scholarly journals Investigating the Effect of Expiratory Time Constant on Outcome in Intubated Patients with Acute Respiratory Failure Caused by COVID-19 in Critical Care Unit: A Research Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Fatemeh Eghtedari ◽  
Shahnaz Fooladi ◽  
Ali Mohammadian Erdi ◽  
Atefeh Shadman ◽  
Mahzad Yousefian
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Time Constant ◽  
Lung Compliance ◽  
Cross Sectional ◽  
Expiratory Time ◽  
Significant Difference ◽  
Lung Resistance ◽  
The Mean

Background: The coronavirus disease 2019 (COVID-19) has a high prevalence and mortality worldwide. Thousands of patients with acute respiratory failure caused by COVID-19 are daily hospitalized in intensive care units (ICUs) around the world. Many of these patients require full mechanical respiratory support and long-term ventilator use. Using different ventilators and calculating important variables can be helpful in meeting therapeutic needs of patients. Objectives: The aim of present study was to investigate the effect of expiratory time constant (RCEXP) on the course of treatment and duration of mechanical ventilation in patients with acute respiratory failure hospitalized in ICU. Methods: The present cross-sectional study was conducted on 60 patients with acute respiratory failure who were hospitalized in the ICU and underwent mechanical ventilation due to COVID-19 in the first six months of 2020. The variables of RCEXP, lung compliance and lung resistance in all patients were recorded daily and analyzed. Then, based on clinical outcome, the patients were divided into two groups: the patients with wean outcome (N = 40) and those with death outcome (N = 20). Results: The mean ± SD of lung compliance in patients who were separated from ventilator and patients with death outcome were 74.73 (18.58) mL/cm H2O and 36.92 (10.56) mL/cm H2O, respectively, which was statistically significant (P = 0.001). The mean ± SD of lung resistance in patients who were separated from ventilator and patients with death outcome were calculated at 9.25 (4.62) and 14 (6.5), respectively, which was statistically significant (P = 0.015). Also, there was a statistically significant difference between the two groups in terms of mean ± SD of RCEXP (0.67 (0.23) vs. 0.49 (0.19), P = 0.010). Conclusions: According to the results of this study, there was a significant difference between high resistance, low compliance, RCEXP, and weaning success of intubation in patients hospitalized in the ICU.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Goal-Directed Mechanical Ventilation: Are We Aiming at the Right Goals? A Proposal for an Alternative Approach Aiming at Optimal Lung Compliance, Guided by Esophageal Pressure in Acute Respiratory Failure

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Arie Soroksky ◽  
Antonio Esquinas
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Chest Wall ◽  
Respiratory System ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Plateau Pressure ◽  
Lung Compliance ◽  
Inspiratory Pressure

Patients with acute respiratory failure and decreased respiratory system compliance due to ARDS frequently present a formidable challenge. These patients are often subjected to high inspiratory pressure, and in severe cases in order to improve oxygenation and preserve life, we may need to resort to unconventional measures. The currently accepted ARDSNet guidelines are characterized by a generalized approach in which an algorithm for PEEP application and limited plateau pressure are applied to all mechanically ventilated patients. These guidelines do not make any distinction between patients, who may have different chest wall mechanics with diverse pathologies and different mechanical properties of their respiratory system. The ability of assessing pleural pressure by measuring esophageal pressure allows us to partition the respiratory system into its main components of lungs and chest wall. Thus, identifying the dominant factor affecting respiratory system may better direct and optimize mechanical ventilation. Instead of limiting inspiratory pressure by plateau pressure, PEEP and inspiratory pressure adjustment would be individualized specifically for each patient's lung compliance as indicated by transpulmonary pressure. The main goal of this approach is to specifically target transpulmonary pressure instead of plateau pressure, and therefore achieve the best lung compliance with the least transpulmonary pressure possible.

scholarly journals The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure

2020 ◽  
Vol 14 ◽  
pp. 117954842096624
Author(s):  
Hawa Edriss ◽  
Shengping Yang ◽  
Edna Juarez ◽  
Joshua Crane ◽  
Michelle Lear ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure ◽  
Peak Pressure ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Mechanical Ventilator ◽  
The Mean ◽  
Pressure Plateau

Background: Pressures measured during mechanical ventilation provide important information about the respiratory system mechanics and can help predict outcomes. Methods: The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic information, clinical information, management requirements, and outcomes, such as mortality, ICU length of stay, and hospital length of stay. Mechanical ventilation pressures were recorded on the second full day of hospitalization. Results: This study included 312 adult patients. The mean age is 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7. Some patients had pulmonary infections (46.2%), and some patients had extrapulmonary infections (34.9%). The overall mortality was 42.6%. In a multi-variable model that included age, gender, number of comorbidities, APACHE 2 score, and PaO2/FiO2 ratio, peak pressure, plateau pressure, driving pressure, and PEEP all predicted mortality when entered into the model separately. There was an increase in peak pressure, plateau pressure, and driving pressure across BMI categories ranging from underweight to obese. Conclusions: This study demonstrates that ventilator pressure measurements made early during the management of patients with acute respiratory failure requiring mechanical ventilation provide prognostic information regarding outcomes, including mortality. Patients with high mechanical ventilator pressures during the early course of their acute respiratory failure require more attention to identify reversible disease processes when possible. In addition, increased BMIs are associated with increased ventilator pressures, and this increases the complexity of the clinical evaluation in the management of obese patients.

scholarly journals NT-Pro-BNP levels during spontaneous breathing test and its association with successful weaning in patients undergoing mechanical ventilation in the Intensive Care Unit: Original Article

2020 ◽  
Vol 8 (1) ◽  
pp. 45-45
Author(s):  
Haleh Mikaeili ◽  
Katrin Bioukaghazadeh ◽  
Masoud Nazemiyeh ◽  
Somaieh Matin
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Venous Blood ◽  
Cross Sectional Study ◽  
Serum Marker ◽  
Cross Sectional ◽  
Significant Difference ◽  
Successful Weaning ◽  
The Mean ◽  
Rate Of Failure

Introduction: Weaning of the patient is one of the important medical challenges. One of the most important causes of failure in weaning is cardiovascular disorders. NT-Pro-BNP is a serum marker for cardiac dysfunction. This study conducted to evaluate the level of NT-Pro-BNP during the spontaneous breathing test (SBT) in patients undergoing mechanical ventilation in ICU and its association with successful weaning. Methods: In this cross-sectional study, we enrolled 42 intubated patients who were admitted to the ICU ward of Imam Reza Hospital and were clinically weaned. After obtaining informed consent, SBT was started for the patient. One and a half hours after SBT onset, a venous blood sample was obtained and the patients were followed for SBT test success and the results were recorded. Patients were extubated in stabilized condition or continued mechanical ventilation if needed. Then Data were analyzed. Results: SBT was successful in 45.2% of patients. 54.8% of patients were male. The most common cause of hospitalization was COPD (35.7%). The mean age of patients with successful SBT was 67.53±6.14 years and in patients with unsuccessful SBT was 68.70±5.44 years. There was a significant difference between NT-Pro-BNP levels half an hour after SBT between two groups of patients with successful (7.15±31.18) and unsuccessful (59.61±196.51) SBT. NT-ProBNP changes before and half an hour after SBT in both groups were statistically significant. Conclusion: NT-Pro-BNP is a predictor criteria of success in weaning in patients and as the level of NT-Pro-BNP increases, the rate of failure in weaning increases.

CLINICAL CHARACTERISTICS, LABORATORY TESTS AND TREATMENT OUTCOME IN PATIENTS WITH ACUTE RESPIRATORY FAILURE REQUIRING INVASIVE MECHANICAL VENTILATOR IN INTENSIVE CARE UNIT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2020 ◽  
pp. 99-105
Author(s):  
Ha Vo Viet ◽  
Quan Phan Van Minh
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Treatment Failure ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
Ventilator Associated Pneumonia ◽  
Invasive Ventilation ◽  
History Of ◽  
The Mean

Ojectives: 1. To describe the clinical and subclinical characteristics of patients with acute respiratory failure requiring invasive ventilation. 2. To evaluate the outcome of acute respiratory failure treatment with invasive ventilation and factors related to treatment failure. Materials and Method: 51 patients diagnosed with acute respiratory failure requiring invasive mechanical ventilation in ICU at Hue University of Medicine and Pharmacy Hospital. The prospective cohort study. Results: The mean age was 69.6 ± 16.4. Tachypnea and agitation were the most common sign (51%). The mean APACHE II score was 20.2 ± 3.3. The mortality rate was 33.3%. The variables associated with treatment failure were age ≥ 70 tuổi (RR = 2.7; p < 0.05), history of chronic kidney disease (RR = 2.9; p < 0.05), sepsis as a cause of mechanical ventilation (RR = 2.5; p < 0.05), ventilator-associated pneumonia (RR = 2.4; p < 0.05) and renal dysfunction during treatment (RR =2.4; p < 0.05). Conclusion: The clinical characteristics of ARF patients requiring IMV were various and the mortality rate remained high. Risk factors for treatment failure included age ≥ 70, history of chronic kidney disease, sepsis as a cause of mechanical ventilation, ventilator-associated pneumonia and renal dysfunction during treatment. Keywords: acute respiratory failure, invasive ventilation, invasive mechanical ventilation

Glucose Levels in Patients With Acute Respiratory Failure Requiring Mechanical Ventilation

2016 ◽  
Vol 32 (10) ◽  
pp. 578-584 ◽  
Author(s):  
Hawa Edriss ◽  
Kavitha Selvan ◽  
Mark Sigler ◽  
Kenneth Nugent
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Adverse Outcomes ◽  
Admission Diagnosis ◽  
Apache Ii Score ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Glucose Levels ◽  
The Mean

Background: Recent studies suggest that patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) frequently develop hyperglycemia, which has been linked to adverse outcomes. Methods: We retrospectively collected information about patient demographics, admission diagnosis, comorbidities, use of insulin, and glucose levels and related tests in 174 patients who required mechanical ventilation for acute respiratory failure. Results: These patients had a mean age of 57.8 ± 16.8 years, a mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 13.8 ± 6.1, and an overall mortality of 32.2%. The mean number of ventilator days was 7.5 ± 7.1. The mean highest glucose level was 239.3 ± 88.9 mg/dL in patients with COPD (n = 41) and 259.1 ± 131.7 mg/dL in patients without COPD (n =133). Patients with diabetes had higher glucose levels than patients without this diagnosis ( P < .05). Patients receiving corticosteroids did not have increased glucose levels ( P > .05). The mortality rate was higher in patients with glucose levels >140 mg/dL than in patients below 140 mg/dL (35.1% vs 10.5%, P < .05 unadjusted analysis). Conclusion: In this study, hyperglycemia occurred in 89% of the patients with acute respiratory failure requiring mechanical ventilation. The most important risk factor for this was a premorbid diagnosis of diabetes.

scholarly journals Gender-wise Comparative Assessment of Lifestyle Patterns and Well-being Status among Healthcare Employees at a Tertiary Care Hospital

2021 ◽  
Author(s):  
Vanajakshamma Velam ◽  
Vyshnavi Kancherla ◽  
Latheef Kasala ◽  
Anusha Kancherla ◽  
Mounica Reddy Pillaram
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Well Being ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference ◽  
Female Employees ◽  
The Mean ◽  
Lifestyle Patterns ◽  
Comprehensive Study

Abstract Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital. Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions. Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health. Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.

scholarly journals Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoling Zhang ◽  
Jingjing Zhang ◽  
Jiamei Li ◽  
Ya Gao ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Venous Blood ◽  
Sensitivity Analyses ◽  
Icu Mortality ◽  
Logistic Regression Models ◽  
The Mean ◽  
The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

scholarly journals Emotional Bonding and Sexual Activity During COVID-19 Lockdown: A Cross-National Pilot Study

2021 ◽  
pp. 263183182110274
Author(s):  
Deblina Roy ◽  
Sujita Kumar Kar ◽  
SM Yasir Arafat ◽  
Pawan Sharma ◽  
Russell Kabir
Keyword(s):  
Online Survey ◽  
Sampling Technique ◽  
Sexual Relationships ◽  
Sexually Active ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Emotional Bonding ◽  
Significant Difference ◽  
The Mean ◽  
Study Participants

Background: The COVID-19 pandemic and lockdown measures have affected the sexuality and emotional bonding among the couple across the world. Objectives: We aimed to assess the effects of the COVID-19 pandemic and lockdown on the married people’s emotional bonding and sexual relationships in 3 south Asian counties (Bangladesh, India, and Nepal). Methods: A cross-sectional online survey was conducted among Bangladesh, India, and Nepal residents from April 3 to April 15, 2020. The survey was designed in English. The participants were selected through convenience sampling technique, the link of the online questionnaire was shared with the participants. Only participants older than 18 years and above, married, and living with their spouses were included in the study. Results: A total number of 120 respondents were included finally for analysis from the participating countries (India, Nepal, and Bangladesh). The mean age of the participants was 35.42 (±5.73) years; the majority were males under the age of 40 years and had completed postgraduation as their qualification. Among the study participants, more than half (53.8%) of the women reported being sexually active during the lockdown, whereas 41% of the men reported being sexually active. Among the sexually active participants, most women (57.7%) reported that they perceived positive emotional bonding with their partners. Nevertheless, there was no significant difference observed when compared with men. There are variations in responses. However, no significant association was identified. Conclusion: There are a few insights from the study, that is, there was no significant difference found in almost 3 countries in emotional intimacy. There had been a trend that there is improved emotional bonding with their partners, although no significant difference was observed.

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

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