Settings and monitoring of mechanical ventilation during physical therapy in adult critically ill patients: protocol for a scoping review

IntroductionEarly mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide real-time monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients.Methods and analysisThis is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation & Sport Medicine, Scielo Citation Index, Epistemónikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician.Ethics and disseminationEthical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, dissemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy stakeholders.

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Recombinant Human Erythropoietin Use in Intensive Care

Annals of Pharmacotherapy ◽

10.1345/aph.1a323 ◽

2002 ◽

Vol 36 (6) ◽

pp. 1068-1074 ◽

Cited By ~ 11

Author(s):

Martin Darveau ◽

Éric Notebaert ◽

André Y Denault ◽

Sylvain Bélisle

Keyword(s):

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Recombinant Human Erythropoietin ◽

Cochrane Library ◽

Optimal Dosage ◽

Human Erythropoietin ◽

The Impact

OBJECTIVE: To review the literature concerning the role of recombinant human erythropoietin (rHuEPO) in reducing the need for transfusion in critically ill patients. DATA SOURCES: Articles were obtained through searches of the MEDLINE database (from 1990 to June 2001) using the key words erythropoietin, epoetin alfa, anemia, reticulocytes, hemoglobin, critical care, intensive care, critical illness, and blood transfusion. Additional references were found in the bibliographies of the articles cited. The Cochrane library was also consulted. STUDY SELECTION AND DATA EXTRACTION: Controlled, prospective, and randomized studies on the use of rHuEPO in critically ill adults were selected. DATA SYNTHESIS: Anemia is a common complication in patients requiring intensive care. It is caused, in part, by abnormally low concentrations of endogenous erythropoietin and is mainly seen in patients with sepsis and multiple organ dysfunction syndrome, in whom inflammation mediator concentrations are often elevated. High doses of rHuEPO produce a rapid response in these patients, despite elevated cytokine concentrations. There have been 3 studies on rHuEPO administration in intensive care and 1 trial in acutely burned patients. Only 2 of these studies looked at the impact of rHuEPO administration on the need for transfusion. CONCLUSIONS: Few randomized, controlled trials explore the role of rHuEPO in critical care. Only 1 was a large, randomized clinical trial, but it presents many limitations. Future outcome and safety studies comparing rHuEPO with placebo must include clinical endpoints such as end-organ morbidity, mortality, transfusion criteria, and pharmacoeconomic analysis. rHuEPO appears to provide an erythropoietic response. Optimal dosage and the real impact of rHuEPO on the need for transfusion in intensive care remain to be determined. Currently, based on the evidence available from the literature, rHuEPO cannot be recommended to reduce the need for red blood cell transfusions in anemic, critically ill patients.

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Tracheostomy

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0117 ◽

2019 ◽

pp. 850-854

Author(s):

Saba Ghorab ◽

David G. Lott

Keyword(s):

United States ◽

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

The United States ◽

Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

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Characteristics of Critically-Ill Patients at Two Tertiary Care Hospitals in Sudan

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.02.011 ◽

2018 ◽

Vol 18 (2) ◽

pp. 190 ◽

Cited By ~ 2

Author(s):

Hagir Sulieman ◽

Wael El-Mahdi ◽

Mohannad Awadelkareem ◽

Lama Nazer

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Intensive Care ◽

Length Of Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Care ◽

Apache Ii ◽

The Mean ◽

Tertiary Care Hospitals

Objectives: Knowledge of intensive care unit (ICU) admission patterns and characteristics is necessary for the development of critical care services, particularly in low-resource settings. This study aimed to describe the characteristics of critically-ill patients admitted to ICUs in Sudan. Methods: This prospective observational study was conducted between February and May 2017 in the ICUs of two government tertiary care hospitals inKhartoum, Sudan. A total of 100 consecutive adult patients admitted to the ICUs were included in the study. The patients’ demographic and clinical characteristics and Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores upon admission were recorded, as well as the reason for admission, presence of any underlying comorbidities, interventional requirements like mechanical ventilation or haemodialysis, length of stay in the ICU and patient outcome. Results: Of the sample, 58% were female and 42% were male. The mean age was 47.4 ± 18.3 years old. Upon admission, the mean APACHE II score was 14.2 ± 9.6. In total, 54% of the patients had no known underlying comorbidities. The most common reasons for ICU admission were neurological diseases (27%), sepsis or infectious diseases (19%) and postoperative management (12%). Mechanical ventilation and haemodialysis were required by 35% and 11% of the patients, respectively. The average length of stay was 10.0 ± 7.2 days and the mortality rate was 24%. Conclusion: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities. Larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals.Keywords: Intensive Care Units; Patient Admission, trends; Critical Care Outcomes; Developing Countries; Sudan.

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Survival After In-Hospital Cardiac Arrest In Critically Ill Patients Implications For The Covid-19 Pandemic?

10.1101/2020.04.11.20060749 ◽

2020 ◽

Author(s):

Saket Girotra ◽

Yuanyuan Tang ◽

Paul S. Chan ◽

Brahmajee K. Nallamothu

Keyword(s):

Mechanical Ventilation ◽

Cardiac Arrest ◽

Critically Ill ◽

Critically Ill Patients ◽

Survival Rates ◽

Ventilatory Support ◽

Survival Outcomes ◽

Do Not Resuscitate ◽

Neurological Disability ◽

Initial Rhythm

The coronavirus disease 2019 (COVID-19) outbreak is placing a considerable strain on U.S. healthcare systems. Due to presumptions of poor outcomes in such critically ill patients, many hospitals have started considering a universal do-not-resuscitate order in patients with confirmed Covid-19 given a limited supply of intensive care unit (ICU) beds and the potential risk of transmission of infection to healthcare workers during resuscitation. However, empirical data on survival of cardiac arrest in Covid-19 patients are unavailable at this time.To inform this debate, we report survival outcomes following cardiopulmonary resuscitation in a cohort of similar critically ill patients with pneumonia or sepsis who were receiving mechanical ventilation in an ICU at the time of arrest. The probability of survival without severe neurological disability (CPC of 1 or 2) ranged from less than 3% to over 22% across key patient subgroups, For patients with an initial rhythm of asystole or PEA, who were also receiving vasopressors at the time of arrest, fewer than 10% were discharged without severe neurological disability (CPC of 1 or 2), and this number dropped to less than 3% in patients over 80 years old. In contrast, survival rates were much higher in younger patients, patients with an initial rhythm of VF or pulseless VT, and in patients receiving ventilatory support without vasopressors.Our findings suggest caution in universal resuscitation policies. Even in a cohort of critically ill patients on mechanical ventilation, survival outcomes following in-hospital resuscitation were not uniformly poor and varied markedly depending on age, co-morbidities and illness severity. We believe that these data can help inform discussions among patients, providers and hospital leaders regarding resuscitation policies and goals of care in the context of the COVID-19 pandemic.

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Validation of the Modified Integrative Weaning Index as a Predictor of Weaning from Mechanical Ventilation in Comparison to Conventional Weaning Indices in Adult Critically Ill Patients

QJM ◽

10.1093/qjmed/hcab086.042 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hythem Mohamed Mamdouh Abdelmeguid Barakat ◽

Galal Adel El-Kady ◽

Adel Mohammed El-Ansary ◽

Mohammed Abd El-Salam El-Gendy

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Good Predictor ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Underlying Disease ◽

Pulmonary Mechanics ◽

Weaning From Mechanical Ventilation ◽

Clinical Practices

Abstract Introduction Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Delays in both removing invasive ventilatory support and excessively early removal are correlated with complications that vary according to the severity of the underlying disease. Several weaning indices and predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. However, none of them have yet presented good results in discriminating the outcome of extubation, even those most used in clinical practices. Aim The aim of this study is to validate the modified integrative weaning index (mIWI) as a reliable weaning index in comparison to the conventional weaning indices in the weaning of critically ill patients from invasive mechanical ventilation. Patients Four hundred patients, above the age of 18 years, on mechanical ventilation for more than 48 hours through an endotracheal tube for any cause were randomly assigned to this study. Methods patients ready to be weaned were assessed using mIWI and conventional indices and monitored for 48 hours. The performance of the indices were assessed in both successful and unsuccessful groups. Results The performance of the mIWI was not significantly superior to the conventional weaning indices in predicting weaning success or failure than the traditional weaning indices. The cut-off value for the predicting successful weaning from mechanical ventilation for the mIWI was higher than suggested by the original study and yet in agreement with some other studies. The cut-off value for the mIWI is higher in patients above the age of 60 years. Conclusion The results of the study revealed that the mIWI is a good predictor of weaning from mechanical ventilation and assessment of pulmonary mechanics and is not significantly superior to the traditional weaning indices, yet is not a good predictor for extubation success.

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Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19

Proceedings of IMPRS ◽

10.18060/24618 ◽

2020 ◽

Vol 3 ◽

Author(s):

Jessica Hammes ◽

Sikandar Khan ◽

Heidi Lindroth ◽

Babar Khan

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Respiratory Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Secondary Outcome ◽

Care Utilization ◽

Increased Risk ◽

Brain Behavior

Background: COVID-19 is associated with severe respiratory failure and high mortality in critically ill patients.2,4,5 Neurologic manifestations of the disease, including delirium and coma, may also be associated with poor clinical outcomes. Delirium is associated with prolonged mechanical ventilation and mortality.3 this study sought to describe the rates, duration, and severity of delirium in patients admitted to the ICU with COVID-19. Methods: A retrospective, observational study was conducted from March 1stto April 27th, 2020, at Indiana University Health Methodist and Eskenazi Health Hospitals. The delirium measurements were extracted in the first 14 days of the ICU stay, using the Richmond Agitation and Sedation Scale (RASS) and the CAM-ICU and CAM-ICU7, for those with a positive COVID-19 diagnosis. The primary outcomes were delirium rates and duration; the secondary outcome was delirium severity. Descriptive statistics and median group comparisons were done using SAS v9.4. Results: Of 144 patients in the study, 73.6% experienced delirium and 76.4% experienced delirium or coma. The median delirium or coma duration was 7 days (IQR: 3-10), and the median delirium duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 2-7) signifying severe delirium. Mechanical ventilation was associated increased risk of developing delirium (OR: 22.65, 95% CL: 5.24-97.82). Mortality was also more likely in patients experiencing delirium: 26.4% compared to 15.8% in patients without delirium. Conclusion: Of the 144 patients included, 73.6% experienced delirium lasting on average 5 days: the median delirium score being severe. Mechanical ventilation was also associated with greater odds of developing delirium. Because Covid-19 is associated with high rates of delirium, leading to increased rates of functionality disability, more resources and attention are needed to prevent and manage delirium in patients.1 References Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine. 2014;42(2):369-377. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020. Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology. 2016;125(6):1229-1241. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020. Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, behavior, and immunity. 2020:S0889-1591(0820)30357-30353.

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Engaging Critically Ill Patients in Symptom Management: Thinking Outside the Box!

American Journal of Critical Care ◽

10.4037/ajcc2016932 ◽

2016 ◽

Vol 25 (4) ◽

pp. 293-300 ◽

Cited By ~ 6

Author(s):

Linda L. Chlan

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Ventilatory Support ◽

Music Listening ◽

Mechanical Ventilatory Support ◽

Icu Patients ◽

Life Itself ◽

The Many

Caring for critically ill patients receiving mechanical ventilation in the intensive care unit (ICU) is an immense challenge for clinicians. Interventions to maintain physiological stability and life itself can cause a number of adverse effects that have a marked impact on patients beyond the period of critical illness or injury. These ICU-acquired conditions include but are not limited to weakness, depression, and post–intensive care syndrome, all of which markedly affect patients’ quality of life after they leave the unit. How best to manage the many symptoms experienced by patients undergoing mechanical ventilation without contributing to adverse ICU-acquired sequelae remains a daunting charge for clinicians and requires innovative “out of the box” approaches to address these complex issues. Systematic, cutting-edge research is needed to challenge the “usual” way of managing ICU patients in order to provide the best available evidence for practice integration that minimizes adverse, ICU-acquired sequelae and improves outcomes for the most vulnerable patients. This article highlights a program of research focused on interventions for managing symptoms in critically ill patients receiving mechanical ventilatory support, including the appropriate empowerment of symptom self-management by patients undergoing mechanical ventilation. Development and testing of innovative, nontraditional interventions specifically tailored for ICU patients receiving mechanical ventilatory support are presented. Music listening is highlighted as a nonpharmacological, adjunctive intervention to reduce anxiety associated with mechanical ventilation. Patient-controlled sedation is discussed as an alternative method to meet patients’ highly individual needs for sedative therapy to promote comfort.

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The efficacy of combination therapies including antiviral drugs, methylprednisolone and daily proning in 20 patients with COVID-19 requiring invasive mechanical ventilation—Case series in a single critical care center in Osaka, Japan

10.21203/rs.3.rs-41984/v1 ◽

2020 ◽

Author(s):

Haruka Shimazu ◽

Kazuhisa Yoshiya ◽

Keisuke Tamagaki ◽

Yasutaka Okamoto ◽

Hitoshi Nakano ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Invasive Mechanical Ventilation ◽

Laboratory Data ◽

Case Series ◽

Group Versus ◽

Survivor Group

Abstract Background: Since December 2019, the COVID-19 infection has drastically spread across China and the world, including Japan. Few reports so far have clarified the prognosis and treatment of critically ill patients managed with invasive mechanical ventilation. This study aimed to present the clinical courses of 20 critically ill patients with invasive mechanical ventilation, which may be valuable for determining future therapies and intensive care of critically ill patients with COVID-19.Methods: In this observational, single-center, cohort study, we included 20 critically ill patients with laboratory-confirmed SARS-CoV-2 infection who were admitted to our hospital ICU and required invasive mechanical ventilation. The patients’ general characteristics, laboratory data, treatments, and outcomes were assessed between survivors and non-survivors.Results: Among these 20 patients, 14 patients survived and 6 patients died. The lowest lymphocyte count (93 vs 279/μL, p<0.01) and the lowest platelet count (12 vs 152×103/μL, p<0.01) were significantly lower, and the highest KL-6 value (1584 vs 546 U/mL, p=0.02) was significantly higher, in the non-survivor group versus the survivor group during the patients’ ICU stay. In addition to antiviral treatments and daily proning of the patients, methylprednisolone was administered to all patients to control cytokine storm syndrome following the virus infection. Six patients died from complications such as fungal infection, but no patients died of respiratory failure. As a result, none of the patients required ECMO.Conclusion: This report described the prognosis of COVID-19 patients required invasive mechanical ventilation in a single Japanese critical care center. Multidisciplinary treatments using a single protocol, including antiviral therapies, anti-inflammatory therapies, and respiratory physiotherapies, were effective for critically ill COVID-19 patients who required invasive mechanical ventilation.

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Cardio circulatory and respiratory monitoring of mechanically ventilated critically ill patients

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v22i1.1205 ◽

2020 ◽

Author(s):

Habib Md Reazaul Karim

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Respiratory Monitoring ◽

Management Decision ◽

Care Practice ◽

Mechanically Ventilated ◽

Treatment Objective ◽

Close Temporal Relationship

Respiratory support in terms of mechanical ventilation is very common in critically ill patients. These patients are often hemodynamically unstable too. The mechanophysiology of mechanical ventilation also affects other organ system and needs assessment and management accordingly. The procedure is not devoid of complication. It also has potential to failure to achieve the treatment objective requiring frequent assessment and adjustment. There is a very close temporal relationship between patients monitoring and management decision in critically ill patients in critical care practice. Early and appropriate information from monitoring can lead to better outcome including reduced mortality. The present review is intended to briefly highlight the current opinions and strategies for cardio circulatory and respiratory monitoring in such patients in critical care unit. Received: 4 Jun 2018Reviewed: 6 Jun 2018Accepted: 13 Sep 2018 Citation: Karim HMR. Cardio circulatory and respiratory monitoring of mechanically ventilated critically ill patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S142-S149

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