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Objective:To compare the predictive ability of SpO 2/FiO 2(S/F) and ROX index on the failure of high-flow nasal cannula(HFNC)therapy in children with acute respiratory failure after congenital heart disease surgery, and to identify the best cut-off point. Methods:Through a case-control study, the clinical data of 371 children with acute respiratory failure after congenital heart surgery treated with HFNC admitted to Guangzhou Women and Children′s Medical Center from January 2018 to December 2021 were retrospectively analyzed.The primary outcome was the need for re-intubation within 48 h after extubation of invasive ventilation.The ability of S/F and ROX index to predict HFNC failure was compared, and the optimal cut-off point was determined based on the area under the curve (AUC) of receiver operating characteristic curve.Results:A total of 371 children were included, of whom 27 (7.3%) eventually required mechanical ventilation within 48 h. The S/F prediction accuracy was highest after 6 h of HFNC treatment(AUC=0.712, 95% CI 0.599-0.825, P=0.001), and the best cut-off point for S/F was 178 mmHg(1 mmHg=0.133 kPa)(sensitivity 74.9%, specificity 69.6%). Whereas the prediction accuracy of the ROX index was highest after 12 hours of HFNC treatment, the AUC was 0.737(95% CI 0.623-0.851, P=0.002), and the best cut-off point of the ROX index was 5.865(sensitivity 72.4% specificity 66.7%). The difference in AUC between S/F after 6 h of HFNC treatment and ROX after 12 h was not statistically significant ( P=0.444), with higher sensitivity and specificity, and earlier prediction time(6 hours) in the former. Conclusion:Children with acute respiratory failure after congenital heart surgery have a strong predictive ability of S/F after 6 h of HFNC treatment, and the risk of HFNC treatment failure is higher in children with S/F <178 mmHg.
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Objective:To analyze the risk factors which may lead to tracheostomy in patients receiving invasive mechanical ventilation (IMV) in emergency intensive care unit (EICU).Methods:A case-control study was adopted to retrospectively analyze the clinical data of patients hospitalized in EICU receiving IMV from August 2016 to August 2019. The clinical data of patients were extracted through the electronic medical record system of the hospital information database. Patients were divided into the tracheostomy group and successful extubation group according to whether they received tracheostomy during hospitalization. The different clinical characteristics of the two groups were compared, and logistic regression was used to analyze the independent risk factors of tracheostomy.Results:A total of 109 patients were included in this study, among which, 53 patients underwent tracheotomy and 56 patients were successfully extubated. Logistic regression showed that GCS score ≤ 8 ( OR=5.10, 95% CI: 1.68-15.42, P < 0.01), cervical spinal cord injury ( OR=10.32, 95% CI: 2.74-38.82, P < 0.01), and sepsis ( OR=3.45, 95% CI: 1.39-8.54, P<0.01) were independent risk factors of tracheostomy for patients receiving IMV in EICU. Conclusions:If patients receiving IMV have GCS score ≤ 8, cervical spinal cord injury, or sepsis, they should be given more attention, because they may need early tracheostomy to save lives and improve the prognosis.
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In an Intensive Care Unit, acute respiratory distress syndrome (ARDS) is a serious condition. Non-cardiogenic pulmonary oedema was the prior name for it. It is caused by a variety of illnesses that cause lung injury, but sepsis is the most common cause. It causes interstitial and alveolar oedema, diffuse alveolar damage, refractory hypoxemia, and ventilation perfusion mismatch by damaging the alveolar capillary membrane. Dyspnoea with diffuse in ltration on chest X-ray is a typical clinical symptom. Low tidal volume, high positive end expiratory pressure (PEEP), and low plateau pressure are all used to treat ARDS. Prone placement improves patient perfusion and thereby increases the PaO/FiO ratio. To treat ARDS, doctors are increasingly turning to high frequency oscillation ventilation (HFOV).
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Background:High flow nasal cannula is a newer modality of treatment for hypoxemic respiratory failure. Present study is conducted to evaluate demographic characteristics, co-morbidities and outcome parameters of patients on High flow nasal cannula. Material And Methods:In retrospective observational study all patients on High flow nasal canula with covid-19 were evaluated for demographic characteristics and outcome with comorbidities during study period.Result:Maximum number of patients belongs to age group 51-60 years. Highest mortality was in the age group of 61-70 years.Conclusion:The High flow nasal cannula therapy may provide important newer modality and helpful in patients with respiratory failure.
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Resumen El uso de terapia nasal de alto flujo (TNAFO) en pacientes con insuficiencia respiratoria aguda grave (IRAG) por neumonía COVID-19 (NCOVID-19) es debatido. Ante la falta de camas en Unidades de Cuidados Intensivos en el Sistema de Salud Pública de la Provincia del Neuquén, se implementó su uso en salas generales. Con el objetivo de describir la experiencia de uso de la TNAFO en pacientes con IRAG por NCOVID-19, se llevó a cabo este estudio retrospectivo multicéntrico. El resultado primario fue la frecuencia de destete exitoso de TNAFO y la mortalidad intrahospitalaria (MIH). Se analizaron 299 pacientes, de éstos, 120 (40.1%) fueron retirados con éxito de la TNAFO. Esta fracasó en 59.8% (179), 44.1% (132) requirió ventilación mecánica invasiva (VMI) y 15.7% (47) no eran candidatos a la intubación. Un índice ROX ≥ 5 a las 6 h después del inicio, se asoció con el éxito de la TNAFO (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). La MIH general fue del 48.5% (145/299), 70.4% (93/132) en aquellos con VMI, 4.2% (5/120) falleció post destete exitoso de la TNAFO y 100% (47/47) en el grupo no candidatos a la intubación. Los pacientes con TNAFO tuvieron una disminución estadísticamente significativa en la MIH y en días de internación. El uso de TNAFO en salas generales logró una reducción en la utilización de VMI, con una reducción de la mortalidad y días de estada en los internados por NCOVID-19 con IRAG.
Abstract The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquén, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed; 120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index ≥ 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.
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Objective:To evaluate the effect of high-flow nasal cannula (HFNC) therapy on patients with moderate acute respiratory failure.Methods:This was a randomized controlled trial. The patients with moderate acute respiratory failure in the Intensive Care Unit (ICU) of Changshu Hospital Affiliated to Soochow University from March 2019 to September 2020 were included. Patients with severe asthma or acute exacerbation of chronic respiratory failure, hemodynamic instability, disturbance of consciousness, non-invasive ventilation (NIV) contraindication, urgent need for endotracheal intubation, refusal of intubation, age <18 years and pregnancy were excluded. The patients were randomized to HFNC or NIV. Treatment failure was defined as the need for intubation and invasive ventilation. The vital signs, ROX index, blood gas analysis index, ultrasound parameters and endotracheal intubation rate were recorded at 1, 6, 12, 24 and 48 h after treatment. Kaplan-Meier method was used to draw the survival curve, and multivariate logistic regression was used to analyze the risk factors of treatment failure.Results:A total of 91 patients were included in the study, including 46 patients in the HFNC group and 45 patients in the NIV group. PaO 2/FiO 2 of the two groups were significantly increased after treatment compared with baseline ( P<0.05). The respiratory rate was lower in the NIV group than in the HFNC group at 1 and 24 h ( P<0.05). There were no significant differences in other vital signs, arterial blood gas and ultrasound parameters between the two groups (all P>0.05). The intubation rate was 52.2% in the HFNC group and 48.9% in the NIV group. Kaplan-Meier survival analysis showed that there was no significant difference in intubation rate and mortality between the two groups ( P>0.05). Multivariate logistic regression analysis showed that increased end-diastolic right ventricle/left ventricle ratio ( OR=1.044, 95% CI: 1.012~1.077) and high acute physiology and chronic health evaluationⅡ score ( OR=1.082, 95% CI: 1.006~1.163) at 0 h, lung ultrasound score ( OR=1.353, 95% CI: 1.034~1.772) and end-diastolic RV/LV ratio ( OR=1.097, 95% CI: 1.038~1.159) at 1 h were independent risk factors for non-invasive respiratory strategies failure. Increased diaphragm excursion ( OR=0.341, 95% CI: 0.165~0.704) at 0 h, high PaO 2/FiO 2 ( OR=0.929, 95% CI: 0.884~0.977), increased ROX index ( OR=0.524, 95% CI: 0.332~0.826), and increased diaphragm mobility ( OR=0.119, 95% CI: 0.030~0.476) at 1 h were independent protective factor for successful treatment. Conclusions:HFNC and NIV can improve oxygenation in patients with acute hypoxemic respiratory failure. There is no significant difference in intubation rate and mortality between HFNC and NIV. Ultrasound parameters may be helpful for predicting treatment failure.
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Objective:To compare the clinical characteristics and analyze the prognostic factors between human immunodeficiency virus (HIV)-infected patients and non-HIV-infected immunocompromised patients with pneumocystis pneumonia (PCP) complicated with acute respiratory failure (ARF) in intensive care unit (ICU).Methods:The clinical data of patients with PCP complicated with ARF admitted in ICU of The First Affiliated Hospital of Zhengzhou University and The Sixth People′s Hospital of Zhengzhou City between May 2018 and October 2020 were retrospectively reviewed. All subjects were divided into HIV-infected group and non-HIV-infected immunocompromised group. General characteristics and underlying diseases of patients in the two groups were analyzed. Laboratory parameters, treatment and outcomes between two groups were compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis, and univariate and multivariate logistic regression models were used to identify the risk factors for the clinical outcome. Results:A total of 129 PCP complicated with ARF patients were enrolled, including 75 HIV-infected patients and 54 non-HIV-infected immunocompromised patients. Only 10.7%(8/75) patients of HIV-infected group received anti-retroviral therapy (ART), but none of the patients in either groups had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. Acute physiology and chronic health evaluation (APACHE) Ⅱ score of HIV-infected group was 18.7±6.0, which was higher than that in non-HIV-infected immunocompromised group (13.1±4.4) when admitted in ICU ( t=-5.45, P<0.001). Hypoproteinemia was common in both groups. Ninety-six percent (72/75) of HIV-infected patients had CD4 + T lymphocyte counts lower than 200/μL and 84.0%(63/75) of patients had CD4 + T lymphocyte counts even lower than 50/μL, while 5.74%(31/54) of patients in non-HIV-infected immunocompromised group had CD4 + T lymphocyte counts lower than 200/μL. The CD4 + /CD8 + T lymphocyte counts ratio was 0.05(0.02, 0.12) in HIV-infected group, which was lower than that in non-HIV-infected immunocompromised group (0.96(0.64, 1.44)), and the difference was statistically significant ( Z=-9.16, P<0.001). The length of ICU stay and hospital stay of non-HIV-infected immunocompromised patients were 10.0(7.0, 14.0) days and 18.0(11.8, 32.5) days, respectively, which were both longer than those in HIV-infected patients (7.0(4.0, 9.0) days and 13.0(7.0, 23.0) days, respectively), and the differences were both statistically significant ( Z=-3.58 and -2.73, respectively, both P<0.050). The hospital mortality of HIV-infected patients was 57.3%(43/75), which was significantly higher than that in non-HIV-infected immunocompromised patients (38.9%, 21/54) ( χ2=4.27, P=0.039). Multivariable logistic regression identified that lactic dehydrogenase (LDH), C-reactive protein (CRP) and APACHE Ⅱ score were the risk factors for the clinical outcome of HIV-infected patients (odds ratio ( OR)= 1.006, 1.015 and 1.736, respectively, all P<0.050). The partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO 2/FiO 2), LDH and CD4 + T lymphocyte counts were the risk factors for the clinical outcome of non-HIV infected immunocompromised patients ( OR=0.970, 1.008 and 0.989, respectively, all P<0.050). Conclusions:PCP patients with ARF are critically ill with high mortality rate. LDH, CRP and APACHEⅡscore are predictors for prognosis of HIV-infected patients with PCP, while PaO 2/FiO 2, LDH and CD4 + T lymphocyte counts are predictors for prognosis of non-HIV infected immunocompromised patients with PCP.
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Objective:To analyze the effect of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute respiratory failure, and investigate the indicators that predict the failure of HFNC.Methods:The clinical data of 174 patients with acute respiratory failure were retrospectively analyzed. The patients were treated with HFNC in the Emergency Department of Hunan Provincial People′s Hospital from January 2018 to September 2020. The vital signs, blood gas analysis, Borg score and ROX index of patients before and one hour after HFNC application were compared, and the application effect of HFNC was judged. The HFNC failure group was defined as patients with respiratory support upgraded to non-invasive ventilation, endotracheal intubation or death within 48 h, and the indicators for predicting the HFNC failure were analyzed.Results:The failure rate of HFNC was 24.13%(42/174). There were significant differences in the heart rate, SpO 2, systolic blood pressure, diastolic blood pressure and PaO 2 of successfal group before and after the use of HFNC, t values were -8.12-4.60, all P<0.05. Multivariate Logistic regression analysis showed that the change value of systolic blood pressure was a protective factor of the failure of HFNC ( OR=0.967, 95% CI were 0.949-0.985, P<0.05). Conclusions:The application of HFNC in patients with acute respiratory failure is feasible and effective, and the change value of systolic blood pressure is an indicator to predict the failure of HFNC.
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Objective:To summarize the clinical experience of treating patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation (ECMO).Methods:In January 2021, an acute mass organic fluorine gas poisoning incident occurred in Quzhou, Zhejiang Province. The clinical data of 4 severe patients with acute poisoning of organic fluorine treated by ECMO in our hospital were retrospectively analyzed, and the epidemiological characteristics, clinical symptoms, signs, the abnormal laboratory studies/examinations, and treatments of this kind poisoning patients, especially, the treatment pattern, support time, complications, and outcomes of ECMO were collected and analyzed.Results:All the 4 patients were male, with an average age of (52±9) years, and all of them came to the emergency department complaining chest tightness, cough and pharyngeal discomfort 6 h after exposure by inhalation. The patient’s condition progressed rapidly with severe acute respiratory failure and circulatory failure as the prominent manifestations. The mechanical ventilations were performed (13.0±4.8) h after poisoning, and ECMO treatment was performed (15.5±5.3) h after poisoning. Among them, 2 patients were treated using venoarterial (VA) ECMO, and 2 patients using venovenous (VV) ECMO, but 1 patient was converted to VA-ECMO 8 h later. The duration of ECMO support for the patients was (8.8±3.6) d. The duration of mechanical ventilation was (23.0±28.7) d and stay in intensive care unit was (42.0±55.4) d. Among them, one patient was transferred to a specialized rehabilitation hospital after the amputation surgery due to lower limb necrosis after VA-ECMO support, and the remaining 3 patients were discharged after recovery.Conclusions:ECMO support might have the irreplaceable value in the treatment of patients with severe acute organic fluorine poisoning, and should be considered as one of the reserves of regional health care system in dealing with public health emergencies.
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Background:During this long COVID-19 pandemic outbreak, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are being widely used to treat of NIV in COVID-19 acute respiratory distress syndrome (ARDS) are lacking, and for this reason it is extremely important to accurately determine the outcomes of this strategy. This study aimed to evaluate clinical data and outcomes of NIV in patients with COVID-19 ARDS.Material And Methods:This is retrospective observation study conducted at government hospital during April 2020 to July 2020. The study was approved by local ethical committee.We analyzed patients with the laboratory confirmed case of COVID-19 infection admitted in intensive care unit who require positive pressure ventilation and perfusion which are not able to maintain on simple O2 masks/ nasal cannula /NRBM. Data related to clinical features and co-morbidities were recorded at admission and clinical laboratory data were recorded at start of NIV and respiratory parameter were recorded at the time of admission, start of NIV and at the time of weaning or shift to invasive ventilation.Result:Out of 119 patients 42 patients were successfully weaned off from non invasive ventilation while remaining were shifted to invasive mechanical ventilation. The patients who were shifted to invasive ventilation were all died. Low P/F ratio, high CRP, high D-dimer, high LDH and high ferritin levels were related to conversion to invasive ventilation and high mortality among the group.Conclusion:Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients. Indirectly, non-invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.
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Resumen: La insuficiencia respiratoria hipoxémica aguda (IRHA) es una de las principales causas de ingreso en la Unidad de Terapia Intensiva en los pacientes adultos, alrededor de 40% de estos pacientes ameritan intubación endotraqueal. La escala HACOR fue diseñada y validada como una puntuación de predicción clínica para el fracaso de la ventilación no invasiva (VNI) en pacientes con IRHA de diferentes etiologías. Objetivo: Analizar la capacidad predictiva de la escala HACOR en relación al fracaso de las puntas nasales de alto flujo (PNAF). Material y métodos: Se realizó un estudio retrospectivo, observacional en la Terapia Intensiva del Hospital Ángeles Mocel, las PNAF se iniciaron cuando el paciente presentaba IRHA, se calculó la escala HACOR a la hora y a las dos horas de colocación de PNAF, la capacidad de predecir el fracaso de las PNAF de la escala HACOR se determinó calculando el área bajo la curva de «característica operativa del receptor¼ (ROC). Resultados: La escala HACOR con mayor poder discriminatorio se obtuvo a las dos horas de inicio de las PNAF con un punto de corte de 5 puntos con un área bajo la curva (AUC): 0.82 (IC 95% 0.67-0.98), se obtuvo una sensibilidad 84% IC 95% (56.6-89.9%), especificidad 81% IC 95% (40.9-92.9%). Conclusiones: Un puntaje mayor o igual a 5 puntos en la escala HACOR predice fracaso de las PNAF y mayor mortalidad con una sensibilidad y especificidad mayor de 80% en los pacientes con neumonía por COVID-19.
Abstract: Acute hypoxemic respiratory failure (AHRF) is one of the main causes of admission to the intensive care unit in adult patients, around 40% of these patients require endotracheal intubation. The HACOR scale was designed and validated as a clinical prediction score for non-invasive ventilation (NIV) failure in patients with HAI of different etiologies. Objective: To analyze the predictive capacity of the HACOR scale in relation to the failure of the PNAF. Material and methods: A retrospective, observational study was carried out in the Intensive Care Unit at Hospital Ángeles Mocel, the PNAF was started when the patient had AHRF, the HACOR scale was calculated at one hour and 2 hours after the placement of the PNAF, the ability to predict HACOR scale PNAF failure was determined by calculating the area under the «receiver operating characteristic¼ (ROC) curve. Results: The HACOR scale with the highest discriminatory power was obtained 2 hours after the start of the PNAF with a cut-off point of 5 points with an area under the curve (AUC): 0.82 (CI 95% 0.67-0.98), it was obtained a sensitivity 84% CI 95% (56.6-89.9%), specificity 81% CI 95% (40.9-92.9%). Conclusions: A score greater than or equal to 5 points on the HACOR scale predicts failure of the PNAF and higher mortality with a sensitivity and specificity greater than 80% in patients with COVID-19 pneumonia.
Resumo: A insuficiência respiratória hipoxêmica aguda (IRHA) é uma das principais causas de admissão em unidade de Terapia Intensiva em Pacientes Adultos, cerca de 40% desses pacientes requerem intubação endotraqueal. A escala HACOR foi desenhada e validada como um escore de predição clínica para falha da ventilação não invasiva (VNI) em pacientes com IRHA de diferentes etiologias. Objetivo: Analisar a capacidade preditiva da escala HACOR em relação à falha das PNAF. Material e métodos: Foi realizado um estudo retrospectivo e observacional na Unidade de Terapia Intensiva do Hospital Ángeles Mocel, a PNAF foi iniciada quando o paciente tinha IRHA, a escala HACOR foi calculada uma hora e 2 horas após a colocação da PNAF, a capacidade de previsão do fracasso das PNAF da escala HACOR foi determinada pelo cálculo da área sob a curva «receiver operating characteristics¼ (ROC). Resultados: A escala HACOR com maior poder discriminatório foi obtida 2 horas após o início das PNAF com ponto de corte de 5 pontos com área sob a curva (AUC): 0.82 (IC 95% 0.67-0.98), foi obtida uma sensibilidade de 84% IC 95% (56.6%-89.9%), especificidade 81% IC 95% (40.9%-92.9%). Conclusões: Uma pontuação maior ou igual a 5 pontos na escala HACOR prediz falha das PNAF e maior mortalidade com sensibilidade e especificidade maior à 80% em pacientes com pneumonia COVID-19.
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Resumen: La traqueostomía percutánea es un procedimiento generalmente seguro, aunque no exento de complicaciones, se considera el procedimiento de elección en el paciente crítico con ventilación mecánica prolongada. Se presenta el caso de una mujer con síndrome de insuficiencia respiratoria aguda secundario a neumonía COVID-19 que requirió traqueostomía percutánea por ventilación prolongada. La paciente desarrolló complicaciones que requirieron intervención quirúrgica.
Abstract: Percutaneous tracheostomy is a generally safe procedure, although not without risk of complications, it is considered the procedure of choice in critically ill patients with prolonged mechanical ventilation. We present the case of a woman with acute respiratory failure syndrome secondary to COVID-19 pneumonia who required percutaneous tracheostomy due to prolonged ventilation. The patient developed significant complications that required surgical intervention.
Resumo: A traqueostomia percutânea é um procedimento geralmente seguro, sem ser isenta de complicações, é o procedimento de escolha em pacientes críticos com ventilação mecânica prolongada. Apresentamos o caso de uma mulher com síndrome de insuficiência respiratória aguda por pneumonia por COVID-19 que necessitou de traqueostomia percutânea devido à ventilação prolongada, evoluindo com complicações, resolvidas com intervenção cirúrgica. A adequação dos métodos guiados por ultrassom para evitar a emissão e exposição a aerossóis é analisada.
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Introducción: En la edad pediátrica hay factores predisponentes importantes que hacen a los niños ser más vulnerables a presentar insuficiencia respiratoria aguda (IRA). Objetivo: Demostrar los beneficios del uso de la cánula nasal de alto flujo (CNAF) en pacientes menores de 5 años con IRA secundaria a enfermedades respiratorias y admitidos a la unidad de cuidados intensivos pediátricos (UCIP). Sujetos y Métodos: Estudio analítico observacional de cohortes mixtas, donde una cohorte esta formada por un grupo expuesto a la CNAF evaluada de manera prospectiva, mientras se comparo con una cohorte histórica. Resultados: 138 pacientes fueron admitidos al estudio de los cuales 69 fueron casos manejados con CNAF y 69 fueron controles que no estuvieron expuestos al uso de la CNAF pero sí a otros modos de ventilación mecánica invasiva. Los días de oxigenoterapia fueron estadísticamente menores en el grupo de casos de 13 (DE 8.01) días a 22 (DE 20.7) días en el grupo control (P = <0.05). Al igual los días de UCIP y los días totales de hospitalización fueron menores en el grupo manejado con CNAF (P = 0.011 y P = 0.001, respectivamente), con una media de tiempo de 10 (DE 7.8) días en UCIP y 17 (DE 9.25) días intrahospitalarios para el grupo de casos versus 14 (DE 10.1) días en UCIP y 28 (DE 23.9) días intrahospitalarios para el grupo control. Conclusión: La CNAF es un método de soporte respiratorio no invasivo, efectivo y fácil de usar en la población pediátrica con IRA secundario a diversas patologías respiratorias.
Introduction: During pediatric ages there are important predisposing factors that make children more vulnerable to present acute respiratory failure (ARF). Objective: Determine the benefits of the use of high flow nasal cannula (HFNC) in patients younger than 5 years with ARF, secondary to respiratory diseases and admitted to the pediatric intensive care unit (PICU). Subjects and Method: Analytical observational study of mixed type cohorts, where a cohort is formed by the group exposed to HFNC and evaluated prospectively, while it was compared with a historical cohort. Results: 138 patients were admitted to the study of which 69 were cases handled with HFNC and 69 were controls who were not exposed to the use of HFNC but to other types of invasive mechanical ventilation. Oxygen therapy days were statistically shorter in the case group from 13 (SD 8.01) days to 22 (SD 20.7) days in the control group (P = <0.05). The length of stay in PICU and the total inpatient days were lower in the group managed with HFNC (P = 0.011, P = 0.001), with a mean time of 10 (SD 7.8) days in PICU and 17 (SD 9.25) inpatient days for the case group versus 14 (SD 10.1) days in PICU and 28 (SD 23.9) inpatient days for the control group. Conclusion: HFNC system is a non-invasive respiratory support method, simple, effective and easy to use in the pediatric population less than 5 years of age with ARF due to various respiratory diseases.
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Objective:To investigate the efficacy and safety of dexmedetomidine in noninvasive continuous positive airway pressure(NCPAP)for acute respiratory failure in children.Methods:Clinical data of children with acute respiratory failure who underwent NCPAP from January 2018 to March 2020 in PICU of Hunan Children′s Hospital were prospectively collected.They were randomly divided into dexmedetomidine group(group D)and midazolam group(group M), with a total of 100 children.We compared the sedation depth of the two groups at 7 time points after sedation at 0.5 h(t1), 1 h(t2), 2 h(t3), 6 h(t4), 12 h(t5), 24 h(t6), and 48 h(t7), time to reach proper sedation, NCPAP time, NCPAP failure rate, oxygenation index(P/F value)before sedation(T0)and 1h(T1), 24h(T2), and 48h(T3)after sedation, and the main vital signs and adverse reactions before sedation(T0)and 1h(T1), 24h(T2), 48h(T3)after sedation.Results:(1)The proportion of proper sedation at T4, T5, T6 and T7 after sedation in group D was higher than that in group M[98%(49/50)vs.84%(42/50), 94%(47/50)vs.90%(45/50), 96%(48/50)vs.88%(44/50), 90%(45/50)vs.88%(44/50), χ2=6.538, 8.043, 8.174, 7.678, all P<0.05]. Time to reach proper sedation in group D was shorter[(58.6±7.9)s vs.(66.7±9.3)s, t=4.682, P<0.01]. (2)The treatment time and failure rate of NCPAP in group D were lower than those in group M[(134.9±25.5)h vs.(147.8±24.3)h, 10%(5/50)vs.28%(14/50), all P<0.05]. P/F after NCPAP treatment in the two groups was improved as compared with that before treatment(all P<0.01), and the improvement was more significant in group D than in group M at T2 and T3 after sedation[(199.3±26.1)vs.(188.5±24.2)mmHg, (212.2±25.4)mmHg vs.(200.8±24.8)mmHg, t=2.132, 2.278, all P<0.05]. (3)There were no significant differences in heart rate(HR), mean arterial pressure(MAP), and respiratory rate(RR)before sedation between the two groups(all P>0.05). HR and RR after sedation in both groups decreased as compared with those before sedation( P<0.01). HR at T1, T2, and T3 after sedation in group D decreased more significantly than that in group M[(116.3±17.6)bpm vs.(124.8±14.1)bpm, (110.2±18.4)bpm vs.(121.9±15.2)bpm, (108.5±18.7)bpm vs.(117.6±12.8)bpm, t=0.479, -3.474, -2.840, all P<0.05]. There was no significant difference in RR after sedation between the two groups( t=1.872, 1.632, 1.675, all P>0.05). MAP at T1 in group D decreased as compared with T0( P<0.01). MAP at T1 in group D was lower than that in group M[(65.5±5.1)mmHg vs.(68.0±5.7)mmHg, t=-2.297, P=0.024]. (4)There was no significant difference in the incidence of total adverse reactions between the two groups[20%(10/50)vs.14%(7/50), P=0.595]. The incidence of bradycardia was higher in group D than in group M[16%(8/50)vs.2%(1/50), P=0.031]. Conclusion:The incidence of adverse reactions of dexmedetomidine and midazolam in the sedation of NCPAP in children with acute respiratory failure is similar, but the sedative effect of dexmedetomidine is better than that of midazolam in the improvement of pulmonary oxygenation.
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Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.
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Resumen La utilización de tratamientos de soporte respiratorio no invasivos en la pandemia por COVID-19, es motivo de controversias. El objetivo de este trabajo observacional, fue mostrar la experiencia del primer mes desde la creación de la Unidad de Soporte Ventilatorio no Invasivo (USoVNI) en el Hospital Fernández. Se describe la creación de la unidad, relación profesional de atención-paciente, tipo de habitación, equipo de protección personal modificado, equipamiento de diagnóstico, monitoreo y soporte ventilatorio para tratamiento, criterios de inclusión y algoritmo de tratamiento. Ingresaron 40 pacientes, 25 (63%) derivados de Clínica Médica, 10 (25%) de Emergentología y 5 (13%) de guardia externa. Al ingreso, se calcularon los escores National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II y Sequential Organ Failure Assessment, con medianas de 12, 8, y 2 puntos, respectivamente. El escore Lung Ultrasonography Score se tomó para cuantificar el compromiso pulmonar ecográficamente. Todos los pacientes ingresaron con máscara con reservorio, y fue estimada una fracción inspirada de O de 80% para el cálculo de la razón presión arterial de O / fracción inspirada de O (Pa/FiO ) de ingreso. El tiempo transcurrido desde el inicio de síntomas hasta el ingreso a la unidad tuvo una mediana de 13 días. El desarrollo de la USoVNI permitió que una gran proporción no fueran trasladados a la Unidad de Terapia Intensiva y podría ser beneficioso para preservar su capacidad. Nuestros resultados sugieren que estas unidades resultarían adecuadas para el tratamiento de la insuficiencia respiratoria aguda grave por COVID-19.
Abstract The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controversial. The aim of this observational study was to show the experience of the first month since the creation of a Non-invasive Ventilatory Support Unit (NIVSU) at Hospital Fernández. We describe the creation of the NIVSU, the health professional-patient ratio, the type of room, the modified personal protection equipment; diagnostic, monitoring and ventilatory support equipment for treatment, as well as the inclusion criteria and the treatment algorithm. Twenty five (63%) of patients were referred from the Internal Medicine Ward, 10 (25%)) from Shock Room, and 5 (13%) from Emergency Ward. National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II and Sequential Organ Failure Assessment, were calculated on admission, with a median of 12, 8, and 2 points, respectively. The Lung Ultrasonography Score was taken to quantify lung ultrasound findings. All patients were admitted with a reservoir mask, 80% inspired O fraction was estimated for the calculation of arterial O pressure/ inspired O fraction ratio (Pa/FiO ) at admission. The median of time elapsed from the onset of symptoms referred by the patient to UNIT admission was 13 days. The development of NIVSU prevented a large proportion of patients from being transferred to Intensive Care Unit (ICU) and it could be beneficial in preserving ICUs capacity. These early results suggest that non-invasive treatment may be beneficial for the treatment of severe acute respiratory failure by COVID-19.
Subject(s)
Humans , Severe Acute Respiratory Syndrome , COVID-19 , Pandemics , SARS-CoV-2 , Intensive Care UnitsABSTRACT
Introduction: Non-invasive ventilation is a new modality of respiratory support therapy in patients with acute chronic obstructive pulmonary disease. Objective: To describe the factors related to failure of non-invasive ventilation treatment in the population of patients with exacerbated chronic obstructive pulmonary disease. Methods: An observational, descriptive and cross-sectional study was carried out in the intensive care units of Saturnino Lora Hospital, between January, 2011 and January, 2019. Results: The presence of leaks, the start time of the treatment longer than 24 hours, the decrease in the average values of pH and Glasgow, the increase in respiratory and heart rates and PaCO2, are associated with failure of non-invasive ventilation. Conclusions: Alterations of typical clinical and hemogasometric variables of ventilation, structure the failure in this patients population.
Introducción: La ventilación no invasiva es una nueva modalidad de terapia de soporte respiratorio en los pacientes con enfermedad pulmonar obstructiva crónica agudizada. Objetivo: Describir los factores relacionados con el fracaso en la población de enfermos con enfermedad pulmonar obstructiva crónica agudizada, tratados con ventilación no invasiva. Métodos: Se realizó un estudio observacional, descriptivo y transversal en las unidades de atención al grave del Hospital Provincial "Saturnino Lora", entre enero de 2011 and enero de 2019. Resultados: La presencia de fugas, el tiempo de inicio del tratamiento mayor de 24 horas, la disminución de los valores promedios del pH y el Glasgow, el incremento de las frecuencias respiratoria y cardiaca y la PaCO2, se asocian con el fracaso de la ventilación no invasiva. Conclusiones: Alteraciones de variables propias de la ventilación, clínicas y hemogasométricas estructuran el fracaso en esta población de enfermos.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Noninvasive Ventilation , Respiratory InsufficiencyABSTRACT
RESUMEN Objetivo: El coronavirus ha emergido este año como causa de neumonía viral. Una de las principales características es su rápida transmisión y su potencial severidad. El objetivo de este estudio de serie de casos es describir las características clínicas de los pacientes con confirmación de enfermedad por coronavirus (COVID-19) admitidos en diferentes unidades de cuidados intensivos de la Argentina con requerimiento de ventilación mecánica. Métodos: Estudio de serie de casos, descriptivo-prospectivo, multicéntrico realizado entre el 01 de abril y el 08 de mayo de 2020. Se incluyeron los datos de los pacientes mayores a 18 años, que ingresaron a la unidad de cuidados intensivos con requerimiento de ventilación mecánica por falla respiratoria aguda con diagnóstico positivo de COVID-19 Resultados: Se registraron las variables de 47 pacientes de 31 unidades cuidados intensivos, 78.7% hombres de una mediana de edad de 61 años, con un SAPS II de 43, un índice de Charlson de 3. El modo ventilatorio inicial fue volume control - continuous mandatory ventilation con volumen corriente menor a 8mL/kg en el 100% de los casos, con una mediana de presión positiva al final de la espiración de 10,5cmH2O. A la fecha de cierre del estudio, 29 pacientes fallecieron, 8 alcanzaron el alta, y 10 pacientes continúan internados al cierre del estudio. El SAPS II fue mayor entre los fallecidos (p = 0.046). El índice de Charlson se asoció con mayor mortalidad (OR = 2,27 IC95% 1,13 - 4,55; p = 0,02). Conclusión: Los pacientes con COVID-19 y ventilación mecánica de esta serie presentan variables clínicas similares a las descriptas a la fecha en otros reportes internacionales. Nuestros hallazgos proporcionan datos que permitirían de alguna manera predecir los resultados.
Abstract Objective: A novel coronavirus emerged this year as a cause of viral pneumonia. The main characteristics of the virus are rapid transmission, high contagion capacity and potential severity. The objective of this case series study is to describe the clinical characteristics of patients with confirmed coronavirus disease (COVID-19) admitted to different intensive care units in Argentina for mechanical ventilation. Methods: A descriptive, prospective, multicenter case series study was conducted between April 1 and May 8, 2020. Data from patients older than 18 years who were admitted to the intensive care unit for mechanical ventilation for acute respiratory failure with a positive diagnosis of COVID-19 were included. Results: The variables for 47 patients from 31 intensive care units were recorded: 78.7% were men (median age of 61 years), with a SAPS II score of 43 and a Charlson index score of 3. The initial ventilatory mode was volume control - continuous mandatory ventilation with a tidal volume less than 8mL/kg in 100% of cases, with a median positive end-expiratory pressure of 10.5cmH2O. At the end of the study, 29 patients died, 8 were discharged, and 10 remained hospitalized. The SAPS II score was higher among patients who died (p = 0.046). Charlson comorbidity index was associated with higher mortality (OR = 2.27, 95% CI 1.13 - 4.55, p = 0.02). Conclusion: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/therapy , Coronavirus Infections/therapy , Intensive Care Units , Argentina , Pneumonia, Viral/physiopathology , Respiratory Insufficiency/virology , Tidal Volume , Positive-Pressure Respiration , Coronavirus Infections/physiopathology , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19ABSTRACT
Lung ultrasound has had a great development in the critical patient management in the last decade. It is a safe, non-invasive and radiation-free tool that allows examining the patient at the bedside without the need for transfer. The last characteristic is particularly beneficial in patients with hypoxemia, hemodynamic instability and with high-risk of nosocomial contamination, as currently occurs in the pandemic caused by the outbreak of the new coronavirus 2019 disease (COVID-19). Lung ultrasound can be used to assess lung aeration in the patient under mechanical ventilation, evaluating the response to different strategies, personalizing lung recruitment maneuvers, and guiding the weaning process. This review describes the basic principles of lung ultrasound to obtain the images and interpret them. Lung ultrasound provides anesthesiologists, intensivists and respiratory therapists a safe and reliable tool for the diagnosis and follow-up of the main pulmonary diseases in the critical ill patient.
El ultrasonido pulmonar ha tenido un gran desarrollo en el abordaje del paciente crítico en las últimas décadas. Constituye una herramienta segura, no invasiva y libre de radiación, que permite examinar al paciente sin necesidad de traslado. Esta última característica es particularmente beneficiosa en pacientes hipóxicos, inestables hemodinámicamente o con alto riesgo de contaminación nosocomial, como ocurre actualmente con la pandemia ocasionada por el brote de la enfermedad del nuevo coronavirus 2019 (COVID-19). El ultrasonido pulmonar puede ser usado, además, para evaluar y monitorizar la aireación pulmonar en el paciente en ventilación mecánica, personalizando maniobras de reclutamiento, testeando la respuesta a diferentes estrategias ventilatorias y monitorizando el proceso de weaning. Esta revisión describe los principios básicos del ultrasonido pulmonar para la obtención de imágenes y su interpretación. Proporcionando a médicos anestesiólogos, intensivistas y kinesiólogos respiratorios una herramienta segura y confiable para el diagnóstico y seguimiento de las principales patologías pulmonares en el paciente crítico.
Subject(s)
Humans , Ultrasonics/methods , Critical Care , Lung Diseases/diagnostic imaging , Respiration, Artificial , Critical Illness , COVID-19/diagnostic imaging , Monitoring, PhysiologicABSTRACT
Objective: To observe the application value of right heart contrast echocardiography in the cannulation of veno-venous extracorporeal membrane oxygenation (V-V ECMO). Methods: A total of 18 patients with acute respiratory failure caused by severe pneumonia who underwent V-V ECMO treatment were enrolled. The patients were intubated through right femoral vein and right internal jugular vein cannulation, and then were divided into contrast group (n=8) and control group (n=10) according to whether underwent right heart contrast echocardiography during intubation or not. Central venous pressure (CVP) and cardiac output (CO) of all patients were measured and recorded. After the operation of ECMO, patients in contrast group received cardiovascular routine ultrasound examination and right heart contrast echocardiography simultaneously to observe and adjust the position of the cannula tip in the inferior vena cava (IVC), while patients in control group received only cardiovascular routine ultrasound to observe the direction of blood flow at the valve of IVC and the position of cannula tip in IVC. The distance between cannula tip and diaphragm (DCTD) and the left femoral artery partial pressure were measured and recorded. The differences of DCTD, left femoral artery oxygen partial pressure, CVP and CO of 2 groups were compared between 2 groups. Results: DCTD (5.14[4.68,5.81]mm) and left femoral artery oxygen partial pressure in contrast group(90.05[85.06, 95.33]mmHg) were both higher than those in control group (3.31[2.96,3.69]mm, 78.61[71.82,81.04]mmHg, Z=-1.93, -2.20, both P0.05). Conclusion: Right heart contrast echocardiography can help to optimize the position of cannula tip in IVC during intubation of V-V ECMO and improve clinical therapeutic effect by reducing recirculation.