Respiratory care
-
An accurate SpO2 value is critical in order to optimally titrate oxygen delivery to patients and to follow oxygenation guidelines. Limited prospective data exist on real-world performance of pulse oximeters in critically ill patients. The objective of this study was to assess accuracy and bias of the SpO2 values measured by several oximeters in hospitalized subjects. ⋯ We found significant bias and moderate accuracy between the tested oximeters and the arterial blood gases in the studied population. These discrepancies may have important clinical impact on the detection of hypoxemia and management of oxygen therapy.
-
Observational Study
Bleeding and Thrombotic Complications in COVID-19-Associated ARDS Requiring ECMO.
We analyzed bleeding and thrombotic complications in COVID-19-associated ARDS requiring extracorporeal membrane oxygenation (ECMO). ⋯ COVID-19-associated ARDS requiring ECMO presented high rates of severe bleeding complications and a protracted course. Further studies are needed to clarify the risks and benefits of ECMO in severe COVID-19-associated ARDS.
-
Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting. ⋯ Severe hypercapnia was associated with mortality in subjects with ARDS who received lung-protective ventilation. Our results deserve further evaluation of the strategies and treatments that aim to control CO2 retention.
-
In refractory respiratory failure, extracorporeal membrane oxygenation (ECMO) is a rescue therapy to prevent ventilator-induced lung injury. Optimal ventilator parameters during ECMO remain unknown. Our objective was to describe the association between mortality and ventilator parameters during ECMO for neonatal and pediatric respiratory failure. ⋯ Avoiding low PEEP on ECMO day 1 for neonates on ECMO may be beneficial, particularly those with a congenital diaphragmatic hernia. No additional ventilator parameters were associated with mortality in either neonatal or pediatric subjects. PEEP is a modifiable parameter that may improve neonatal survival during ECMO and requires further investigation.
-
Whereas pulmonary exacerbations and aerobic fitness play a key role in the prognosis of cystic fibrosis (CF), the use of ventilatory threshold data as markers of exacerbation risk has been scarcely addressed. This study sought to examine the association between aerobic fitness, assessed through ventilatory threshold variables recorded during cardiopulmonary exercise testing (CPET), and the risk of exacerbations in individuals with CF. ⋯ Our results suggest an association between CPET variables at the ventilatory threshold and exacerbations. Percentage V̇O2 at the ventilatory threshold could serve as a complementary variable to monitor exacerbations in people with CF.