Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction

Background The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized. Methods We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002–2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models. Results A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support ( p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74–1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88–3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time. Conclusion Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.

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Non-invasive ventilation with autotitrating EPAP maybe confirm successful likelihood of extubation for COPD patients with ST-segment elevation myocardial infarction

10.1183/1393003.congress-2017.pa1892 ◽

2017 ◽

Author(s):

BoXue Han ◽

Yunxi Song ◽

Suiyang Zhang ◽

Meilin Liu ◽

Dongxia Wang ◽

...

Keyword(s):

Myocardial Infarction ◽

Invasive Ventilation ◽

St Segment Elevation ◽

Non Invasive ◽

Segment Elevation Myocardial Infarction ◽

Copd Patients ◽

Non Invasive Ventilation ◽

St Segment

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Protocolized Post-Extubation Respiratory Support to prevent reintubation: protocol and statistical analysis plan for a clinical trial

BMJ Open ◽

10.1136/bmjopen-2019-030476 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030476 ◽

Cited By ~ 1

Author(s):

Jonathan Dale Casey ◽

Erin R Vaughan ◽

Bradley D Lloyd ◽

Peter A Bilas ◽

Eric J Hall ◽

...

Keyword(s):

Mechanical Ventilation ◽

Usual Care ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Respiratory Support ◽

Invasive Ventilation ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Risk Patients

IntroductionFollowing extubation from invasive mechanical ventilation, nearly one in seven critically ill adults requires reintubation. Reintubation is independently associated with increased mortality. Postextubation respiratory support (non-invasive ventilation or high-flow nasal cannula applied at the time of extubation) has been reported in small-to-moderate-sized trials to reduce reintubation rates among hypercapnic patients, high-risk patients without hypercapnia and low-risk patients without hypercapnia. It is unknown whether protocolised provision of postextubation respiratory support to every patient undergoing extubation would reduce the overall reintubation rate, compared with usual care.Methods and analysisThe Protocolized Post-Extubation Respiratory Support (PROPER) trial is a pragmatic, cluster cross-over trial being conducted between 1 October 2017 and 31 March 2019 in the medical intensive care unit of Vanderbilt University Medical Center. PROPER compares usual care versus protocolized post-extubation respiratory support (a respiratory therapist-driven protocol that advises the provision of non-invasive ventilation or high-flow nasal cannula based on patient characteristics). For the duration of the trial, the unit is divided into two clusters. One cluster receives protocolised support and the other receives usual care. Each cluster crosses over between treatment group assignments every 3 months. All adults undergoing extubation from invasive mechanical ventilation are enrolled except those who received less than 12 hours of mechanical ventilation, have ‘Do Not Intubate’ orders, or have been previously reintubated during the hospitalisation. The anticipated enrolment is approximately 630 patients. The primary outcome is reintubation within 96 hours of extubation.Ethics and disseminationThe trial was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registration numberNCT03288311.

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Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05692-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tommaso Tonetti ◽

Lara Pisani ◽

Irene Cavalli ◽

Maria Laura Vega ◽

Elisa Maietti ◽

...

Keyword(s):

Mechanical Ventilation ◽

Controlled Trial ◽

Invasive Mechanical Ventilation ◽

Chronic Obstructive ◽

Invasive Ventilation ◽

Obstructive Pulmonary Disease ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Acute Exacerbations

Abstract Background Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial. Methods multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality. Discussion Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD. Trial registration ClinicalTrials.gov, NCT04582799. Registered 12 October 2020, .

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Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2016.09.037 ◽

2017 ◽

Vol 119 (2) ◽

pp. 171-177 ◽

Cited By ~ 9

Author(s):

Thomas S. Metkus ◽

Aiham Albaeni ◽

Nisha Chandra-Strobos ◽

Shaker M. Eid

Keyword(s):

Myocardial Infarction ◽

Respiratory Support ◽

Prognostic Impact ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Invasive mechanical ventilation in cancer patients: prior non-invasive ventilation is a poor prognostic factor

Critical Care ◽

10.1186/cc8445 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P213

Author(s):

A Meert ◽

T Berghmans ◽

N Nayer ◽

M Paesmans ◽

E Markiewicz ◽

...

Keyword(s):

Mechanical Ventilation ◽

Prognostic Factor ◽

Cancer Patients ◽

Invasive Mechanical Ventilation ◽

Invasive Ventilation ◽

Poor Prognostic Factor ◽

Non Invasive ◽

Non Invasive Ventilation

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Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: Evidence from critically ill COVID-19 patients

10.21203/rs.3.rs-1044681/v1 ◽

2021 ◽

Author(s):

Michael Hultström ◽

Ola Hellkvist ◽

Lucian Covaciu ◽

Filip Fredén ◽

Robert Frithiof ◽

...

Keyword(s):

Invasive Mechanical Ventilation ◽

High Flow ◽

University Hospital ◽

Respiratory Support ◽

Arterial Oxygen ◽

Invasive Ventilation ◽

Steady State Condition ◽

Non Invasive ◽

Non Invasive Ventilation ◽

High Flow Oxygen

Abstract Introduction The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC. Methods This was a sub-study of a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden for critical COVID-19. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV). Results A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio (up to 48 mmHg, from HFNC to MV). Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mm Hg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible. Conclusion HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio precludes using ARDS grade as a measure of pulmonary damage during HFNC.

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How far is too far? A review of non-invasive ventilation as ceiling of care in COVID-19 patients not suitable for invasive mechanical ventilation

10.1183/13993003.congress-2021.pa1093 ◽

2021 ◽

Author(s):

Elizabeth Springate ◽

Jonathon Shaw

Keyword(s):

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

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Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

Italian Journal of Medicine ◽

10.4081/itjm.2017.675 ◽

2017 ◽

Vol 11 (1) ◽

pp. 57

Author(s):

Enrico Cinque ◽

Ines Maria Grazia Piroddi ◽

Cornelius Barlascini ◽

Alessandro Perazzo ◽

Antonello Nicolini

Keyword(s):

Mechanical Ventilation ◽

Severe Disease ◽

Invasive Mechanical Ventilation ◽

Clinical Signs ◽

Case Series ◽

Community Acquired Pneumonia ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible Staphylococcus aureus co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

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Diabetes and Overweight/Obesity Are Independent, Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International, Multicenter Retrospective Meta-analysis

10.2337/figshare.13616024 ◽

2021 ◽

Author(s):

Danielle K. Longmore ◽

Jessica E. Miller ◽

Siroon Bekkering ◽

Christoph Saner ◽

Edin Mifsud ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Invasive Ventilation ◽

Site Specific ◽

Non Invasive ◽

Obesity And Diabetes ◽

Non Invasive Ventilation

<a>OBJECTIVE </a> Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19) but the contribution of overweight and/or diabetes remain unclear. In a multi-center international study, we investigated if overweight, obesity and diabetes were independently associated with COVID-19 severity, and whether the body mass index (BMI)-associated risk was increased among those with diabetes. RESEARCH DESIGN & METHODS We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modelling the odds of each outcome (supplemental oxygen/non-invasive ventilation, invasive mechanical ventilation, and in-hospital mortality) by BMI category (reference, overweight, obese) adjusting for age, sex, and pre-specified co-morbidities. Subgroup analysis was performed on patients with pre-existing diabetes. Site-specific estimates were combined in a meta-analysis. RESULTS Among 7244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/non-invasive ventilation (random effects adjusted odds ratio [aOR] 1.44 [95% CI 1.15-1.80]) and invasive mechanical ventilation (aOR 1.22 [CI 1.03-1.46]). There was no association between overweight and in-hospital mortality (aOR 0.88 [CI 0.74-1.04]). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. CONCLUSIONS In adults hospitalized with COVID-19, overweight as well as obesity and diabetes were associated with increased odds of respiratory support but not mortality. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.

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