Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios

Abstract Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

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The use of high-flow nasal cannula (HFNC) as respiratory support in neonatal and pediatric intensive care units in Germany – A nationwide survey

Respiratory Medicine ◽

10.1016/j.rmed.2017.08.027 ◽

2017 ◽

Vol 131 ◽

pp. 210-214 ◽

Cited By ~ 8

Author(s):

Florian Schmid ◽

Dirk Manfred Olbertz ◽

Manfred Ballmann

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Pediatric Intensive Care ◽

Nationwide Survey ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

High Flow Nasal Cannula ◽

Pediatric Intensive Care Units

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Ethical aspects of the COVID-19 crisis: How to deal with an overwhelming shortage of acute beds

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620922788 ◽

2020 ◽

Vol 9 (3) ◽

pp. 248-252 ◽

Cited By ~ 7

Author(s):

Jean-Louis Vincent ◽

Jacques Creteur

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Ethical Dilemmas ◽

Respiratory Support ◽

Limited Resources ◽

Ethical Aspects ◽

Current Outbreak ◽

Treat All

The current outbreak of SARS-CoV-2 has and continues to put huge pressure on intensive care units (ICUs) worldwide. Many patients with COVID-19 require some form of respiratory support and often have prolonged ICU stays, which results in a critical shortage of ICU beds. It is therefore not always physically possible to treat all the patients who require intensive care, raising major ethical dilemmas related to which patients should benefit from the limited resources and which should not. Here we consider some of the approaches to the acute shortages seen during this and other epidemics, including some guidelines for triaging ICU admissions and treatments.

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Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

10.21203/rs.2.21580/v2 ◽

2020 ◽

Author(s):

Xin Liu ◽

Zhankui Li ◽

Xiaohui Chen ◽

Bei Cao ◽

Shaojie Yue ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Intervention Program ◽

Infant Health ◽

Kangaroo Mother Care ◽

Respiratory Support ◽

Neonatal Intensive Care Units ◽

Cross Sectional

Abstract Background To understand the feasibility and method of adoption of KMC in the context of China's NICUs. Describe the utilization of kangaroo mother care (KMC) in eight self-selected neonatal intensive care units (NICUs) participating in premature birth and infant’s intervention program. Methods A cross-sectional study of preterm infants discharged from eight NICUs in April 2018 . For infants was collected this included postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC. Results 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. Conclusion After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest to continue to promote parents KMC education enhancing preterm infant health.

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Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2020.704 ◽

2020 ◽

Vol 15 ◽

Author(s):

Valentina Di Lecce ◽

Giovanna Elisiana Carpagnano ◽

Paola Pierucci ◽

Vitaliano Nicola Quaranta ◽

Federica Barratta ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Clinical Outcomes ◽

Intensive Care Units ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Severe Respiratory Failure ◽

Non Invasive ◽

Baseline Characteristics ◽

Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

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Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

10.21203/rs.2.21580/v3 ◽

2020 ◽

Author(s):

Xin Liu ◽

Zhankui Li ◽

Xiaohui Chen ◽

Bei Cao ◽

Shaojie Yue ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Infant Health ◽

Kangaroo Mother Care ◽

Respiratory Support ◽

Neonatal Intensive Care Units ◽

Cross Sectional ◽

Parental Experience

Abstract Background: Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).Methods: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.Results: 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.Conclusions: After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

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