SIMULATION TRAINING FOR DOCTORS OF SURGICAL SPECIALTIES UNDER THE ADDITIONAL PROFESSIONAL TRAINING PROGRAM “INVASIVE MECHANICAL VENTILATION AND OTHER METHODS OF RESPIRATORY SUPPORT IN PATIENTS WITH NOVEL CORONAVIRUS INFECTION COVID-19"

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personnel protective equipments (PPEs). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽

10.3390/children8111035 ◽

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.

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The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

10.21203/rs.3.rs-722133/v1 ◽

2021 ◽

Author(s):

Allan Cameron ◽

Sharif Fattah ◽

Laura Knox ◽

Pauline Grose

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Royal Infirmary ◽

High Dependency ◽

Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

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Protocolized Post-Extubation Respiratory Support to prevent reintubation: protocol and statistical analysis plan for a clinical trial

BMJ Open ◽

10.1136/bmjopen-2019-030476 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030476 ◽

Cited By ~ 1

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.

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Experience of N-acetylcysteine airway management in the successful treatment of one case of critical condition with COVID-19

10.21203/rs.3.rs-34193/v1 ◽

2020 ◽

Author(s):

Yan Liu ◽

Guoshi Luo ◽

Xin Qian ◽

Chenglin Wu ◽

Yijun Tang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Airway Management ◽

Critical Condition ◽

Respiratory Support ◽

Artificial Airway ◽

Anastomotic Fistula ◽

Management Experience ◽

Novel Coronavirus ◽

Acid Test

Abstract Object: To report the successful diagnosis and treatment of a patient with critical condition of novel coronavirus pneumonia (COVID-19) and to summarize its clinical features and airway management experience in successful treatment.Methods: Retrospectively analyzed the successful management of one case of COVID-19 with critical condition combined respiratory failure and discussed the clinical characteristics and airway management of the patient in conjunction with a review of the latest literature.Results: A patient with an anastomotic fistula after radical treatment of esophageal cancer and right-side encapsulated pyopneumothorax was admitted with cough and dyspnea and was diagnosed with novel coronavirus pneumonia and malnutrition by pharyngeal swab nucleic acid test in combination with chest CT. The patient was treated with antibiotics, antiviral and antibacterial medications, respiratory support, expectorant nebulization, and nutritional support, expressed progressive deterioration. Endotracheal intubation and mechanical ventilation were performed since the onset of the type Ⅱ respiratory failure on the 13th day of admission. The patient had persistent refractory hypercapnia after mechanical ventilation. Based on the treatment mentioned above, combined with repeated bronchoalveolar lavage by using N-acetylcysteine (NAC) inhalation solution, the patient's refractory hypercapnia was gradually improved. It was cured and discharged after being given the mechanical ventilation for 26 days as well as 46 days of hospitalization, currently is surviving well.Conclusion: Patients with severe conditions of novel coronavirus pneumonia often encounter bacterial infection in their later illness-stages. They may suffer respiratory failure and refractory hypercapnia that is difficult to improve due to excessive mucus secretion leading to small airway obstruction. In addition to the use of reasonable antibiotics and symptomatic respiratory support and other treatment, timely artificial airway and repeated bronchoalveolar NAC inhalation solution lavage, expectorant and other airway management are essential for such patients.

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The Life of a Simulation Center in the Era of the Novel Coronavirus Infection Pandemic

Virtual Technologies in Medicine ◽

10.46594/2687-0037_2021_3_1326 ◽

2021 ◽

Vol 1 (3) ◽

pp. 128-129

Author(s):

S. V. Khodus ◽

V. S. Oleksik

Keyword(s):

Simulation Training ◽

The Novel ◽

Test Task ◽

Before And After ◽

Simulation Scenario ◽

Coronavirus Infection ◽

Novel Coronavirus ◽

Simulation Center

A study was carried out among 76 students who took part in the Olympiad contests in practical medical skills in an innovative distance format. The data obtained testify to the effectiveness of distance simulation training, the assessment of which was carried out by students answering test questions before and after passing the test task, as well as by assessing the students' actions during the remote passage of the simulation scenario by experts.

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The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support

Canadian Respiratory Journal ◽

10.1155/2020/3953280 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Seyhan Pala Cifci ◽

Yasemin Urcan Tapan ◽

Bengu Turemis Erkul ◽

Yusuf Savran ◽

Bilgin Comert

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Oxygen Therapy ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

High Flow Oxygen ◽

The Impact

Objective. Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. Materials and Methods. One hundred and eighty-seven patients who met inclusion criteria, treated in Dokuz Eylul University Medical Intensive Care Unit between January 1, 2016, and October 31, 2018, were examined retrospectively. These patients’ demographic data, oxygen saturation (SpO2) values for the first 24 hours, APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, whether they needed intubation, if they did how many days they got ventilated, length of stay in intensive care unit and hospital, maximum PaO2 values of the first day, oxygen treatment method of the first 24 hours, and the rates of mortality were recorded. Results. Hyperoxemia was determined in 62 of 187 patients who were not treated with invasive mechanic ventilation in the first 24 hours of admission. Upon further investigation of the relation between comorbid situations and hyperoxia, hyperoxia frequency in patients with COPD was detected to be statistically low (16% vs. 35%, p<0.008). Hospital mortality was significantly high (51.6% vs. 35.2%, p<0.04) in patients with hyperoxia. When the types of oxygen support therapies were investigated, hyperoxia frequency was found higher in patients treated with supplemental oxygen (nasal cannula, oronasal mask, high flow oxygen therapy) than patients treated with NIMV (44.2% vs. 25.5%, p<0.008). After exclusion of 56 patients who were intubated and treated with invasive mechanical ventilation after the first 24 hours, hyperoxemia was determined in 46 of 131 patients. Mortality in patients with hyperoxemia who were not treated with invasive mechanical ventilation during hospital stay was statistically higher when compared to normoxemic patients (41.3% vs 15.3%, p<0.001). Conclusion. We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.

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Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620919947 ◽

2020 ◽

pp. 204887262091994

Author(s):

Thomas Metkus ◽

P Elliott Miller ◽

Carlos L Alviar ◽

Jacob C Jentzer ◽

Sean van Diepen ◽

...

Keyword(s):

Myocardial Infarction ◽

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Invasive Ventilation ◽

St Segment Elevation ◽

Non Invasive ◽

Segment Elevation Myocardial Infarction ◽

Non Invasive Ventilation ◽

St Segment

Background The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized. Methods We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002–2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models. Results A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support ( p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74–1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88–3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time. Conclusion Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.

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Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽

10.1159/000515818 ◽

2021 ◽

pp. 1-9

Author(s):

Kirsten Glaser ◽

Clyde J. Wright

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Neonatal Lung ◽

The Individual

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

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Mechanical respiratory support for COVID-19: lessons from 2020

Translational Medicine ◽

10.18705/2311-4495-2021-8-1-19-37 ◽

2021 ◽

Vol 8 (1) ◽

pp. 19-37

Author(s):

V. A. Mazurok

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Intensive Therapy ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Low Flow ◽

Death Sentence ◽

Technical Equipment ◽

Unsuccessful Attempt ◽

Wide Range

Intensive therapy of out-of-hospital pneumonia in conditions of mass admission of patients during 2020 presented many lessons, including regarding the strategy of respiratory support, as it turned out that mechanical ventilation in passive patients with COVID-19 is almost equivalent to a death sentence. On the other hand, maintaining spontaneous breathing in dyspnea and hyperpnea conditions can cause specific self-inflicted lung injuryUnexpectedly, the good tolerability of hypoxemia by patients has led to the emergence of the terms “happy hypoxia” and “permissive hypoxemia,” reflecting the effective functioning of acute adaptation mechanisms: increasing heart productivity and oxygen utilization.A step-by-step strategy for respiratory therapy was formed: 1) oxygen therapy (low-flow, high-flow), 2) non-invasive respiratory support (NIV), 3) controlled lung ventilation. Among the most effective resources for mobilizing alveoli in patients with COVID-19 was the prone position.Compared to a tight mask, the helmet turned out to be the most effective method of conducting NIV. When using the helmet, bedsores on the face and the bridge of the nose do not develop, enteral nutrition is possible, subjective tolerability of NIV by patients is increased.Conversion to invasive mechanical ventilation is considered in case of energy inadmissibility of spontaneous breathing and development of central nervous system disorders. Breathing equipment with a wide range of ventilation modes and expert capabilities for respiratory monitoring is needed to carry out both mechanical ventilation and especially NIV.If pulmonary gas exchange is not possible, the only means of saving the patient remains extracorporeal membrane oxygenation — a method that requires huge energy costs from trained medical personnel and good technical equipment of the clinic.One of the most visible lessons presented by the pandemic of viral pneumonia is the unsuccessful attempt to speed up the training of “intensive care specialists” through on-line courses, webinars and even guide sheets.

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