Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 657
Filter
2.
Respir Care ; 68(6): 713-720, 2023 06.
Article in English | MEDLINE | ID: covidwho-20237263

ABSTRACT

INTRODUCTION: Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure. METHODS: We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session. RESULTS: Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m2 in PP, 2.5 ± 0.6 L/min/m2 before PP (SP1), and 2.6 ± 0.5 L/min/m2 after PP (SP2, P < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 (P < .001). There was no significant difference in PaO2 /FIO2 and breathing frequency. CONCLUSION: CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Adult , Humans , COVID-19/complications , COVID-19/therapy , Prone Position , Prospective Studies , Wakefulness , Hemodynamics , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
3.
Respiration ; 102(6): 426-438, 2023.
Article in English | MEDLINE | ID: covidwho-20235512

ABSTRACT

BACKGROUND: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. METHODS: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). RESULTS: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54-72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). CONCLUSIONS: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Venous Thromboembolism , Male , Adult , Humans , Middle Aged , Aged , Female , SARS-CoV-2 , Anticoagulants , Critical Illness , Heparin/adverse effects , Intensive Care Units , Oxygen , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/therapy , Respiratory Insufficiency/chemically induced
4.
BMJ Case Rep ; 16(5)2023 May 25.
Article in English | MEDLINE | ID: covidwho-20240668

ABSTRACT

A man in his mid-30s presented to the emergency department with a 1-week history of fatigue, loss of appetite, fever and productive (yellow) cough. This progressed to requiring admission to intensive care needing a oxygen therapy via high-flow nasal cannula for acute hypoxaemic respiratory failure. He had recently started vortioxetine for major depressive disorder, and his acute symptoms correlated with an increase in the dose of vortioxetine. For more than 20 years, rare but consistent reports of serotonergic medications have been implicated in eosinophilic pulmonary conditions. During this same period, serotonergic medications have become a mainstay solution for a wide range of depressive symptoms and disorders. This is the first report of an eosinophilic pneumonia-like syndrome occurring while consuming the novel serotonergic medication vortioxetine.


Subject(s)
Depressive Disorder, Major , Pulmonary Eosinophilia , Respiratory Insufficiency , Male , Humans , Vortioxetine/adverse effects , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/diagnosis , Pulmonary Eosinophilia/chemically induced , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/drug therapy , Syndrome , Respiratory Insufficiency/chemically induced , Respiratory Insufficiency/therapy
5.
West J Emerg Med ; 24(3): 511-521, 2023 Apr 28.
Article in English | MEDLINE | ID: covidwho-2325938

ABSTRACT

INTRODUCTION: High-flow nasal cannula (HFNC) is a respiratory support measure for coronavirus 2019 (COVID-19) patients that has been increasingly used in the emergency department (ED). Although the respiratory rate oxygenation (ROX) index can predict HFNC success, its utility in emergency COVID-19 patients has not been well-established. Also, no studies have compared it to its simpler component, the oxygen saturation to fraction of inspired oxygen (SpO2/FiO2 [SF]) ratio, or its modified version incorporating heart rate. Therefore, we aimed to compare the utility of the SF ratio, the ROX index (SF ratio/respiratory rate), and the modified ROX index (ROX index/heart rate) in predicting HFNC success in emergency COVID-19 patients. METHODS: We conducted this multicenter retrospective study at five EDs in Thailand between January-December 2021. Adult patients with COVID-19 treated with HFNC in the ED were included. The three study parameters were recorded at 0 and 2 hours. The primary outcome was HFNC success, defined as no requirement of mechanical ventilation at HFNC termination. RESULTS: A total of 173 patients were recruited; 55 (31.8%) had successful treatment. The two-hour SF ratio yielded the highest discrimination capacity (AUROC 0.651, 95% CI 0.558-0.744), followed by two-hour ROX and modified ROX indices (AUROC 0.612 and 0.606, respectively). The two-hour SF ratio also had the best calibration and overall model performance. At its optimal cut-point of 128.19, it gave a balanced sensitivity (65.3%) and specificity (61.8%). The two-hour SF≥128.19 was also significantly and independently associated with HFNC failure (adjusted odds ratio 0.29, 95% CI 0.13-0.65; P=0.003). CONCLUSION: The SF ratio predicted HFNC success better than the ROX and modified ROX indices in ED patients with COVID-19. With its simplicity and efficiency, it may be the appropriate tool to guide management and ED disposition for COVID-19 patients receiving HFNC in the ED.


Subject(s)
COVID-19 , Respiratory Insufficiency , Adult , Humans , Oxygen , Cannula , Oxygen Saturation , Retrospective Studies , Respiratory Rate , COVID-19/therapy , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy
7.
JAMA Netw Open ; 6(5): e2314678, 2023 05 01.
Article in English | MEDLINE | ID: covidwho-2322210

ABSTRACT

Importance: Existing reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, with variable outcomes noted for the maternal-fetal dyad. Objective: To examine maternal and perinatal outcomes associated with ECMO used for COVID-19 with respiratory failure during pregnancy. Design, Setting, and Participants: This retrospective multicenter cohort study examined pregnant and postpartum patients who required ECMO for COVID-19 respiratory failure at 25 hospitals across the US. Eligible patients included individuals who received care at one of the study sites, were diagnosed with SARS-CoV-2 infection during pregnancy or up to 6 weeks post partum by positive nucleic acid or antigen test, and for whom ECMO was initiated for respiratory failure from March 1, 2020, to October 1, 2022. Exposures: ECMO in the setting of COVID-19 respiratory failure. Main outcome and measures: The primary outcome was maternal mortality. Secondary outcomes included serious maternal morbidity, obstetrical outcomes, and neonatal outcomes. Outcomes were compared by timing of infection during pregnancy or post partum, timing of ECMO initiation during pregnancy or post partum, and periods of circulation of SARS-CoV-2 variants. Results: From March 1, 2020, to October 1, 2022, 100 pregnant or postpartum individuals were started on ECMO (29 [29.0%] Hispanic, 25 [25.0%] non-Hispanic Black, 34 [34.0%] non-Hispanic White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) during pregnancy, 21 (21.0%) within 24 hours post partum, and 32 (32.0%) between 24 hours and 6 weeks post partum; 79 (79.0%) had obesity, 61 (61.0%) had public or no insurance, and 67 (67.0%) did not have an immunocompromising condition. The median (IQR) ECMO run was 20 (9-49) days. There were 16 maternal deaths (16.0%; 95% CI, 8.2%-23.8%) in the study cohort, and 76 patients (76.0%; 95% CI, 58.9%-93.1%) had 1 or more serious maternal morbidity events. The largest serious maternal morbidity was venous thromboembolism and occurred in 39 patients (39.0%), which was similar across ECMO timing (40.4% pregnant [19 of 47] vs 38.1% [8 of 21] immediately postpartum vs 37.5% postpartum [12 of 32]; P > .99). Conclusions and Relevance: In this multicenter US cohort study of pregnant and postpartum patients who required ECMO for COVID-19-associated respiratory failure, most survived but experienced a high frequency of serious maternal morbidity.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Pregnancy Complications, Infectious , Respiratory Insufficiency , Pregnancy , Female , Infant, Newborn , Humans , Adult , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Cohort Studies , Postpartum Period , Respiratory Insufficiency/therapy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy
8.
Br J Nurs ; 32(9): 412-419, 2023 May 11.
Article in English | MEDLINE | ID: covidwho-2317367

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes (COVID-19) has proven to be the greatest challenge to modern global health care, infecting more than 450 million people worldwide and responsible for just over 6 million deaths. Over the past 2 years there have been major advances in the treatment of COVID-19, including a significant reduction in the number of individuals developing severe symptoms, since the introduction of COVID-19 vaccines and the advances in pharmacological treatments. However, for those individuals who become infected with COVID-19 and develop acute respiratory failure, the use of continuous positive airway pressure (CPAP) continues to be an essential management strategy that reduces mortality risk and the need for invasive mechanical ventilation. Without any standard regional or national guidelines on CPAP initiation and up-titration during the pandemic, a protocol proforma was devised for use in the author's clinical area. This was particularly useful for staff caring for seriously ill COVID-19 patients who were unfamiliar with providing CPAP. It is hoped that this article will contribute to the knowledge base of nurses and may encourage them to create a similar proforma for use in their clinical area.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , SARS-CoV-2 , Continuous Positive Airway Pressure , COVID-19 Vaccines , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Patient Care
10.
Int J Infect Dis ; 133: 60-66, 2023 Aug.
Article in English | MEDLINE | ID: covidwho-2315485

ABSTRACT

OBJECTIVES: We compared the risk of environmental contamination among patients with COVID-19 who received high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and conventional oxygen therapy (COT) via nasal cannula for respiratory failure. METHODS: Air was sampled from the hospital isolation rooms with 12 air changes/hr where 26 patients with COVID-19 received HFNC (up to 60 l/min, n = 6), NIV (n = 6), or COT (up to 5 l/min of oxygen, n = 14). Surface samples were collected from 16 patients during air sampling. RESULTS: Viral RNA was detected at comparable frequency in air samples collected from patients receiving HFNC (3/54, 5.6%), NIV (1/54, 1.9%), and COT (4/117, 3.4%) (P = 0.579). Similarly, the risk of surface contamination was comparable among patients receiving HFNC (3/46, 6.5%), NIV (14/72, 19.4%), and COT (8/59, 13.6%) (P = 0.143). An increment in the cyclic thresholds of the upper respiratory specimen prior to air sampling was associated with a reduced SARS-CoV-2 detection risk in air (odds ratio 0.83 [95% confidence interval 0.69-0.96], P = 0.027) by univariate logistic regression. CONCLUSION: No increased risk of environmental contamination in the isolation rooms was observed in the use of HFNC and NIV vs COT among patients with COVID-19 with respiratory failure. Higher viral load in the respiratory samples was associated with positive air samples.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , COVID-19/complications , SARS-CoV-2 , Oxygen , Oxygen Inhalation Therapy/adverse effects , Respiratory Insufficiency/therapy , Respiratory Insufficiency/etiology
11.
Eur Respir Rev ; 32(168)2023 Jun 30.
Article in English | MEDLINE | ID: covidwho-2317148

ABSTRACT

Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Humans , Wakefulness , Prone Position/physiology , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Lung , Patient Positioning/methods
12.
J Bronchology Interv Pulmonol ; 29(2): 125-130, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-2307958

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to hypoxemic respiratory failure resulting in prolonged mechanical ventilation. Typically, tracheostomy is considered in patients who remain ventilator dependent beyond 2 weeks. However, in the setting of this novel respiratory virus, the safety and benefits of tracheostomy are not well-defined. Our aim is to describe our experience with percutaneous tracheostomy in patients with COVID-19. MATERIALS AND METHODS: This is a single center retrospective descriptive study. We reviewed comorbidities and outcomes in patients with respiratory failure due to COVID-19 who underwent percutaneous tracheostomy at our institution from April 2020 to September 2020. In addition, we provide details of our attempt to minimize aerosolization by using a modified protocol with brief periods of planned apnea. RESULTS: A total of 24 patients underwent percutaneous tracheostomy during the study. The average body mass index was 33.0±10.0. At 30 days posttracheostomy 17 (71%) patients still had the tracheostomy tube and 14 (58%) remained ventilator dependent. There were 3 (13%) who died within 30 days. At the time of data analysis in November 2020, 9 (38%) patients had died and 7 (29%) had been decannulated. None of the providers who participated in the procedure experienced signs or symptoms of COVID-19 infection. CONCLUSION: Percutaneous tracheostomy in prolonged respiratory failure due to COVID-19 appears to be safe to perform at the bedside for both the patient and health care providers in the appropriate clinical context. Morbid obesity did not limit the ability to perform percutaneous tracheostomy in COVID-19 patients.


Subject(s)
COVID-19 , Respiratory Insufficiency , COVID-19/complications , Humans , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2 , Tracheostomy/adverse effects , Tracheostomy/methods
13.
Crit Care ; 27(1): 92, 2023 03 21.
Article in English | MEDLINE | ID: covidwho-2290512

ABSTRACT

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at  https://www.biomedcentral.com/collections/annualupdate2023 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from  https://link.springer.com/bookseries/8901 .


Subject(s)
Noninvasive Ventilation , Respiratory Distress Syndrome , Respiratory Insufficiency , Humans , Intensive Care Units , Respiration, Artificial , Respiratory Insufficiency/therapy , Oximetry
15.
Pediatr Ann ; 52(4): e146-e152, 2023 Apr.
Article in English | MEDLINE | ID: covidwho-2302218

ABSTRACT

This article reviews the current trends and management of respiratory emergencies in children. Respiratory emergencies are a common report in pediatrics and often require prompt recognition and intervention. It is important to differentiate upper from lower respiratory disease processes because the management is often different. With the advent of many vaccinations, the concern for certain diseases has changed with variations in the prevalence of other organisms. This article discusses detection and management of many respiratory emergencies. [Pediatr Ann. 2023;52(4):e146-e152.].


Subject(s)
Emergencies , Respiratory Insufficiency , Child , Humans , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy
16.
BMC Pulm Med ; 23(1): 145, 2023 Apr 26.
Article in English | MEDLINE | ID: covidwho-2302135

ABSTRACT

BACKGROUND: We aimed to investigate the effects of awake prone positioning (APP) in nonintubated adult patients with acute hypoxemic respiratory failure due to COVID-19. METHODS: The PubMed, Embase, Web of Science and Cochrane Central Register databases were searched up to June 1, 2022. All randomized trials investigating the effects of APP were included in the present meta-analysis. The primary outcome was intubation rate, and the secondary outcomes included the length of intensive care unit (ICU) stay, hospital stay, and mortality. Prescribed subgroup analysis was also conducted. RESULTS: A total of 10 randomized trials enrolling 2324 patients were ultimately included in the present study. The results indicated that APP was associated with a significant reduction in the intubation rate (OR 0.77, 95% CI 0.63 to 0.93, P = 0.007). However, no differences could be observed in the length of ICU stay or hospitalization or mortality. Subgroup analysis suggested that patients in the ICU settings (OR 0.74, 95% CI 0.60 to 0.91, P = 0.004), patients whose median APP time was more than 4 h (OR 0.77, 95% CI 0.63 to 0.93, P = 0.008), and patients with an average baseline SpO2 to FiO2 ratio less than 200 (OR 0.75, 95% CI 0.61 to 0.92) were more likely to benefit from APP, indicated a significantly reduced intubation rate. CONCLUSION: Based on the current evidence, nonintubated adult patients with hypoxemic respiratory failure due to COVID-19 infection who underwent APP were shown to have a significantly reduced intubation rate. However, no differences in ICU or hospital length of stay or mortality could be observed between APP and usual care. REGISTRATION NUMBER: CRD42022337846.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Adult , Humans , COVID-19/complications , COVID-19/therapy , Prone Position , Wakefulness , Randomized Controlled Trials as Topic , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy
17.
Transplantation ; 107(6): 1278-1285, 2023 06 01.
Article in English | MEDLINE | ID: covidwho-2300686

ABSTRACT

In patients with severe acute respiratory distress syndrome caused by coronavirus 2019 (COVID-19), mortality remains high despite optimal medical management. Extracorporeal membrane oxygenation (ECMO) has been widely used to support such patients. ECMO is not a perfect solution; however, there are several limitations and serious complications associated with ECMO use. Moreover, the overall short-term mortality rate of patients with COVID-19 supported by ECMO is high (~30%). Some patients who survive severe acute respiratory distress syndrome have chronic lung failure requiring oxygen supplementation, long-term mechanical ventilation, or ECMO support. Although lung transplant remains the most effective treatment for patients with end-stage lung failure from COVID-19, optimal patient selection and transplant timing for patients with COVID-19-related lung failure are not clear. Access to an artificial lung (AL) that can be used for long-term support as a bridge to transplant, bridge to recovery, or even destination therapy will become increasingly important. In this review, we discuss why the COVID-19 pandemic may drive progress in AL technology, challenges to AL implementation, and how some of these challenges might be overcome.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Humans , Pandemics , Respiratory Insufficiency/therapy , Respiratory Distress Syndrome/therapy , Lung
18.
PeerJ ; 11: e15174, 2023.
Article in English | MEDLINE | ID: covidwho-2304300

ABSTRACT

Background: In the treatment of acute hypoxemic respiratory failure (AHRF) due to coronavirus 2019 (COVID-19), physicians choose respiratory management ranging from low-flow oxygen therapy to more invasive methods, depending on the severity of the patient's symptoms. Recently, the ratio of oxygen saturation (ROX) index has been proposed as a clinical indicator to support the decision for either high-flow nasal cannulation (HFNC) or mechanical ventilation (MV). However, the reported cut-off value of the ROX index ranges widely from 2.7 to 5.9. The objective of this study was to identify indices to achieve empirical physician decisions for MV initiation, providing insights to shorten the delay from HFNC to MV. We retrospectively analyzed the ROX index 6 hours after initiating HFNC and lung infiltration volume (LIV) calculated from chest computed tomography (CT) images in COVID-19 patients with AHRF. Methods: We retrospectively analyzed the data for 59 COVID-19 patients with AHRF in our facility to determine the cut-off value of the ROX index for respiratory therapeutic decisions and the significance of radiological evaluation of pneumonia severity. The physicians chose either HFNC or MV, and the outcomes were retrospectively analyzed using the ROX index for initiating HFNC. LIV was calculated using chest CT images at admission. Results: Among the 59 patients who required high-flow oxygen therapy with HFNC at admission, 24 were later transitioned to MV; the remaining 35 patients recovered. Four of the 24 patients in the MV group died, and the ROX index values of these patients were 9.8, 7.3, 5.4, and 3.0, respectively. These index values indicated that the ROX index of half of the patients who died was higher than the reported cut-off values of the ROX index, which range from 2.7-5.99. The cut-off value of the ROX index 6 hours after the start of HFNC, which was used to classify the management of HFNC or MV as a physician's clinical decision, was approximately 6.1. The LIV cut-off value on chest CT between HFNC and MV was 35.5%. Using both the ROX index and LIV, the cut-off classifying HFNC or MV was obtained using the equation, LIV = 4.26 × (ROX index) + 7.89. The area under the receiver operating characteristic curve, as an evaluation metric of the classification, improved to 0.94 with a sensitivity of 0.79 and specificity of 0.91 using both the ROX index and LIV. Conclusion: Physicians' empirical decisions associated with the choice of respiratory therapy for HFNC oxygen therapy or MV can be supported by the combination of the ROX index and the LIV index calculated from chest CT images.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , Retrospective Studies , COVID-19/therapy , Respiratory Insufficiency/therapy , Oxygen , Oxygen Inhalation Therapy/methods
20.
Crit Care Med ; 51(7): 892-902, 2023 Jul 01.
Article in English | MEDLINE | ID: covidwho-2284165

ABSTRACT

OBJECTIVES: Extracorporeal carbon dioxide removal (ECCO 2 R) devices are effective in reducing hypercapnia and mechanical ventilation support but have not been shown to reduce mortality. This may be due to case selection, device performance, familiarity, or the management. The objective of this study is to investigate the effectiveness and safety of a single ECCO 2 R device (Hemolung) in patients with acute respiratory failure and identify variables associated with survival that could help case selection in clinical practice as well as future research. DESIGN: Multicenter, multinational, retrospective review. SETTING: Data from the Hemolung Registry between April 2013 and June 2021, where 57 ICUs contributed deidentified data. PATIENTS: Patients with acute respiratory failure treated with the Hemolung. The characteristics of patients who survived to ICU discharge were compared with those who died. Multivariable logistical regression analysis was used to identify variables associated with ICU survival. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 159 patients included, 65 (41%) survived to ICU discharge. The survival was highest in status asthmaticus (86%), followed by acute respiratory distress syndrome (ARDS) (52%) and COVID-19 ARDS (31%). All patients had a significant reduction in Pa co2 and improvement in pH with reduction in mechanical ventilation support. Patients who died were older, had a lower Pa o2 :F io2 (P/F) and higher use of adjunctive therapies. There was no difference in the complications between patients who survived to those who died. Multivariable regression analysis showed non-COVID-19 ARDS, age less than 65 years, and P/F at initiation of ECCO 2 R to be independently associated with survival to ICU discharge (P/F 100-200 vs <100: odds ratio, 6.57; 95% CI, 2.03-21.33). CONCLUSIONS: Significant improvement in hypercapnic acidosis along with reduction in ventilation supports was noted within 4 hours of initiating ECCO 2 R. Non-COVID-19 ARDS, age, and P/F at commencement of ECCO 2 R were independently associated with survival.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Humans , Aged , Carbon Dioxide , Retrospective Studies , COVID-19/complications , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency/therapy , Respiratory Insufficiency/etiology
SELECTION OF CITATIONS
SEARCH DETAIL