The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

2020 ◽  
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Li-Pang Chuang ◽  
Shih-Wei Lin ◽  
Shaw-Woei Leu ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Binary Logistic Regression ◽  
Driving Pressure ◽  
Mechanical Power ◽  
Regression Analyses ◽  
Ventilator Support ◽  
History Of ◽  
Group Regression ◽  
Ventilated Patients

Abstract Background: Recent studies reported that mechanical power (MP) has been associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. Methods: In total, 313 patients with severe pneumonia were enrolled. Serial MP was recorded daily for either 21 days or until ventilator support was no longer required. The associations between all variables and 28-day mortality were analyzed using binary logistic regression analyses. Results: The ARDS group (106 patients) demonstrated lower age, higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, high incidences of shock and jaundice, higher MP and driving pressure on Day 1, and higher death within 28 days than the non-ARDS group. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.041; 95% confidence interval, 1.013-1.071). MP persisted high in non-survivors and low in survivors among the ARDS group, the non-ARDS group and all patients.Conclusions: MP was associated with the 28-day mortality in ventilated patients with severe pneumonia both in the ARDS and non-ARDS groups. MP had better predicted value for 28-day mortality than driving pressure.

scholarly journals The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1862
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Li-Pang Chuang ◽  
Shih-Wei Lin ◽  
Shaw-Woei Leu ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Driving Pressure ◽  
Mechanical Power ◽  
Health Evaluation ◽  
Independent Factor ◽  
Ventilator Support ◽  
History Of ◽  
Ventilated Patients

Recent studies have reported that mechanical power (MP) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. In total, the data of 313 patients with severe pneumonia were used for analysis. Serial MP was calculated daily for either 21 days or until ventilator support was no longer required. Compared with the non-ARDS group, the ARDS group (106 patients) demonstrated lower age, a higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, elevated incidences of shock and jaundice, higher MP and driving pressure on Day 1, and more deaths within 28 days. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.048; 95% confidence interval, 1.020–1.077). MP was persistently high in non-survivors and low in survivors among the ARDS group, the non-ARDS group, and all patients. These findings indicate that MP is associated with the 28-day mortality in ventilated patients with severe pneumonia, both in the ARDS and non-ARDS groups. MP had a better predicted value for the 28-day mortality than the driving pressure.

Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome

2018 ◽  
Vol 46 (2) ◽  
pp. 300-306 ◽  
Author(s):  
Hiroko Aoyama ◽  
Tommaso Pettenuzzo ◽  
Kazuyoshi Aoyama ◽  
Ruxandra Pinto ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Driving Pressure ◽  
Ventilated Patients

scholarly journals Decision support system to evaluate VENTilation in the Acute Respiratory Distress Syndrome (DeVENT study): Trial Protocol

2021 ◽  
Author(s):  
Brijesh V Patel ◽  
Sharon Mumby ◽  
Nicholas Johnson ◽  
Emanuela Falaschetti ◽  
Jorgen Hansen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Decision Support ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Driving Pressure ◽  
Ventilator Induced Lung Injury ◽  
Ventilated Patients

Background: The Acute Respiratory Distress Syndrome (ARDS) occurs in response to a variety of insults, and mechanical ventilation is life-saving in this setting, but ventilator induced lung injury can also contribute to the morbidity and mortality in the condition. The Beacon Caresystem is a model-based bedside decision support system using mathematical models tuned to the individual patient's physiology to advise on appropriate ventilator settings. Personalised approaches using individual patient description may be particularly advantageous in complex patients, including those who are difficult to mechanically ventilate and wean, in particular ARDS. Methods: We will conduct a multi-centre international randomised, controlled, allocation concealed, open, pragmatic clinical trial to compare mechanical ventilation in ARDS patients following application of the Beacon Caresystem to that of standard routine care to investigate whether use of the system results in a reduction in driving pressure across all severities and phases of ARDS. Discussion. Despite 20 years of clinical trial data showing significant improvements in ARDS mortality through mitigation of ventilator induced lung injury, there remains a gap in its personalised application at the bedside. Importantly, the protective effects of higher positive end-expiratory pressure (PEEP) were noted only when there were associated decreases in driving pressure. Hence, the pressures set on the ventilator should be determined by the diseased lungs' pressure-volume relationship which is often unknown or difficult to determine. Knowledge of extent of recruitable lung could improve the ventilator driving pressure. Hence, personalised management demands the application of mechanical ventilation according to the physiological state of the diseased lung at that time. Hence, there is significant rationale for the development of point-of-care clinical decision support systems which help personalise ventilatory strategy according to the current physiology. Furthermore, the potential for the application of the Beacon Caresystem to facilitate local and remote management of large numbers of ventilated patients (as seen during this COVID-19 pandemic), could change the outcome of mechanically ventilated patients during the course of this and future pandemics. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04115709

scholarly journals Adjacent digit fingerprint white line count differences: a pointer to sexual dimorphism for forensic application

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Magaji Garba Taura ◽  
Lawan Hassan Adamu ◽  
Abdullahi Yusuf Asuku ◽  
Kabiru Bilkisu Umar ◽  
Musa Abubakar
Keyword(s):  
Logistic Regression ◽  
Sexual Dimorphism ◽  
Binary Logistic Regression ◽  
Stepwise Logistic Regression ◽  
Regression Analyses ◽  
Forensic Application ◽  
White Line ◽  
Study Population ◽  
Right And Left Hands

Abstract Background Sex determination is one of the leading criterion in identification and verification of an individual. However, the potential roles of differences in adjacent fingerprint white line count (FWLC) in sex inference are not well elucidated in the literature especially among Hausa population. The study was conducted to determine sexual dimorphism and predict sex using adjacent digit FWLC difference (adj. DFWLCD) among Hausa population of Kano state, Nigeria. Methods The study population involved 300 participants. FWLC was determined from a plain fingerprint captured using live scanner. The formula for adj. DFWLCD of thumb and fifth digit is dR15 for right hand. The same applied for possible combination in cephalocaudal direction. Mann-Whitney and t tests were used for comparison of variables between sexes. Binary logistic regression analyses were employed for determination of sex. Results We observed a significantly larger adj. DFWLCD in males compared with females in most of the digit combination. A significant sexual dimorphism was observed in most of the adj. DFWLCD involving ring digit in both right (dR14, dR24, and dR34) and left (dL14, dL24, and dL34). The best discrimination was observed in adjacent FWLC difference of second and fourth digits in both right and left digits (dR24 and dL24). This was further supported by stepwise logistic regression analyses. Conclusion The adj. DFWLCD exhibits sexual dimorphism. The best prediction potentials were found to be dR24 and dL24 for right and left hands respectively.

scholarly journals Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Reem M. Elsaid ◽  
Ashraqat S. Namrouti ◽  
Ahmad M. Samara ◽  
Wael Sadaqa ◽  
Sa’ed H. Zyoud
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Binary Logistic Regression ◽  
Nausea And Vomiting ◽  
Prior History ◽  
Factors Associated ◽  
Duration Of Surgery ◽  
History Of

Abstract Background Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. Methods This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. Results Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03–5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17–4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). Conclusions PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients’ outcomes.

scholarly journals Willingness to receive future COVID-19 vaccines following the COVID-19 epidemic in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yehong Zhou ◽  
Junjie Zhang ◽  
Wenwen Wu ◽  
Man Liang ◽  
Qiang-Song Wu
Keyword(s):  
Vaccine Safety ◽  
Older Individuals ◽  
Regression Analyses ◽  
Pharmacological Interventions ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
History Of ◽  
Potential Factors ◽  
To Receive

Abstract Background There are no pharmacological interventions currently available to prevent the transmission of SARS-CoV-2 or to treat COVID-19. The development of vaccines against COVID-19 is essential to contain the pandemic. we conducted a cross-sectional survey of Shanghai residents to understand residents’ willingness to be vaccinated with any future COVID-19 vaccines and take measures to further improve vaccination coverage. Methods We conducted a cross-sectional survey using self-administered anonymous questionnaires from 1 July to 8 September 2020. The main outcome was willingness of participants, and any children or older individuals living with them, to receive future COVID-19 vaccines. Logistic regression analyses were used to explore potential factors associated with vaccination willingness. Results A total of 1071 participants were asked about their willingness to receive future COVID-19 vaccines, for themselves and at least 747 children and 375 older individuals (≥60 years old) living with them. The highest proportion of expected willingness to vaccinate was among participants (88.6%), followed by children (85.3%) and older individuals (84.0%). The main reasons for reluctance to vaccinate among 119 participants were doubts regarding vaccine safety (60.0%) and efficacy (28.8%). Participants with a self-reported history of influenza vaccination were more likely to accept COVID-19 vaccines for themselves [adjusted odds ratio (OR) = 1.83; 95% confidence interval (CI): 1.19–2.82], their children (adjusted OR = 2.08; 95%CI: 1.30–3.33), and older individuals in their household (adjusted OR = 2.12; 95%CI: 1.14–3.99). Participants with older individuals in their families were less willing to vaccinate themselves (adjusted OR = 0.59; 95%CI: 0.40–0.87) and their children (adjusted OR = 0.58; 95%CI: 0.38–0.89). Conclusions Participants were more reluctant to accept COVID-19 vaccines for older individuals living with them. The presence of older individuals in the home also affected willingness of participants and their children to be vaccinated.

Surfactant therapy in combination treatment of COVID-19 related acute respiratory distress syndrome

2021 ◽  
pp. 50-56
Author(s):  
Renat R. Gubaidullin ◽  
◽  
Aleksandr P. Kuzin ◽  
Vladimir V. Kulakov ◽  
◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Standard Therapy ◽  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Lung Ventilation ◽  
Surfactant Therapy

ntroduction. The COVID-19 pandemic caused an outbreak of viral lung infections with severe acute respiratory syndrome complicated with acute respiratory failure. Despite the fact that the pandemic has a lengthened run, none of the therapeutic approaches have proved to be sufficiently effective according to the evidence-based criteria. We consider the use of surfactant therapy in patients with severe viral pneumonia and acute respiratory distress syndrome (ARDS) as one of the possible methods for treating COVID-19 related pneumonia. Objective. To prove the clinical efficacy and safety of orally inhaled Surfactant-BL, an authorized drug, in the combination therapy of COVID-19 related ARDS. Materials and methods. A total of 38 patients with COVID-19 related severe pneumonia and ARDS were enrolled in the study. Of these, 20 patients received the standard therapy in accordance with the temporary guidelines for the prevention, diagnosis and treatment of the novel coronavirus infection (COVID-19) of the Ministry of Health of the Russian Federation, version 9. And 18 patients received the surfactant therapy in addition to the standard therapy. Surfactant-BL was used in accordance with the instructions on how to administer the drug for the indication – prevention of the development of acute respiratory distress syndrome. A step-by-step approach to the build-up of the respiratory therapy aggressiveness was used to manage hypoxia. We used oxygen inhalation via a face mask with an oxygen inflow of 5–15 l/min, highflow oxygen therapy via nasal cannulas using Airvo 2 devices, non-invasive lung ventilation, invasive lung ventilation in accordance with the principles of protective mechanical ventilation. Results and discussion. Significant differences in the frequency of transfers to mechanical ventilation, mortality, Intensive Care Unit (ICU) and hospitalization length of stay (p <0.05) were found between the groups. Patients receiving surfactant therapy who required a transfer to mechanical ventilation accounted for 22% of cases, and the mortality rate was 16%. In the group of patients receiving standard therapy without surfactant inhalation 45% were transferred to mechanical ventilation, and 35% died. For patients receiving surfactant therapy, the hospital stay was reduced by 20% on average, and ICU stay by 30%. Conclusion. The inclusion of surfactant therapy in the treatment of COVID-19 related severe pneumonia and ARDS can reduce the progression of respiratory failure, avoid the use of mechanical ventilation, shorten the ICU and hospitalization length of stay, and improve the survival rate of this patient cohort.

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