Articles: mechanical-ventilation.
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The use of extracorporeal membrane oxygenation (ECMO) in adult patients continues to increase. Suspicion of brain death while on ECMO creates a conundrum. The American Academy of Neurology states that apnea testing is a critical component of the process to declare brain death. However, there is a paucity of literature on apnea testing for confirmation of brain death in patients on venoarterial ECMO and venovenous ECMO. Traditional apnea testing does not consider ECMO physiology or de-recruitment of the lungs in this subset of critically ill patients. Complications with traditional apnea testing include hemodynamic instability that may lead to cardiac arrest and death. ⋯ In 5 subjects on ECMO, the carbogen method for apnea testing as part of the process to declare brain death was accurate in predicting the end point of the apnea test. With the increased use of ECMO in adults and the ongoing need for organs, methods to confirm brain death with apnea testing while on ECMO should be further studied.
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Frontiers in medicine · Jan 2020
Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19.
Acute respiratory distress syndrome (ARDS) related to Coronavirus disease (COVID-19) is associated with high mortality. It has been suggested that venovenous extracorporeal membrane oxygenation (ECMO) was suitable in this indication, albeit the effects of ECMO on the mechanical respiratory parameters have been scarcely described. In this case-series, we prospectively described the use of venovenous ECMO and its effects on mechanical respiratory parameters in eleven COVID-19 patients with severe ARDS. ⋯ Nine (82%) patients experienced ECMO-related complications and the main complication was major bleeding requiring blood transfusions. Intensive care unit mortality rate was 55% but no patient died from ECMO-related complications. In COVID-19 patients with severe ARDS, venovenous ECMO allowed ultra-protective ventilation, improved oxygenation and should be considered in highly selected patients with the most severe ARDS.
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Clinical epidemiology · Jan 2020
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.
Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources. ⋯ This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.
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Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. ⋯ We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.
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J Multidiscip Healthc · Jan 2020
Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey.
As the global outbreak of COVID-19 continues to ravage the world, it is important to understand how frontline clinicians manage ventilatory support and the various limiting factors. ⋯ Our results show that general clinical practices involving ventilatory support were highly heterogeneous, with limited use of standard protocols and most frontline clinicians depending on isolated and varied management guidelines. We found increased staff workload, lack of trained staff and shortage of PPE to be the main limiting factors affecting global COVID-19 ventilatory support management.