# ent

id: cord-016042-iyuca9lv
type: ORG
entity:
  Standard Protocols for Noninvasive Mechanical Ventilation in Patients with High Risk Infections date 2013


id: cord-000705-w52dc97h
type: WORK_OF_ART
entity:
  The National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome ARDS Clinical Trials Network


id: cord-000705-w52dc97h
type: DISEASE
entity:
  influenza A actual weight height severity of illness Acute Physiology And Chronic Health Evaluation II APACHE II organ failures


id: cord-011269-j2rogzm7
type: ORG
entity:
  Core Competencies for Interprofessional Collaborative Practice Board on Global Health Institute of Medicine


id: cord-034578-i9rdubix
type: PROTEIN
entity:
  creatinine alanine transaminase aspartate transaminase lactate dehydrogenase C reactive protein D dimer ferritin


id: cord-014538-6a2pviol
type: PROTEIN
entity:
  Bruno Neuville Mathilde D ortho Marie Pia Bouadma Lila Rouvel Tallec Anny Rudler Marika Weiss Nicolas Perlbarg Vincent Galanaud Damien Thabut Dominique Rachdi Emna


id: cord-014538-6a2pviol
type: DNA
entity:
  Louf Durier Aurore Tapponnier Romain Louis Bruno Forel Jean Marie Bisbal Magali Lehingue Samuel Rambaud Romain


id: cord-014538-6a2pviol
type: DISEASE
entity:
  Deransy Romain Brisson Hélène Monsel Antoine Conti Filomena Scatton Olivier Langeron Olivier Ghezala Hassen Ben Snouda Salah


id: cord-014538-6a2pviol
type: DISEASE
entity:
  neoplasms breast lung ovarian urologic gastrointestinal digestive system abdominal brain carcinoid tumor sarcoma testicular seminoma


id: cord-011222-7aha5b07
type: DISEASE
entity:
  paraplegia dementia chronic pulmonary disease liver disease peptic ulcer disease renal disease rheumatic disease cancer


id: cord-260220-f1tpkw1o
type: DISEASE
entity:
  influenza A H1N1 virus occurred worldwide Some patients required Intensive Care Unit ICU admission The use of non invasive ventilation NIV


id: cord-276238-2hv46ftk
type: LAW
entity:
  Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome A Randomized Clinical Trial Characteristics of COVID 19


id: cord-267537-akzydy7l
type: CHEMICAL
entity:
  N glycans on processing and biological activity of the Nipah virus fusion protein Crystal structure of the


id: cord-103020-ckuma42j
type: GGP
entity:
  PCO 2 2 2kPa p 0 05 and bicarbonate 4 9mmol L p 0 05 measured at followup after initiation of home NIV relative to measurements at baseline indicate control of hypercapnic respiratory failure Figure 4 CC BY ND 4 0 International license It is made available under a is the author funder


id: cord-034185-e0am7pa6
type: ORG
entity:
  Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting


id: cord-034185-e0am7pa6
type: ORG
entity:
  Venturi mask World Health Organization World Federation of Societies of Anaesthesiologists WHO WFSA International Standards for a Safe Practice of Anesthesia Ketorolac


id: cord-313816-7d8x7fjp
type: ORG
entity:
  Spanish Society of Intensive Care Medicine SEMICYUC Spanish Society of Pulmonologists SEPAR Spanish Society of Emergency SEMES Spanish Society of Anesthesiology Reanimation and Pain SEDAR


id: cord-005727-li8pwigg
type: PROTEIN
entity:
  LIMON System Ò Pulsion Medical System Munchen Germany was measured once a day for 3 postoperative days POD


id: cord-005727-li8pwigg
type: GGP
entity:
  MV 7 1 1 8 vs 7 9 1 7 L min p 0 003 PEEP 9 5 vs 10 4 cmH 2 O p 0 01 FiO 2 35 13 vs 45 18 p 0 001 Vt PBW 8 1 0 8 vs 8 4 0 8 mL Kg PBW p 0 003 and Pplat 22 6 vs 24 6 cmH 2 O p 0 01 than ASV Static compliance PaO 2 FiO 2 ratio and PaCO 2


id: cord-005727-li8pwigg
type: ORG
entity:
  Hirosaki University Graduate School of Medicine Division of Intensive Care Hirosaki Japan INTRODUCTION


id: cord-005727-li8pwigg
type: PRODUCT
entity:
  A S Puxty 1 J Kinsella 1 K Anderson 1 1 Glasgow Royal Infirmary Department of Anaesthetics Glasgow UK Etomidate


id: cord-005727-li8pwigg
type: DATE
entity:
  between 1st of January of 1999 to 31st of December 2001 and 1st of January of 2007 to 31st of December 2009


id: cord-005727-li8pwigg
type: CHEMICAL
entity:
  alcohol n 7 HCV n 3 alcohol HCV n 2 alpha 1 antitrypsin deficiency n 1 budd chiari syndrome n 1 or cryptogenic n 1


id: cord-005727-li8pwigg
type: CHEMICAL
entity:
  garlic 43 apple vinegar 39 lavandula stoechas 31 cratageus 29 and ginger honey mixture 27 The average educational degree of herbal product users was


id: cord-352059-1bjskqyg
type: WORK_OF_ART
entity:
  Potdar Varsha Praharaj Ira Giri Sidhartha Sapkal Gajanan Yadav Pragya Choudhary Manohar Lal Dar Lalit Sugunan A


id: cord-352059-1bjskqyg
type: ORG
entity:
  The National Centre for Disease Control NCDC Ministry of Health and Family Welfare Integrated Disease Surveillance Programme IDSP


id: cord-027805-p0bhju1s
type: DNA
entity:
  MBU 12 P Oral Nasal Oxygen Mask Communication and Speech Enhancement System US9344781 US Patent Throat Microphone US Patent Communication and Speech Enhancement System US9943712 Systems and Methods for Communicating Through a Hard Plastic Mask US Patent Dolores Speech Products Speech


id: cord-027805-p0bhju1s
type: WORK_OF_ART
entity:
  Exploring Reasons for Declining and Withdrawing From Non Invasive Ventilation Among Motor Neurone Disease Patients An Interpretative Phenomenological Analysis Communicating


id: cord-027805-p0bhju1s
type: DISEASE
entity:
  Tooth Bone Conduction Microphone US Patent Two Way Communication System and Method of Use US Patent The physiological microphone PMIC A competitive alternative for speaker assessment in stress detection and speaker verification US Patent Language


id: cord-290684-3f6prlqy
type: ORG
entity:
  Chinese Thoracic Society Society of Critical Care Medicine of Chinese Medical Association Respiratory


id: cord-335078-z7k59k8o
type: DNA
entity:
  F1000Res DOI 10 12688 f1000research 25384 1 sha 10ee27d59dc90bf69ff23f8cfbbea7877f72ec17 doc_id 335078 cord_uid z7k59k8o


id: cord-312864-km07zhn1
type: WORK_OF_ART
entity:
  Potalivo A Montomoli J Facondini F Sanson G Lazzari Agli L A Perin T Cristini F Cavagna E De Giovanni R Biagetti C Panzini I Ravaiolo C Bitondo M Guerra D Giuliani G Mosconi E Guarino S Marchionni E Gangitano G Valentini I Giampaolo L Muratori F Nardi G


id: cord-312864-km07zhn1
type: CHEMICAL
entity:
  L A Perin T Cristini F Cavagna E De Giovanni R Biagetti C Panzini I Ravaiolo C Bitondo M Guerra D Giuliani G Mosconi E Guarino S Marchionni E


id: cord-335975-m6lkrehi
type: GGP
entity:
  envenomations i e 0 098 The median age was 43 years with extremes ranging from 20 to 78 years The sex ratio was 4 Scorpion stings occurred at night in 80 of patients 60 in the first half of the night between 6 pm and 11 59 pm and 20 in the second half of the night 0 to 5 h Venom inoculation points were in the lower limbs in 80 of cases followed by upper limbs 20 The color of the incriminated scorpion was yellow in 80 black in 10 and unspecified in 10 of the cases For admission classes there were 10 Class I 80 Class II


id: cord-013149-y0dbhtef
type: DNA
entity:
  Einfluss hat Etliche rezente Daten konnten dies eindrucksvoll belegen Zwei Landmark Studien an über 2200 Patienten eine davon prospektiv durchgeführt zeigten sogar


id: cord-013149-y0dbhtef
type: PROTEIN
entity:
  zur Behandlung von Krebserkrankungen zugelassen Im Zuge der äußerst vielgestaltigen Toxizität benötigt jeder Dritte mit diesen Medikamenten behandelte Patient eine notfallmedizinische Versorgung Auch für Intensivmediziner rückt bei Auftreten von


id: cord-013149-y0dbhtef
type: GGP
entity:
  zur Behandlung von Krebserkrankungen zugelassen Im Zuge der äußerst vielgestaltigen Toxizität benötigt


id: cord-355038-o2hr5mox
type: CELL_LINE
entity:
  Kais Regaieg Sabrine Nakaa Arnaud Mailloux Madjid Boukari Johana Cohen Dany Goldgran Toledano Groupe hospitalier intercommunal Le Raincy Montfermeil Montfermeil France Correspondence Kais Regaieg


id: cord-355038-o2hr5mox
type: GGP
entity:
  H2 r 0 37 95 CI 0 10 0 59 p 0 0064 We showed a significant relationship between the variation in plasma concentration of GRP78


id: cord-355038-o2hr5mox
type: GGP
entity:
  IV p 10 3 duration of symptoms before hospitalization p 0 03 APACHE II score p 0 04 pH p 0 004 shock on admission p 0 01 and septic shock as evolutionary complication p 0 01 were predictors of mortality in our study Besides shock on admission p 0 001 and as evolutionary complication p 0 017 were the two independent prognostic factors


id: cord-355038-o2hr5mox
type: GGP
entity:
  Agir À Domicile GALICIER Lionel Consultancy Expert NOVARTIS EUSAPHARMA Trainings Teaching Baxalta PFIZER Invitation to national or international congresses No conflict of interest ICHAÏ Philippe No conflict of interest IMEN Sioud No conflict of interest IOOS Vincent No disclosure ISERIN Franck No disclosure ISSA Nahema No conflict of interest JABER Samir Consultancy Expert drager Fisher Paykel Medtronic Baxter Xenios Fresenius Invitation to national or international congresses Drager No conflict of interest JACQ Gwenaëlle No conflict of interest JACQUET Emmanuelle


id: cord-355038-o2hr5mox
type: ORG
entity:
  Réanimation Médicale CHU RENNES Rennes France 3 Réanimation Chirurgicale CHU NANTES Nantes France 4 Réanimation


id: cord-355038-o2hr5mox
type: ORG
entity:
  Fresenius Medical Care Consultancy Expert Fresenius Medical Care Trainings Teaching Fresenius Medical Care Invitation


id: cord-355038-o2hr5mox
type: DISEASE
entity:
  thoracic abdominal neurosurgery gynecologic urologic otorhinolaryngology or spinal surgery The primary


# bib

id: cord-000619-3bakci02
author: Zhang, Peng-jun
date: 2012-02-01
txt: ./txt/cord-000619-3bakci02.txt
cache: ./cache/cord-000619-3bakci02.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311613/
doi: 10.1186/1471-2334-12-29
summary:
  title: Clinical features and risk factors for severe and critical pregnant women with 2009 pandemic H1N1 influenza infection in China Data on risk factors associated with death of pregnant women and neonates with pH1N1 infections are limited outside of developed countries. METHODS: Retrospective observational study in 394 severe or critical pregnant women admitted to a hospital with pH1N1 influenza from Sep. 1, 2009 to Dec. 31, 2009. Preterm delivery was a risk factor for neonatal death among pregnant women with pH1N1 influenza infection. However, information is limited concerning the risk factors for maternal and neonatal death when pregnancy is complicated by severe or critical illness related to 2009 pH1N1 influenza. In this report, we described the characteristics of pH1N1 influenza in pregnant women and the risk factors for maternal and neonatal death. The clinical data reported herein is consistent with previous studies that demonstrate that pregnant women with influenza are at an increased risk of serious illness and death.

title:
  Clinical features and risk factors for severe and critical pregnant women with 2009 pandemic H1N1 influenza infection in China

abstract:
  BACKGROUND: 2009 pandemic H1N1 (pH1N1) influenza posed an increased risk of severe illness among pregnant women. Data on risk factors associated with death of pregnant women and neonates with pH1N1 infections are limited outside of developed countries. METHODS: Retrospective observational study in 394 severe or critical pregnant women admitted to a hospital with pH1N1 influenza from Sep. 1, 2009 to Dec. 31, 2009. rRT-PCR testing was used to confirm infection. In-hospital mortality was the primary endpoint of this study. Univariable logistic analysis and multivariate logistic regression analysis were used to investigate the potential factors on admission that might be associated with the maternal and neonatal mortality. RESULTS: 394 pregnant women were included, 286 were infected with pH1N1 in the third trimester. 351 had pneumonia, and 77 died. A PaO(2)/FiO(2 )≤ 200 (odds ratio (OR), 27.16; 95% confidence interval (CI), 2.64-279.70) and higher BMI (i.e. ≥ 30) on admission (OR, 1.26; 95% CI, 1.09 to 1.47) were independent risk factors for maternal death. Of 211 deliveries, 146 neonates survived. Premature delivery (OR, 4.17; 95% CI, 1.19-14.56) was associated neonatal mortality. Among 186 patients who received mechanical ventilation, 83 patients were treated with non-invasive ventilation (NIV) and 38 were successful with NIV. The death rate was lower among patients who initially received NIV than those who were initially intubated (24/83, 28.9% vs 43/87, 49.4%; p = 0.006). Septic shock was an independent risk factor for failure of NIV. CONCLUSIONS: Severe hypoxemia and higher BMI on admission were associated with adverse outcomes for pregnant women. Preterm delivery was a risk factor for neonatal death among pregnant women with pH1N1 influenza infection. NIV may be useful in selected pregnant women without septic shock.


id: cord-000705-w52dc97h
author: Ríos, Fernando G
date: 2011-08-17
txt: ./txt/cord-000705-w52dc97h.txt
cache: ./cache/cord-000705-w52dc97h.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387643/
doi: 10.1186/cc10369
summary:
  METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. Although a mild form of the disease was prevalent, it soon became evident that the 2009 influenza A (H1N1) virus could also provoke severe, acute respiratory failure requiring admission to the intensive care unit (ICU) for mechanical ventilation [16] , which was reflected in the severe pathological injury found at autopsy [17] . This was a multicenter, inception cohort study that included patients aged > 15 years admitted to the ICU with a previous history of influenza-like illness, evolving to acute respiratory failure that required mechanical ventilation during the 2009 winter in the Southern Hemisphere. We report on a large, prospective cohort of 2009 influenza A (H1N1) patients that were mechanically ventilated for acute respiratory failure due to diffuse pneumonitis during the pandemic in Argentina.

title:
  Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation During The 2009 Influenza A (H1N1) Pandemic

abstract:
  INTRODUCTION: Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. RESULTS: During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated. Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO(2)/FIO(2 )170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH(2)O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H(2)O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. CONCLUSIONS: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings.


id: cord-002078-38rmx65j
author: Korkmaz Ekren, Pervin
date: 2016-05-31
txt: ./txt/cord-002078-38rmx65j.txt
cache: ./cache/cord-002078-38rmx65j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886426/
doi: 10.1186/s12890-016-0236-y
summary:
  title: Can fiberoptic bronchoscopy be applied to critically ill patients treated with noninvasive ventilation for acute respiratory distress syndrome? The primary outcome of this prospective observational study was to evaluate the feasibility, safety and contribution in diagnosis and/or modification of the ongoing treatment of fiberoptic bronchoscopy (FOB) in patients with ARDS treated with NIV. METHODS: ARDS patients treated with NIV and who require FOB as the diagnostic or therapeutic procedure were included the study. Fiberoptic bronchoscopy (FOB) may be required in some patients with acute respiratory failure in intensive care units (ICU), mainly as diagnostic tool or to remove abundant secretions [7, 8] . Abbreviations APACHE II: Acute Physiology and Chronic Health Evaluation II; ARDS: acute respiratory distress syndrome; BAL: bronchoalveolar lavage; COPD: chronic obstructive pulmonary disease; EPAP: expiratory positive airway pressures; FOB: fiberoptic bronchoscopy; ICU: intensive care unit; IPAP: inspiratory positive airway pressure; NIV: noninvasive ventilation; PEEP: positive end expiratory pressure.

title:
  Can fiberoptic bronchoscopy be applied to critically ill patients treated with noninvasive ventilation for acute respiratory distress syndrome? Prospective observational study

abstract:
  BACKGROUND: Noninvasive ventilation (NIV) is a cornerstone for the treatment of acute respiratory failure of various etiologies. Using NIV is discussed in mild-to-moderate acute respiratory distress syndrome (ARDS) patients (PaO(2)/FiO(2) > 150). These patients often have comorbidities that increase the risk for bronchoscopy related complications. The primary outcome of this prospective observational study was to evaluate the feasibility, safety and contribution in diagnosis and/or modification of the ongoing treatment of fiberoptic bronchoscopy (FOB) in patients with ARDS treated with NIV. METHODS: ARDS patients treated with NIV and who require FOB as the diagnostic or therapeutic procedure were included the study. Intensive care ventilators or other dedicated NIV ventilators were used. NIV was applied via simple oro-nasal mask or full-face mask. Pressure support or inspiratory positive airway pressure (IPAP), external positive end expiratory pressure (PEEP) or expiratory positive airway pressure (EPAP) levels were titrated to achieve an expiratory tidal volume of 8 to 10 ml/kg according to ideal body weight, SpO(2) > 90 % and respiratory rate below 25/min. RESULTS: Twenty eight subjects (mean age 63.3 ± 15.9 years, 15 men, 13 women, PaO(2)/FiO(2) rate 145 ± 50.1 at admission) were included the study. Overall the procedure was well tolerated with only 5 (17.9 %) patients showing minor complications. There was no impairment in arterial blood gas and cardiopulmonary parameters after FOB. PaO(2)/FiO(2) rate increased from 132.2 ± 49.8 to 172.9 ± 63.2 (p = 0.001). No patient was intubated within 2 h after the bronchoscopy. 10.7, 32.1 and 39.3 % of the patients required invasive mechanical ventilation after 8 h, 24 h and 48 h, respectively. Bronchoscopy provided diagnosis in 27 (96.4 %) patients. Appropriate treatment was decided according to the results of the bronchoscopic sampling in 20 (71.4 %) patients. CONCLUSION: FOB under NIV could be considered as a feasible tool for diagnosis and guide for treatment of patients with ARDS treated via NIV in intensive care units. However, FOB-correlated life-treathening complications in severe hypoxemia should not be forgotten. Furthermore, further controlled studies involving a larger series of homogeneous ARDS patients undergoing FOB under NIV are needed to confirm these preliminary findings.


id: cord-005727-li8pwigg
title: ESICM 2010 MONDAY SESSIONS 11 October 2010
author: nan
date: 2010-08-31
txt: ./txt/cord-005727-li8pwigg.txt
cache: ./cache/cord-005727-li8pwigg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095301/
doi: 10.1007/s00134-010-1999-x
abstract: nan
summary:
  Since, continuous epidural analgesia provides the required level of analgesia to support early mobilization and significant reduction in pulmonary and cardiovascular morbidity in the early postoperative period, we postulated that the use of low dose of continuous epidural morphine might improve postoperative analgesia and reduce undesirable side effects in elderly patientsTherefore, the present study was designed to evaluate the effects of morphine administered via epidural patients controlled analgesia and intravenous tramadol + metamizol on postoperative pain control and side effects in elderly patients after major abdominal surgery. For each ventilated patient the following data was registered:Age, APACHE II, the reason of admission, risk factors, use NIV, MV duration, timing of tracheostomy, time of diagnosis of VAP, microbiological data, length of stay and mortality in ICU. 23rd ESICM ANNUAL CONGRESS -BARCELONA, SPAIN -9-13 OCTOBER 2010 S131 Evaluated factors: patient characteristics, signs, symptoms, abscess location, time between symptoms and hospital admission and surgery, lab results, microbiology, antibiotic therapy, APACHE2, SAPS2, SOFA, length of ICU stay, surgical re-intervention, duration of mechanical ventilation, infectious complications, critical illness myopathy (CIM), renal replacement therapy (RRT), re-intubation, tracheotomy, mortality.


id: cord-009375-2hflah2h
author: WANG, Xi-Jun
date: 2006-06-15
txt: ./txt/cord-009375-2hflah2h.txt
cache: ./cache/cord-009375-2hflah2h.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148955/
doi: 10.1016/s1872-2075(06)60038-1
summary:
  The envelope attachment glycoprotein (G) and fusion protein (F′) of Nipah virus (NiV) play a key role in viral entry and induction of neutralization antibody. Furthermore, the G and F protein-specific antibodies could neutralize the infectivity of the VSVΔG*F/G, the NiV F and G-envelope glycoproteins of pseudotype recombinant Vesicular Stomatitis Virus expressing green fluorescence protein. Furthermore, the G and F protein-specific antibodies could neutralize the infectivity of the VSVΔG*F/G, the NiV F and G-envelope glycoproteins of pseudotype recombinant Vesicular Stomatitis Virus expressing green fluorescence protein. For detecting reactionogenicity of rNF and rNG expressed by the recombinant baculoviruses, ELISA plates were coated with the lysate of sf9 cells that were infected by rBac-NiV-F and rBac-NiV-G and detected with 1:200 dilution of polyclone serum from rabbits immunized with inactivated NiV (kindly provided by Dr. L. In this study, immunization with insect cells was infected by the recombinant baculoviruses, thereby expressing NiV G and F proteins, eliciting G and F protein-specific antibody responses in mice.

title:
  Study of Fusion Protein and Attachment Glycoprotein of Nipah Virus Expressed in Recombinant Baculovirus

abstract:
  The envelope attachment glycoprotein (G) and fusion protein (F′) of Nipah virus (NiV) play a key role in viral entry and induction of neutralization antibody. In this study, recombinant baculoviruses, rBac-NF and rBac-NG, were generated to express F and G proteins of NiV. The expressions of recombinant G (rNG) and F (rNF) proteins in rBac-NF and rBac-NG-infected cells were confirmed by Western blot. Both rNG and rNF showed sensitive and specific antigenic reaction to rabbit serum anti-Nipah virus in indirect immunofluorescence detection and indirect ELISA. Immunization with rBac-NF and rBac-NG-infected insect cells elicited G and F protein-specific antibody responses in mice. Furthermore, the G and F protein-specific antibodies could neutralize the infectivity of the VSVΔG*F/G, the NiV F and G envelope glycoproteins of pseudotype recombinant Vesicular Stomatitis Virus expressing green fluorescence protein. The results demonstrated that the F and G proteins expressed by the recombinant baculoviruses could be safe diagnostic antigens for the surveillance and monitoring of NiV and could also be promising subunit vaccines for the prevention of NiV.


id: cord-010669-rg2p3kal
author: Fubini, PE
date: 2020-05-07
txt: ./txt/cord-010669-rg2p3kal.txt
cache: ./cache/cord-010669-rg2p3kal.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206709/
doi: 10.1186/s12245-020-00284-y
summary:
  BACKGROUND: In chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), non-invasive ventilation (NIV) is generally recommended and has proven its benefits by reducing endotracheal intubation (ETI) rates, intensive care unit (ICU) admissions, complications, and mortality. CASE PRESENTATION: We report two cases of ARF in COPD patients who were successfully treated by NIV in prehospital setting and avoided ETI despite contraindications (altered mental status with a Glasgow Coma Scale < 8) and failure risk factors (severe respiratory acidosis with pH < 7.25). Acute respiratory failure (ARF) in chronic obstructive pulmonary disease (COPD) patients is a well-known indication for non-invasive ventilation (NIV) trial [1] . We report here two cases of ARF in COPD patients with severe respiratory acidosis and hypercapnic coma successfully treated by NIV in the prehospital setting. In conclusion, for COPD patients presenting ARF, NIV trial could be considered even when relative contraindications such as an altered level of consciousness or a severe respiratory acidosis are present.

title:
  Prehospital reversal of profound respiratory acidosis and hypercapnic coma by non-invasive ventilation: a report of two cases

abstract:
  BACKGROUND: In chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), non-invasive ventilation (NIV) is generally recommended and has proven its benefits by reducing endotracheal intubation (ETI) rates, intensive care unit (ICU) admissions, complications, and mortality. Choosing between immediate ETI or NIV trial is often difficult when such patients present with an altered mental status. Some guidelines recommend avoiding NIV when consciousness is impaired given the risk of aspiration, and some authors suggest that a pH < 7.25 is highly predictive of NIV failure. Though clinical response to a well-adjusted NIV treatment can be both swift and spectacular, these contraindications probably encourage physicians to proceed to immediate ETI. Some studies indeed report that NIV was not even considered in as many as 60% of patients who might have benefited from this therapy, though ETI related complications might have been avoided had NIV been successfully applied. CASE PRESENTATION: We report two cases of ARF in COPD patients who were successfully treated by NIV in prehospital setting and avoided ETI despite contraindications (altered mental status with a Glasgow Coma Scale < 8) and failure risk factors (severe respiratory acidosis with pH < 7.25). CONCLUSION: In COPD patients presenting ARF, NIV trial could be considered even when relative contraindications such as an altered level of consciousness or a severe respiratory acidosis are present.


id: cord-010850-zj6k7wz9
title: Noninvasive ventilation for pediatric interfacility transports: a retrospective study
author: Holbird, Samantha
date: 2020-05-13
txt: ./txt/cord-010850-zj6k7wz9.txt
cache: ./cache/cord-010850-zj6k7wz9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222886/
doi: 10.1007/s12519-020-00363-3
summary:
  BACKGROUND: To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) or high-flow nasal cannula (HFNC) during interfacility transport (IFT). Pediatric patients aged 28 days to < 17 years, who required IFT between January 2017 and December 2018, were identified through a transport registry and were included in the study. The objectives of this retrospective chart review study were to characterize pediatric patients requiring IFTs and NIV and to examine their clinical outcomes, including the need for airway instrumentation. A total of 120 patients (Table 1 ) on NIV or HFNC for IFT were studied (26.7% of transport cohort), but 2 had incomplete records and were excluded from analysis. Our crude IFT data showed that in 2019, 62% of patients requiring respiratory support were initiated on NIV; in 2014, it was less than 10%.

abstract:
  BACKGROUND: To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) or high-flow nasal cannula (HFNC) during interfacility transport (IFT). METHODS: A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit. Pediatric patients aged 28 days to < 17 years, who required IFT between January 2017 and December 2018, were identified through a transport registry and were included in the study. RESULTS: A total of 118 (26.7%) patients received CPAP/BIPAP or HFNC support for IFT. The most common respiratory diagnosis was bronchiolitis (46%). These patients were placed on respiratory support, 31.4 minutes after the transport team’s arrival. None required intubation during their IFT, despite mean transport times of 163 minutes. CONCLUSIONS: This study may provide important information for programs with large catchment areas, in which large distances and transport times should not be barriers to NIV implementation.


id: cord-011222-7aha5b07
author: Huang, Cheng-Chi
date: 2020-03-30
txt: ./txt/cord-011222-7aha5b07.txt
cache: ./cache/cord-011222-7aha5b07.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223827/
doi: 10.1007/s11739-020-02315-1
summary:
  NIV use was frequently observed in old-age persons (aOR 3.99, 95% CI 3.06–5.21 for those aged ≥ 80 years), women (aOR 1.33, 95% CI 1.18–1.50), patients admitted to a high-level hospital (aOR 1.95, 95% CI 1.63−2.34 for those admitted to a medical center), and patients with a higher Charlson comorbidity index (CCI, aOR 1.38−1.66 for those CCI ≥ 2). In addition, patients with chronic pulmonary disease, cancer, and congestive heart failure were predominant in NIV users and were significantly associated with NIV use. Patients comorbid with a medical history of cancer (aOR 2.57, 95% CI 2.23−2.97), chronic pulmonary disease (aOR 2.24, 95% CI 1.97−2.55), and congestive heart failure (aOR 1.27, 95% CI 1.08−1.49) had a significantly higher NIV choice compared to that of individuals without those medical history.

title:
  The application of non-invasive and invasive mechanical ventilation in the first episode of acute respiratory failure

abstract:
  Acute respiratory failure (RF) is a life-threatening syndrome. This study investigated the application of two major clinical strategies, non-invasive mechanical ventilation (NIV) and invasive mechanical ventilation (IMV), in the first episode of acute RF. Data from the longitudinal health insurance database, which included 1,000,000 insured citizens, were used. The NIV group consisted of 1201 patients and the IMV group consisted of 16,072 patients. Chi-square test and t test were applied to determine the differences in categorical and continuous variables. Further analysis was performed by using univariate and multivariable logistic regression and Poisson regression. There was a significant increase of 733% in the number of NIV users from 2000 to 2012. NIV use was frequently observed in old-age persons (aOR 3.99, 95% CI 3.06–5.21 for those aged ≥ 80 years), women (aOR 1.33, 95% CI 1.18–1.50), patients admitted to a high-level hospital (aOR 1.95, 95% CI 1.63−2.34 for those admitted to a medical center), and patients with a higher Charlson comorbidity index (CCI, aOR 1.38−1.66 for those CCI ≥ 2). In addition, patients with chronic pulmonary disease, cancer, and congestive heart failure were predominant in NIV users and were significantly associated with NIV use. Overall, the use of NIV has markedly increased over the past few years. Persons of advanced age, women, patients admitted to a high-level hospital, and patients with multiple comorbidities were associated with more frequent NIV use. Chronic pulmonary disease, cancer, and congestive heart failure were most important comorbidities for NIV use. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11739-020-02315-1) contains supplementary material, which is available to authorized users.


id: cord-011269-j2rogzm7
author: Stefan, Mihaela S.
date: 2020-05-06
txt: ./txt/cord-011269-j2rogzm7.txt
cache: ./cache/cord-011269-j2rogzm7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223919/
doi: 10.1186/s43058-020-00028-2
summary:
  title: Protocol for two-arm pragmatic cluster randomized hybrid implementation-effectiveness trial comparing two education strategies for improving the uptake of noninvasive ventilation in patients with severe COPD exacerbation Through a series of mixed-methods studies, we have found that successful implementation of NIV requires physicians, respiratory therapists (RTs), and nurses to communicate and collaborate effectively, suggesting that efforts to increase the use of NIV in COPD need to account for the complex and interdisciplinary nature of NIV delivery and the need for team coordination. The overall objective of this study is to conduct a pragmatic, parallel, 2-arm randomized cluster trial to compare the effectiveness of two implementation strategies: on-line education (OLE) and interprofessional education (IPE) on the uptake of NIV. Hospitals that demonstrate interest in participating in the study will be asked to commit to form a COPD-NIV team composed of one physician, one RT, and one nurse that will be in close contact with the investigators and are responsible for delivering the educational intervention in their institution.

title:
  Protocol for two-arm pragmatic cluster randomized hybrid implementation-effectiveness trial comparing two education strategies for improving the uptake of noninvasive ventilation in patients with severe COPD exacerbation

abstract:
  BACKGROUND: COPD is the fourth leading cause of death in the US, and COPD exacerbations result in approximately 700,000 hospitalizations annually. Patients with acute respiratory failure due to severe COPD exacerbation are treated with invasive (IMV) or noninvasive mechanical ventilation (NIV). Although IMV reverses hypercapnia/hypoxia, it causes significant morbidity and mortality. There is strong evidence that patients treated with NIV have better outcomes, and NIV is recommended as first line therapy in these patients. Yet, several studies have demonstrated substantial variation in the use of NIV across hospitals, leading to preventable morbidity and mortality. Through a series of mixed-methods studies, we have found that successful implementation of NIV requires physicians, respiratory therapists (RTs), and nurses to communicate and collaborate effectively, suggesting that efforts to increase the use of NIV in COPD need to account for the complex and interdisciplinary nature of NIV delivery and the need for team coordination. Therefore, we propose to compare two educational strategies: online education (OLE) and interprofessional education (IPE) which targets complex team-based care in NIV delivery. METHODS AND DESIGN: Twenty hospitals with low baseline rates of NIV use will be randomized to either the OLE or IPE study arm. The primary outcome of the trial is change in the hospital rate of NIV use among patients with COPD requiring ventilatory support. In aim 1, we will compare the uptake change over time of NIV use among patients with COPD in hospitals enrolled in the two arms. In aim 2, we will explore mediators’ role (respiratory therapist autonomy and team functionality) on the relationship between the implementation strategies and implementation effectiveness. Finally, in aim 3, through interviews with providers, we will assess acceptability and feasibility of the educational training. DISCUSSIONS: This study will be among the first to carefully test the impact of IPE in the inpatient setting. This work promises to change practice by offering approaches to facilitate greater uptake of NIV and may generalize to other interventions directed to seriously-ill patients. TRIAL REGISTRATION: Name of registry: ClinicalTrials.gov Trial registration number: NCT04206735 Date of Registration: December 20, 2019


id: cord-013149-y0dbhtef
title: Hämatoonkologie und Intensivmedizin: Vom Tabu zur Conditio sine qua non
author: Wohlfarth, P.
date: 2020-10-12
txt: ./txt/cord-013149-y0dbhtef.txt
cache: ./cache/cord-013149-y0dbhtef.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549082/
doi: 10.1007/s00063-020-00737-5
summary:
  Timing der Intensivstationsaufnahme Die vorhandenen Daten über kritisch kranke Krebspatienten mit den häufigsten Intensivstationsaufnahmegründen, ARV und Sepsis, zeigen einmütig, dass eine möglichst frühzeitige Verlegung auf die Intensivstation, also bei manifestem oder eventuell auch nur drohendem Organversagen, erfolgen sollte [8, 9] . Bei Patienten mit "chronic obstructive pulmonary disease" (COPD) und hypertensivem Lungenödem stellt die nichtinvasive Beatmung (NIV) den Goldstandard der Therapie dar und es gibt keine evidenzbasierte Rationale, dass dies nicht auch bei Krebspatienten gelten sollte. These include defining proper goals of intensive care treatment, managing acute respiratory failure with diverse differential considerations, treating immunologic side-effects of ever new and innovative cancer therapies, as well as numerous clinical scenarios which may exclusively arise in cancer patients. Cancer · Intensive care unit · Acute respiratory failure · Immunotherapy · iCHOP und womöglich "um jeden Preis" nicht zu intubieren, kann somit als überholt, ja im Fall sekundärerIntubationenbeiNIV-Versagen sogar als potenziell gefährlich angesehen werden.

abstract:
  Intensivists are confronted with a broad spectrum of specific clinical problems while caring for critically ill cancer patients. These include defining proper goals of intensive care treatment, managing acute respiratory failure with diverse differential considerations, treating immunologic side-effects of ever new and innovative cancer therapies, as well as numerous clinical scenarios which may exclusively arise in cancer patients. To help clinicians handle such challenges, the initiative Intensive Care in Hematologic and Oncologic Patients (iCHOP) has been dealing with these topics for several years. Supported by several Austrian and German medical societies of intensive care medicine, hematology and oncology, the first “Consensus statement for cancer patients requiring intensive care support” has only recently been released. Acute respiratory failure and its management continues to be a major focus in critically ill cancer patients due to its frequency and its prognostic impact. While noninvasive oxygenation strategies were considered the gold standard of therapy, more recent high-quality data do not show clinical benefits of such techniques including high flow nasal oxygen. On the contrary, several studies revealed an unidentified etiology of an acute respiratory failure as the only potentially modifiable risk factor for adverse outcome. Consequently, evidence-based and rigorously applied diagnostic algorithms are of utmost importance in these patients. Furthermore, intensivists are increasingly confronted with the rising incidence of various and new immunotherapy-associated toxicities and their management.


id: cord-014538-6a2pviol
title: Proceedings of Réanimation 2017, the French Intensive Care Society International Congress
author: Kamilia, Chtara
date: 2017-01-10
txt: ./txt/cord-014538-6a2pviol.txt
cache: ./cache/cord-014538-6a2pviol.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225389/
doi: 10.1186/s13613-016-0224-7
abstract: nan
summary:
  Other parameters that were significantly different between the patients who died and those who survived were an advanced age, an elevated IGS II score at hospital admission, an elevated SOFA score at study entry, a late healthcare-associated infection and several biological variables: a high C reactive protein, low albumin and prealbumin and a poor percent of monocytes expressing HLA-DR, all measured at day 7. Parameters collected were demographic features, comorbidities, regular treatment, dyspnea assessed by the MRC scale, initial clinical severity reflected by SAPS II and APACHE II scores, modalities and ICU admission deadlines, initial arterial blood gas analysis, management of patients in the ICU (ventilation modalities, prescription of antibiotics, use of vasoactive drugs) and their outcomes (incidence of nosocomial infections and their sites, length of stay and ICU mortality).


id: cord-015548-zjrkfe9b
title: Invasive and non-invasive mechanical ventilation
author: Popat, Bhavesh
date: 2012-05-18
txt: ./txt/cord-015548-zjrkfe9b.txt
cache: ./cache/cord-015548-zjrkfe9b.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108446/
doi: 10.1016/j.mpmed.2012.03.010
summary:
  Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta-analysis Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

abstract:
  Early recognition of patients who might potentially require ventilatory support is a key goal of critical care outreach programs and an important skill for all hospital medical staff. Decisions about the initiation and timing of invasive ventilation can be difficult and early discussion with critical care colleagues is essential. Appropriateness of invasive ventilatory support may also be an issue requiring advanced discussion with patients and their families. In the past 10–15 years, the role of non-invasive ventilation (NIV) has expanded, not least in an attempt to minimize the complications inherent with invasive ventilation. As such, NIV is now considered first-line therapy in some conditions (chronic obstructive pulmonary disease, pulmonary oedema, mild-to-moderate hypoxaemic respiratory failure in immunocompromised patients), and a ‘trial of NIV’ is often considered in respiratory failure resulting from an increasingly wide range of causes. When using NIV, the importance of the environment (setting, monitoring and experience of staff) and forward planning cannot be overemphasized. When used for other than the standard indications, NIV should be employed in a high-dependency/intensive care setting only in patients for whom invasive ventilation would be considered.


id: cord-016042-iyuca9lv
author: Keymel, Stefanie
date: 2013-05-29
txt: ./txt/cord-016042-iyuca9lv.txt
cache: ./cache/cord-016042-iyuca9lv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120195/
doi: 10.1007/978-3-7091-1496-4_40
summary:
  Noninvasive ventilation (NIV) is associated with lower rates of endotracheal intubation and decreased mortality in patients with acute respiratory failure. With endemic and high-risk infection, most of the critically ill patients develop acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). A year later, the British Thoracic Society (BTS) published guidelines on the use of NIV in patients with acute respiratory failure (ARF). The Canadian Critical Care Trials group made no recommendations about the use of NIV in ARDS patients or those with severe community-acquired pneumonia (CAP) in 2011 [ 5 ] . • Current guidelines do not recommend NIV for the treatment of hypoxemic respiratory failure in endemic and pandemic infections (e.g., SARS or H1N1). International consensus conference in intensive care medicine: noninvasive positive pressure ventilation in acute respiratory failure Noninvasive positive pressure ventilation treatment for acute respiratory failure in SARS

title:
  Noninvasive Mechanical Ventilation Guidelines and Standard Protocols for Noninvasive Mechanical Ventilation in Patients with High-Risk Infections

abstract:
  Noninvasive ventilation (NIV) is associated with lower rates of endotracheal intubation and decreased mortality in patients with acute respiratory failure. Therefore, NIV should be preferred to invasive ventilation whenever possible [1]. In clinical settings, most of the patients were treated by NIV because of pulmonary edema or exacerbated chronic obstructive lung disease (COPD) [2]. With endemic and high-risk infection, most of the critically ill patients develop acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). Furthermore, NIV, an “aerosol-producing factor” might be regarded as a high-risk procedure for medical staff [3].


id: cord-016416-h3cjylcl
title: Pathophysiology of Acute Respiratory Failure in Children with Bronchiolitis and Effect of CPAP
author: Javouhey, Etienne
date: 2013-05-29
txt: ./txt/cord-016416-h3cjylcl.txt
cache: ./cache/cord-016416-h3cjylcl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120685/
doi: 10.1007/978-3-7091-1496-4_27
summary:
  Curiously, blood gas analyses have not been found to be good indicators of ventilatory support requirement except in the study of Campion et al., where a high level of CO 2 before CPAP was predictive of NIV failure defi ned as the need for invasive ventilation [ 8 ] . Liet and colleagues reported three cases of infants with severe bronchiolitis treated with this mode during invasive mechanical ventilation and showed that NAVA was able to improve synchrony, decrease the oxygen requirement, and decrease peak airway pressure from 28 ± 3 to 15 ± 5 cmH 2 O [ 33 ] . Moreover, as no study has been performed on NIV at two pressure levels in bronchiolitis, there is no evidence that NIV after CPAP or HFC failure can obviate the need for intubation and invasive ventilation.

abstract:
  Acute bronchiolitis is the most common lower respiratory tract infection (LRTI) during the first year of life. Respiratory syncytial virus (RSV) infection is the most prevalent virus found in these children, accounting for 60–80 % of cases. The rate of hospitalization is less than 2 %. Up to 8 % of those hospitalized require ventilatory support [1, 2].


id: cord-016744-jzhuq4te
title: Noninvasive Mechanical Ventilation: Models to Assess Air and Particle Dispersion
author: Hui, David S. C.
date: 2013-05-29
txt: ./txt/cord-016744-jzhuq4te.txt
cache: ./cache/cord-016744-jzhuq4te.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121120/
doi: 10.1007/978-3-7091-1496-4_2
summary:
  particles generated during tidal breathing [ 8 ] , NIV may disperse potentially infected aerosols, especially when patients cough and sneeze frequently, contributing to nosocomial transmission of infl uenza. As there is no reliable, safe marker that can be introduced into human lungs for experimental purposes, the laser smoke visualization method and the human patient simulator (HPS) model have been adopted as the method for studying exhaled air dispersion during application of various types of respiratory therapy in hospital medical wards, including the negative-pressure isolation room [ 10 -13 ] . Sections through the leakage jet plume were then revealed by a thin, green laser light sheet (532 nm wavelength, continuous-wave A laser beam located on the right side of the bed lateral to the human patient simulator illuminates the exhaled air particles leaking from the exhalation ports of the face mask in the coronal plane.

abstract:
  Respiratory failure is a major complication of viral infections such as severe acute respiratory syndrome (SARS) [1], avian influenza H5N1 infection [2], and the 2009 pandemic influenza (H1N1) infection [3]. The course may progress rapidly to acute respiratory distress syndrome (ARDS) and multi-organ failure, requiring intensive care. Noninvasive ventilation (NIV) may play a supportive role in patients with severe viral pneumonia and early ARDS/acute lung injury. It can act as a bridge to invasive mechanical ventilation, although it is contraindicated in critically ill patients with hemodynamic instability and multi-organ dysfunction syndrome [4]. Transmission of some of these viral infections can convert from droplets to airborne during respiratory therapy.


id: cord-016844-lq2bgu7a
author: Teksam, Ozlem
date: 2013-05-29
txt: ./txt/cord-016844-lq2bgu7a.txt
cache: ./cache/cord-016844-lq2bgu7a.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121261/
doi: 10.1007/978-3-7091-1496-4_29
summary:
  title: Noninvasive Mechanical Ventilation in Patients with High-Risk Infections and Mass Casualties in Acute Respiratory Failure: Pediatric Perspective Invasive mechanical ventilation (IMV) is a critical intervention in many cases of acute respiratory failure (ARF), but there are absolute risks associated with endotracheal intubation (ETI). Additionally, the World Health Organization''s interim guidelines on the prevention and control of acute respiratory diseases associated with health care have included NIV among the aerosol-generating procedures in which there is possibly an increased risk of respiratory pathogen transmission [ 11 ] . Nonetheless, after the most important two viral pandemics during the last decade, especially the last one with infl uenza A(H1N1), most of the societies including above-mentioned and the European Respiratory Society, European Society of Intensive Care Medicine, and The American Association for Respiratory Care have recommended that NIV not be used to treat ARF due to H1N1, particularly in severely ill patients.

title:
  Noninvasive Mechanical Ventilation in Patients with High-Risk Infections and Mass Casualties in Acute Respiratory Failure: Pediatric Perspective

abstract:
  Respiratory problems are common symptoms in children and common reason for visits to the pediatric emergency department (PED) and admission to the pediatric intensive care unit (PICU). Although the great majority of cases are benign and self-limited, requiring no intervention, some patients need respiratory support. Invasive mechanical ventilation (IMV) is a critical intervention in many cases of acute respiratory failure (ARF), but there are absolute risks associated with endotracheal intubation (ETI). On the other hand, noninvasive ventilation (NIV) is an extremely valuable alternative to IMV. A major reason for the increasing use of NIV has been the desire to avoid the complications of IMV. It is generally much safer than IMV and has been shown to decrease resource utilization. Its use also avoids the complications and side effects associated with ETI, including upper airway trauma, laryngeal swelling, postextubation vocal cord dysfunction, nosocomial infections, and ventilator-associated pneumonia. There are a number of advantages of NIV including leaving the upper airway intact, preserving the natural defense mechanisms of the upper airways, decreasing the need for sedation, maintaining the ability to talk while undergoing NIV, and reducing the length of hospitalization and its associated costs [1–3].


id: cord-016897-t71f10kv
title: Preventing Airborne Disease Transmission: Implications for Patients During Mechanical Ventilation
author: Flores, Marco V.
date: 2013-05-29
txt: ./txt/cord-016897-t71f10kv.txt
cache: ./cache/cord-016897-t71f10kv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121330/
doi: 10.1007/978-3-7091-1496-4_34
summary:
  We discuss the risk of transmitting these procedures and the strategies for mechanical ventilation in future airborne epidemics with special consideration given to the issue of protecting health care workers (HCWs). In contrast to the situation regarding severe acute respiratory syndrome (SARS) or tuberculosis prevention in HCWs, little attention has been given to the importance of HCWs personal protective equipment (PPE) (gowns, gloves, masks) for prevention and management of infl uenza. There is also potential for NIV to reduce the need for intubation in patients with infl uenza pneumonia or chronic respiratory disease, facilitate extubation, and widen the provision of ventilator support outside the intensive care unit (ICU). Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebulizer treatment and chest physiotherapy in clinical practice: implications for management of pandemic infl uenza and other airbone infections Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review

abstract:
  The organisms causing respiratory infections such as influenza are spread in droplets or aerosols or by direct or indirect contact with contaminated surfaces. Certain medical procedures have been termed aerosol generating because they are associated with high or augmented inspiratory and expiratory flows, which can increase microbial dissemination. Invasive ventilation maneuvers and noninvasive ventilation (NIV) fall into that category. We discuss the risk of transmitting these procedures and the strategies for mechanical ventilation in future airborne epidemics with special consideration given to the issue of protecting health care workers (HCWs).


id: cord-017240-2vqehqfh
title: Noninvasive Mechanical Ventilation for Hypoxemic Respiratory Failure-Related Infectious Diseases
author: Trindade e Silva, Luis Paulo
date: 2013-05-29
txt: ./txt/cord-017240-2vqehqfh.txt
cache: ./cache/cord-017240-2vqehqfh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121750/
doi: 10.1007/978-3-7091-1496-4_7
summary:
  • Evidence level 2-derived from systematic reviews with homogeneity of cohort studies, individual cohorts, and/or poor-quality RCTs. NIV is applied in patients with a "do not intubate" order, as a palliative measure in terminally ill patients, to prevent extubation failure in patients with COPD or heart failure, for communityacquired pneumonia (CAP) in COPD patients, to prevent and treat postoperative respiratory failure, and to prevent ARF due to asthma. [ 2 ] , which included eight RCTs that had studied patients with AHRF secondary to causes other than ACPO, the NIV reduced the ETI rate by 23 %, the length of stay in the intensive care unit (ICU) by 2 days, and ICU mortality by 17 % (absolute risk reduction). [ 8 ] , in a prospective observational study, compared the effi cacy of NIV in patients without COPD but with hypoxemic respiratory failure due to ACPO (15 patients) or severe CAP (18 patients).

abstract:
  The strict range of applicability of noninvasive ventilation (NIV)—which had been applied only to patients with an exacerbation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPO)—has been extended during the last two decades.


id: cord-017282-rahtmu3h
title: Pneumonia
author: Marvisi, Maurizio
date: 2019-08-06
txt: ./txt/cord-017282-rahtmu3h.txt
cache: ./cache/cord-017282-rahtmu3h.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121799/
doi: 10.1007/978-3-030-26664-6_12
summary:
  All patients with CAP should receive oxygen treatment as needed with the aim of maintaining an arterial oxygen saturation (SpO 2 ) of 92% corresponding to a partial pressure of oxygen in the blood of about 60 mmHg. Lower values are accepted in cases of underlying severe pulmonary disease with a risk of carbon dioxide retention. While the clinical practice guidelines on evidence-based application of NIV for community-acquired pneumonia did not provide a recommendation for its use, the Infectious Disease Society of America/American Thoracic Society guidelines on management of CAP did suggest a cautious trial of NIV [2, 12] . Most studies on NIV and treatment of acute hypoxemic respiratory failure, including CAP, have been carried out in the critical care setting and have reported controversial results with varying failure rates for NIV use. Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

abstract:
  Pneumonia is a common cause of hospital admission and community-acquired pneumonia (CAP) is a growing health problem in developed country and worldwide. Elderly patients suffer from more severe disease, require intensive care unit (ICU) admission, and exhibit higher mortality compared with their younger counterparts. The immunological changes that occur with age called “immunosenescence” (decreased efficiency of the adaptive and innate immune systems) are known to be responsible for the increased susceptibility of elderly persons to infectious diseases and for their limited response to vaccines [1].


id: cord-017786-kfl6xt31
title: Guidelines for Health Organizations: European Perspectives and Experience in Pandemics
author: Curiel-Balsera, Emilio
date: 2013-05-29
txt: ./txt/cord-017786-kfl6xt31.txt
cache: ./cache/cord-017786-kfl6xt31.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122448/
doi: 10.1007/978-3-7091-1496-4_41
summary:
  Recommendations for droplets include patient isolation with protective measures for health care providers and other patients, use of double-circuit tubes and special fi lters for nonrebreathing devices, minimization of leaks, preferably fullface mask or helmet interfaces, avoidance of heated humidifi ers, and disposing of mask and tubes after use according to routine infection control procedures [ 7 ] . The document states that: …noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, but could be useful in experienced centers and in cases of respiratory failure associated with exacerbation of chronic obstructive pulmonary disease or heart failure. • Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with ARDS but could be useful in experienced centers and in cases of respiratory failure associated with exacerbation of chronic obstructive pulmonary disease or heart failure.

abstract:
  In Europe, the rate of noninvasive ventilation (NIV) use in intensive care units (ICUs) is about 35 % for ventilated patients and higher (roughly 60 %) in respiratory ICUs or emergency departments. In North America, this form of ventilation is begun most often in emergency departments (EDs), most patients being transferred to the ICU or step-down units in hospitals with such facilities. This low rate of use in some hospitals is related to scarce knowledge on or experience with this technique, insufficient technical equipment, and inadequate funding. Despite these limitations, NIV is increasingly being used outside traditional and respiratory ICUs, including EDs, postsurgical recovery rooms, cardiology, neurology, and oncology wards, and palliative care units.


id: cord-027526-ohcu28rk
author: Zhou, Xiaoyang
date: 2020-06-22
txt: ./txt/cord-027526-ohcu28rk.txt
cache: ./cache/cord-027526-ohcu28rk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306939/
doi: 10.1186/s13054-020-03090-3
summary:
  METHODS: A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Nevertheless, the latest meta-analysis [19] of randomized controlled trials (RCTs) suggested that compared to COT, preventive use of NIV after extubation had no effect on the re-intubation rate or mortality in post-extubated patients. Relevant studies regarding preventive use of various respiratory support methods, including COT, NIV, HFOT, and HFOT+NIV, after planned extubation in critically ill medical patients were searched systematically by two independent reviewers (Xu Z and Chen B) from database inception through December 19, 2019, in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials.

title:
  Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

abstract:
  BACKGROUND: Respiratory support has been increasingly used after extubation for the prevention of re-intubation and improvement of prognosis in critically ill medical patients. However, the optimal respiratory support method is still under debate. This network meta-analysis (NMA) aims to evaluate the comparative effectiveness of various respiratory support methods used for preventive purposes after scheduled extubation in critically ill medical patients. METHODS: A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Study selection, data extraction, and quality assessments were performed in duplicate. The primary outcomes included re-intubation rate and short-term mortality. RESULTS: Seventeen RCTs comprising 3341 participants with 4 comparisons were included. Compared with COT, NIV significantly reduced the re-intubation rate [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.39 to 0.77; moderate quality of evidence] and short-term mortality (RR 0.66, 95% CI 0.48 to 0.91; moderate quality of evidence). Compared to COT, HFOT had a beneficial effect on the re-intubation rate (RR 0.55, 95% CI 0.35 to 0.86; moderate quality of evidence) but no effect on short-term mortality (RR 0.79, 95% CI 0.56 to 1.12; low quality of evidence). No significant difference in the re-intubation rate or short-term mortality was found among NIV, HFOT, and HFOT+NIV. The treatment rankings based on the surface under the cumulative ranking curve (SUCRA) from best to worst for re-intubation rate were HFOT+NIV (95.1%), NIV (53.4%), HFOT (51.2%), and COT (0.3%), and the rankings for short-term mortality were NIV (91.0%), HFOT (54.3%), HFOT+NIV (43.7%), and COT (11.1%). Sensitivity analyses of trials with a high risk of extubation failure for the primary outcomes indicated that the SUCRA rankings were comparable to those of the primary analysis. CONCLUSIONS: After scheduled extubation, the preventive use of NIV is probably the most effective respiratory support method for comprehensively preventing re-intubation and short-term death in critically ill medical patients, especially those with a high risk of extubation failure.


id: cord-027805-p0bhju1s
author: Wong, An-Kwok Ian
date: 2020-06-15
txt: ./txt/cord-027805-p0bhju1s.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314319/
doi: 10.1097/cce.0000000000000121
summary:
  DATA SOURCES: We searched MEDLINE and Google Scholar for "speech," "communication," "impairment," "failure," "complications," "NIPPV," "NIV," and "noninvasive ventilation." STUDY SELECTION: We included articles with patients in acute respiratory failure. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes. W ith landmark trials demonstrating the efficacy of noninvasive ventilation (NIV) in cardiogenic pulmonary edema and acute exacerbations of chronic obstructive pulmonary disease, NIV has changed the standard of care for acute respiratory failure (ARF) and reduced the amount of invasive mechanical ventilation (IMV) being used (1) (2) (3) (4) . Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation

title:
  Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review

abstract:
  OBJECTIVES: With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs. DATA SOURCES: We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.” STUDY SELECTION: We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea. DATA SYNTHESIS: Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes. CONCLUSIONS: Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.


id: cord-029392-5s5686i9
author: Zayed, Yazan
date: 2020-07-17
txt: ./txt/cord-029392-5s5686i9.txt
cache: ./cache/cord-029392-5s5686i9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366473/
doi: 10.1186/s40560-020-00468-x
summary:
  Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. CONCLUSIONS: Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. In this first network meta-analysis comparing various oxygenation strategies in patients at risk for hypoxemic respiratory failure or established respiratory failure within 7 days of surgery, we have found that NIV and HFNC were associated with a significant reduction in intubation rates and ICU-acquired infections when compared to standard oxygen therapy.

title:
  Effect of oxygenation modalities among patients with postoperative respiratory failure: a pairwise and network meta-analysis of randomized controlled trials

abstract:
  BACKGROUND: Postoperative respiratory failure is associated with increased perioperative complications. Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure. METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to September 2019. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. We performed a Bayesian network meta-analysis to calculate the odds ratio (OR) and Bayesian 95% credible intervals (CrIs). RESULTS: Nine RCTs representing 1865 patients were included (the mean age was 61.6 ± 10.2 and 64.4% were males). In comparison with standard oxygen, NIV was associated with a significant reduction in intubation rate (OR 0.23; 95% Cr.I. 0.10–0.46), mortality (OR 0.45; 95% Cr.I. 0.27–0.71), and intensive care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25–0.70). Compared to standard oxygen, HFNC was associated with a significant reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08–0.76) and ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20–0.80), but not mortality (OR 0.58; 95% Cr.I. 0.26–1.22). There were no significant differences between HFNC and NIV regarding different outcomes. In a subgroup analysis, we observed a mortality benefit with NIV over standard oxygen in patients undergoing cardiothoracic surgeries but not in abdominal surgeries. Furthermore, in comparison with standard oxygen, NIV and HFNC were associated with lower intubation rates following cardiothoracic surgeries while only NIV reduced the intubation rates following abdominal surgeries. CONCLUSIONS: Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. Moreover, NIV was associated with reduced mortality in comparison with standard oxygen.


id: cord-030131-klhg7x8z
author: Tan, Dingyu
date: 2020-08-06
txt: ./txt/cord-030131-klhg7x8z.txt
cache: ./cache/cord-030131-klhg7x8z.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407427/
doi: 10.1186/s13054-020-03214-9
summary:
  title: High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. METHODS: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. CONCLUSION: Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC after extubation did not result in increased rates of treatment failure compared with NIV. Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC as compared with NIV after extubation did not result in increased rates of treatment failure, while HFNC had better tolerance and comfort.

title:
  High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial

abstract:
  BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent post-extubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. METHODS: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). RESULTS: Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group—risk difference of − 5.8% (95% CI, − 23.8–12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of − 50.0% (95% CI, − 74.6 to − 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p < 0.050). Twenty-four hours after extubation, the respiratory rate of the HFNC group had returned to baseline, but the NIV group was still higher than the baseline. Forty-eight hours after extubation, the respiratory rates of both groups were not significantly different from the baseline. The average number of daily airway care interventions in the NIV group was 7 (5–9.3), which was significantly higher than 6 (4–7) times in the HFNC group (p = 0.006). The comfort score and incidence of nasal and facial skin breakdown of the HFNC group was also significantly better than that of the NIV group [7 (6–8) vs 5 (4–7), P < 0.001] and [0 vs 9.6%, p = 0.027], respectively. CONCLUSION: Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC after extubation did not result in increased rates of treatment failure compared with NIV. HFNC also had better tolerance and comfort than NIV. TRIAL REGISTRATION: chictr.org (ChiCTR1800018530). Registered on 22 September 2018, http://www.chictr.org.cn/usercenter.aspx


id: cord-034185-e0am7pa6
author: Piccioni, Federico
date: 2020-10-23
txt: ./txt/cord-034185-e0am7pa6.txt
cache: ./cache/cord-034185-e0am7pa6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582032/
doi: 10.1186/s13741-020-00159-z
summary:
  We do not recommend the routine use of either continuous positive airway pressure (CPAP) or non invasive ventilation (NIV) to prevent postoperative pulmonary complications, prolonged length of stay, and mortality (both in ICU and in hospital) in patients undergoing major thoracic surgery. Level of evidence: Fair Strength of recommendation: C A meta-analysis of 45 studies including almost 5800 patients showed that a single perioperative dose of intravenous dexamethasone resulted in significant reductions in pain scores and opioid use, and was associated with shorter stays in the post-anesthesia recovery room, compared with placebo or antiemetic treatment (Waldron et al. Level of evidence: Fair Strength of recommendation: A Multiple clinical trials have shown that, in patients undergoing open thoracotomy or other major surgical procedures, thoracic epidural analgesia (TEA) is superior to intravenous opioid administration in terms of postoperative pain relief, length of hospital stay, and incidence of postoperative complications (Hazelrigg et al.

title:
  Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

abstract:
  INTRODUCTION: Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. METHODS: A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. RESULTS: Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. CONCLUSIONS: These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.


id: cord-034578-i9rdubix
title: Outcomes of COVID-19 patients treated with continuous positive airway pressure outside ICU
author: Vaschetto, Rosanna
date: 2020-10-30
txt: ./txt/cord-034578-i9rdubix.txt
cache: ./cache/cord-034578-i9rdubix.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607967/
doi: 10.1183/23120541.00541-2020
summary:
  AIM: We aim at characterising a large population of Coronavirus 19 (COVID-19) patients with moderate-to-severe hypoxemic acute respiratory failure (ARF) receiving CPAP outside intensive care unit (ICU), and ascertaining whether the duration of CPAP application increased the risk of mortality for patients requiring intubation. We designed this retrospective multicentre study to describe the clinical characteristics of patients with laboratory-confirmed COVID-19 treated with CPAP outside ICU, to assess 60-day in-hospital mortality, and hospital length of stay (LOS), and to ascertain whether the duration CPAP application prior to CPAP failure affects outcome in patients requiring endotracheal intubation. This multicentre retrospective observational study on 537 patients hypoxemic ARF secondary to laboratory-confirmed COVID-19 infection, shows that CPAP applied to different therapeutic goals i.e., candidate to intubation in the case of CPAP failure and do-not-intubate in which CPAP is considered the ceiling of treatment, is feasible outside ICU.

abstract:
  AIM: We aim at characterising a large population of Coronavirus 19 (COVID-19) patients with moderate-to-severe hypoxemic acute respiratory failure (ARF) receiving CPAP outside intensive care unit (ICU), and ascertaining whether the duration of CPAP application increased the risk of mortality for patients requiring intubation. METHODS: In this retrospective, multicentre cohort study, we included COVID-19 adult patients, treated with CPAP outside ICU for hypoxemic ARF from March 1(st) to April 15(th), 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay (LOS), and 60-day in-hospital mortality. RESULTS: The study includes 537 patients with a median age of 69 (IQR, 60–76) years. Males were 391 (73%). According to predefined CPAP therapeutic goal, 397 (74%) patients were included in full treatment subgroup, and 140 (26%) in the do-not intubate (DNI) subgroup. Median CPAP duration was 4 (IQR, 1–8) days, while hospital LOS 16 (IQR, 9–27) days. Sixty-day in-hospital mortality was overall 34% (95%CI, 0.304–0.384), and 21% (95%CI, 0.169–0.249) and 73% (95%CI, 0.648–0.787) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95%CI, 0.345–0.488) for 180 (45%) CPAP failures requiring intubation, while 2% (95%CI, 0.008–0.035) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality [HR, 1.093 (95%CI, 1.010–1.184)]. CONCLUSIONS: We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.


id: cord-103020-ckuma42j
author: McDowell, G.
date: 2020-11-12
txt: ./txt/cord-103020-ckuma42j.txt
cache: ./cache/cord-103020-ckuma42j.txt
extension: .txt
mime: text/plain
url: http://medrxiv.org/cgi/content/short/2020.11.08.20227892v1?rss=1
doi: 10.1101/2020.11.08.20227892
summary:
  Background Outcomes for chronic obstructive pulmonary disease (COPD) patients with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). The primary outcome of this study was time to readmission or death at 12 months in patients receiving home-NIV versus a retrospectively identified control cohort of 27 patients with hypercapnic COPD who had not been referred for home-NIV. The present study retrospectively analysed all patients who were commenced on therapy over the first 12 months of this service, with aim of determining whether outcomes similar to RCTs were achieved in a real-world cohort of hypercapnic COPD patients with typical comorbidities (which would have excluded many from NIV RCTs) who are managed with remote-monitored home NIV. Changes in healthcare usage (number of hospital admissions, OBDs, and respiratory nurse home visits) and capillary blood gas PCO 2 and bicarbonate between NIV users, NIV non-users and the control cohort were analysed using Wilcoxon signed-rank test.

title:
  Two-way remote monitoring allows effective and realistic provision of home-NIV to COPD patients with persistent hypercapnia.

abstract:
  Background Outcomes for chronic obstructive pulmonary disease (COPD) patients with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to assess outcomes of home-NIV in hypercapnic COPD patients managed remotely. Methods Retrospective analysis of a dataset of 46 COPD patients with persistent hypercapnic respiratory failure who commenced home-NIV managed by two-way remote monitoring (Lumis, AirView, ResMed) between February 2017 and January 2018. The primary outcome of this study was time to readmission or death at 12 months in patients receiving home-NIV versus a retrospectively identified control cohort of 27 patients with hypercapnic COPD who had not been referred for home-NIV. Results The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38-250.63) versus the control cohort (66 days, 95% CI 21.9-110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77-394.23) and 70 days (95% CI, 55.31-84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9mmol/L (p<0.0151) and daytime PCO2 2.2kPa (p<0.032) demonstrate efficacy of home-NIV. A median reduction of 14 occupied bed days per annum versus previous year prior to NIV was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion These findings confirm the benefits of home-NIV in clinical practice and support the use of two-way remote monitoring as a feasible solution to managing the delivery of home-NIV for COPD patients with persistent hypercapnia.


id: cord-260220-f1tpkw1o
author: Timenetsky, Karina T
date: 2011-09-28
txt: ./txt/cord-260220-f1tpkw1o.txt
cache: ./cache/cord-260220-f1tpkw1o.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/1756-0500-4-375
doi: 10.1186/1756-0500-4-375
summary:
  In this study we describe the respiratory profile, the mortality rate, and the benefit of using NIV in patients with confirmed diagnosis of influenza AH1N1 who were admitted in the ICU during the year 2009. To confirm the cases of swine-origin influenza A H1N1 virus by real-time RT-PCR (RT-RTPCR), nasopharyngeal-swab samples were collected at hospital admission and respiratory secretions obtained from intubated patients. Noninvasive mechanical ventilation was instituted in the confirmed influenza A H1N1 when there were signs of acute respiratory failure at hospital admission or during ICU stay. Patients that were admitted with signs of acute respiratory failure as described above, with extreme levels of hypoxemia (PaO2 lower than 60 mmHg with a high oxygen concentration delivered by a mask with a non re-breathing system -100%), low level of consciousness, or refuse to use NIV were promptly intubated at ICU admission.

title:
  High success and low mortality rates with non-invasive ventilation in influenza A H1N1 patients in a tertiary hospital

abstract:
  BACKGROUND: In 2009, an outbreak of respiratory illness caused by influenza A H1N1 virus occurred worldwide. Some patients required Intensive Care Unit (ICU) admission. The use of non-invasive ventilation (NIV) in these patients is controversial, as the aerosol dispersion may contaminate the environment and health-care co-workers. METHODS: Describe the respiratory profile, the mortality rate, and the benefit of using NIV in patients with confirmed diagnosis of influenza AH1N1 who were admitted in the ICU during the year 2009. RESULTS: A total of 1, 401 cases of influenza A H1N1 were confirmed in our hospital by real-time RT-PCR in 2009, and 20 patients were admitted to the ICU. The patients' ages ranged from 18 to 74 years (median of 42). Acute Respiratory Failure (ARF) was present in 70% of patients. The median Acute Physiology and Chronic Health Evaluation II score was 7 (range 7 to 25). Of the 14 patients who developed ARF, 85.7% needed NIV and 14% needed invasive MV at admission. Our success rate (41.6%) with NIV was higher than that described by others. The hospital mortality rate was 2.1%. When influenza A H1N1 arrived in Brazil, the disease was already on endemic alert in other countries. The population was already aware of the symptoms and the health-care system of the treatment. This allowed patients to be properly and promptly treated for influenza A H1N1, while health-care workers took protective measures to avoid contamination. CONCLUSION: In our study we found a high success and low mortality rates with non-invasive ventilation in patients with influenza A H1N1.


id: cord-267537-akzydy7l
title: An antibody against the F glycoprotein inhibits Nipah and Hendra virus infections
author: Dang, Ha V.
date: 2019-09-30
txt: ./txt/cord-267537-akzydy7l.txt
cache: ./cache/cord-267537-akzydy7l.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/31570878/
doi: 10.1038/s41594-019-0308-9
summary:
  Cryo-electron microscopy, triggering and fusion studies show the antibody binds to a prefusion-specific quaternary epitope, conserved in NiV F and HeV F glycoproteins, and prevents membrane fusion and viral entry. To elucidate the mechanism of 5B3-mediated neutralization of NiV and HeV, we determined a cryo-EM structure of a stabilized NiV F ectodomain trimer in complex with the 5B3 antibody Fab fragment at 3.5 Å resolution (Fig. 2a,b , Table 1 and Extended Data 1). To further study the mechanism of action of 5B3/h5B3.1 in the context of a full-length, membrane-embedded F glycoprotein, we carried out cell-cell fusion assays in the presence of varying concentrations of mAbs. We observed that 5B3 and h5B3.1 prevented NiV F-and HeV F-mediated membrane fusion in a concentration-dependent manner, consistent with the expectation that trapping F in the prefusion conformation actually resulted in inhibition of membrane fusion (Figs.

abstract:
  Nipah virus (NiV) and Hendra virus (HeV) are zoonotic henipaviruses (HNVs) responsible for outbreaks of encephalitis and respiratory illness with fatality rates of 50–100%. No vaccines or licensed therapeutics currently exist to protect humans against NiV or HeV. HNVs enter host cells by fusing the viral and cellular membranes via the concerted action of the attachment (G) and fusion (F) glycoproteins, the main targets of the humoral immune response. Here, we describe the isolation and humanization of a potent monoclonal antibody cross-neutralizing NiV and HeV. Cryo-electron microscopy, triggering and fusion studies show the antibody binds to a prefusion-specific quaternary epitope, conserved in NiV F and HeV F glycoproteins, and prevents membrane fusion and viral entry. This work supports the importance of the HNV prefusion F conformation for eliciting a robust immune response and paves the way for using this antibody for prophylaxis and post-exposure therapy with NiV- and HeV-infected individuals.


id: cord-268049-7xqln70d
title: COVID-19 respiratory support in the emergency department setting
author: Montrief, Tim
date: 2020-08-08
txt: ./txt/cord-268049-7xqln70d.txt
cache: ./cache/cord-268049-7xqln70d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.ajem.2020.08.001
doi: 10.1016/j.ajem.2020.08.001
summary:
  DISCUSSION: Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. [29] [30] [31] [32] Based on currently available evidence, the WHO states that "HFNC and NIV systems with good interface fitting do not create widespread dispersion of exhaled air and therefore should be associated with [a] low risk of airborne transmission." 15 The risk of respiratory pathogen transmission when using HFNC is subject to a variety of factors, including the duration of support, maximal flow rate, patient sneezing or coughing, cannula fit, and patient cooperation. 35 Many guidelines, including those by Australian and New Zealand Intensive Care Society (ANZICS), the WHO, and the Surviving Sepsis Campaign recommend the use of HFNC in COVID-19 patients presenting with acute hypoxemic respiratory failure unresponsive to conventional oxygen therapy. 20 Notably, the SCCM guidelines on the management of critically ill patients with COVID-19 recommend "a trial of NIV with close monitoring and shortinterval assessment for worsening of respiratory failure" if HFNC is not available and there is no urgent indication for intubation.

abstract:
  INTRODUCTION: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19), may result in severe complications, multiorgan dysfunction, acute respiratory failure, and death. SARS-CoV-2 is highly contagious and places healthcare workers at significant risk, especially during aerosol-generating procedures, including airway management. OBJECTIVE: This narrative review outlines the underlying respiratory pathophysiology of patients with COVID-19 and discusses approaches to airway management in the emergency department (ED) based on current literature. DISCUSSION: Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. Among hospitalized patients, 10–20% require intensive care unit admission, and 3–10% require intubation and mechanical ventilation. While providing respiratory support for these patients, proper infection control measures, including adherence to personal protective equipment policies, are necessary to prevent nosocomial transmission to healthcare workers. A structured approach to respiratory failure in these patients includes the use of exogenous oxygen via nasal cannula or non-rebreather, as well as titrated high-flow nasal cannula and non-invasive ventilation. This review offers several guiding principles and resources designed to be adapted in conjunction with local workplace policies for patients requiring endotracheal intubation. CONCLUSIONS: While the fundamental principles of acute respiratory failure management are similar between COVID-19 and non-COVID-19 patients, there are some notable differences, including a focus on provider safety. This review provides an approach to airway management and respiratory support in the patient with COVID-19.


id: cord-276238-2hv46ftk
title: The role of helmet-delivered noninvasive pressure support ventilation in COVID-19 patients
author: Ing, Richard J.
date: 2020-05-08
txt: ./txt/cord-276238-2hv46ftk.txt
cache: ./cache/cord-276238-2hv46ftk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1053/j.jvca.2020.04.060
doi: 10.1053/j.jvca.2020.04.060
abstract: nan
summary:
  5 The aim of this stand-alone editorial is to examine the role of helmet delivered continuous positive airway pressure (CPAP) noninvasive ventilation (NIV) as an adjunct to mechanical ventilation in patients requiring respiratory support in COVID-19. The recent Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 consensus statement agrees that; following admission for COVID-19, each patient may progress at a variable rate to either recovery, with minimal oxygen requirements and no ventilatory support, or a worsening of the disease process and the need for an escalation in NIV and mechanical ventilation. 11 The usual features of typical ARDS, recently termed the H-type, in COVID-19 patients are a progressive deteriorating lung compliance requiring increased inspired oxygen concentration(FiO 2 ), high positive end expiratory pressure (PEEP), prone ventilation, sedation with paralysis and inotropic support.


id: cord-290684-3f6prlqy
author: Duan, Jun
date: 2020-07-29
txt: ./txt/cord-290684-3f6prlqy.txt
cache: ./cache/cord-290684-3f6prlqy.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0735675720306665?v=s5
doi: 10.1016/j.ajem.2020.07.071
summary:
  title: Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. CONCLUSIONS: In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. The Asian Critical Care Clinical Trials Group has suggested that the HFNC and NIV only can be used in COVID-19 patients with mild acute respiratory distress syndrome (ARDS) [21] .

title:
  Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

abstract:
  BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. METHODS: This study was performed in four hospitals of China from January to March 2020. We retrospectively enrolled 23 and 13 COVID-19 patients who used HFNC and NIV as first-line therapy, respectively. RESULTS: Among the 23 patients who used HFNC as first-line therapy, 10 experienced HFNC failure and used NIV as rescue therapy. Among the 13 patients who used NIV as first-line therapy, one (8%) used HFNC as rescue therapy due to NIV intolerance. The duration of HFNC + NIV (median 7.1, IQR: 3.5–12.2 vs. 7.3, IQR: 5.3–10.0 days), intubation rate (17% vs. 15%) and mortality (4% vs. 8%) did not differ between patients who used HFNC and NIV as first-line therapy. In total cohorts, 6 (17%) patients received intubation. Time from initiation of HFNC or NIV to intubation was 8.4 days (IQR: 4.4–18.5). And the time from initiation of HFNC or NIV to termination in patients without intubation was 7.1 days (IQR: 3.9–10.3). Among all the patients, C-reactive protein was independently associated with intubation (OR = 1.04, 95% CI: 1.01–1.07). In addition, no medical staff got nosocomial infection who participated in HFNC and NIV management. CONCLUSIONS: In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. And no medical staff got nosocomial infection during this study.


id: cord-293170-ir2y6sfz
title: COVID-19 patients: when and whom to ventilate?
author: Lal, Tusharindra
date: 2020-08-19
txt: ./txt/cord-293170-ir2y6sfz.txt
cache: ./cache/cord-293170-ir2y6sfz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.4266/acc.2020.00451
doi: 10.4266/acc.2020.00451
abstract: nan
summary:
  As the cases of severe acute respiratory syndrome (SARS) increase rapidly, finding ICU beds, ventilators, intensivists, and critical care nurses remains a big challenge. A metaanalysis that included 1,084 patients from eight selected studies showed that high-flow nasal cannula (HFNC) treatment could reduce the rate of endotracheal intubation and ICU mortality [3] . A more recent review concluded that HFNC and NIV should be reserved for patients with mild acute respiratory distress syndrome until further data are available [4]. With medical facilities severely stretched out, especially in resource-limited regions like India and other developing nations with large population clusters, selective use of HFNC or NIV may reduce the need for ventilated ICU beds while achieving desired clinical results. Large RCTs or well-designed observational studies are needed to define stratification of COVID-19 patients for the best choice of initial respiratory support keeping in mind the resources available and the judicious and timely use of invasive ventilation.


id: cord-303292-iheq50ub
title: How to ventilate obese patients in the ICU
author: De Jong, Audrey
date: 2020-10-23
txt: ./txt/cord-303292-iheq50ub.txt
cache: ./cache/cord-303292-iheq50ub.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33095284/
doi: 10.1007/s00134-020-06286-x
summary:
  Regarding mechanical ventilation in patients with and without acute respiratory distress syndrome (ARDS), low tidal volume (6 ml/kg of predicted body weight) and moderate to high positive end-expiratory pressure (PEEP), with careful recruitment maneuver in selected patients, are advised. During invasive mechanical ventilation, patients with obesity are more prone to lung collapse and require higher PEEP to avoid it; low V T is calculated on predicted body weight. In a randomized controlled trial of the same team comparing HFNC to standard oxygen [87] in high-risk non-hypercapnic patients including 22% of patients with obesity, the study was stopped due to low recruitment after 155 patients, without any difference in extubation failure rate found between the two groups. PBW predicted body weight, PEEP positive end-expiratory pressure, ARDS acute respiratory distress syndrome, ECMO extracorporeal membrane oxygenation, CPAP continuous positive airway pressure, NIV noninvasive ventilation, HFNC high-flow nasal cannula oxygen patients.

abstract:
  Obesity is an important risk factor for major complications, morbidity and mortality related to intubation procedures and ventilation in the intensive care unit (ICU). The fall in functional residual capacity promotes airway closure and atelectasis formation. This narrative review presents the impact of obesity on the respiratory system and the key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity. Non-invasive strategies should first optimize body position with reverse Trendelenburg position or sitting position. Noninvasive ventilation (NIV) is considered as the first-line therapy in patients with obesity having a postoperative acute respiratory failure. Positive pressure pre-oxygenation before the intubation procedure is the method of reference. The use of videolaryngoscopy has to be considered by adequately trained intensivists, especially in patients with several risk factors. Regarding mechanical ventilation in patients with and without acute respiratory distress syndrome (ARDS), low tidal volume (6 ml/kg of predicted body weight) and moderate to high positive end-expiratory pressure (PEEP), with careful recruitment maneuver in selected patients, are advised. Prone positioning is a therapeutic choice in severe ARDS patients with obesity. Prophylactic NIV should be considered after extubation to prevent re-intubation. If obesity increases mortality and risk of ICU admission in the overall population, the impact of obesity on ICU mortality is less clear and several confounding factors have to be taken into account regarding the “obesity ICU paradox”. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06286-x) contains supplementary material, which is available to authorized users.


id: cord-309518-seonrtn3
title: Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome
author: Alraddadi, Basem M.
date: 2019-03-18
txt: ./txt/cord-309518-seonrtn3.txt
cache: ./cache/cord-309518-seonrtn3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30884185/
doi: 10.1111/irv.12635
summary:
  BACKGROUND: Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied. [9] [10] [11] [12] While NIV may initially avoid the need for intubation and invasive mechanical ventilation (MV) , several studies have reported high failure rates and the need for invasive ventilation among patients with severe acute respiratory distress syndrome (ARDS) and an association with increased mortality. 12 In a recent analysis from the LUNG SAFE study on unselected patients with ARDS, NIV was associated with higher intensive care unit (ICU) mortality in patients with the ratio of partial pressure of oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ) lower than 150 mm Hg. 12 The role of NIV in AHRF secondary to viral respiratory infections is unclear.

abstract:
  BACKGROUND: Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied. METHODS: Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV). RESULTS: Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90‐day mortality (propensity score‐adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27). CONCLUSIONS: In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.


id: cord-312864-km07zhn1
author: Potalivo, A.
date: 2020-08-15
txt: ./txt/cord-312864-km07zhn1.txt
cache: ./cache/cord-312864-km07zhn1.txt
extension: .txt
mime: text/plain
url: http://medrxiv.org/cgi/content/short/2020.08.13.20174615v1?rss=1
doi: 10.1101/2020.08.13.20174615
summary:
  title: Sixty-day mortality among 520 Italian hospitalized COVID-19 patients according to the adopted ventilatory strategy in the context of an integrated multidisciplinary clinical organization: a population-based cohort study 4, 8, 9, 11 Thus, the number of hospitalized COVID-19 patients treated with oxygen supplementation and NIV has been markedly underreported leading to inaccurate information regarding the overall use of the different respiratory supports and outcomes. Using clinical and demographics information routinely collected in a unique database including all residents in the entire province, we performed the present population-based cohort study with the following aims: 1) to describe the characteristics of hospitalized COVID-19 patients, 2) to examine patient outcomes overall and stratified by the adopted respiratory support, 3) to describe the organization of local healthcare system. It should be noted that in our study we documented for patients treated with NIV and/or IMV -despite a similar P/F ratio (median 98.0; IQR 84.0-124.5) and a higher SOFA score (median 8; IQR 6-10)-a considerably lower 60-day mortality rate, overall and in individual groups.

title:
  Sixty-day mortality among 520 Italian hospitalized COVID-19 patients according to the adopted ventilatory strategy in the context of an integrated multidisciplinary clinical organization: a population-based cohort study

abstract:
  Background: Among COVID-19 patients, the decision of which ventilation strategy to adopt is crucial and not guided by existing outcome evidence. We described the clinical characteristics and outcomes of hospitalized COVID-19 patients according to the adopted respiratory strategy. Methods: Population-based cohort study including all COVID-19 patients (26/02/2020-18/04/2020) within Rimini Italian province. Hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (group Oxygen), NIV (group NIV-only), IMV (group IMV-only), and IMV after a NIV trial (group IMV-after-NIV). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab. Findings: We identified 1,424 symptomatic patients: 520 (36.5%) were hospitalized, the remaining 904 (63.5%) were treated at home with no 60-days death. According to the respiratory support, 408 (78.5%) were assigned to Oxygen, 46 (8.8%) to NIV-only, 25 (4.8%) to IMV-after-NIV, and 41 (7.9%) to IMV-only groups. There was no significant difference in the P/F at IMV inception among IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p = 0.165). Compared with Oxygen group, the 60-day mortality risk significantly increased for IMV-after-NIV (HR 2.776; p=0.024) and IMV-only group (HR 2.966; p=0.001). Conclusions: This study provides a population-based figure of the impact of the COVID-19 epidemic. A similar 60-days mortality risk was found for patients undergoing immediate IMV and those intubated after a NIV trial. Many patients had a favorable outcome after prolonged IMV.


id: cord-313639-qpt47sx2
title: Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China
author: Zheng, Yi
date: 2020-05-20
txt: ./txt/cord-313639-qpt47sx2.txt
cache: ./cache/cord-313639-qpt47sx2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1631/jzus.b2000174
doi: 10.1631/jzus.b2000174
summary:
  OBJECTIVE: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. For this retrospective study, we analyzed data from patients admitted between Jan. 22 and Mar. 5, 2020, who had been diagnosed (according to the guidance of NHC (2020a)) with SARS-CoV-2 pneumonia in the ICU in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. In this single-center case series of 34 ICU patients with SARS-CoV-2 infection in Hangzhou, China, 97.1% (33 cases) of patients had complications caused by ARDS, 44.1% (15) received IMV, 55.9% (19) only needed noninvasive respiratory support.

abstract:
  OBJECTIVE: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. METHODS: A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared. RESULTS: The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization CONCLUSIONS: Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.


id: cord-313816-7d8x7fjp
author: Cinesi Gómez, C.
date: 2020-05-07
txt: ./txt/cord-313816-7d8x7fjp.txt
cache: ./cache/cord-313816-7d8x7fjp.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S234119292030069X
doi: 10.1016/j.redare.2020.05.001
summary:
  title: Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. It includes a more detailed description of the recommendations for the use of non-invasive respiratory support (NIRS) in the management of acute respiratory failure (ARF) secondary to infection by the new SARS-CoV-2 coronavirus that causes the disease called COVID-19 that is intended to supplement the regularly updated recommendations issued by the Ministry of Health, Consumer Affairs and Social Welfare (MH) 1,2 .

title:
  Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

abstract:
  Abstract Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.


id: cord-327622-ezgufe24
author: Kaur, Ramandeep
date: 2020-09-23
txt: ./txt/cord-327622-ezgufe24.txt
cache: ./cache/cord-327622-ezgufe24.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03231-8
doi: 10.1186/s13054-020-03231-8
summary:
  • When removing the endotracheal tube, simultaneously turn off the ventilator • Avoid disconnecting ETT from the ventilator circuit before extubation to reduce spray of contaminated aerosols 9 Transport • Place a filter between the artificial airway and the transport ventilator circuit • Use HME that has filter function (HME-F) • Consider clamping the ETT before disconnection from ventilator circuit 10 Bronchoscopy assist* 2 in vivo [44, 45] • For spontaneously breathing patients, place a surgical mask on patient''s face (Fig. 7a, b) • Use NIV mask with examination port for patients on NIV (Fig. 7d) • Use swivel adapter to insert bronchoscope for intubated patient (Fig. 7c) Abbreviations: HFNC high-flow nasal cannula, IPPB intermittent positive pressure breathing, HME heat moisture exchanger, ETT endotracheal tube, NIV non-invasive ventilation *Based on CDC guidelines, these procedures should ideally be performed in airborne infection isolation rooms entrainment or nonrebreather mask [53] .

title:
  Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19

abstract:
  Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.


id: cord-330704-4piesfxu
title: Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19
author: Avdeev, Sergey N.
date: 2020-10-01
txt: ./txt/cord-330704-4piesfxu.txt
cache: ./cache/cord-330704-4piesfxu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33067061/
doi: 10.1016/j.ajem.2020.09.075
summary:
  MATERIALS & METHODS: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. However, there were major concerns that HFNC or NIV may create risks for health care workers (HCWs) because of SARS-CoV-2 transmission via aerosols [6] while the data on the efficacy of noninvasive modalities in COVID-19-associated AHRF are still limited [6] [7] [8] . This study suggests that the use of NIV is feasible in acute hypoxemic respiratory failure in patients with COVID-19 outside intensive care unit and can be considered as an effective means to improve oxygenation in patients not responding to conventional oxygen therapy. In summary, we have shown that NIV is feasible in patients with COVID-19 with acute hypoxemic respiratory failure outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

abstract:
  AIM: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF) [1]. We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. MATERIALS & METHODS: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. RESULTS: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO(2), D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. CONCLUSIONS: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.


id: cord-335078-z7k59k8o
author: Burton-Papp, Helmi C.
date: 2020-07-31
txt: ./txt/cord-335078-z7k59k8o.txt
cache: ./cache/cord-335078-z7k59k8o.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33110499/
doi: 10.12688/f1000research.25384.1
summary:
  In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Here we build on this literature offering an examination of changes in oxygenation, as measured by PaO 2 /FiO 2 , across multiple episodes of prone positioning in conscious patients, with moderate to severe hypoxia, undergoing non-invasive ventilation following admission to the intensive care unit for advanced respiratory support. Although there is only limited data available on the effectiveness of non-invasive ventilation (NIV) in COVID-19, early provision of NIV in moderate to severe acute hypoxic respiratory failure is associated with reduced ICU mortality and intubation rate 12 . This is a retrospective report on a subgroup of 20 patients with severe COVID-19 who were able to self-prone while receiving non-invasive ventilation in the ICU, among a grand total of 81 patients admitted to the ICU during the study period.The primary outcome reported by the authors is change in PaO2/FiO2 ratio while in prone position.

title:
  Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

abstract:
  Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care. Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO (2)/FiO (2) (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.


id: cord-335975-m6lkrehi
title: Proceedings of Réanimation 2018, the French Intensive Care Society International Congress
author: nan
date: 2018-02-05
txt: ./txt/cord-335975-m6lkrehi.txt
cache: ./cache/cord-335975-m6lkrehi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-017-0345-7
doi: 10.1186/s13613-017-0345-7
abstract: nan
summary:
  A qSOFA score relying on 3 simple clinical criteria (respiratory rate, mental status and systolic blood pressure) has been proposed to better identify septic patients with associated higher mortality outside the intensive care unit (Seymour CW et al., JAMA 2016) . We propose to determine whether the arterial oxygen pressure (PaO2) at intensive care unit (ICU) admission affects mortality at day 28 (D28) in patients with septic shock subjected to mechanical out-of-hospital ventilation. Conclusion: In this study, we report a significant association between hyperoxemia at ICU admission and mortality at D28 in patients with septic shock subjected to pre-hospital invasive mechanical ventilation. The aim of this study was to describe outcome of pediatric patient with hematologic disease hospitalized in our intensive care unit for respiratory failure and to investigate the clinical variables associated with mortality.


id: cord-336690-ajmuaw10
title: COVID-19: Respiratory support outside the intensive care unit
author: McEnery, Tom
date: 2020-04-09
txt: ./txt/cord-336690-ajmuaw10.txt
cache: ./cache/cord-336690-ajmuaw10.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32278367/
doi: 10.1016/s2213-2600(20)30176-4
abstract: nan
summary:
  The optimal mode of respiratory support for individuals with severe coronavirus disease 2019 (COVID-19) before invasive mechanical ventilation (IMV) is currently a subject of much debate. Recently published guidelines 1 and a Comment 2 differ substantially to other guidelines in this regard, with some advocating high flow nasal cannulae (HFNC) over non-invasive ventilation (NIV), 1,2 or vice versa (NHS guidance). In acute respiratory distress syndrome (ARDS), early intubation was associated with survival benefit when PaO 2 /FiO 2 ratio was <150 when compared with NIV. Conversely, data from only one study 6 on the severe acute respiratory syndrome (SARS) outbreak suggest that NIV can successfully avoid intubation. Non-invasive ventilation of patients with acute respiratory distress syndrome. Effectiveness of non-invasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure


id: cord-344641-rog2h4g7
author: Franco, Cosimo
date: 2020-08-03
txt: ./txt/cord-344641-rog2h4g7.txt
cache: ./cache/cord-344641-rog2h4g7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1183/13993003.02130-2020
doi: 10.1183/13993003.02130-2020
summary:
  INTRODUCTION: The Coronavirus 2(SARS-CoV-2) outbreak spread rapidly in Italy and the lack of intensive care unit(ICU) beds soon became evident, forcing the application of noninvasive respiratory support(NRS) outside the ICU, raising concerns over staff contamination. Data were collected including medication, mode and usage of the NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation(NIV)), length of stay in hospital, endotracheal intubation(ETI) and deaths. Variables recorded for each patient were obtained for the period from March 1 st until May 10 th 2020 and included the following: demographics (age, sex), comorbidities (type and number), respiratory condition at admission (respiratory rate (RR), PaO 2 /FiO 2 ratio), medications (type of drugs prescribed), mode and usage of the NRS (ventilatory settings for NIV and CPAP, and flow rate for HFNC), and stay in hospital (days).

title:
  Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia

abstract:
  INTRODUCTION: The Coronavirus 2(SARS-CoV-2) outbreak spread rapidly in Italy and the lack of intensive care unit(ICU) beds soon became evident, forcing the application of noninvasive respiratory support(NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff, the feasibility, and outcomes of NRS applied to patients outside the ICU. METHODS: In this observational study, data from 670 consecutive patients with confirmed COVID-19 referred to the Pulmonology Units in nine hospitals between March 1st and May 10th,2020 were analysed. Data were collected including medication, mode and usage of the NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation(NIV)), length of stay in hospital, endotracheal intubation(ETI) and deaths. RESULTS: Forty-two health-care workers (11.4%) tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean age was 68 (sd 13) years. The PaO(2)/FiO(2) ratio at baseline was 152±79, and the majority of patients (49.3%) were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9% with 16%, 30%, and 30%, while the total ETI rate was 27% with 29%, 25% and 28%, for HFNC, CPAP, and NIV, respectively, and the relative probability to die was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression. CONCLUSIONS: The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination.


id: cord-346565-vsgbmxzv
author: Cascella, Marco
date: 2020-07-27
txt: ./txt/cord-346565-vsgbmxzv.txt
cache: ./cache/cord-346565-vsgbmxzv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/medicina56080377
doi: 10.3390/medicina56080377
summary:
  Treatment of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia (CARDS) represents a clinical challenge, requiring often invasive mechanical ventilation (IMV). Despite that at the beginning of the pandemic, early invasive mechanical ventilation was indicated as the optimal strategy for CARDS management, in COVID-19 pneumonia the clinical picture of severe hypoxemia contrasted with the typical ARDS respiratory mechanics. Clinical experience, for example, suggested that non-invasive ventilation (NIV) has a role of primary importance in the management of CARDS as it can improve oxygenation, limiting the work of the respiratory muscles and preventing the onset of the patient self-inflicted lung injury (P-SILI) [2] . In this setting, adding the prone position to NIV could improve oxygenation, decrease respiratory effort, reducing self-induced lung injury, and avoid the need of intubation and invasive ventilation, which could be particularly useful in the case of reduced availability of intensive care unit (ICU) beds [4] [5] [6] .

title:
  Rapid and Impressive Response to a Combined Treatment with Single-Dose Tocilizumab and NIV in a Patient with COVID-19 Pneumonia/ARDS

abstract:
  Treatment of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia (CARDS) represents a clinical challenge, requiring often invasive mechanical ventilation (IMV). Since the pathogenesis of CARDS it probably involves a direct viral attack to pulmonary and endothelium cells, and immune-mediated inflammation with dysfunctional coagulation, it was suggested to interfere with interleukin-6 (IL-6) activity by using the IL-6 receptor monoclonal antibody tocilizumab (TCZ). We reported the case of a 54-year-old 100 kg male COVID-19 patient (BMI 29) with severe respiratory insufficiency featuring dyspnea and hypoxia (SpO(2) 89% on room; PaO(2) 53 mmHg). Despite treatment with antiviral and non-invasive ventilation (NIV), after 24 h there was a progressive worsening of clinical conditions with higher fever (40 °C), increased dyspnea, and hypoxia (PaO(2)/FiO(2) or P/F ratio of 150). The patient was at the limit to be sedated and intubated for IMV. He was treated with tocilizumab (8 mg/Kg i.v., single shot 800 mg) and NIV in the prone positioning. After only 96 h, the clinical, laboratory, and imaging findings showed incredible improvement. There was an important gain in oxygenation (P/F 300), a decrease of C-reactive protein values, and a decrease of the fever. Both the neutrophil-to-lymphocyte ratio (NLR) and the derived NLR ratio dropped down to 44%. Chest imaging confirmed the favorable response. This case suggested that for CARDS management efforts are needed for reducing its underlying inflammatory processes. Through a multiprofessional approach, the combination of IL-6-targeting therapies with calibrated ventilatory strategies may represent a winning strategy for improving outcomes.


id: cord-352059-1bjskqyg
author: Gupta, Nivedita
date: 2020-04-28
txt: ./txt/cord-352059-1bjskqyg.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32242875/
doi: 10.4103/ijmr.ijmr_594_20
summary:
  The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, which is the apex laboratory for viral diagnosis and research in India, optimized the conventional and real-time PCR assays targeting different genomic regions of SARS-CoV-2 and initiated testing of suspected cases. Before initiating testing of clinical specimens from suspected cases of SARS-CoV-2, each VRDL shared results from the rRT-PCR runs performed with positive and negative controls with the apex laboratory (NIV, Pune). Expansion of testing capabilities and selection of testing laboratories for SARS-CoV-2: Following the increase in the load of screening samples from suspected cases with symptoms and travel history to China or asymptomatic persons with travel history to Wuhan after January 15, 2020, it was decided that strategically located VRDLs needed to start testing for SARS-CoV-2 in addition to Thereafter, NCDC, Delhi, initiated independent testing; however, results were shared with ICMR on a daily basis.

title:
  Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories

abstract:
  BACKGROUND & OBJECTIVES: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. METHODS: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea. RESULTS: Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive. INTERPRETATION & CONCLUSIONS: Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.


id: cord-352577-h3652seb
title: Expanding the Use of Noninvasive Ventilation During an Epidemic
author: Kopić, Jasminka
date: 2014-08-27
txt: ./txt/cord-352577-h3652seb.txt
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mime: text/plain
url: https://doi.org/10.1017/dmp.2014.71
doi: 10.1017/dmp.2014.71
summary:
  4 When appropriately indicated and promptly administered, NIV offers an alternative to tracheal intubation, sedation, risk of infection, and myriad complications associated with invasive ventilation, and it can promote rapid respiratory recovery, and reduce a patient''s dependence on critical care facilities. Rello et al described NIV use at ICU admission in 1 of 3 patients with H1N1 virus and respiratory failure, but 75% of them had an unfavorable clinical course and required tracheal intubation and invasive mechanical ventilation. In a position statement, the Australian Society for Infectious Diseases recommends "reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation." 31 The UK Department of Health, in "Guidance for infection control in critical care for pandemic influenza," approved the use of NIV under strict infection control measures.

abstract:
  Noninvasive ventilation (NIV) is a proved and effective therapeutic option for some patients with respiratory failure. During an epidemic, NIV can free up respirators and other intensive care unit equipment for patients with respiratory insufficiency whose survival depends exclusively on invasive ventilation. Some guidelines have indicated that NIV is potentially hazardous and should not be recommended for use during epidemics, given the perceived potential risk of transmission from aerosolized pathogen dispersion to other patients or medical staff. Conversely, some reports of previous epidemics describe NIV as a very efficient and safe modality of respiratory support, if strict infection control measures are implemented. We discuss NIV use during epidemics and indicate the need for prospective randomized clinical studies on the efficacy of NIV in epidemic conditions to provide important information to the current body of literature. Meanwhile, the use of NIV under strict infection control guidelines should be incorporated into epidemic preparedness planning. (Disaster Med Public Health Preparedness. 2014;8:1-5)


id: cord-352850-as12ll8s
author: Wang, Tao
date: 2020-06-23
txt: ./txt/cord-352850-as12ll8s.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.1097/ccm.0000000000004473
doi: 10.1097/ccm.0000000000004473
summary:
  title: Clinical Features of Coronavirus Disease 2019 Patients With Mechanical Ventilation: A Nationwide Study in China Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40–6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65–12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85–16.12; p = 0.002). Compared with NIV group, IMV cases had higher levels of lactate dehydrogenase, d-dimer, CRP and WBC count, and lower levels of albumin and oxygenation index (Table E2 , Supplemental Digital Content 1, http://links.lww.com/CCM/ F609); and showed a higher incidence of elevated d-dimer at admission with multivariate logistic regression analysis (>1.5 mg/L; HR, 3.05; 95% CI, 1.07-8.69, p = 0.037) ( Table 1) .

title:
  Clinical Features of Coronavirus Disease 2019 Patients With Mechanical Ventilation: A Nationwide Study in China

abstract:
  OBJECTIVES: The outbreak of coronavirus disease 2019 is becoming a worldwide pandemic. Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China. DESIGN: Prospective observational study. SETTING: The rapid spread of severe acute respiratory syndrome coronavirus 2 has infected more than 7.7 million people and caused more than 423,000 deaths. PATIENTS: Adult hospitalized coronavirus disease 2019 patients with mechanical ventilation from 557 hospitals from China. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From a nationwide cohort, 141 coronavirus disease 2019 cases with mechanical ventilation were extracted from 1,590 cases. Cigarette smoke, advanced age, coexisting chronic illness, elevated systolic blood pressure, high body temperature, and abnormal laboratory findings are common in these ventilated cases. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40–6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65–12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85–16.12; p = 0.002). Compared with patients with noninvasive mechanical ventilation, patients who needs invasive mechanical ventilation showed higher rate of elevated d-dimer (> 1.5 mg/L) at admission (hazard ratio, 3.28, 95% CI, 1.07–10.10; p = 0.039). CONCLUSIONS: The potential risk factors of elevated d-dimer level could help clinicians to identify invasive mechanical ventilation requirement at an early stage, and coexisting chronic obstructive pulmonary disease or chronic renal disease are independent risk factors associated with fatal outcome in coronavirus disease 2019 patients with mechanical ventilation.


id: cord-354330-pud2rqxk
author: Pirzada, Abdul Rouf
date: 2020-06-17
txt: ./txt/cord-354330-pud2rqxk.txt
cache: ./cache/cord-354330-pud2rqxk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s41782-020-00092-7
doi: 10.1007/s41782-020-00092-7
summary:
  The procedures that are believed to have a potential to generate aerosols and droplets as a source of respiratory pathogens include positive pressure ventilation (bilevel positive airway pressure (BPAP) and continuous positive airway pressure (CPAP)), endotracheal intubation, airway suction, high-frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy [5] [6] [7] . In the hospital, the procedures that are believed to or have a potential to generate aerosols and droplets as a source of respiratory pathogens include positive pressure ventilation (BiPAP and CPAP), endotracheal intubation, airway suction, high-frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy [5, 8] . NIV in hospital, in a setting of suspected or confirmed case of COVID-19, warrants infectious disease protocol of isolation in negative pressure room preferably with an anteroom and attached washroom (well ventilated) and personal protective equipment for attending staff; however, it is not possible in high volume patient inflow.

title:
  Management of Aerosol during Noninvasive Ventilation for Patients with Sleep-Disordered Breathing: Important Messages during the COVID-19 Pandemic

abstract:
  With the advent of COVID-19 infection and its rapid spread, preventive strategies are being developed worldwide, besides following the universal infection control guidelines. Prevention of spread through aerosol generation is one of the essential strategies in this regard, particularly for patients with sleep-disordered breathing at home and during hospital admission. Aerosols are produced, at home and in health care facilities, by natural processes and aerosol-generating procedures. To address this impinging problem, aerosol-generating procedures, like non-invasive ventilation (NIV), are to be handled meticulously, which might warrant isolation and sometimes device/interface modifications.


id: cord-355038-o2hr5mox
title: Proceedings of Réanimation 2020, the French Intensive Care Society International Congress
author: nan
date: 2020-02-11
txt: ./txt/cord-355038-o2hr5mox.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32048060/
doi: 10.1186/s13613-020-0623-7
abstract: nan
summary:
  Conclusion: In patients with moderate-to-severe ARDS, a higher tidal volume under PSV within the 72 h following neuromuscular blockers cessation is independently associated with the 28-day mortality.Compliance with ethics regulations: Yes. Kaplan-Meier estimate of the cumulative probability of survival according to the mean tidal volume (Vt)-lower of higher than 8 ml/ kg-under pressure support ventilation (PSV) during the "transition period" transfusion is associated with adverse events, and equipoise remains on the optimal transfusion strategy in oncologic patients in surgical setting. Compliance with ethics regulations: Yes. Patients and methods: In a retrospective monocentric study (01/2013-01/2017) conducted in cardio-vascular surgical intensive care unit (ICU) in Henri Mondor teaching hospital, all consecutive adult patients who underwent peripheral VA-ECMO were included, with exclusion of those dying in the first 24 h. Compliance with ethics regulations: Yes. Rationale: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission in immunocompromised patients and the need for invasive mechanical ventilation has become a major clinical end-point in randomized controlled trials (RCT).


id: cord-355450-v3eh1rtk
title: Influenza and respiratory syncytial virus infections in the oldest-old continent
author: Boattini, Matteo
date: 2020-06-27
txt: ./txt/cord-355450-v3eh1rtk.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s10096-020-03959-9
doi: 10.1007/s10096-020-03959-9
summary:
  Influenza and respiratory syncytial virus (RSV) infections are associated with high rate of morbidity, mortality, and an important burden on healthcare systems worldwide, especially among elderly patients [1] [2] [3] [4] [5] [6] . Especially in epidemiological research, oldest-old patients are considered to be a part of the wider age group of the elderly (≥ 65 years old), and there is limited published evidence about predictors of severity of illness and mortality in viral infections, such as caused by influenza and RSV. The aim of this study was to describe the clinical features of an oldest-old population admitted with influenza and/or RSV infections in three southern European hospitals over two consecutive winter seasons and identify predictors of pneumonia, non-invasive ventilation (NIV), and in-hospital death (IHD). Moreover, in our study, hospital-acquired influenza and/or RSV infections were not identified as predictors of pneumonia, use of NIV, and IHD for patients aged 65 years and older, moving away from evidence available so far [9, 10] .

abstract:
  SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni- and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02–3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67–11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09–8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06–13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14–5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.


