scholarly journals Monitoring Analgesia in COVID 19 Ventilated Patients in an In Intensive Care Unit – Case Series

2020 ◽  
Vol 7 (12) ◽  
pp. 5135-5138
Author(s):  
N Loutsky ◽  
L Yehya ◽  
I Chorni ◽  
Gal Sahaf Levin ◽  
E Vikhrova ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Physiological Response ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Invasive Monitoring ◽  
Initial Experience ◽  
Non Invasive ◽  
Ventilated Patients

Critically ill COVID 19 patients requiring prolonged mechanical ventilation, receive analgesics and sedatives to prevent agitation which may cause patient ventilator asynchrony. Anticipating the physiological response to painful stimuli, such as endotracheal tube suctioning or repositioning, is difficult and titrating analgesics and sedatives may be improved by continuous non-invasive monitoring of levels of analgesia. We describe our initial experience using the PMD-200 monitor with the NOL™ index algorithm (Medasense Biometrics, Ramat Gan Israel) to provide continuous, non-invasive monitoring of analgesia in COVID 19 ventilated patients. Publication of deidentified patient data was determined EC exempt.

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

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.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1035
Author(s):  
Rachel K. Marlow ◽  
Sydney Brouillette ◽  
Vannessa Williams ◽  
Ariann Lenihan ◽  
Nichole Nemec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Non Invasive ◽  
Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series

2020 ◽  
Author(s):  
Anne M Hause ◽  
Lakshmi Panagiotakopoulos ◽  
Eric S Weintraub ◽  
Lina S Sy ◽  
Sungching C Glenn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Respiratory Failure ◽  
Virus Infection ◽  
Respiratory Syncytial Virus Infection ◽  
Case Series ◽  
Adverse Outcomes ◽  
Syncytial Virus

Abstract We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

scholarly journals The percutaneous dilatational tracheostomy in the intensive care unit - our experience

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 77-82
Author(s):  
Vladimir Dolinaj ◽  
Sanja Milosev ◽  
Gordana Jovanovic ◽  
Ana Andrijevic ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prothrombin Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Seldinger Technique ◽  
Dilatational Tracheostomy ◽  
Tracheal Cannula

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

scholarly journals Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

2019 ◽  
Vol 36 (1) ◽  
Author(s):  
Elnaz Faramarzi ◽  
Ata Mahmoodpoor ◽  
Hadi Hamishehkar ◽  
Kamran Shadvar ◽  
Afshin Iranpour ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Length Of Stay ◽  
Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Elnaz Faramarzi ◽  
Ata Mahmoodpoor ◽  
Hadi Hamishehkar ◽  
Kamran Shadvar ◽  
Afshin Iranpour ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Length Of Stay ◽  
Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. doi: https://doi.org/10.12669/pjms.36.2.1321 How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(2):48-53. doi: https://doi.org/10.12669/pjms.36.2.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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