INFLUENCE OF THE BLOOD GAS COMPOSITION AND MECHANICAL VENTILATION PARAMETERS OF THE MEDICAL EVACUATION PROGNOSIS OF CRITICALLY ILL PATIENTS

The clinical estimation of the state of patient is one of the basic components of the checking of the state of patient, but more precise and more objective indices today become necessary. The arterial blood gases analysis helps to select the optimum regime of mechanical ventilation. The medical evacuation of the critically ill patients frequently requires the correction of the parameters of respiratory support. The conducted investigations showed that the prognostics of unfavorable outcome within the first three days from the moment of the medical evacuation are hypercapnia, which exists during the process of evacuation in spite of the correction of the parameters of mechanical ventilation, reduction in the saturation of the arterial blood. The forecast of the medical evacuation is located as well in the direct correlation with the manifestation of acidosis, and at the moment of the completion of the transfer of the patient the greatest prognostic significance they possess the low level of the partial tension of oxygen in the artery. The application of a portable express-analyzer of blood gases permits implementation of correction parameters of respiratory support and to increase quality and safety of the medical evacuation of patients.

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Prognostic Significance of Thyroid Hormone For Prolonged Mechanical Ventilation In Critically Ill Patients With Cardiac Surgery

10.21203/rs.3.rs-1029226/v1 ◽

2021 ◽

Author(s):

Xiao Shen ◽

Jiakui Sun ◽

Liang Hong ◽

Xiaochun Song ◽

Cui Zhang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Thyroid Hormone ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Prognostic Significance ◽

Multivariate Logistic Regression Analysis ◽

Free Triiodothyronine ◽

Total Triiodothyronine

Abstract Background: This study aimed to examine the correlation between thyroid hormone and prolonged mechanical ventilation (MV) in the adult critically ill patients having undergone cardiac surgery. Methods: The present study refers to a retrospective, cohort study that was conducted at Cardiovascular Intensive Care Unit (CVICU) of Nanjing First Hospital from March 2019 to December 2020. Patients receiving cardiac surgery and admitted to the center of the authors in the study period were screen for a potential inclusion. Demographic information, thyroid hormone and other laboratory measurements and outcome variables were recorded for analyses. Prolonged MV was defined as the duration of MV after cardiac surgery longer than 5 days. Thyroid hormones were assessed for the prognostic significance for prolonged MV.Results: On the whole, 118 patients having undergone cardiac surgery were included and analyzed in this study. Patients fell to the control (n=64) and the prolonged MV group (n=54) by complying with the duration of MV after cardiac surgery. The median total triiodothyronine (TT3) and free triiodothyronine (FT3) were 1.03 nmol/L and 3.52 pmol/L in the prolonged MV group before cardiac surgery, significantly lower than 1.23 nmol/L (P=0.005) and 3.87 pmol/L, respectively in the control (P=0.038). multivariate logistic regression analysis indicated that TT3 before surgery (pre-op TT3) had a good prognostic significance for prolonged MV (OR: 0.049, P=0.012). Conclusions: This study concluded that decreased triiodothyronine (T3) could be common in the cardiac patients with prolonged MV, and it would be further reduced after patients undergoing cardiac surgery. Besides, decreased T3 before surgery could act as an effective predictor for prolonged MV after cardiac surgery.

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Critical care demand and intensive care supply for patients in Japan with COVID-19 at the time of the state of emergency declaration in April 2020: a descriptive analysis.

10.21203/rs.3.rs-40419/v1 ◽

2020 ◽

Author(s):

Yosuke Fujii ◽

Kiichi Hirota

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Descriptive Analysis ◽

The State ◽

State Of Emergency ◽

Medical Institutions ◽

Number Of Patients ◽

Care Capacity

Abstract Background : The coronavirus disease 2019 (COVID-19) pandemic, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), threatened to overwhelm Japan’s intensive care capacity due to the rising numbers of infected patients. This study aimed to determine the number of critically ill patients with COVID-19 who required intensive care, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), during the pandemic and to compare these patient numbers with Japan’s overall intensive care capacity. Results : Japanese Society of Intensive Care Medicine datasets were used to obtain the number of confirmed patients with COVID-19 who had undergone mechanical ventilation and ECMO between February 15 and June 4 2020, to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan. In total, 17968 ICU days, 15171 mechanical ventilation days, and 2797 ECMO days were attributable to patients with COVID-19. There was a median (interquartile range) 143 (63-255) patients in ICU, 124 (51-225) patients on mechanical ventilation, and 18 (15-36) patients on ECMO machines. During the epidemic peak in late April, 11443 patients (1.03 per 10000 adults) had been infected, 373 patients (0.034 per 10000 adults) were in ICU, 312 patients (0.028 per 10000 adults) were receiving mechanical ventilation, and 62 patients (0.0056 per 10000 adults) were on ECMO machines per day. The number of infected patients at the peak of the epidemic was 651% of total designated beds and the number of patients requiring intensive care at the peak of the epidemic was 6.0% of total ICU beds in Japan, 19.1% of total board-certified intensivists in Japan and 106% of total designated medical institutions for Category II infectious diseases in Japan, respectively. Conclusions : Following the state of emergency declaration on April 7 2020, the number of patients with COVID-19 and the number of critically ill patients continued to rise, exceeding the number of designated beds but not exceeding ICU capacity. Urgent nationwide and regional planning is needed to prevent an overwhelming burden on ICUs in relation to critically ill patients with COVID-19 in Japan.

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Critical care demand and intensive care supply for patients in Japan with COVID-19 at the time of the state of emergency declaration in April 2020: a descriptive analysis.

10.1101/2020.06.20.20136150 ◽

2020 ◽

Author(s):

Yosuke Fujii ◽

Kiichi Hirota

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Descriptive Analysis ◽

The State ◽

State Of Emergency ◽

Medical Institutions ◽

Number Of Patients ◽

Care Capacity

AbstractBackgroundThe coronavirus disease 2019 (COVID-19) pandemic, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), threatened to overwhelm Japan’s intensive care capacity due to the rising numbers of infected patients. This study aimed to determine the number of critically ill patients with COVID-19 who required intensive care, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), during the pandemic and to compare these patient numbers with Japan’s overall intensive care capacity.MethodsJapanese Society of Intensive Care Medicine datasets were used to obtain the number of confirmed patients with COVID-19 who had undergone mechanical ventilation and ECMO between February 15 and June 4 2020, to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan.ResultsIn total, 17968 ICU days, 15171 mechanical ventilation days, and 2797 ECMO days were attributable to patients with COVID-19. There was a median (interquartile range) 143 (63-255) patients in ICU, 124 (51-225) patients on mechanical ventilation, and 18 (15-36) patients on ECMO machines. During the epidemic peak in late April, 11443 patients (1.03 per 10000 adults) had been infected, 373 patients (0.034 per 10000 adults) were in ICU, 312 patients (0.028 per 10000 adults) were receiving mechanical ventilation, and 62 patients (0.0056 per 10000 adults) were on ECMO machines per day. The number of infected patients at the peak of the epidemic was 651% of total designated beds and the number of patients requiring intensive care at the peak of the epidemic was 6.0% of total ICU beds in Japan, 19.1% of total board-certified intensivists in Japan and 106% of total designated medical institutions for Category II infectious diseases in Japan, respectively.ConclusionsFollowing the state of emergency declaration on April 7 2020, the number of patients with COVID-19 and the number of critically ill patients continued to rise, exceeding the number of designated beds but not exceeding ICU capacity. Urgent nationwide and regional planning is needed to prevent an overwhelming burden on ICUs in relation to critically ill patients with COVID-19 in Japan.

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Faculty Opinions recommendation of A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1855959.3703054 ◽

2010 ◽

Author(s):

Tarek Sharshar

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Randomised Trial

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Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽

10.1186/s13054-021-03540-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eleni Papoutsi ◽

Vassilis G. Giannakoulis ◽

Eleni Xourgia ◽

Christina Routsi ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Mortality And Morbidity ◽

Icu Admission ◽

All Cause Mortality ◽

Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Effectiveness of anaesthesia ventilator use for mechanical ventilation in critically ill patients during the COVID-19 pandemic

British Journal of Anaesthesia ◽

10.1016/j.bja.2021.04.001 ◽

2021 ◽

Author(s):

Aurélie GOUEL-CHERON ◽

Yoann ELMALEH ◽

Camille COUFFIGNAL ◽

Elie KANTOR ◽

Simon MESLIN ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

Intensive Care Medicine Experimental ◽

10.1186/s40635-020-00307-1 ◽

2020 ◽

Vol 8 (S1) ◽

Author(s):

Chiara Robba ◽

Dorota Siwicka-Gieroba ◽

Andras Sikter ◽

Denise Battaglini ◽

Wojciech Dąbrowski ◽

...

Keyword(s):

Carbon Dioxide ◽

Mechanical Ventilation ◽

Cardiac Arrest ◽

Oxygen Demand ◽

Blood Gases ◽

Metabolic Energy ◽

High Morbidity ◽

Arterial Blood Gases ◽

Arterial Blood ◽

Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

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Selection strategy for sedation depth in critically ill patients on mechanical ventilation

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01452-7 ◽

2021 ◽

Vol 21 (S2) ◽

Author(s):

Longxiang Su ◽

Chun Liu ◽

Fengxiang Chang ◽

Bo Tang ◽

Lin Han ◽

...

Keyword(s):

Mechanical Ventilation ◽

Dimensionality Reduction ◽

Critically Ill ◽

Critically Ill Patients ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sedation And Analgesia ◽

Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

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