Early intensive physical rehabilitation combined with a protocolized decannulation process in tracheostomized survivors from severe COVID-19 pneumonia with chronic critical illness

(1) Background: Intensive care unit (ICU) survivors from severe COVID-19 acute respiratory distress syndrome (CARDS) with chronic critical illness (CCI) may be considered vast resource consumers with a poor prognosis. We hypothesized that a holistic approach combining an early intensive rehabilitation with a protocol of difficult weaning would improve patient outcomes (2) Methods: A single-center retrospective study in a five-bed post-ICU weaning and intensive rehabilitation center with a dedicated fitness room specifically equipped to safely deliver physical activity sessions in frail patients with CCI. (3) Results: Among 502 CARDS patients admitted to the ICU from March 2020 to March 2022, 50 consecutive tracheostomized patients were included in the program. After a median of 39 ICU days, 25 days of rehabilitation were needed to restore patients’ autonomy (ADL, from 0 to 6; p < 0.001), to significantly improve their aerobic capacity (6-min walking test distance, from 0 to 253 m; p < 0.001) and to reduce patients’ vulnerability (frailty score, from 7 to 3; p < 0.001) and hospital anxiety and depression scale (HADS, from 18 to 10; p < 0.001). Forty-eight decannulated patients (96%) were discharged home. (4) Conclusions: A protocolized weaning strategy combined with early intensive rehabilitation in a dedicated specialized center boosted the physical and mental recovery

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Delayed but successful response to noninvasive ventilation in COPD patients with acute hypercapnic respiratory failure

Malcolm Lemyze,1,2 Quentin Bury,3 Aur&eacute;lie Guiot,4 Marie Jonard,1,2 Usman Mohammad,2 Nicolas Van Grunderbeeck,5 Gaelle Gasan,1 Didier Thevenin,2 Jihad Mallat2 1Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, 2Intensive Care Unit, Arras Hospital, Arras, 3Respiratory Intermediate Care Unit, B&eacute;thune Beuvry Hospital, B&eacute;thune, 4Department of Cardiology, Bois Bernard Hospital, Bois Bernard, 5Respiratory Step Down Unit, Schaffner Hospital, Lens, France Background: We evaluated a new noninvasive ventilation (NIV) protocol that allows the pursuit of NIV in the case of persistent severe respiratory acidosis despite a first NIV challenge in COPD patients with acute hypercapnic respiratory failure (AHRF). Patients and methods: A prospective observational multicentric pilot study was conducted in three tertiary hospitals over a 12-month study period. A total of 155 consecutive COPD patients who were admitted for AHRF and treated by NIV were enrolled. Delayed response to NIV was defined as a significant clinical improvement in the first 48&nbsp;h following NIV initiation despite a persistent severe respiratory acidosis (pH&nbsp;&lt;7.30) after the first 2&nbsp;h of NIV trial. Results: NIV failed in only 10 patients (6.5%). Delayed responders to NIV (n=83, 53%) exhibited similar nutritional status, comorbidities, functional status, frailty score, dyspnea score, and severity score at admission, compared with early responders (n=62, 40%). Only age (66 vs 70 years in early responders; P=0.03) and encephalopathy score (3 [2&ndash;4] vs 3 [2&ndash;4] in early responders; P=0.015) were different among the responders. Inhospital mortality did not differ between responders to NIV (n=10, 12% for delayed responders vs n=10, 16% for early responders, P=0.49). A second episode of AHRF occurred in 20 responders (14%), equally distributed among early and delayed responders to NIV (n=9, 14.5% in early responders vs n=11, 13% in delayed responders; P=0.83), with a poor survival rate (n=1, 5%). Conclusion: Most of the COPD patients with AHRF have a successful outcome when NIV is pursued despite a persistent severe respiratory acidosis after the first NIV trial. The outcome of delayed responders is similar to the one of the early responders. On the contrary, the second episode of AHRF during the hospital stay carries a poor prognosis. Keywords: noninvasive ventilation, acute respiratory failure, COPD, hypercapnia, intubation&nbsp