scholarly journals The efficacy of combination therapies including antiviral drugs, methylprednisolone and daily proning in 20 patients with COVID-19 requiring invasive mechanical ventilation—Case series in a single critical care center in Osaka, Japan

2020 ◽  
Author(s):  
Haruka Shimazu ◽  
Kazuhisa Yoshiya ◽  
Keisuke Tamagaki ◽  
Yasutaka Okamoto ◽  
Hitoshi Nakano ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Case Series ◽  
Group Versus ◽  
Survivor Group

Abstract Background: Since December 2019, the COVID-19 infection has drastically spread across China and the world, including Japan. Few reports so far have clarified the prognosis and treatment of critically ill patients managed with invasive mechanical ventilation. This study aimed to present the clinical courses of 20 critically ill patients with invasive mechanical ventilation, which may be valuable for determining future therapies and intensive care of critically ill patients with COVID-19.Methods: In this observational, single-center, cohort study, we included 20 critically ill patients with laboratory-confirmed SARS-CoV-2 infection who were admitted to our hospital ICU and required invasive mechanical ventilation. The patients’ general characteristics, laboratory data, treatments, and outcomes were assessed between survivors and non-survivors.Results: Among these 20 patients, 14 patients survived and 6 patients died. The lowest lymphocyte count (93 vs 279/μL, p<0.01) and the lowest platelet count (12 vs 152×103/μL, p<0.01) were significantly lower, and the highest KL-6 value (1584 vs 546 U/mL, p=0.02) was significantly higher, in the non-survivor group versus the survivor group during the patients’ ICU stay. In addition to antiviral treatments and daily proning of the patients, methylprednisolone was administered to all patients to control cytokine storm syndrome following the virus infection. Six patients died from complications such as fungal infection, but no patients died of respiratory failure. As a result, none of the patients required ECMO.Conclusion: This report described the prognosis of COVID-19 patients required invasive mechanical ventilation in a single Japanese critical care center. Multidisciplinary treatments using a single protocol, including antiviral therapies, anti-inflammatory therapies, and respiratory physiotherapies, were effective for critically ill COVID-19 patients who required invasive mechanical ventilation.

scholarly journals Clinical Characteristics of Critically Ill Patients Infected with COVID-19 in Rasoul Akram Hospital in Iran: A Single Center Study

2020 ◽  
Vol 10 (5) ◽  
Author(s):  
Poupak Rahimzadeh ◽  
Saied Amniati ◽  
Reza Farahmandrad ◽  
Seyed Hamid Reza Faiz ◽  
Setareh Hedayati Emami ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Case Series ◽  
Signs And Symptoms ◽  
Number Of Patients ◽  
Single Center Study ◽  
Very High

Background: Knowledge about clinical features of critically ill patients with COVID-19 still lacks adequate information up to now. Objectives: We aimed to describe and compare the epidemiological and clinical characteristics of critically ill patients with COVID-19 in Rasoul Akram Hospital. Methods: In this case series, 70 critically ill patients with COVID-19 admitted in ICU wards of Rasoul Akram Hospital, Tehran, Iran, from 29 February to 25 April 2020 were enrolled. Demographic and clinical characteristics, laboratory data, and outcomes of the patients were all collected and compared between deceased and recovered patients. Results: Fifty-six cases had died of COVID-19, and 14 patients had fully recovered and discharged. The median age of the patients was 68 years old, ranging from 22 to 91 years, 66% were men, 80% had one or more comorbidities, and hypertension was the most common comorbidities (45% of deceased cases). The most common signs and symptoms at the onset of illness were SPO2 depression (92%) and dyspnea (90%). Dyspnea was significantly more common in deceased patients (95%) than recovered patients (70%) (P = 0.048). Most patients had lymphopenia (80%). The number of patients who needed mechanical ventilation in the deceased patients was 53 (95%), which was significantly more than the recovered patients (10 [70%]) (P = 0.048). Conclusions: The mortality rate of critically ill patients with COVID-19 is very high, and the patients with dyspnea and required mechanical ventilation are at higher risk for death.

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

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.

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

scholarly journals Clinical Course and Outcomes of Severe Covid-19: A National Scale Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2282 ◽  
Author(s):  
Moran Amit ◽  
Alex Sorkin ◽  
Jacob Chen ◽  
Barak Cohen ◽  
Dana Karol ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Infection ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Case Series ◽  
Government Officials ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Overall Mortality

Knowledge of the outcomes of critically ill patients is crucial for health and government officials who are planning how to address local outbreaks. The factors associated with outcomes of critically ill patients with coronavirus disease 2019 (Covid-19) who required treatment in an intensive care unit (ICU) are yet to be determined. Methods: This was a retrospective registry-based case series of patients with laboratory-confirmed SARS-CoV-2 who were referred for ICU admission and treated in the ICUs of the 13 participating centers in Israel between 5 March and 27 April 2020. Demographic and clinical data including clinical management were collected and subjected to a multivariable analysis; primary outcome was mortality. Results: This study included 156 patients (median age = 72 years (range = 22–97 years)); 69% (108 of 156) were male. Eighty-nine percent (139 of 156) of patients had at least one comorbidity. One hundred three patients (66%) required invasive mechanical ventilation. As of 8 May 2020, the median length of stay in the ICU was 10 days (range = 0–37 days). The overall mortality rate was 56%; a multivariable regression model revealed that increasing age (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), the presence of sepsis (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), and a shorter ICU stay(OR = 0.90 for each day, 95% CI = 0.84–0.96) were independent prognostic factors. Conclusions: In our case series, we found lower mortality rates than those in exhausted health systems. The results of our multivariable model suggest that further evaluation is needed of antiviral and antibacterial agents in the treatment of sepsis and secondary infection.

scholarly journals Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

Critical Care ◽  
2013 ◽  
Vol 17 (2) ◽  
pp. 223 ◽  
Author(s):  
Antonio M Esquinas Rodriguez ◽  
Peter J Papadakos ◽  
Michele Carron ◽  
Roberto Cosentini ◽  
Davide Chiumello
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive

scholarly journals Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Francesco Mojoli ◽  
Andrea Cortegiani ◽  
Elena Giovanna Bignami ◽  
Mariachiara Ippolito ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Working Group ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Italian Society ◽  
Expert Consensus ◽  
Consensus Statements

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

scholarly journals Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

2020 ◽  
pp. 175114371990010 ◽  
Author(s):  
Raymond Dominic Savio ◽  
Rajalakshmi Parasuraman ◽  
Daphnee Lovesly ◽  
Bhuvaneshwari Shankar ◽  
Lakshmi Ranganathan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Prone Position ◽  
Supine Position ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

Effects Of Mechanical In-Exsufflation On Mucus Clearance In Critically Ill Patients On Invasive Mechanical Ventilation

2020 ◽  
Author(s):  
Roberto Martinez-Alejos ◽  
Joan-Daniel Martí ◽  
Gianluigi Li Bassi ◽  
Daniel Gonzalez-Anton ◽  
Xabier Pilar-Diaz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Invasive Technique ◽  
Pulmonary Mechanics ◽  
Post Intervention ◽  
Mucus Clearance ◽  
Registration Number ◽  
Clinically Significant

Abstract Background: Mechanical insufflation-exsufflation (MI-E) is a non-invasive technique performed through the CoughAssist In-Exsufflator to simulate cough and remove mucus from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation (MV) are not fully elucidated. The purpose of this study was to compare the efficacy and safety of MI-E combined or not to manual chest physiotherapy (CPT) in these patients.Methods: This cross-over clinical study enrolled consecutive patients who were sedated, intubated and on MV > 48h with expected maintenance of these criteria > 24h. Over a 24-hour period, patients randomly performed two sessions of manual CPT with or without additional MI-E before tracheal suctioning. Following each procedure, volume of retrieved mucus (ml) was assessed to evaluate efficacy. We evaluated respiratory flows, pulmonary mechanics and hemodynamics before, during, and after treatment. In addition, safety of MI-E was also appraised.Results: 26 patients were included. In comparison to CPT, mucus volume retrieved was significantly higher during CPT+MI-E (0.42 [0; 1.39] ml vs 2.29 [1; 4.67] ml; p < 0.001). The respiratory system compliance immediately improved from pre and post Crs values in CPT+MI-E group (55.7 ml/cmH2O [38.3; 67.4] vs. 68.6ml/cmH2O [47.8;94.9]; p<0.001). Although, such increase was not significantly different between CPT and CPT+MI-E group (p=0.057). Heart rate significantly increased in both groups (p < 0.005) immediately after each intervention. Additionally, a significant impact on oxygenation was observed in the CPT+MI-E group when comparing the baseline values with the values one-hour post-intervention (p<0.05). Finally, several transitory hemodynamic variations occurred during both interventions, but these were non-significant and considered clinically irrelevant.Conclusion: In mechanically ventilated patients, MI-E increases the amount of secretions that can be retrieved post-CPT, without causing clinically significant adverse events.Clinical Trials Registration Number: NCT03316079 (24/11/2015; retrospectively registered)

Sign in / Sign up

Export Citation Format

Share Document