scholarly journals Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262315
Author(s):  
Christian Karagiannidis ◽  
Corinna Hentschker ◽  
Michael Westhoff ◽  
Steffen Weber-Carstens ◽  
Uwe Janssens ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Invasive Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Local Health ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Local Health Care ◽  
Overall Mortality

Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

scholarly journals Changes in utilization and outcomes of mechanical ventilation of COVID-19 during the course of the pandemic in Germany in 2020: an observational study of 7,490 patients

2021 ◽  
Author(s):  
Christian Karagiannidis ◽  
Corinna Hentschker ◽  
Michael Westhoff ◽  
Steffen Weber-Carstens ◽  
Uwe Janssens ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Local Health ◽  
Autumn Period ◽  
Spring Period ◽  
Local Health Care ◽  
Overall Mortality

Background The role of non invasive ventilation (NIV) in severe COVID-19 requiring mechanical ventilation (MV) remains a matter of debate. Methods In this observational study of confirmed COVID-19 cases claims data of the Local Health Care Funds of MV patients were comparably analysed: spring period of 2020 (February to May) versus autumn period (October/November). Findings In a nationwide cohort 7,490 cases were included: median age 70 (IQR 60to79) years, 66% male, hypertension 67%, diabetes 42%, cardiac arrhythmia 43%, congestive heart failure 34%, renal failure 27%. Overall, 3,851 (51%) patients primarily received invasive MV without NIV, 1,614 (22%) patients received NIV without having been escalated to intubation, and 1,247 (17%) patients had NIV failure (NIVF), defined by endotracheal intubation following NIV. Comparing cases of the first and second period, the proportion of patients who received invasive MV decreased from 74% to 39%. Accordingly, the proportion of patients with NIV without subsequent intubation increased from 10% to 28%, and those failing NIV increased from 9% to 21%. The overall median length of hospital stay decreased from 26 to 22 days, and the overall duration of MV decreased from 11.6 to 7.6 days. The NIV failure rate decreased from 49% (219/449) to 42% (927/2,185). Overall mortality remained unchanged (51% and 53% respectively). Mortality was 39% with NIV only, 52% with invasive MV and 66% with NIVF with mortality rates steadily increasing from 58% in early NIVF (day 1) to 75% in late NIV-F (>5 days). Interpretation The utilization of NIV rapidly increased during the autumn period compared to the spring period 2020, which was associated with a reduced duration of MV and hospital stay, but not with overall mortality. NIVF rates are high and are associated with increased mortality rates, particularly in late NIVF. In contrast, NIV success is associated with the lowest mortality rates.

Non-Invasive Ventilation in Infants Attending a Tertiary Care Center: A Retrospective Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Shafiqa Alsharif
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Electronic System ◽  
Shortness Of Breath ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Bronchiolitis was found to be the greatest worldwide cause of infant hospitalization presenting with symptoms of cough, wheezes, difficulty in breathing, decreased feeding, and apneas. It is estimated that 1-3% of hospitalized infants will require treatment in an intensive care unit especially when risk factors are present. This study analyzes the use of Non-invasive ventilation (NIV) in severe bronchiolitis and its role in reducing the rate of ventilator associated pneumonia (VAP), and the duration of oxygen requirement. Data were collected retrospectively through PHENIX; hospital electronic system for infants less than one year old. Shortness of breath, cough, apnea, cyanosis, N-CPAP immediate or later after few hours, mechanical ventilation (MV), length of hospital stay, and survival status were the outcome variables. Mann-Whitney U test was performed via SPSS version 25.0.Fifty-five infants with bronchiolitis were admitted with forty-nine episodes receiving NIV or MV. A total of thirty-seven infants were treated with NIV while 15 infants were treated with MV. Fever was the major indication for initiating NIV among infants followed by cough, apnea, and shortness of breath. Insignificant evidence was reported between baseline respiratory parameters and infants receiving NIV and MV. Changes in respiratory variables in the first four hours showed significant increase for infants receiving NIV than those receiving MV. Infants receiving NIV had significantly fewer days in NIV and PICU, but insignificant fewer days in hospital stay. The experience for using NIV in infants admitted for bronchiolitis recommends that NIV might be adjunct to mechanical ventilation. This strategy was related with a lower rate of pneumonia and a shorter duration of oxygen therapy.

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

Trials ◽  
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, .

Abstract 15821: Safety and Efficacy of Non-invasive Ventilation During Exercise Training in Patients With Acute Heart Failure. A Randomized Prospective Controlled Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mayron F Oliveira ◽  
Rita L Santos ◽  
Vanessa M Mendez ◽  
Priscila A Sperandio ◽  
Iracema I Umeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Adverse Events ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Invasive Ventilation ◽  
Serious Adverse Events ◽  
Safety And Efficacy ◽  
Non Invasive ◽  
Non Invasive Ventilation

Background: Exercise training (ET) is well established to improve functional capacity and quality of life in patients (pts) with chronic heart failure. However, the ET benefits in acute heart failure (AHF) are unknown. Purpose: We aimed to study the safety and efficacy of ET alone or combined with non-invasive ventilation (NIV) compared to standard medical treatment in hospitalized pts with AHF. Methods: Twenty-nine pts with AHF (68% ischemic), 56±7 years, left ventricle ejection fraction of 25±5%, NTproBNP of 2456±730, 6-minute walk test distance (6MWD = 225±39meters) were randomized into 3 groups: ET + NIV with sub therapeutic positive airway pressure (PAP) (ET,n=9), ET + NIV set to 14 of inspiratory and 8 cmH2O of expiratory PAP, respectively (EV,n=11) and standard treatment (CO,n=9). The ET and EV groups performed a daily session of unloaded exercise on cycle ergometer for 20 min or tolerance limit, for 8 consecutives days. In EV and ET, oxygen pulse saturation (SpO2), heart rate (HR), respiratory rate (RR), blood pressure (BP), blood lactate were measured at baseline (D1), during exercise, and at day 10 (D10). Serious adverse events (death or worsening heart failure) were also assessed on D10. Results: Length of hospital stay was shorter in EV group (17±10 days) compared to ET (23±8 days) and CO (39±15 days) (p<0,05). There were more serious adverse events in CO (66,6%) compared to both EV and ET (15%). Dobutamine use at D10 was less frequent in EV (18,2%) and ET (22,2%) groups than in CO (33,3%) (p<0.05). There was a marked improvement in Δ6MWD between D1 and D10 in EV (Δ127±72 meters), though increase in Δ6MWD was also seen in ET (Δ72±26 meters) and CO (Δ41±19meters), p<0,05. The EV group also showed higher endurance and lower peak HR at end-exercise than ET at D10 (128±10 vs. 92±8 min and 73±12 vs. 104±25 bpm, respectively; p<0,05). There was a similar reduction in NTproBNP levels but no differences were found in BP, SpO2, RR and blood lactate. Conclusion: Aerobic exercise in AHF was safe, reduced length of hospital stay and need for inotropics at D10. NIV + ET increased exercise endurance with lower cardiovascular stress.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030476 ◽  
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.

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

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 <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> 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.

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

2020 ◽  
pp. 204887262091994
Author(s):  
Thomas Metkus ◽  
P Elliott Miller ◽  
Carlos L Alviar ◽  
Jacob C Jentzer ◽  
Sean van Diepen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
St Segment Elevation ◽  
Non Invasive ◽  
Segment Elevation Myocardial Infarction ◽  
Non Invasive Ventilation ◽  
St Segment

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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