Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19

IntroductionAwake prone positioning (APP) might benefit patients with COVID-19 by improving oxygenation, but it is unknown whether this improvement can be sustained with serial proning episodes.MethodsWe conducted a retrospective review of adults with COVID-19 admitted to one intensive care unit, in those who underwent APP and controls. Patients in both groups had type 1 respiratory failure requiring oxygen (but not initially intubated), confirmed SARS-CoV-2 PCR by nasopharyngeal swab and findings of multifocal ground-glass opacities on imaging. For the APP group, serial SpO2/FiO2 measurements were recorded after each proning episode.ResultsOf 77 patients admitted, 50 (65%) were excluded because they had already been intubated. Another 7 (9%) had undergone APP prior to admission. Of the remaining 20, 10 underwent APP and 10 were controls. Patients in both groups had similar demographics, subsequent intubation and survival. Of those who underwent APP, SpO2/FiO2 was most likely to increase after the first episode (before median: 152, IQR 135–185; after: median 192, IQR 156–234, p=0.04). Half of participants (5) in the APP group were unable to tolerate more than two APP episodes.ConclusionsMost patients with COVID-19 admitted to the intensive care are not suitable for APP. Of those who are, many cannot tolerate more than two episodes. Improvements in SpO2/FiO2 secondary to APP are transient and most likely in the first episode. Our findings may explain why other studies have failed to show improvements in mortality from APP despite improvements in oxygenation.

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Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Critical Care Research and Practice ◽

10.1155/2020/6688120 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Andrei Karpov ◽

Anish R. Mitra ◽

Sarah Crowe ◽

Gregory Haljan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Respiratory Rate ◽

Prolonged Mechanical Ventilation ◽

Case Series ◽

Prone Positioning ◽

Retrospective Case ◽

Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

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Acute respiratory failure

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.1705_update_004 ◽

2010 ◽

pp. 3132-3146 ◽

Cited By ~ 1

Author(s):

Susannah Leaver ◽

Timothy Evans

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Intensive Care Unit Admission ◽

Acute Respiratory Failure ◽

Normal Range ◽

Common Problems

Acute respiratory failure is defined clinically by hypoxaemia (PaO2 <8 kPa, normal range 10–13.3 kPa) with (type 2) or without (type 1) hypercapnia (PaCO2 >6.5 kPa). It is one of the most common problems afflicting the severely ill patient and often necessitates intensive care unit admission....

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Faculty Opinions recommendation of Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1141938.599045 ◽

2009 ◽

Author(s):

John Kress

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure

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Higher Acid-Base Imbalance Associated with Respiratory Failure Could Decrease the Survival of Patients with Scrub Typhus during Intensive Care Unit Stay: A Gene Set Enrichment Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8101580 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1580 ◽

Cited By ~ 1

Author(s):

Kyoung Min Moon ◽

Kyueng-Whan Min ◽

Mi-Hye Kim ◽

Dong-Hoon Kim ◽

Byoung Kwan Son ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Scrub Typhus ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Acid Base ◽

Gene Set Enrichment ◽

Gene Set ◽

Gene Sets

Ninety percent of patients with scrub typhus (SC) with vasculitis-like syndrome recover after mild symptoms; however, 10% can suffer serious complications, such as acute respiratory failure (ARF) and admission to the intensive care unit (ICU). Predictors for the progression of SC have not yet been established, and conventional scoring systems for ICU patients are insufficient to predict severity. We aimed to identify simple and robust indicators to predict aggressive behaviors of SC. We evaluated 91 patients with SC and 81 non-SC patients who were admitted to the ICU, and 32 cases from the public functional genomics data repository for gene expression analysis. We analyzed the relationships between several predictors and clinicopathological characteristics in patients with SC. We performed gene set enrichment analysis (GSEA) to identify SC-specific gene sets. The acid-base imbalance (ABI), measured 24 h before serious complications, was higher in patients with SC than in non-SC patients. A high ABI was associated with an increased incidence of ARF, leading to mechanical ventilation and worse survival. GSEA revealed that SC correlated to gene sets reflecting inflammation/apoptotic response and airway inflammation. ABI can be used to indicate ARF in patients with SC and assist with early detection.

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New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol

BMJ Open ◽

10.1136/bmjopen-2016-011298 ◽

2016 ◽

Vol 6 (8) ◽

pp. e011298 ◽

Cited By ~ 6

Author(s):

Samir Jaber ◽

Nicolas Molinari ◽

Audrey De Jong

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Orotracheal Intubation ◽

High Flow ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Apnoeic Oxygenation

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Tyrosine kinase inhibitors for acute respiratory failure due to non-small-cell lung cancer involvement in intensive care unit

CHEST Journal ◽

10.1016/j.chest.2021.06.079 ◽

2021 ◽

Author(s):

Y. Tandjaoui-Lambiotte ◽

Y. Akrour ◽

A. Gibelin ◽

F. Gonzalez ◽

A. Stoclin ◽

...

Keyword(s):

Lung Cancer ◽

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Tyrosine Kinase ◽

Acute Respiratory Failure ◽

Small Cell Lung Cancer ◽

Kinase Inhibitors ◽

Small Cell ◽

Small Cell Lung

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Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study

Palliative Medicine ◽

10.1177/02692163211018342 ◽

2021 ◽

pp. 026921632110183

Author(s):

Ruth Piers ◽

Eva Van Braeckel ◽

Dominique Benoit ◽

Nele Van Den Noortgate

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Oldest Old ◽

Case Report Form ◽

Resuscitation Orders ◽

Intensive Care Admission ◽

Treatment Limitation ◽

Early Decision

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty ( p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure ( p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.

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Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽

10.1093/qjmed/hcab086.039 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed N Al Shafi'i ◽

Doaa M. Kamal El-din ◽

Mohammed A. Abdulnaiem Ismaiel ◽

Hesham M Abotiba

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Positive Pressure Ventilation ◽

Invasive Mechanical Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Positive Pressure ◽

Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

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