scholarly journals Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nai-Min Kang ◽  
Nan Zhang ◽  
Bao-Jian Luo ◽  
En-Dong Wu ◽  
Jian-Quan Shi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Invasive Ventilation ◽  
Ventilation Time ◽  
Non Invasive ◽  
Randomized Controlled

Abstract Background Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure. Methods Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning. Results After treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): − 36.2 h, 95% confidence interval (CI) − 53.6, − 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040). Conclusions Sequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events. Registration number for clinical trial Chinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020

Sequential Non-Invasive Following Short-Term Invasive Mechanical Ventilation in the Treatment of Tuberculosis with Respiratory Failure: A Randomized Controlled Study

2021 ◽  
Author(s):  
Nai-Min Kang ◽  
Nan Zhang ◽  
Bao-Jian Luo ◽  
En-Dong Wu ◽  
Jian-Quan Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Arterial Oxygen ◽  
Controlled Study ◽  
Invasive Ventilation ◽  
Ventilation Time ◽  
Non Invasive ◽  
Randomized Controlled

Abstract Background: Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV (SMV) in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of SMV in the treatment of tuberculosis with respiratory failure.Methods. Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into SMV group (n=24) and conventional MV (CMV) group (n=20). Initially, the patients in both groups received invasive positive pressure ventilation (IPPV). When the patients' conditions were relieved, the ventilation modality in SMV group was switched to oronasal face continuous positive airway pressure (CPAP) until weaning. Results. After treatment, the patients in SMV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in CMV group (all P value>0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P>0.05), but SMV group significantly reduced the time of invasive ventilation (mean difference (MD):-36.2 hrs,95% confidence interval (CI):-53.6,-18.8 hrs,P<0.001). SMV group also reduced the incidence of ventilator-associated pneumonia (VAP;relative risk (RR):0.44,95% CI:0.24,0.83,P=0.006) and atelectasis (RR:0.49,95% CI:0.24,1.00,P=0.040). Conclusions. SMV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events.

scholarly journals Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Raphaël Cinotti ◽  
Jean-Baptiste Lascarrou ◽  
Marie-Ange Azais ◽  
Gwenhaël Colin ◽  
Jean-Pierre Quenot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Fluid Balance ◽  
Fluid Overload ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Single Blind

Abstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = − 4.8 95% CI [− 7.3 to − 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1.

scholarly journals Tofacitinib versus standard of care treatment in patients with COVID-19: a multicenter non-randomized controlled study

2021 ◽  
Author(s):  
Sergey Moiseev ◽  
Nikolay Bulanov ◽  
Anastasiia Zykova ◽  
Michail Brovko ◽  
Pavel Novikov ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Standard Of Care ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Randomized Controlled ◽  
Standard Of Care Treatment

This non-randomized controlled study aimed to assess the efficacy of tofacitinib in reducing the risk of invasive mechanical ventilation or death in patients with COVID-19. Patients with COVID-19 associated with reduced oxygen saturation, increased C-reactive protein (≥50 mg/L), and/or persisting fever were recruited. Tofacitinib was administered in addition to standard of care therapy. Study outcomes were evaluated separately in the groups of patients with oxygen saturation at rest ≤93% and >93%. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression analysis adjusted for inverse propensity score weighting. Overall, 384 patients with COVID-19 (212 males; median age 60 years) were included in our study and were treated with tofactinib (n=131) or standard of care alone (n=253). The percentages of patients who started mechanical ventilation or died during hospitalization in the tofacitinib and control groups were 12.5% (9/72) vs. 14.1% (26/185) among patients who required respiratory support (HR 0.92, 95% CI 0.33-2.56), and 1.7% (1/59) vs. 4.4% (3/68) in those with normal oxygen saturation (HR 0.83; 95 CI 0.07-9.44). Tofacitinib did not reduce the risk of invasive mechanical ventilation or death in patients with COVID-19, although the analysis of these outcomes favored tofacitinib.

scholarly journals Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 859
Author(s):  
Helmi C. Burton-Papp ◽  
Alexander I. R. Jackson ◽  
Ryan Beecham ◽  
Matteo Ferrari ◽  
Myra Nasim-Mohi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Prone Positioning ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure ◽  
Patients Experience ◽  
Adequate Oxygenation

Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care.  Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO2/FiO2 (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.

scholarly journals An Open Randomized Controlled Study on the Efficacy of Low-Sodium Water Intake Evaluated by Non-Invasive Methods in Patients with Cellulite

2003 ◽  
Vol 1 (1) ◽  
pp. 43-48 ◽  
Author(s):  
P. Puddu ◽  
C. Ventrice ◽  
G. Pennasilico ◽  
G. Guarnaccia ◽  
M. Ruffelli ◽  
...  
Keyword(s):  
Water Intake ◽  
Subcutaneous Fat ◽  
Dietary Treatment ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
High Sodium ◽  
Adequate Diet ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Low Sodium

Cellulite is the result of complex physiological changes of the subcutaneous fat layer and of microcirculation, clinically manifesting as orange peel skin especially in women and involving thighs, buttocks, and abdomen. An adequate water intake has been suggested to be helpful in controlling the development and worsening of the disease. An open randomized controlled study has been performed to evaluate modification induced by an adequate diet associated to low-sodium or high-sodium water intake on some clinical features of patients affected with mild to moderate cellulite. Non-invasive instrumental investigations (Bioelectrical Impedance Analysis (BIA), thermography and skin echography) were used before and after dietary treatment. A significant improvement of the disease, in terms of weight loss, cutaneous microcirculation and reduction of subcutaneous fat layer, was observed in the group of patients who underwent low-sodium water intake. An adequate dietary treatment associated to a low-sodium water intake is able to efficiently controll some biological and clinical parameters of mild to moderate cellulite.

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