Utility of non-invasive mechanical ventilation in critically ill patients with exacerbated COPD. Systematic review

Background: non-invasive mechanical ventilation is a useful ventilatory support method for patients with acute respiratory failure or exacerbation of chronic obstructive pulmonary disease mediated by different mechanisms. It helps to reduce airflow resistance and facilitates lung expansion, reducing respiratory muscle fatigue. This allows the patient to breathe more efficiently. By providing positive pressure into the airways, it helps to open the collapsed alveoli and lower airways improving gas exchange. As a consequence, oxygenation enhances. Additionally, by increasing air flow, it helps to eliminate carbon dioxide accumulated in the lungs. It reduces respiratory stress by relieving the feeling of shortness of breath as well as excessive respiratory work, reducing anxiety and stress associated with respiratory distress. Importantly, the decision to use non-invasive ventilation as an alternative to endotracheal intubation should be based on a careful evaluation of the patient and continuous monitoring of their response to the treatment. Not all patients are suitable candidates for non-invasive ventilation and in some cases endotracheal intubation may be necessary to ensure adequate ventilation. Method: a systematic review was carried out. Results: 6 articles that met the criteria were reviewed, the number of patients included was 552,23 % (127 patients) were hospitalized in the general ward and 77 % (425 patients) in the Intensive Care Unit, of the total patients. 83,51 % received treatment with non-invasive ventilation, 11,77 % oxygen therapy and 4,71 % endotracheal intubation upon admission. 5,61 % of the total patients required endotracheal intubation during the course of their hospitalization. Conclusion: in selected patients, Non-invasive ventilation reduces the rate of endotracheal intubation, infectious complications, hospital stay and relapsed. When appropriately used from its implementation until its withdrawal once the respiratory failure is solved, it has a beneficial impact on the patient as well as the economic burden by reducing healhcare cos

Assessment of the efficacy in athletes and non-athletes of the use of creatine monohydrate in physical exercise: a systematic review

Introduction: considering the growing awareness of the population regarding the importance of engaging in physical activity, the utilization of supplements, such as creatine monohydrate, is also expanding in search of the attributed benefits of these substances. This study describes and analyzes the relationship between supplementation with creatine monohydrate and the improvement in the athletic performance of athletes from various disciplines and training levels, as well as non-athletes. Material and method: a systematic review of clinical trials that address the use of creatine monohydrate in various sports contexts was conducted, followed by an analysis of the results based on body composition, jump capacity, and strength performance to determine points of correlation between the data presented in each publication. Results: a significant improvement in body composition, jump capacity, and strength performance was observed among participants who used supplementation, although in many cases, the results were heterogeneous. Conclusions: creatine monohydrate supplementation positively influences body composition and physical performance, but further research is needed to understand its effects in specific populations

Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries

IMPORTANCE: Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES: To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS:The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES:Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES: The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS: Of 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE: Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS

Evaluation of an Active Humidification System for Inspired Gas

ObjectivesThe effectiveness of the active humidification systems (AHS) in patients already weaned from mechanical ventilation and with an artificial airway has not been very well described. The objective of this study was to evaluate the performance of an AHS in chronically tracheostomized and spontaneously breathing patients.MethodsMeasurements were quantified at three levels of temperature (T°) of the AHS: level I, low; level II, middle; and level III, high and at different flow levels (20 to 60 L/minute). Statistical analysis of repeated measurements was performed using analysis of variance and significance was set at a P<0.05.ResultsWhile the lowest temperature setting (level I) did not condition gas to the minimum recommended values for any of the flows that were used, the medium temperature setting (level II) only conditioned gas with flows of 20 and 30 L/minute. Finally, at the highest temperature setting (level III), every flow reached the minimum absolute humidity (AH) recommended of 30 mg/L.ConclusionAccording to our results, to obtain appropiate relative humidity, AH and T° of gas one should have a device that maintains water T° at least at 53℃ for flows between 20 and 30 L/m, or at T° of 61℃ at any flow rate

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

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)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, NCT02010073

Assessment of the efficacy in athletes and non-athletes of the use of creatine monohydrate in physical exercise: a systematic review

Introduction: considering the growing awareness of the population regarding the importance of engaging in physical activity, the utilization of supplements, such as creatine monohydrate, is also expanding in search of the attributed benefits of these substances. This study describes and analyzes the relationship between supplementation with creatine monohydrate and the improvement in the athletic performance of athletes from various disciplines and training levels, as well as non-athletes. Material and method: a systematic review of clinical trials that address the use of creatine monohydrate in various sports contexts was conducted, followed by an analysis of the results based on body composition, jump capacity, and strength performance to determine points of correlation between the data presented in each publication. Results: a significant improvement in body composition, jump capacity, and strength performance was observed among participants who used supplementation, although in many cases, the results were heterogeneous. Conclusions: creatine monohydrate supplementation positively influences body composition and physical performance, but further research is needed to understand its effects in specific populations

Utility of non-invasive mechanical ventilation in critically ill patients with exacerbated COPD. Systematic review

Background: non-invasive mechanical ventilation is a useful ventilatory support method for patients with acute respiratory failure or exacerbation of chronic obstructive pulmonary disease mediated by different mechanisms. It helps to reduce airflow resistance and facilitates lung expansion, reducing respiratory muscle fatigue. This allows the patient to breathe more efficiently. By providing positive pressure into the airways, it helps to open the collapsed alveoli and lower airways improving gas exchange. As a consequence, oxygenation enhances. Additionally, by increasing air flow, it helps to eliminate carbon dioxide accumulated in the lungs. It reduces respiratory stress by relieving the feeling of shortness of breath as well as excessive respiratory work, reducing anxiety and stress associated with respiratory distress. Importantly, the decision to use non-invasive ventilation as an alternative to endotracheal intubation should be based on a careful evaluation of the patient and continuous monitoring of their response to the treatment. Not all patients are suitable candidates for non-invasive ventilation and in some cases endotracheal intubation may be necessary to ensure adequate ventilation. Method: a systematic review was carried out. Results: 6 articles that met the criteria were reviewed, the number of patients included was 552,23 % (127 patients) were hospitalized in the general ward and 77 % (425 patients) in the Intensive Care Unit, of the total patients. 83,51 % received treatment with non-invasive ventilation, 11,77 % oxygen therapy and 4,71 % endotracheal intubation upon admission. 5,61 % of the total patients required endotracheal intubation during the course of their hospitalization. Conclusion: in selected patients, Non-invasive ventilation reduces the rate of endotracheal intubation, infectious complications, hospital stay and relapsed. When appropriately used from its implementation until its withdrawal once the respiratory failure is solved, it has a beneficial impact on the patient as well as the economic burden by reducing healhcare cos

Obstetric Disorders in the ICU

AbstractPregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.</jats:p