Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa2277
Maria Augusta Costa deMoura, J. Moura, V. Moura, M. Moura, R. Stirbulov
{"title":"Outcomes among immunecompetent and immunocompromised and pneumonia and trachea-bronchitis in mechanical ventilation","authors":"Maria Augusta Costa deMoura, J. Moura, V. Moura, M. Moura, R. Stirbulov","doi":"10.1183/13993003.congress-2019.pa2277","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa2277","url":null,"abstract":"","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"138 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79348003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa4009
Dong Yon Kim, Sung-wook Kang, Hye Ri Choi, C. Choi, Y. Kim, H. Choi, Jung Mi Lee
Influencing factors on the changes of ICU family members’ satisfaction Soyoung Yang, Hye Ri Choi, In-Ho Yang, Mira Song, Jun Ki Min, Minji Lee, Yee Hyung Kim, Sung Wook Kang (1.Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Korea, 2.Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gang Dong, Korea, 3.School of Health in Social Science, University of Edinburgh, UK)
{"title":"Influencing factors on changes of ICU family members satisfaction","authors":"Dong Yon Kim, Sung-wook Kang, Hye Ri Choi, C. Choi, Y. Kim, H. Choi, Jung Mi Lee","doi":"10.1183/13993003.congress-2019.pa4009","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa4009","url":null,"abstract":"Influencing factors on the changes of ICU family members’ satisfaction Soyoung Yang, Hye Ri Choi, In-Ho Yang, Mira Song, Jun Ki Min, Minji Lee, Yee Hyung Kim, Sung Wook Kang (1.Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Korea, 2.Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gang Dong, Korea, 3.School of Health in Social Science, University of Edinburgh, UK)","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81640947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa4027
L. Roesthuis, H. V. D. Hoeven, C. Sinderby, T. Frenzel, C. Ottenheijm, L. Brochard, J. Doorduin, L. Heunks
Introduction: Respiratory muscle weakness frequently develops in critically ill patients and is associated with difficult weaning from mechanical ventilation and increased mortality. No drug has been approved to improve respiratory muscle function. However, we have previously shown that the calcium sensitizer levosimendan improves contractility of diaphragm muscle fibers in vitro and diaphragm contractility in healthy subjects in vivo. Objectives: To investigate the effects of levosimendan on diaphragm contractile efficiency in mechanically ventilated patients. Methods: In a double-blind placebo-controlled trial mechanically ventilated patients (N=39) performed two continuous positive airway pressure (CPAP) trials for 30-minutes each with 5 hour interval. After the first CPAP trial, study medication (either levosimendan 0.2 µg/kg/min or placebo) was administered. During both trials electrical activity of the diaphragm (EAdi), transdiaphragmatic pressure (Pdi) and tidal volume (TV) were continuously measured. Neuromechanical efficiency (primary outcome parameter) was defined as ΔPdi/ΔEAdi. Results: Neuromechanical efficiency did not improve after levosimendan. However, ΔEAdi and tidal volume were higher after levosimendan administration (31% and 11%, respectively). P0.1, a measure for respiratory load, increased in the placebo group by 41%, while it remained constant in the levosimendan group. PaCO2 significantly decreased (44 mmHg vs 42 mmHg) in response to levosimendan administration. Conclusions: Although levosimendan did not improve diaphragm contractile efficiency, tidal volume increased, while P0.1 and PaCO2 decreased.
危重患者经常出现呼吸肌无力，并伴有机械通气困难脱机和死亡率增加。目前还没有药物被批准用于改善呼吸肌功能。然而，我们之前已经表明，钙敏化剂左西孟旦在体外改善膈肌纤维的收缩力，在体内改善健康受试者的膈肌收缩力。目的:探讨左西孟旦对机械通气患者膈肌收缩效率的影响。方法:在一项双盲安慰剂对照试验中，机械通气患者(N=39)进行两次持续气道正压通气(CPAP)试验，每次30分钟，间隔5小时。在第一次CPAP试验后，给予研究药物(左西孟旦0.2µg/kg/min或安慰剂)。在两次试验中，连续测量膈肌电活动(EAdi)、横膈膜压力(Pdi)和潮气量(TV)。神经机械效率(主要结局参数)定义为ΔPdi/ΔEAdi。结果:左西孟旦后神经力学效率无明显提高。但左西孟旦给药后ΔEAdi和潮气量升高(分别为31%和11%)。衡量呼吸负荷的P0.1在安慰剂组增加了41%，而左西孟旦组保持不变。左西孟旦组PaCO2显著降低(44 mmHg vs 42 mmHg)。结论:左西孟旦虽未提高膈肌收缩效率，但潮气量升高，P0.1和PaCO2降低。
{"title":"Late Breaking Abstract - Effects of levosimendan on diaphragm contractile efficiency in patients weaning from mechanical ventilation","authors":"L. Roesthuis, H. V. D. Hoeven, C. Sinderby, T. Frenzel, C. Ottenheijm, L. Brochard, J. Doorduin, L. Heunks","doi":"10.1183/13993003.congress-2019.pa4027","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa4027","url":null,"abstract":"Introduction: Respiratory muscle weakness frequently develops in critically ill patients and is associated with difficult weaning from mechanical ventilation and increased mortality. No drug has been approved to improve respiratory muscle function. However, we have previously shown that the calcium sensitizer levosimendan improves contractility of diaphragm muscle fibers in vitro and diaphragm contractility in healthy subjects in vivo. Objectives: To investigate the effects of levosimendan on diaphragm contractile efficiency in mechanically ventilated patients. Methods: In a double-blind placebo-controlled trial mechanically ventilated patients (N=39) performed two continuous positive airway pressure (CPAP) trials for 30-minutes each with 5 hour interval. After the first CPAP trial, study medication (either levosimendan 0.2 µg/kg/min or placebo) was administered. During both trials electrical activity of the diaphragm (EAdi), transdiaphragmatic pressure (Pdi) and tidal volume (TV) were continuously measured. Neuromechanical efficiency (primary outcome parameter) was defined as ΔPdi/ΔEAdi. Results: Neuromechanical efficiency did not improve after levosimendan. However, ΔEAdi and tidal volume were higher after levosimendan administration (31% and 11%, respectively). P0.1, a measure for respiratory load, increased in the placebo group by 41%, while it remained constant in the levosimendan group. PaCO2 significantly decreased (44 mmHg vs 42 mmHg) in response to levosimendan administration. Conclusions: Although levosimendan did not improve diaphragm contractile efficiency, tidal volume increased, while P0.1 and PaCO2 decreased.","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"138 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80274626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa2287
Gil Gonçalves, M. Leitão, Luís Linhares, J. P. Baptista, P. Martins
{"title":"Characterization of patients with pneumonia and chronic structural lung disease admitted to an ICU","authors":"Gil Gonçalves, M. Leitão, Luís Linhares, J. P. Baptista, P. Martins","doi":"10.1183/13993003.congress-2019.pa2287","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa2287","url":null,"abstract":"","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90587205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa4022
Paulina Ezcurra, M. Venuti, E. Gogniat, M. Ducrey, J. Dianti, A. Midley, S. Giannasi, E. S. Román, Nicolás Roux
Introduction: High flow nasal cannula (HFNC) is effective in preventing extubation respiratory failure in high risk patients. However there is a lack of information in which variables better predict which patients will not benefit from this intervention. Objective: Our goal is to identify variables that could predict which patients will not benefit with HFNC for extubation failure prevention. Methods: Prospective interventional single center study in an intensive care unit in Argentina. We included patients with at least one pre-specified risk factor who required invasive mechanical ventilation (IMV) for more than 48hs and passed a spontaneous breathing trial. HFNC was administered for the first 24hs following extubation. We divided extubation failure causes into those related with worsening of respiratory variables and non-respiratory related causes. Results: We include 165 patients. 40(24.2%) presented extubation failure, 18(10.9%) of which were for non-respiratory related causes and 22(13.3%) for worsening of respiratory variables. None of the pre-specified risk factors individually or combine between this were associated with extubation failure. The median of days of IMV prior to extubation was the only variable associated with extubation failure (5(3-6) vs 4(3-5), p=0.02) in the failure and success group respectively. Conclusions: Incidence of extubation failure in high risk patients receiving HFNC for extubation failure prevention was similar to that reported in previous trials. None of the pre-specified risk factors predicted extubation failure. Time of IMV prior to extubation was the only variable associated with extubation failure.
{"title":"Prognostic factors for extubation failure in high risk patients using high-flow nasal cannula","authors":"Paulina Ezcurra, M. Venuti, E. Gogniat, M. Ducrey, J. Dianti, A. Midley, S. Giannasi, E. S. Román, Nicolás Roux","doi":"10.1183/13993003.congress-2019.pa4022","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa4022","url":null,"abstract":"Introduction: High flow nasal cannula (HFNC) is effective in preventing extubation respiratory failure in high risk patients. However there is a lack of information in which variables better predict which patients will not benefit from this intervention. Objective: Our goal is to identify variables that could predict which patients will not benefit with HFNC for extubation failure prevention. Methods: Prospective interventional single center study in an intensive care unit in Argentina. We included patients with at least one pre-specified risk factor who required invasive mechanical ventilation (IMV) for more than 48hs and passed a spontaneous breathing trial. HFNC was administered for the first 24hs following extubation. We divided extubation failure causes into those related with worsening of respiratory variables and non-respiratory related causes. Results: We include 165 patients. 40(24.2%) presented extubation failure, 18(10.9%) of which were for non-respiratory related causes and 22(13.3%) for worsening of respiratory variables. None of the pre-specified risk factors individually or combine between this were associated with extubation failure. The median of days of IMV prior to extubation was the only variable associated with extubation failure (5(3-6) vs 4(3-5), p=0.02) in the failure and success group respectively. Conclusions: Incidence of extubation failure in high risk patients receiving HFNC for extubation failure prevention was similar to that reported in previous trials. None of the pre-specified risk factors predicted extubation failure. Time of IMV prior to extubation was the only variable associated with extubation failure.","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76161443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.oa3297
K. Ho, J. Sheehan, J. Salonia
{"title":"Thirty-Day Readmission Among Patients With Acute Respiratory Distress Syndrome and Effects on Outcomes","authors":"K. Ho, J. Sheehan, J. Salonia","doi":"10.1183/13993003.congress-2019.oa3297","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa3297","url":null,"abstract":"","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73638725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa2184
H. Nyström, J. Berkius, M. Ekström, S. Walther, M. Inghammar
Background: Current knowledge about prognosis after intensive care for COPD exacerbation in patients with long-term oxygen therapy (LTOT) is limited.Aims: To investigate survival after ICU admissio ...
{"title":"Survival after intensive care for COPD exacerbation in patients with and without long-term oxygen therapy: a nationwide cohort study","authors":"H. Nyström, J. Berkius, M. Ekström, S. Walther, M. Inghammar","doi":"10.1183/13993003.congress-2019.pa2184","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa2184","url":null,"abstract":"Background: Current knowledge about prognosis after intensive care for COPD exacerbation in patients with long-term oxygen therapy (LTOT) is limited.Aims: To investigate survival after ICU admissio ...","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84786556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa2278
J. Yarascavitch, C. Vogler, S. Cannon-Bailey
Background: Trilogy Evo (Philips Respironics, Murrysville PA) is a new life support ventilator that provides invasive and non-invasive ventilation to adult and pediatric patients with a minimum weight of 2.5kg. Aims: To evaluate the performance of the Trilogy Evo ventilator compared to parameters from user’s current ventilator. Methods: Patients treated with invasive mechanical ventilation via tracheostomy tube (IPAP 15.9 ± 3.2cmH2O, EPAP 5.3 ± 1.6cmH2O, and tidal volume 263 ± 166ml) were enrolled. At baseline, users were monitored on their current ventilator (LTV or Trilogy) for 15 minutes then were set-up on the Trilogy Evo for at least 15 minutes with one or more of the following circuits: Passive, ActivePAP, Active Flow and Dual Limb. Pulse oximetry (SpO2) and End Tidal CO2 (EtCO2) were recorded. Results: Thirteen participants (7 males, age 11.3 ± 10.1) completed the study. Modes utilized were SIMV-VC (n=9), S/T (n=3), and A/C-PC (n=1). Trilogy Evo passive circuit settings were IPAP 15.4 ± 3.7 cmH2O, EPAP 5.2 ± 1.5 cmH2O, and tidal volume 236 ± 166 ml. No clinical difference in EtCO2 mmHg (baseline 31.6 ± 6.3 vs Trilogy Evo 29.7 ± 6.9) or SpO2% (baseline 97.3 ± 1.8 vs Trilogy Evo 97.6 ± 1.2) were detected. In users with significant leaks around their trach tubes, the tidal volume and/or pressure settings needed to be decreased to match baseline therapy due to leak compensation algorithms with the passive circuit on Trilogy Evo. Conclusion: In this group of patients, Trilogy Evo provided effective ventilation based on SpO2 and EtCO2 values. The leak compensation capabilities may offer benefits to patients with airway leak issues.
背景:Trilogy Evo (Philips呼吸器，Murrysville PA)是一种新型生命支持呼吸机，为成人和儿童患者提供有创和无创通气，最低体重为2.5kg。目的:将Trilogy Evo呼吸机的性能与用户现有呼吸机的参数进行比较。方法:纳入经气管造口管有创机械通气患者(IPAP 15.9±3.2cmH2O, EPAP 5.3±1.6cmH2O，潮气量263±166ml)。在基线时，用户在其当前呼吸机(LTV或Trilogy)上监测15分钟，然后在Trilogy Evo上设置至少15分钟，并使用以下一种或多种电路:被动，ActivePAP, Active Flow和双肢。记录脉搏血氧(SpO2)和末潮CO2 (EtCO2)。结果:13名参与者(7名男性，年龄11.3±10.1岁)完成了研究。采用的模式有SIMV-VC (n=9)、S/T (n=3)和A/C-PC (n=1)。Trilogy Evo被动回路设置为IPAP 15.4±3.7 cmH2O, EPAP 5.2±1.5 cmH2O，潮气量236±166 ml。EtCO2 mmHg(基线31.6±6.3 vs Trilogy Evo 29.7±6.9)或SpO2%(基线97.3±1.8 vs Trilogy Evo 97.6±1.2)无临床差异。对于气管周围有明显泄漏的用户，由于Trilogy Evo上的无源电路的泄漏补偿算法，需要降低潮气量和/或压力设置，以匹配基线治疗。结论:在本组患者中，根据SpO2和EtCO2值，Trilogy Evo提供了有效的通气。泄漏补偿功能可能为气道泄漏问题的患者提供益处。
{"title":"A preliminary clinical evaluation of a new portable life support ventilator with invasively ventilated home users","authors":"J. Yarascavitch, C. Vogler, S. Cannon-Bailey","doi":"10.1183/13993003.congress-2019.pa2278","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa2278","url":null,"abstract":"Background: Trilogy Evo (Philips Respironics, Murrysville PA) is a new life support ventilator that provides invasive and non-invasive ventilation to adult and pediatric patients with a minimum weight of 2.5kg. Aims: To evaluate the performance of the Trilogy Evo ventilator compared to parameters from user’s current ventilator. Methods: Patients treated with invasive mechanical ventilation via tracheostomy tube (IPAP 15.9 ± 3.2cmH2O, EPAP 5.3 ± 1.6cmH2O, and tidal volume 263 ± 166ml) were enrolled. At baseline, users were monitored on their current ventilator (LTV or Trilogy) for 15 minutes then were set-up on the Trilogy Evo for at least 15 minutes with one or more of the following circuits: Passive, ActivePAP, Active Flow and Dual Limb. Pulse oximetry (SpO2) and End Tidal CO2 (EtCO2) were recorded. Results: Thirteen participants (7 males, age 11.3 ± 10.1) completed the study. Modes utilized were SIMV-VC (n=9), S/T (n=3), and A/C-PC (n=1). Trilogy Evo passive circuit settings were IPAP 15.4 ± 3.7 cmH2O, EPAP 5.2 ± 1.5 cmH2O, and tidal volume 236 ± 166 ml. No clinical difference in EtCO2 mmHg (baseline 31.6 ± 6.3 vs Trilogy Evo 29.7 ± 6.9) or SpO2% (baseline 97.3 ± 1.8 vs Trilogy Evo 97.6 ± 1.2) were detected. In users with significant leaks around their trach tubes, the tidal volume and/or pressure settings needed to be decreased to match baseline therapy due to leak compensation algorithms with the passive circuit on Trilogy Evo. Conclusion: In this group of patients, Trilogy Evo provided effective ventilation based on SpO2 and EtCO2 values. The leak compensation capabilities may offer benefits to patients with airway leak issues.","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88122618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa2272
H. Yoo, Jin Young Lee, Junehee Park, J. Song, S. Zo, K. Jeon
{"title":"Plasma level of TNF related apoptosis inducing ligand is associated with severity of disease in patients with sepsis and septic shock","authors":"H. Yoo, Jin Young Lee, Junehee Park, J. Song, S. Zo, K. Jeon","doi":"10.1183/13993003.congress-2019.pa2272","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa2272","url":null,"abstract":"","PeriodicalId":7201,"journal":{"name":"Acute critical care","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79501085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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