Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review

Abstract Background Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia. Methods This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue—shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support. Results Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24–49%] vs. 63% [44–68%], p < 0.001); and a larger extent of gas:blood volume mismatch (43% [30–49%] vs. 25% [14–28%], p = 0.001), due to higher shunt (23% [15–32%] vs. 5% [2–16%], p = 0.001) and non-aerated/non perfused regions (5% [3–10%] vs. 1% [0–2%], p = 0.001). The PaO2/FiO2 ratio correlated positively with normally aerated tissue (ρ = 0.730, p < 0.001) and negatively with the extent of gas-blood volume mismatch (ρ = − 0.633, p < 0.001). Conclusions In critically ill patients with severe COVID-19 pneumonia, the need for invasive mechanical ventilation and oxygenation impairment were associated with loss of aeration and the extent of gas:blood volume mismatch. Graphic abstract

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Continued intercostal Branches Block in MidAxillary Line (BRILMA) as pain control technique for unilateral and severe thoracic trauma patients with non-Invasive mechanical ventilation

10.26226/morressier.58f5b033d462b80296c9dec1 ◽

2017 ◽

Author(s):

Nerea García González

Keyword(s):

Mechanical Ventilation ◽

Pain Control ◽

Thoracic Trauma ◽

Invasive Mechanical Ventilation ◽

Control Technique ◽

Trauma Patients ◽

Non Invasive ◽

Midaxillary Line

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Failure of High-Flow Nasal Cannula and Non-invasive Ventilation Can Be Associated with Increased Risk of Mortality and Morbidity in Critically Ill Children

10.21203/rs.2.13540/v1 ◽

2019 ◽

Author(s):

Fatih AYGUN ◽

CANSU DURAK ◽

Fatih VAROL ◽

Alper KACAR ◽

Emre AYGUN ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Critically Ill ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Critically Ill Children ◽

High Flow Nasal Cannula ◽

Mortality And Morbidity ◽

Non Invasive ◽

Risk Of Mortality

Abstract Background: This retrospective study aimed to describe the efficacy, complications, and outcome of non-invasive mechanical ventilation (NIV) in critically ill children. Non-invasive mechanical ventilation (NIV) has achieved a significant breakthrough success in treating acute respiratory failure. NIV failure drastically increases the risk of mortality and morbidity. Many factors have been associated with the success of NIV. Methods. We performed a multicenter retrospective study using the demographic, prognostic, and laboratory findings of children (<18 years old) who were admitted in two pediatric intensive care units (PICUs). We compared clinical and laboratory variables in both successful and failed NIV groups. Results. Between January 2014 and April 2019, 1101 children were admitted to two PICU wards, of which, 403 were eligible for this study. In total, 138 (34.2%) patients received high-flow nasal cannula (HFNC), 138 (34.2%) patients received NIV-pressure control and 127 (31.6%) received NIV-pressure support (PSV). Patient mortality was 3.2% (13 patients) and the success rate of our study was 83.4%. Majority of our patients were provided NIV on admission (62.8%). Patients with successful NIV required fewer inotropic drugs, had shorter PICU stay duration, and a lower mortality rate during the follow up. The failure group presented a greater frequency of NIV-PSV and NIV-PCV use, along with higher NIV-associated complications. Logistic regression analysis revealed that NIV and HFNC failure increased PICU mortality by 19 times. Conclusions. HFNC and NIV are support modalities for respiratory distress in the PICU and were associated with a significant decrease in the PICU intubation rate.

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Clinical characteristics of critically ill patients with COVID-19

10.1101/2020.12.09.20246413 ◽

2020 ◽

Author(s):

Indalecio Carboni Bisso ◽

Iván Huespe ◽

Carolina Lockhart ◽

Agustín Massó ◽

Julieta González Anaya ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

High Complexity ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Imaging Results ◽

Critical Patients ◽

Ventilatory Mechanics

ABSTRACTObjectiveDescribe the clinical and respiratory characteristics of critical patients with coronavirus disease 2019 (COVID-19).DesignObservational and retrospective study over 6 months.SettingIntensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina.PatientsPatients older than 18 years with laboratory-confirmed COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study.Variables of interestDemographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded.ResultsA total of 168 critically ill patients with COVID-19 were included. 66% were men with a median age of 65 years (58-75. 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4% of the patients. 67.9 % required invasive mechanical ventilation (MV), and no patient was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. 36% of patients were ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and the mortality in the ICU was 25%.ConclusionsIn this study of critical patients infected by SARS-CoV-2 in a high-complexity hospital, the majority were comorbid elderly men, a large percentage required invasive mechanical ventilation, and ICU mortality was 25%.

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