scholarly journals Performance of The Decarboxylation Index To Predict CO2 Removal And Mechanical Ventilation Reduction Under VV-ECMO Or High-Flow ECCO2R

2022 ◽  
Author(s):  
Thomas Laumon ◽  
Elie Courvalin ◽  
Geoffrey Dagod ◽  
Pauline Deras ◽  
Mehdi Girard ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gas Flow ◽  
Blood Gases ◽  
High Flow ◽  
Trial Registration ◽  
Respiratory Support ◽  
Co2 Removal ◽  
Linear Regression Models ◽  
The Relationship ◽  
Simple Parameter

Abstract Background: Optimal decarboxylation dose under extracorporeal respiratory support to ensure sufficient reduction of mechanical ventilation stress remains unclear and understudied. The aim of this study was to assess the interdependence of blood flow (BF) and gas flow (GF) in predicting CO2 removal and mechanical ventilation reduction (MVR) under extracorporeal respiratory support. Methods: All patients who benefited from veno-venous ECMO (HLS-maquet 7.0, 1.8 m²) and high-flow ECCO2R (HLS-maquet 5.0, 1.3 m²) in our intensive care unit over a period of 18 months were included. CO2 removal was calculated from inlet/outlet blood gases performed in clinical practice during the first 7 days of oxygenator use. The relationship between the BF × GF product and CO2 removal or MVR was studied using linear regression models. Results: Eighteen patients were analysed, corresponding to 24 oxygenators and 261 datasets. CO2 removal was 393 mL/min (IQR, 310–526 mL/min) for 1.8 m2 oxygenators and 179 mL/min (IQR, 165–235 mL/min) for 1.3 m2 oxygenators. The decarboxylation index was associated linearly with CO2 removal (R2 = 0.62 and R2 = 0.77 for the two oxygenators, respectively) and MVR (R2 = 0.72 and R2 = 0.62, respectively). Values in the range 20−30L2/min2 were associated with an MVR ratio between 38% and 58% for 1.8 m2 oxygenators, and between 37% and 55% for 1.3 m2 oxygenators. Conclusion: The decarboxylation index is a simple parameter to predict CO2 removal and MVR under extracorporeal respiratory support. A BF of 2 L2/min2 or more may be necessary to obtain a significant reduction of mechanical convection.Trial Registration: Being a retrospective study, no trial registration was made.

Factors Associated with Respiratory Support after Cesarean Hysterectomy

2021 ◽  
Vol 104 (8) ◽  
pp. 1347-1353
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Blood Components ◽  
Factors Associated ◽  
Cesarean Hysterectomy ◽  
Asa Classification ◽  
The Relationship ◽  
Postoperative Mechanical Ventilation

Background: Cesarean hysterectomy is a major operation that causes massive hemorrhage and larger fluid resuscitation. Thus, postoperative mechanical ventilation support is required in some patients, involving longer hospital stay and high cost of hospital care. Objective: To find the predictive factors for postoperative respiratory support in pregnant women underwent cesarean hysterectomy. Materials and Methods: A retrospective review of patients underwent cesarean hysterectomy between January 2014 and June 2019 was conducted. Patient characteristics, anesthetic records and hospital length of stay were reviewed. The relationship between factors and postoperative mechanical ventilator (PMV) was also analyzed. Results: A total of 180 patients were included in the present study, wherein, 64 patients (35%) required PMV and 30 patients (16%) needed postoperative oxygen support. Multivariable logistic regression was used to identify the relationship between PMV and the associated factors. The authors found the American Society of Anesthesiologists (ASA) classification and the volume of intraoperative blood components replacement (packed red blood cells [PRC] and fresh frozen plasma [FFP]) were significantly related to PMV: ASA3 16.51 (95% CI 1.89 to 144.33), ASA4 183.25 (95% CI 2.92 to 11,500.65), p=0.003; PRC 1.0028 (95% CI 1.0008 to 1.0047), p=0.001; FFP 1.0022 (95% CI 1.0000 to 1.0043), p=0.029, respectively. Conclusion: Postoperative mechanical ventilation was found in one-third of the cesarean hysterectomy patients and associated with ICU admission along with increased in post-operative length of hospital stay. The ASA classification and intraoperative volume of blood components replacement were significantly associated with PMV. Factors associated significantly with respiratory support were ASA classification and duration surgery. Keywords: Factors associated; Respiratory support; Cesarean hysterectomy

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.

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

2020 ◽  
Vol 65 (2) ◽  
pp. 84-89
Author(s):  
A. S. Minin ◽  
N. P. Shen ◽  
I. D. Panov ◽  
S. A. Bem
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Significance ◽  
Blood Gases ◽  
The State ◽  
Respiratory Support ◽  
Medical Evacuation ◽  
Arterial Blood ◽  
The Moment

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.

scholarly journals Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience

2020 ◽  
Vol 7 (1) ◽  
pp. e000678 ◽  
Author(s):  
Rob J Hallifax ◽  
Benedict ML Porter ◽  
Patrick JD Elder ◽  
Sarah B Evans ◽  
Chris D Turnbull ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
High Flow ◽  
Respiratory Support ◽  
Severe Illness ◽  
High Dependency Unit ◽  
Single Centre ◽  
High Dependency ◽  
Improved Outcomes ◽  
Continuous Positive Airways Pressure

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.

scholarly journals Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

2019 ◽  
Vol 30 (1) ◽  
pp. 66-73
Author(s):  
Elizabeth C. Ciociola ◽  
Karan R. Kumar ◽  
Kanecia O. Zimmerman ◽  
Elizabeth J. Thompson ◽  
Melissa Harward ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Prolonged Length

AbstractBackground:Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.Methods:We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.Results:A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.Conclusion:Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

2020 ◽  
Vol 5 (4) ◽  
pp. 1006-1010
Author(s):  
Jennifer Raminick ◽  
Hema Desai
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oxygen Therapy ◽  
Respiratory Illness ◽  
High Flow ◽  
Oral Feeding ◽  
Respiratory Support ◽  
Acute Respiratory Illness ◽  
High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

Camouflaging in non-autistic adults is associated with poorer mental health

2019 ◽  
Author(s):  
Mark Somerville ◽  
Sarah E. MacPherson ◽  
Sue Fletcher-Watson
Keyword(s):  
Mental Health ◽  
Executive Function ◽  
Autistic Traits ◽  
Self Report ◽  
Linear Regression Models ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Autistic People ◽  
Autistic Adults ◽  
The Relationship

Camouflaging is a frequently reported behaviour in autistic people, which entails the use of strategies to compensate for and mask autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a non-autistic sample, examining the relationship between autistic traits, camouflaging, and mental health. In addition, the role of executive functions as a mechanism underpinning camouflaging was explored. Sixty-three non-autistic adults completed standardised self-report questionnaires which measured: autistic traits, mental health symptoms, and camouflaging behaviours. In addition, a subset (n=51) completed three tests of executive function measuring inhibition, working memory, and set-shifting. Multiple linear regression models were used to analyse data. Results indicated that autistic traits are not associated with mental health symptoms when controlling for camouflaging, and camouflaging predicted increased mental health symptoms. Camouflaging did not correlate with any measure of executive function. These findings have implications for understanding the relationship between autistic traits and mental health in non-autistic people and add to the growing development of theory and knowledge about the mechanism and effects of camouflaging.

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