Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Estudio clínico, observacional, de una nueva modalidad ventilatoria; Ventilación Asistida Proporcional. Hospital de la Santa Creu i Sant Pau, Barcelona, 2010

La ventilació assistida proporcional és una modalitat en la que el respirador genera una assistència proporcional a l’esforç muscular del pacient. En aquest estudi s’han inclòs vuit malalts en “weaning” de la ventilació mecànica. Es descriu la tolerància clínica i es quantifica l’esforç muscular dels pacients. L’esforç muscular va estar sempre dintre de límits predefinits de confort. Concloem que la ventilació assistida proporcional dóna una ventilació mecànica similar a altres modalitats i és probablement més fisiològica.La Ventilación Asistida Proporcional es una modalidad en la que el respirador genera una asistencia proporcional al esfuerzo muscular del paciente. En el estudio se incluyeron ocho pacientes en “weaning” de ventilación mecánica. Se describe la tolerancia clínica y analiza el esfuerzo muscular que los pacientes realizan. El esfuerzo muscular se mantuvo dentro de los niveles predefinidos de confort durante toda la ventilación. Concluimos que la ventilación asistida proporcional brinda una ventilación mecánica similar a otras modalidades ventilatorias y probablemente más fisiológica

Efectos fisiológicos de diferentes estrategias ventilatorias empleadas en pacientes con insuficiencia respiratoria aguda severa

Los estudios realizados en la presente tesis están alineadas en determinar los efectos fisiológicos de dos estrategias utilizadas en pacientes en ventilación mecánica con insuficiencia respiratoria aguda severa. Las estrategias analizadas son habitualmente utilizadas en estos pacientes. El primer estudio presentado es sobre el alargamiento de la pausa inspiratoria. En este estudio se ha confirmado que el alargamiento de la pausa inspiratoria disminuye significativamente el espacio muerto y la PaCO2. Con este estudio, se proporciona una aplicación clínica de esta estrategia, ya que, la disminución de la PaCO2 permite disminuir el volumen corriente administrado y ayudar a la ventilación protectiva. El segundo estudio presentado es sobre la variación de los volúmenes pulmonares y el strain (deformación del tejido pulmonar causado por el cambio de volumen) con el cambio de posición de supino a prono. Este estudio ha permitido demostrar que los volúmenes pulmonares aumentan significativamente en la posición prono y disminuye significativamente el strain dinámico sobre el tejido pulmonar. Estos hallazgos pueden explicar la mejoría de los resultados clínicos con el uso de la posición prono en pacientes con síndrome de distres respiratorio agudo grave. La relativa sencillez e inocuidad de las estrategias estudiadas facilita su aplicación en el manejo clínico diario de estos pacientes y la información encontrada puede servir de base para futuros estudios y ampliar su uso en otro tipo de pacientes y patologías.The studies described in this thesis are about the physiological effects of two common strategies that are used in mechanically ventilated patients with acute severe respiratory failure. The first study was about the prolongation of inspiratory pause. This study confirmed that the prolongation of inspiratory pause significantly decreased dead space and PaCO2. Indeed, this study provides a clinical application of this strategy, because the decrease of the PaCO2 allows a significant decrease of tidal volume and helps to set the protective ventilation. The second study analysed the variation of lung volumes and strain with the change from supine position to prone position. This study showed a significant increase in lung volumes and a significant decrease of strain in prone position. These findings could explain the improvement of outcomes with prone position in severe acute respiratory distress syndrome patients. The relative simplicity and safety of these strategies facilitates its application at the bedside. These data could form the basis for future studies in other types of patients and pathologies

Treatment and clinical evolution of a patient with a presumptive diagnosis of catastrophic antiphospholipid syndrome

El síndrome antifosfolipídico catastrófico representa menos del 1 % de casos registrados a nivel mundial, su afectación multiorgánica se desarrolla en un período inferior a una semana, con una mortalidad muy alta. Reportamos el caso de una paciente con antecedentes de várices e historia familiar de síndrome antifosfolipídico y lupus eritematoso sistémico. La condición clínica debuta con un cuadro de tormenta trombótica luego de una aneurismectomía, en contexto de un síndrome antifosfolipídico no diagnosticado. El cuadro súbito ameritó manejo en terapia intensiva y tratamiento con metilprednisolona e infliximab. La evolución de la paciente no fue favorable y falleció por una probable coagulación intravascular diseminada asociada a síndrome antifosfolipídico catastrófico. El caso resalta la importancia del método clínico en el diagnóstico y tratamiento temprano de enfermedades poco comunesThe catastrophic antiphospholipid syndrome represents less than 1% of cases registered worldwide, the multi-organ involvement develops in a period of less than a week, with very high mortality. We report the case of a patient with history of varicose veins and family history of antiphospholipid syndrome and systemic lupus erythematosus. The clinical condition began with a thrombotic storm after an aneurysmectomy, in the context of undiagnosed antiphospholipid syndrome. The sudden symptoms required management in intensive care unit and treatment with methylprednisolone and infliximab. The patient's evolution was not favorable and she died due to probable disseminated intravascular coagulation associated with catastrophic antiphospholipid syndrome. The case highlights the importance of the clinical method in the early diagnosis and treatment of rare diseases

Estudio clínico, observacional, de una nueva modalidad ventilatoria; Ventilación Asistida Proporcional. Hospital de la Santa Creu i Sant Pau, Barcelona, 2010

La ventilació assistida proporcional és una modalitat en la que el respirador genera una assistència proporcional a l'esforç muscular del pacient. En aquest estudi s'han inclòs vuit malalts en "weaning" de la ventilació mecànica. Es descriu la tolerància clínica i es quantifica l'esforç muscular dels pacients. L'esforç muscular va estar sempre dintre de límits predefinits de confort. Concloem que la ventilació assistida proporcional dóna una ventilació mecànica similar a altres modalitats i és probablement més fisiològica.La Ventilación Asistida Proporcional es una modalidad en la que el respirador genera una asistencia proporcional al esfuerzo muscular del paciente. En el estudio se incluyeron ocho pacientes en "weaning" de ventilación mecánica. Se describe la tolerancia clínica y analiza el esfuerzo muscular que los pacientes realizan. El esfuerzo muscular se mantuvo dentro de los niveles predefinidos de confort durante toda la ventilación. Concluimos que la ventilación asistida proporcional brinda una ventilación mecánica similar a otras modalidades ventilatorias y probablemente más fisiológica