Evaluation of the relationship of Delta-CO2 with IVC-CI, IJV-CI, and CVP values in intubated critically ill patients with spontaneous breathing, and who were applied invasive mechanical ventilation in CPAP mode

2020 ◽  
Vol 27 (12) ◽  
pp. 3222
Author(s):  
Cem Kacar ◽  
Osman Uzundere ◽  
Mustafa Bicak ◽  
Deniz Kandemir ◽  
Sedat Kaya ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Spontaneous Breathing ◽  
Invasive Mechanical Ventilation ◽  
Relationship Of ◽  
The Relationship

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation

2016 ◽  
Vol 30 (5) ◽  
pp. 763-769 ◽  
Author(s):  
Kenshi Hayashida ◽  
Takeshi Umegaki ◽  
Hiroshi Ikai ◽  
Genki Murakami ◽  
Masaji Nishimura ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Drug Utilization ◽  
Critically Ill Patients ◽  
Sedative Drug ◽  
The Relationship

scholarly journals Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

Critical Care ◽  
2013 ◽  
Vol 17 (2) ◽  
pp. 223 ◽  
Author(s):  
Antonio M Esquinas Rodriguez ◽  
Peter J Papadakos ◽  
Michele Carron ◽  
Roberto Cosentini ◽  
Davide Chiumello
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive

scholarly journals Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Francesco Mojoli ◽  
Andrea Cortegiani ◽  
Elena Giovanna Bignami ◽  
Mariachiara Ippolito ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Working Group ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Italian Society ◽  
Expert Consensus ◽  
Consensus Statements

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

scholarly journals Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

2020 ◽  
pp. 175114371990010 ◽  
Author(s):  
Raymond Dominic Savio ◽  
Rajalakshmi Parasuraman ◽  
Daphnee Lovesly ◽  
Bhuvaneshwari Shankar ◽  
Lakshmi Ranganathan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Prone Position ◽  
Supine Position ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

Effects Of Mechanical In-Exsufflation On Mucus Clearance In Critically Ill Patients On Invasive Mechanical Ventilation

2020 ◽  
Author(s):  
Roberto Martinez-Alejos ◽  
Joan-Daniel Martí ◽  
Gianluigi Li Bassi ◽  
Daniel Gonzalez-Anton ◽  
Xabier Pilar-Diaz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Invasive Technique ◽  
Pulmonary Mechanics ◽  
Post Intervention ◽  
Mucus Clearance ◽  
Registration Number ◽  
Clinically Significant

Abstract Background: Mechanical insufflation-exsufflation (MI-E) is a non-invasive technique performed through the CoughAssist In-Exsufflator to simulate cough and remove mucus from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation (MV) are not fully elucidated. The purpose of this study was to compare the efficacy and safety of MI-E combined or not to manual chest physiotherapy (CPT) in these patients.Methods: This cross-over clinical study enrolled consecutive patients who were sedated, intubated and on MV > 48h with expected maintenance of these criteria > 24h. Over a 24-hour period, patients randomly performed two sessions of manual CPT with or without additional MI-E before tracheal suctioning. Following each procedure, volume of retrieved mucus (ml) was assessed to evaluate efficacy. We evaluated respiratory flows, pulmonary mechanics and hemodynamics before, during, and after treatment. In addition, safety of MI-E was also appraised.Results: 26 patients were included. In comparison to CPT, mucus volume retrieved was significantly higher during CPT+MI-E (0.42 [0; 1.39] ml vs 2.29 [1; 4.67] ml; p < 0.001). The respiratory system compliance immediately improved from pre and post Crs values in CPT+MI-E group (55.7 ml/cmH2O [38.3; 67.4] vs. 68.6ml/cmH2O [47.8;94.9]; p<0.001). Although, such increase was not significantly different between CPT and CPT+MI-E group (p=0.057). Heart rate significantly increased in both groups (p < 0.005) immediately after each intervention. Additionally, a significant impact on oxygenation was observed in the CPT+MI-E group when comparing the baseline values with the values one-hour post-intervention (p<0.05). Finally, several transitory hemodynamic variations occurred during both interventions, but these were non-significant and considered clinically irrelevant.Conclusion: In mechanically ventilated patients, MI-E increases the amount of secretions that can be retrieved post-CPT, without causing clinically significant adverse events.Clinical Trials Registration Number: NCT03316079 (24/11/2015; retrospectively registered)

scholarly journals Pharmacokinetic/Toxicodynamic Analysis of Colistin-Associated Acute Kidney Injury in Critically Ill Patients

2017 ◽  
Vol 61 (11) ◽  
Author(s):  
Alan Forrest ◽  
Samira M. Garonzik ◽  
Visanu Thamlikitkul ◽  
Evangelos J. Giamarellos-Bourboulis ◽  
David L. Paterson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Steady State ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Patient Factors ◽  
Potential Patient ◽  
Relationship Of ◽  
The Relationship

ABSTRACT Acute kidney injury (AKI) occurs in a substantial proportion of critically ill patients receiving intravenous colistin. In the pharmacokinetic/toxicodynamic analysis reported here, the relationship of the occurrence of AKI to exposure to colistin and a number of potential patient factors was explored in 153 critically ill patients, none of whom were receiving renal replacement therapy. Tree-based modeling revealed that the rates of AKI were substantially higher when the average steady-state plasma colistin concentration was greater than ∼2 mg/liter.

scholarly journals Obesity May Not Be Associated with 28-Day Mortality, Duration of Invasive Mechanical Ventilation and Length of Intensive Care Unit and Hospital Stay in Critically Ill Patients with Severe Acute Respiratory Syndrome Coronavirus-2: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 674
Author(s):  
Sjaak Pouwels ◽  
Dharmanand Ramnarain ◽  
Emily Aupers ◽  
Laura Rutjes-Weurding ◽  
Jos van Oers
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Significant Difference

Background and Objectives: The aim of this study was to investigate the association between obesity and 28-day mortality, duration of invasive mechanical ventilation and length of stay at the Intensive Care Unit (ICU) and hospital in patients admitted to the ICU for SARS-CoV-2 pneumonia. Materials and Methods: This was a retrospective observational cohort study in patients admitted to the ICU for SARS-CoV-2 pneumonia, in a single Dutch center. The association between obesity (body mass index > 30 kg/m2) and 28-day mortality, duration of invasive mechanical ventilation and length of ICU and hospital stay was investigated. Results: In 121 critically ill patients, pneumonia due to SARS-CoV-2 was confirmed by RT-PCR. Forty-eight patients had obesity (33.5%). The 28-day all-cause mortality was 28.1%. Patients with obesity had no significant difference in 28-day survival in Kaplan–Meier curves (log rank p 0.545) compared with patients without obesity. Obesity made no significant contribution in a multivariate Cox regression model for prediction of 28-day mortality (p = 0.124), but age and the Sequential Organ Failure Assessment (SOFA) score were significant independent factors (p < 0.001 and 0.002, respectively). No statistically significant correlation was observed between obesity and duration of invasive mechanical ventilation and length of ICU and hospital stay. Conclusion: One-third of the patients admitted to the ICU for SARS-CoV-2 pneumonia had obesity. The present study showed no relationship between obesity and 28-day mortality, duration of invasive mechanical ventilation, ICU and hospital length of stay. Further studies are needed to substantiate these findings.

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