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Ventilator-associated events: From surveillance to optimizing management

Journal of Intensive Medicine 2023年第3期3卷 204-211页

作者： Sergio Ramirez-Estrada Yolanda Peña-Lopez Tarsila Vieceli Jordi Rello Intensive Care Department Hospital Sanitas CIMABarcelona 08034Spain Paediatric Critical Care Department Hospital Universitari Vall d’HebronBarcelona 08035Spain Clinical Research/Epidemiology in Pneumonia and Sepsis(CRIPS) Vall d’Hebron Research InstituteBarcelona 08035Spain Infectious Diseases Department Hospital de Clínicas de Porto AlegrePorto Alegre RS 90035-007Brazil Universitat Internacional de Catalunya Barcelona 08195Spain

mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)defined criteria for ventilator-associated events(VAE).Ten years later,a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published.Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher thanlower severity.To date,it is estimated that around 30%of ventilated patients in the intensive care unit(ICU)develop VAE.While surveillance enhances the detection of infectious and non-infectious MV-related complicationsthat are severe enough to impact the patient’s outcomes,there are still many gaps in its classification and management.In this review,we provide an update by discussing VAE etiologies,epidemiology,and classification.Preventive strategies on optimizing ventilation,sedative and neuromuscular blockade therapy,and restrictivefluid management are warranted.An ideal VAE bundle is likely to minimize the period of intubation.We believethat it is time to progress from just surveillance to clinical care.Therefore,with this review,we have aimed toprovide a roadmap for future research on the subject.

关键词： Intensive care mechanical ventilation Infection control Ventilator-associated pneumonia

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Is COVID-19 different from other causes of acute respiratory distresssyndrome?

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Journal of Intensive Medicine 2023年第3期3卷 212-219页

作者： François M.Beloncle Medical ICU University Hospital of AngersVent’LabUniversity of AngersAngers 49033France

Coronavirus disease 2019(COVID-19)pneumonia can lead to acute hypoxemic respiratory failure.When mechanical ventilation is needed,almost all patients with COVID-19 pneumonia meet the criteria for acute respiratorydistress syndrome(ARDS).The question of the specificities of COVID-19-associated ARDS compared to othercauses of ARDS is of utmost importance,as it may justify changes in ventilatory strategies.This review aims todescribe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategiesare required in these patients.

关键词： mechanical ventilation Respiratory mechanics Gas exchange Recruitability Dead space

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Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

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世界临床病例杂志 2023年第26期11卷 6040-6050页

作者： Jun-Jun Wang Zhong Zhou Li-Ying Zhang Department of Respiratory and Critical Care Medicine The First People's Hospital of Yangquan CityYangquan 045000Shanxi ProvinceChina Department of Respiratory and Critical Care Medicine Guiyang Public Health Treatment CenterGuiyang 550001Guizhou ProvinceChina Department of Respiratory and Critical Care Medicine The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200023China

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively limited.This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation.AIM To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation parameters.METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory failure.The participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate management.We thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data analysis.RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ICU.However,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide improvements.There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(Pmechanical ventilation until extubation or ICU departure.The occurrence of barotrauma

关键词： Chronic obstructive pulmonary disease mechanical ventilation Volume-controlled ventilation Pressurecontrolled ventilation Barotrauma Respiratory failure

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Analysis of prognostic factors in patients with emergency sepsis

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世界临床病例杂志 2023年第25期11卷 5903-5909页

作者： Xian-Li Ning Min Shao Department of Emergency Anqing Municipal HospitalAnqing 246000Anhui ProvinceChina Department of Critical Care Medicine The First Affiliated Hospital of Anhui Medical UniversityHefei 230031Anhui ProvinceChina

BACKGROUND Emergency sepsis is a common and serious infectious disease,and its prognosis is influenced by a number of factors.AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care.By retrospectively analysing the clinical data collected,we conducted a comprehensive analysis of factors such as age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,therapeutic measures,immune status and severity of infection.METHODS Data collection:Clinical data were collected from patients diagnosed with acute sepsis,including basic information,laboratory findings,medical history and treatment options.Variable selection:Variables associated with prognosis were selected,including age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,treatment measures,immune status and severity of infection.Data analysis:The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis.The impact of each factor on prognosis was assessed according to prognostic indicators,such as survival,length of stay and complication rates.RESULTS Descriptive statistics:Descriptive statistics were performed on the data collected from the patients,including their basic characteristics and clinical presentation.CONCLUSION Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis.

关键词： Platelet count Length of ICU stay mechanical ventilation Abdominal infection Combined coronary artery disease

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Efficacy and safety of ivermectin in patients with mild and moderate COVID-19:A randomized controlled trial

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Asian Pacific Journal of Tropical Medicine 2023年第1期16卷 3-8页

作者： Alireza Malektojari Sara Ghazizadeh Mohammad Hamed Ersi Elham Brahimi Soheil Hassanipour Mohammad Fathalipour Mehdi Hassaniazad Evidence Based Medicine Center Hormozgan University of Medical SciencesBandar AbbasIran Clinical Research Development Center of Shahid Mohammadi Hospital Hormozgan University of Medical SciencesBandar AbbasIran Infectious and Tropical Diseases Research Center Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran Gastrointestinal and Liver Diseases Research Center Guilan University of Medical SciencesRashtIran Department of Pharmacology and Toxicology Faculty of PharmacyHormozgan University of Medical SciencesBandar AbbasIran

Objective:To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19.Methods:This study was a single-center,randomized,open-label,controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19.According to the 1:1 ratio between the study groups(ivermectin group and standard treatment group),patients were randomly admitted to each intervention arm.Results:The mean age of the participants in the ivermectin group was(48.37±13.32)years.Eighteen of them were males(54.5%)and the participants in the control group had a mean age of(46.28±14.47)years,with nineteen of them being males(59.4%).As a primary outcome,after 5 days of randomization,there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital(P=0.168).ICU admission(P=0.764),length of stay in ICU(P=0.622),in-hospital mortality(P=0.427),adverse drug reactions,and changes in the mean difference of laboratory data had not any significant difference between the two groups(except for urea change).In addition,the radiologic findings of the two groups of patients were not significantly different.Linear regression analysis showed that for every 10 years increase of age,0.6 day of hospitalization duration was increased.There was no statistically significant association between other variables and clinical outcomes.Conclusions:Among adult hospitalized patients with moderate to severe COVID-19,there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement,and mortality of the participants.

关键词： COVID-19 Randomized controlled trial Ivermectin Hospitalization mechanical ventilation Clinical symptoms

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Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population

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International Journal of Ophthalmology(English edition) 2022年第12期15卷 1978-1984页

作者： Yi-An Li Xiao-Hong Zhou Xiao-Jing Cai Chen-Hao Yang Department of Ophthalmology Children’s Hospital of Fudan UniversityShanghai 201102China

AIM:To investigate the ratio of spontaneous regression of retinopathy of prematurity(ROP)and to explore the possible relevant predictive factors.METHODS:A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected.Stage,zone,and duration of ROP were recorded.Statistical analysis was performed on 51 possible predictive factors.RESULTS:Totally 356 infants showed spontaneous regression.The incidence was 100%,95.3%,and 22.7%in stage 1,2,and 3,respectively.The 13.4%of the ROP with plus disease eventually resolved spontaneously.All affected eyes of aggressive posterior retinopathy of prematurity(APROP)failed to spontaneously regress.The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP.Days of mechanical ventilation(OR=0.981,95%CI,0.965-0.997,P=0.021),retinal hemorrhage(OR=0.173,95%CI,0.064-0.470,P=0.001),delivery pattern(OR=2.750,95%CI,1.132-6.681,P=0.025),maternal anemia in pregnancy(OR=0.142,95%CI,0.036-0.563,P=0.005),the stages(at initial diagnosis OR=0.183,95%CI,0.041-0.816,P=0.026;at final diagnosis OR=0.031,95%CI,0.006-0.167,Pmechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution.The pattern of delivery and the mother's anemia during pregnancy can also affect the prognosis of ROP.

关键词： retinopathy of prematurity predictive factors spontaneous regression anemia during pregnancy mechanical ventilation pattern of delivery retinal hemorrhage

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Effect of external diaphragm pacemaker for mechanical ventilation weaning after stroke

Effect of external diaphragm pacemaker for mechanical ventil...

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第十三届中国医师协会神经外科医师年会

作者： Wang Zhiwei Jiang Qiao Li Zhanfu Department of Intensive Care Medicine Guangdong 999 Brain Hospital

Objective To investigate the effect of external diaphragm pacemaker（EDP）for mechanical ventilation weaning after stroke.Methods Included in this study were 40 patients treated with mechanical ventilation after stroke in our ICU between September 2015 and February 2016.These patients were randomly assigned to Normal group（n=20）and EDP group（n=20）.All the patients received routine SBT training with T-tube when meet the requirements according to 2012 Guide on mechanical ventilation and Weaning.In addition,EDP group was subjected to EDP therapy.Time for weaning,rate of endotracheal tube withdrawal,rate of reintubation within 48 h,incidence of respiratory infections and length of ICU stay were compared in the two groups.Results The time for weaning and endotracheal tube withdrawal rate is was significantly decreased in EDP group than that in Normal group（3.85±1.34 d 比 5.21±1.57,P＜0.05;75%比 35%,P＜0.05）.By the way,the length of ICU stay in EDP group was also less than Normal group（7.49±1.22 比 10.08±1.41,P＜0.05）.However,the incidence of respiratory infections between two groups showed no significant difference.Conclusion Combining routine SBT train with EDP therapy can improve self-respiration ability and do help to reduce endotracheal tube withdrawal within 48 h and length of ICU stay.Comprehensive measures should be consider to control the incidence of respiratory infections since it’s related to multiple factors like age,aspiration,hand hygiene and so on.

关键词： Stroke External diaphragm pacemaker mechanical ventilation

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Pleural effusion in critically ill patients and intensive care setting

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World Journal of Clinical Cases 2023年第5期11卷 989-999页

作者： Adel Salah Bediwy Mohammed Al-Biltagi Nermin Kamal Saeed Hosameldin A Bediwy Reem Elbeltagi Department of Chest Diseases Faculty of MedicineTanta UniversityTanta 31527AlgharbiaEgypt Department of Chest Diseases University Medical CenterArabian Gulf UniversityDr.Sulaiman Al Habib Medical GroupManama 26671Bahrain Department of Pediatric Faculty of MedicineTanta UniversityTanta 31527AlgharbiaEgypt Department of Pediatric University Medical CenterKing Abdulla Medical CityArabian Gulf UniversityDr.Sulaiman Al Habib Medical GroupManama 26671Bahrain Medical Microbiology Section Chairperson of the Pathology DepartmentSalmaniya Medical ComplexMinistry of HealthKingdom of BahrainManama 26671Bahrain Microbiology Section Pathology DepartmentRoyal College of Surgeons in Ireland-BahrainBusiateen 15503MuharraqBahrain Faculty of Medicine Tanta UniversityTanta 31527AlgharbiaEgypt Department of Medicine Royal College of Surgeons in Ireland-BahrainBusaiteen 15503MuharraqBahrain

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

关键词： Pleural effusion Intensive care unit mechanical ventilation Diagnosis Drainage Pigtail catheters

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Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome:A retrospective observational study

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World Journal of Virology 2022年第6期11卷 477-484页

作者： Yudhyavir Singh Kapil Dev Soni Abhishek Singh Nikita Choudhary Fahina Perveen Richa Aggarwal Nishant Patel Shailendra Kumar Anjan Trikha Department of Anesthesiology Pain Medicine and Critical CareAll India Institute of Medical SciencesNew Delhi 110029India Department of Critical and Intensive Care Jai Prakash Narayan Apex Trauma CenterAll India Institute of Medical SciencesNew Delhi 110029India Department of Anesthesia All India Institute of Medical SciencesNew Delhi 110029India

BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.

关键词： COVID-19 Intubation mechanical ventilation ICU Tracheostomy Oxygen therapy

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Effects of continuous tracheal gas insufflation during pressure limited ventilation on pulmonary surfactant in rabbits with acute lung injury

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Chinese Medical Journal 2006年第17期119卷 1415-1420页

作者： ZHU Guang-fa ZHANG Wei ZONG Hua LIANG Ying Department of Respiratory Medicine Beijing Anzhen HospitalCapital University of Medical Science Beijing 100029 China

Background Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury （VILI）. Tracheal gas insuffiation （TGI） is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume （VT） while maintaining constant partial arterial CO2 pressure （PaCO2）. We hypothesised that TGI limited peak inspiratory pressure （PIP） and VT and would minimize conventional mechanical ventilation （CMV） induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury （ALI）. Methods ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min （TGI group） or CMV group （n=8 for each group）, and subsequently ventilated with limited PIP and VT to maintain PaCO2 within 35 to 45 mmHg for 4 hours. Physiological dead space to VT ratio （VD/VT）, dynamic respiratory compliance （Cdyn） and partial arterial O2 pressure （PaO2） were monitored. After ventilation, lungs were analysed for total phospholipids （TPL）, total proteins （TP）, pulmonary surfactant small to large aggregates ratio （SA/LA） in bronchoalveolar lavage fluid （BALF） and for determination of alveolar volume density （Vv）, myeloperoxidase and interleukin （IL）-8. Results TGI resulted in significant （P〈0.05 or P〈0.01） decrease in PIP [（22.4±1.8） cmH20 vs （29.5±1.1） cmH2O], VT [（6.9±1.3） ml/kg vs （9.8±1.11） ml/kg], VD/VT [（32±5）% vs （46±2）%], TP [（109±22） mg/kg vs （187±25） mg/kg], SA/LA （2.5±0.4 vs 5.4±0.7）, myeloperoxidase [（6.2±0.5） U/g tissue vs （12.3±0.8） U/g tissue] and IL-8 [（987±106） ng/g tissue vs （24±3） mN/m] of BALF, and significant （P〈0.05） increase in Cdyn [（0.47±0.02） ml·cmH2O^-1·kg^-1 vs （0.31±0.02） ml·cmH2O^-1·kg^-1], PaO2 [（175±24） mmHg vs （135±26） mmHg], TPL/TP （52±8 vs 33±11） and Vv （0.65±0.05 vs 0.44±0.07） as compared with CMV. Conclusions In this animal model of ALI, TGI

关键词： tracheal gas insufflation acute lung injury pulmonary surfactant ventilator induced lung injury mechanical ventilation

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