Examining the intubation decision in randomised clinical trials.

https://bit.ly/3qAmCYt

Self-Extubation Revisited: A Case-Control Study.

Background: To increase the understanding of the self-extubation phenomena, we assessed its rate in our medical ICU and aimed to identify the risk factors of self-extubation and the risk factors for re-intubation.

Methods: We prospectively identified subjects who self-extubated. Their baseline characteristics, including the Richmond Agitation Severity Scale score, reason for intubation, shift, distance of the endotracheal tube tip to the carina, and outcomes were collected retrospectively.

Acute respiratory failure in randomized trials of noninvasive respiratory support: A systematic review of definitions, patient characteristics, and criteria for intubation.

Purpose: To examine the definitions of acute respiratory failure, the characteristics of recruited patients, and the criteria for intubation used in randomized trials.

Methods: We searched MEDLINE for randomized trials of noninvasive respiratory support modalities in patients with de novo respiratory failure. We included trials from 1995 to 2017 that enrolled 40 or more patients and used intubation as an outcome.

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline.

The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations.

The clinical implications of tests confirming COPD in subjects hospitalized with exacerbations.

Background: The diagnosis of COPD in patients hospitalized for AECOPD can be confirmed by spirometry showing obstruction or radiographs showing emphysema. The evidence for COPD is sometimes absent or contradicts this diagnosis. The inaccurate attribution of the exacerbation to COPD can lead to suboptimal care and worse outcome.

DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure.

Background: The assessment of the work of breathing in the definitions of respiratory failure is vague and variable.

Objective: Identify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients.

Methods: We examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation, or T-piece.

Effect of arterial puncture on ventilation.

Background: Clinicians frequently assume that during arterial puncture for measuring arterial blood gases patients hyperventilate from pain and anxiety. This assumption leads clinicians to falsely interpret a PaCO and pH near the upper limit of normal as a chronic respiratory acidosis corrected by an acute respiratory alkalosis.

Objective: Determine if participants hyperventilate during arterial puncture from pain and anxiety.

The effects of obesity on lung volumes and oxygenation.

Introduction: Obesity can cause hypoxemia by decreasing lung volumes to where there is closure of lung units during normal breathing. Studies describing this phenomenon are difficult to translate into clinical practice. We wanted to determine the lung volume measurements that are associated with hypoxemia in obese patients, and explore how we could use these measurements to identify them.

Therapeutic hypothermia at an urban public hospital: Development, implementation, experience and outcomes.

Background: Therapeutic hypothermia (TH) improves the outcome of comatose patients suffering an out-of-hospital sudden cardiac arrest (SCA) with shockable rhythm and return of spontaneous circulation (ROSC). Evidence supporting its use in other circumstances is weak and the adoption of TH remains limited.

Objective: Describe the development and implementation of a TH program at an urban public hospital and report outcomes of out-of-hospital and in-hospital SCA and important quality measures.

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients.

Background: Polysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities.

Objective: We evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB.

The validity and reliability of the clinical assessment of increased work of breathing in acutely ill patients.

Background: Mechanical ventilation is frequently indicated to reduce the work of breathing. Because it cannot be measured easily at the bedside, physicians rely on surrogate measurements such as patient appearance of distress and increased breathing effort.

Objective: We determined the validity and reliability of subjectively rating the appearance of respiratory distress and the reliability of 11 signs of increased breathing effort.

Effect of Wakefulness-Promoting Agents on Sleepiness in Patients with Sleep Apnea Treated with CPAP: A Meta-Analysis.

Study Objectives: To perform a meta-analysis of the effect of wakefulness-promoting agents (modafinil and armodafinil) in patients with residual sleepiness after CPAP therapy for obstructive sleep apnea.

Methods: We conducted a systematic search of MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014) and Cochrane Database for randomized placebo controlled trials on modafinil or armodafinil in patients who met established criteria for diagnosis of obstructive sleep apnea, adequate continuous positive airway pressure use, and who complained of residual sleepiness. Risk of bias was assessed.

Association between rating of respiratory distress and vital signs, severity of illness, intubation, and mortality in acutely ill subjects.

Background: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death.

Is the content of textbooks on the evaluation of a patient in respiratory distress adequate?

Background: The ability to rapidly and precisely evaluate patients in respiratory distress is essential. Due to limited opportunities for formal instruction during training, textbooks are the main educational source to teach junior physicians how to interpret the signs of respiratory distress. The quality of the textbook content relevant to respiratory distress is unknown.

Accuracy and reliability of extubation decisions by intensivists.

Background: Mortality increases when extubations fail. Although predictors of extubation failure have been evaluated, physicians' reasoning to extubate a patient has received minimal attention. We hypothesized that the accuracy and reliability of physicians' extubation decisions are low.

Predicting extubation failure after successful completion of a spontaneous breathing trial.

Objective: To derive a clinical prediction rule that uses bedside clinical variables to predict extubation failure (reintubation within 48 h) after a successful spontaneous breathing trial.

Methods: This prospective observational cohort study was performed at the Northwestern Memorial Hospital in Chicago, Illinois, which is a large tertiary-care university hospital. Among 673 consecutive patients who received mechanical ventilation during a 15-month period, 122 were ventilated for at least 2 days and did not undergo withdrawal of support or tracheostomy.

Recent advances in obesity hypoventilation syndrome.

Obesity hypoventilation syndrome (OHS) consists of a combination of obesity and chronic hypercapnia accompanied by sleep-disordered breathing. During the last 3 decades, the prevalence of extreme obesity has markedly increased in the United States and other countries. With a global epidemic of obesity, the prevalence of OHS is bound to increase.

Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea.

Background: Daytime hypercapnia is common in morbidly obese patients with obstructive sleep apnea and is associated with serious complications. Our objective was to quantify the effect of adherence with positive airway pressure on hypercapnia and hypoxia in these patients.

Methods: We performed a retrospective cohort study of 75 patients using a multivariable general linear model analysis to identify variables that predicted changes in PaCO2 and PaO2 after therapy.

Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea.

Patients with obesity hypoventilation syndrome (OHS) have a lower quality of life, more healthcare expenses, a greater risk of pulmonary hypertension, and a higher mortality compared to eucapnic patients with obstructive sleep apnea (OSA). Despite significant morbidity and mortality associated with OHS, it is often unrecognized and treatment is frequently delayed. The objective of this observational study was to determine the prevalence of OHS in patients with OSA seen at the sleep disorders clinic of a large public urban hospital serving predominantly minority population and to identify clinical--not mechanistic--predictors that should prompt clinicians to measure arterial blood gases.

The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea.

Obstructive sleep apnea (OSA) is independently associated with glucose intolerance and insulin resistance, and recent studies have shown that continuous positive airway pressure (CPAP) improves insulin sensitivity. The objective of this study was to describe the change in glycosylated hemoglobin (HbA1c) after treatment with CPAP in patients with type 2 diabetes mellitus and OSA. To test this hypothesis, we performed a retrospective analysis of 38 patients seen in the sleep clinic of an urban public teaching hospital.

Potassium sorbate reduces gastric colonization in patients receiving mechanical ventilation.

Objectives: Tube feeding might increase gastric burden of pathogenic bacteria and predispose patients to ventilator-associated pneumonia. We sought to determine whether a tube feeding formula acidified using potassium sorbate could reduce gastric burden of potentially pathogenic bacteria.

Design: Prospective, randomized, double-blind trial.