scholarly journals Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

2020 ◽  
Vol 15 ◽  
Author(s):  
Valentina Di Lecce ◽  
Giovanna Elisiana Carpagnano ◽  
Paola Pierucci ◽  
Vitaliano Nicola Quaranta ◽  
Federica Barratta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
Non Invasive ◽  
Baseline Characteristics ◽  
Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

scholarly journals Outcomes and characteristics of COVID-19 patients treated with CPAP/ HFNO outside of the intensive care setting

2021 ◽  
pp. 00318-2021
Author(s):  
Dominic L Sykes ◽  
Michael G Crooks ◽  
Khaing Thu Thu ◽  
Oliver I Brown ◽  
Theodore J p Tyrer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Care Setting ◽  
Treatment Options ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Intensive Care Setting ◽  
Non Invasive ◽  
Significant Difference

BackgroundContinuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to COVID-19 pneumonia. Limited data are available for patients treated with non-invasive respiratory support outside of the intensive care setting.MethodsIn this single-centre observational study we observed the characteristics, physiological observations, laboratory tests, and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with non-invasive respiratory support outside of the intensive care setting.ResultsWe report the outcomes of 140 patients (Mean Age=71.2 [sd=11.1], 65% Male [n=91]) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.ConclusionsCPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.

scholarly journals Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1035
Author(s):  
Rachel K. Marlow ◽  
Sydney Brouillette ◽  
Vannessa Williams ◽  
Ariann Lenihan ◽  
Nichole Nemec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Non Invasive ◽  
Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

scholarly journals Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakub Smiechowicz ◽  
Barbara Barteczko-Grajek ◽  
Barbara Adamik ◽  
Jozef Bojko ◽  
Waldemar Gozdzik ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Organ Failure ◽  
Intensive Care Units ◽  
Sofa Score ◽  
Influenza Infection ◽  
Winter Season ◽  
Respiratory Support ◽  
Costly Treatment ◽  
High Degree

Abstract Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

scholarly journals Role of Non-Invasive Mechanical Ventilation for Acute Respiratory Failure in Cancer Patients

2020 ◽  
Vol 3 (1) ◽  
pp. 298-301
Author(s):  
Madindra Bahadur Basnet ◽  
Krishna Prasad Acharya ◽  
Deepak Adhikari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Cancer Patients ◽  
Invasive Mechanical Ventilation ◽  
Invasive Ventilation ◽  
Timely Initiation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Introduction: Acute respiratory failure is a common cause of Intensive care Unit admission for cancer patients. Non-invasive ventilation comes in between the two extreme situations: either provide only oxygen or ventilate invasively. This study was done to find the usefulness and efficacy of non-invasive ventilation in a cancer patient. Materials and Methods: A cross-sectional study was done at Nepal Cancer Hospital. Data analysis of patients requiring non-invasive ventilation at the Intensive care Unit from April 14, 2018, to April 13, 2019, were included. Results: Among 68 studied patients, the primary reason for the initiation of non-invasive ventilation sepsis (16.32%), pneumonia (10.88%), and lung cancer (10.2%). Postoperative atelectasis, pulmonary edema, and morphine overdose were associated with good respiratory improvement and Intensive care Unit survival (100%, 75% and 66.67% respectively). Respiratory failure with carcinoma lung, lung fibrosis, acute respiratory distress syndrome, terminally ill patients, and patients with low Glasgow Coma Scale had high failure rates (Survival: 13.33%, 14.29%, 16.67%, 0%, and 20% respectively). Conclusions: Non-invasive ventilation seems to be an effective way of ventilation for cancer patients. The selection of patients and timely initiation of non-invasive ventilation is of utmost importance for a better outcome.  

Non-invasive ventilation in intensive care unit: yesterday, today, tomorrow (literature review)

2021 ◽  
pp. 42-51
Author(s):  
A. V. Vlasenko ◽  
A. G. Koryakin ◽  
E. A. Evdokimov ◽  
I. S. Klyuev
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Negative Effects ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The One

The development of medical technologies and the emergence of new methods of respiratory support with extensive capabilities to control positive pressure on the inhale and exhale made it possible to implement non-invasive ventilation. The integration of microprocessors in modern respiratory interfaces, on the one hand, and a deeper understanding of the mechanisms of the pathogenesis of respiratory failure, on the other hand, made it possible to improve and implement various methods of non-invasive respiratory support in everyday clinical practice. The experience gained in recent decades with the use of non-invasive ventilation made it possible to widely use this method of respiratory support in a wide variety of clinical situations. However, the selection of patients for mask ventilation, the choice of method and algorithm for its application, prognosis of effectiveness, prevention of negative effects, as before, remain relevant. This dictates the need to continue studying the clinical efficacy of non-invasive ventilation in patients with respiratory failure of various origins. The review presents the possibilities and limitations of the use of non-invasive respiratory support in patients with respiratory failure in the intensive care unit.

scholarly journals Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1053
Author(s):  
Shayan Kassirian ◽  
Ravi Taneja ◽  
Sanjay Mehta
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
The Right

Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.

scholarly journals Clinical outcomes of patients with COVID-19 admitted for respiratory support to the intensive care units in Russia

2020 ◽  
Vol 29 (3) ◽  
pp. 25-36
Author(s):  
P. Glybochko ◽  
V. Fomin ◽  
S. Moiseev ◽  
S. Avdeev ◽  
A. Yavorovskiy ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Respiratory Support

scholarly journals Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France

2021 ◽  
Vol 10 (23) ◽  
pp. 5650
Author(s):  
Maxime Volff ◽  
David Tonon ◽  
Youri Bommel ◽  
Noémie Peres ◽  
David Lagier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Intensive Care Units ◽  
Arterial Thrombosis ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Factors Associated ◽  
Icu Admission ◽  
Ventilated Patients

Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and 29 (17–46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. Conclusion: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis.

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