scholarly journals Faculty Opinions recommendation of Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019-Related Respiratory Failure.

2021 ◽  
Author(s):  
Richard Branson
Keyword(s):  
Respiratory Failure ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Respiratory Failure

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kusum S. Mathews ◽  
Howard Soh ◽  
Shahzad Shaefi ◽  
Wei Wang ◽  
Sonali Bose ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

The Feasibility of Objective Sleep-Quality Assessment in an ICU Setting

2021 ◽  
Vol 104 (2) ◽  
pp. 304-309
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Sleep Quality ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Sleep Stages ◽  
Poor Sleep ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: Sleep disruptions frequently occur in hospitalized patients, especially with critically ill, mechanically ventilated patients. Severely altered sleep architectures result in unclassifiable sleep stages as listed by the conventional Rechtschaffen and Kales (R&K) criteria, and a new classification for sleep scoring including atypical sleep (AS) and pathological wakefulness (PW) has recently been proposed. Objective: To demonstrate the feasibility of performing objective sleep qualification in patients receiving mechanical ventilation due to acute respiratory failure. Materials and Methods: In the present prospective cohort study, polysomnography was performed in 38 patients requiring invasive mechanical ventilation due to acute respiratory failure at the respiratory care unit (RCU) of Siriraj Hospital between February and December 2017. Their sleep stages were analyzed by conventional rules and the new classifications of AS and PW. The associations between the presence of AS or PW and the patients’ characteristics were analyzed. Correlations between sleep quality and clinical parameters were also determined. Results: Most of the patients had poor sleep quality with median sleep efficiency (IQR) of 35.9% (18.5, 62.3) and significantly decreased slowwave sleep [median (IQR) 0.4% (0.00, 5.70)] and REM [median (IQR) 1.3% (0.00, 6.43)]. According to the new classifications, 14 out of 38 (prevalence of 36.8%) mechanically ventilated patients had AS. The prevalence of PW and either AS or PW were 36.8% and 52.6%, respectively. A higher baseline respiratory rate was observed among patients who had either AS or PW at 24 versus 20 breaths/minute (p=0.02), while a longer duration of mechanical ventilator support was found in patients with PW at nine versus five (p=0.003). Patient-ventilator asynchrony was also noted in all patients. Conclusion: Sleep quality among critically ill and mechanically ventilated patients was severely disturbed. A higher prevalence of AS and PW were noted. The technical feasibility of sleep recording in Thai intensive care unit (ICU) settings was established. Keywords: Polysomnography, Atypical sleep, ICU

scholarly journals Outcomes in mechanically ventilated patients with hypoxaemic respiratory failure caused by COVID-19

2020 ◽  
Vol 125 (6) ◽  
pp. e480-e483
Author(s):  
Luigi Camporota ◽  
Barnaby Sanderson ◽  
Alison Dixon ◽  
Francesco Vasques ◽  
Andrew Jones ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

2020 ◽  
Author(s):  
Mehdi Shelhamer ◽  
Paul D. Wesson ◽  
Ian L. Solari ◽  
Deanna L. Jensen ◽  
William Alex Steele ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Competing Risks ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Hospital Death ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Physiologic Parameters ◽  
Ventilated Patients

Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 (P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2:FiO2) were significantly improved during days 4-7 (P < 0.05 for all). CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

scholarly journals Association of weaning preparedness with extubation outcome of mechanically ventilated patients in medical intensive care units: a retrospective analysis

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8973
Author(s):  
Feng-Ching Lin ◽  
Yao-Wen Kuo ◽  
Jih-Shuin Jerng ◽  
Huey-Dong Wu
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Intensive Care Units ◽  
Extubation Failure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Failure Group ◽  
Medical Intensive Care ◽  
Ventilated Patients

Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure (p = 0.037). The failure group also had a higher WEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291–6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560–16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness.

Abstract W MP61: Relationship Between Tracheostomy and Readmission Rates Among Mechanically Ventilated Patients with Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shouri Lahiri ◽  
Babak Navi ◽  
Daniel M Lapidus ◽  
Sachin Agarwal ◽  
Halinder S Mangat ◽  
...  
Keyword(s):  
New York ◽  
Respiratory Failure ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Discharge Disposition ◽  
Ventilated Patients

Introduction: Patients with ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) who undergo mechanical ventilation (MV) frequently require tracheostomy for management of persistent respiratory failure. Given the potential complications of chronic immobility and respiratory failure, these patients may be at high risk for hospital readmission. Methods: Using previously validated ICD-9-CM codes and statewide administrative claims data from California (2005-2011), Florida (2005-2012), and New York (2006-2011), we compared readmission rates among patients with a first-recorded stroke (IS, ICH, or SAH) who received MV and were discharged with or without a tracheostomy. Survival statistics and Poisson regression analyses with robust standard errors were used to report rates of hospital readmission and the association between tracheostomy and readmission rates. Results: Among 39,881 patients with stroke who underwent MV, 10,690 received a tracheostomy. The rate of any readmission was 21.1% (95% CI 20.3-21.9%) at 1 month and 45.1% (95% CI 44.2-46.1%) at 1 year among patients with tracheostomy versus 17.1% (95% CI 16.6-17.5%) and 35.3% (95% CI 34.8-35.9%) among those without a tracheostomy. The overall readmission rate throughout follow-up was 5.03 (95% CI 5.00-5.07) readmissions per 100 patients per month in those with tracheostomy versus 3.69 (95% CI 3.64-3.73) in those without tracheostomy. After adjustment for stroke type, demographic characteristics, vascular risk factors, Elixhauser comorbidities, stroke complications (e.g., seizures), and discharge disposition from the index hospitalization, tracheostomy was associated with a slightly increased readmission rate (incidence rate ratio, 1.04; 95% CI 1.00-1.08, p=0.04). Conclusion: Readmission rates among mechanically ventilated patients with stroke were not substantially higher than overall readmission rates seen in the general hospitalized population of elderly patients. There was a statistically significant but not clinically meaningful association between tracheostomy placement and readmission rates. These data may be helpful when counseling the families of patients with severe stroke.

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