem ◽  
Alice Bérezné ◽  
Yannick Allanore ◽  
Guillaume Geri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Systemic Sclerosis ◽  
Endotracheal Intubation ◽  
Noninvasive Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Mortality Rates ◽  
Icu Admission ◽  
Life Threatening

Objective.Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU.Methods.We performed a single-center retrospective study over 6 years (November 2006–December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed.Results.Forty-one patients with a median age of 50 years [interquartile range (IQR) 40–65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34–128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%.Conclusion.This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.

scholarly journals Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot’

2020 ◽  
Vol 79 (9) ◽  
pp. 1156-1162 ◽  
Author(s):  
Kristin M D’Silva ◽  
Naomi Serling-Boyd ◽  
Rachel Wallwork ◽  
Tiffany Hsu ◽  
Xiaoqing Fu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Rheumatic Disease ◽  
Clinical Features ◽  
Hot Spot ◽  
Similar Proportion ◽  
Laboratory Findings ◽  
Intensive Care Admission ◽  
Comparative Cohort Study

ObjectiveTo investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease.MethodsWe conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality.ResultsWe identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69).ConclusionsPatients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.

scholarly journals Doxycycline and Pentoxifylline for Mild and Mild-To-Moderate Covid-19

2020 ◽  
Author(s):  
Emil Toma
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Primary Outcome ◽  
Essential Medicine ◽  
Standard Of Care ◽  
Severe Form ◽  
Intensive Care Admission ◽  
Antiviral Effects ◽  
Progression Of Disease ◽  
Anti Inflammatory

We are proposing, for any interested investigator, a randomized open clinical trial for mild and mild-to-moderate Covid-19 comparing a treatment regimen with standard of care, and eventually with another investigational regimen, if ongoing or will be implemented. The patients could be hospitalized or ambulatory but not requiring admission to intensive care units and mechanical ventilation. The proposed therapeutic regimen consists of doxycycline (an antimicrobial having also anti-inflammatory properties, probable antioxidant and possible some antiviral effects), and pentoxifylline, a hemorheological compound used in occlusive arterial diseases but also having proven anti-inflammatory properties. Doxycycline is included in the WHO’s list of essential medicine being an effective, safe, widely available, and inexpensive medication and widely accessible. It will be administered at a dosage of 100 mg orally twice daily for ten days. Pentoxifylline, in clinical use since 1972, and also widely accessible, will be given at a dosage of 400 mg orally, also twice daily, for ten days. The primary outcome measures are: 1) Progression of disease to a severe form requiring intensive care admission and mechanical ventilation; 2) Fatality rates and 3) Time to clinical recovery.This proposal was presented to the National Directors and Core Leads meeting of the Canadian Trials Network (CTN) on May 6, 2020. The interventional trial template suggested by CTN was used for designing the trial.

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