Volume-assured pressure support mode plus pirfenidone as resuscitation therapy in patients with exacerbation of idiopathic pulmonary fibrosis

Introduction: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This case report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of a patient’s symptoms in combination with high-resolution computed tomography (HRCT) evidence.Material and methods: An 83-year-old female patient with multiple hospital admissions within a  six-month period initially presented with cardiac symptoms which were later attributed to a possible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis.Conclusion: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis

Sequential Organ Failure in cancer patients admitted to the Intensive Care Unit at the National Oncologic Institute in Ecuador

Cancer patients experience life threatening complications related to their chemotherapeutic regimen or underlying neoplastic disease. A prognostic assessment is helpful to evaluate patients admitted to the Intensive Care Unit (ICU). We intend to assess the severity of organ dysfunctions in cancer patients utilizing the Sequential Organ Failure Assessment (SOFA) score. Methods. We followed 50 cancer patients from their admission to the ICU until their discharge from the unit or their demise in a prospective descriptive observational study. Selected patients were grouped for their evaluation in two categories: solid tumors or hemato-oncologic diseases.Pacientes con cáncer están expuestos a varias complicaciones amenazantes de su vida, ya sea por el agresivo régimen de quimioterapia o por la enfermedad subyacente. A estos pacientes cuya estancia en UCI podría ser cuestionada una evaluación del pronóstico podría sería de ayuda. Objetivos.- Es evaluar la severidad de la secuencial falla de órganos “Sequential Organ Failure Assessment (SOFA) score” en pacientes oncológicos ingresados en el Servicio de Medicina Intensiva del Instituto Oncológico Nacional SOLCA. Guayaquil-Ecuador

Noninvasive Mechanical Ventilation with Average Volume-Assured Pressure Support versus BiPAP S/T in De Novo Hypoxemic Respiratory Failure

BACKGROUND: Bilevel positive airway pressure in spontaneous/time and average volume-assured pressure support (BiPAP·S/T–AVAPS) could maintain an adequate tidal volume by reducing the patient's inspiratory effort; however, this ventilatory strategy has not been compared with other ventilatory modes, especially the conventional BiPAP S/T mode, when noninvasive mechanical ventilation (NIMV) is used. The primary objective of this study was to determine the rate of success and failure of the use of BiPAP·S/T-AVAPS versus BiPAP·S/T alone in patients with mild-to-moderate “de novo” hypoxemic respiratory failure. METHODS: This was a matched-cohort study. Subjects with mild-to-moderate de novo hypoxemic respiratory failure were divided into two groups according to the ventilatory strategy used. The subjects in the BiPAP·S/T group were paired with those in the BiPAP·S/T-AVAPS group. RESULTS: A total of 58 subjects were studied. Twenty-nine subjects in the BiPAP·S/T group were paired with 29 subjects in the BiPAP·S/T-AVAPS group. Twenty patients (34.5%) presented with “failure of NIMV,” while 38 (65.5%) patients did not. In addition, 13 (22.4%) patients died, while 45 (77.6%) recovered. No differences were found in the percentage of intubation (P=0.44) and mortality (P=0.1). CONCLUSION: The BiPAP S/T-AVAPS ventilator mode was not superior to the BiPAP·S/T mode. A high mortality rate was observed in patients with NIMV failure in both modes. This trial is registered with https://doi.org/10.1186/ISRCTN17904857

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Background: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemic respiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO2/FiO2, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO2/FiO2: higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). A value of P < 0.05 was considered significant. Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes (P = 0.04), peak inspired pressure (P < 0.001), PaO2 (P < 0.001), SaO2 (P < 0.002), PaO2/FiO2 (P < 0.002), RR (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.Background: This study was designed to determine the results associated with the use of noninvasive mechanicalventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemicrespiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not producedby acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO2/FiO2,who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador.Subjects were divided into two groups and compared according to their PaO2/FiO2: higher than 100 and up to 200mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAPS/T-AVAPS strategy). Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortalityrate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidalvolumes heart rate (P = 0.04), peak inspired pressure (P &lt; 0.001), PaO2 (P &lt; 0.001), SaO2 (P &lt; 0.002), PaO2/FiO2 (P &lt;0.002), arterial blood pressure (P &lt; 0.001), HR (P &lt; 0.001), and inspiratory time (P = 0.029) measured at baseline andat 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratoryfailure with special vigilance concerning exhaled tidal volumes and inspired pressure