Community versus academic hospital community-acquired pneumonia patients: a nested cohort study.

Background: Most Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.

Methods: This nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals.

Consequences of Pausing Heated Humidification During Invasive Ventilation.

Background: During invasive mechanical ventilation, where medical gases are very dry and the upper airway is bypassed, appropriate gas conditioning and humidification are mandatory at all times. Results of in vitro studies suggest that dry gases may improve lung deposition during nebulization, but this has not been confirmed through in vivo studies. The objective of this study was to measure gas humidity under multiple conditions to better describe gas hygrometry when heated humidifiers are turned off.

Clinical Implementation of Automated Oxygen Titration in a Tertiary Care Hospital.

Background: When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. S should be monitored closely and O flows adjusted accordingly. Achieving this goal might be easier with automated O titration compared with manual titration of fixed-flow O.

Ozanimod Therapy in Patients With COVID-19 Requiring Oxygen Support: A Randomized Open-Label Pilot Trial.

Background: Sphingosine-1-phosphate receptor ligands (SRLs) dampen immunopathologic damages in models of viral pneumonia.

Research Question: Is it feasible to administer an SRL therapy, here ozanimod (OZA), to acutely ill patients infected with SARS-CoV-2?

Study Design And Methods: The prospective randomized open-label COVID-19 Ozanimod Intervention (COZI) pilot trial was conducted in three Canadian hospitals. Patients admitted for COVID-19 requiring oxygen were eligible.

Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial.

Importance: Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded.

Objective: To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures.

Evaluation of the Humidification Performances of New Generation of Heated Wire Humidifiers.

Background: At high ambient temperatures in ICU rooms, the humidification performances of heated-wire humidifiers are significantly reduced, with delivered gas humidity well below 30 mg HO/L, which leads to an increased risk of endotracheal occlusions, subocclusions, or mucociliary dysfunction. The objective of the study was to evaluate the humidity delivered at the Y-piece with new-generation heated-wire humidifiers with advanced algorithm (FP950 [Fisher & Paykel Healthcare, Auckland, New Zealand] and VHB20 [Vincent Medical, Inspired, Hong Kong]) while varying ambient temperatures.

Methods: We measured, on the bench, the hygrometry of inspiratory gases delivered by a new generation of heated-wire humidifiers (i) FP950, (ii) VHB20 and a previous generation of heated-wire humidifiers, (iii) MR850 (Fisher & Paykel) with the usual settings (37°C at the chamber/40°C at the Y-piece), (iv) MR850 with no temperature gradient (40°C/40°C), and (v) MR850 with the automatic compensation algorithm activated.

Automated O Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases.

Background: Exercise-induced O desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O titration was superior to fixed-flow O to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O titration on these outcomes.

Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia.

Background: Automated oxygen titration to maintain a stable S has been developed for spontaneously breathing patients but has not been evaluated during CPAP and noninvasive ventilation (NIV).

Methods: We performed a randomized controlled crossover, double-blind study on 10 healthy subjects with induced hypoxemia during 3 situations: spontaneous breathing with oxygen support, CPAP (5 cm HO), and NIV (7/3 cm HO). We conducted in random order 3 dynamic hypoxic challenges of 5 min (F 0.

Accuracy of Multiple Pulse Oximeters in Stable Critically Ill Patients.

Background: An accurate S value is critical in order to optimally titrate oxygen delivery to patients and to follow oxygenation guidelines. Limited prospective data exist on real-world performance of pulse oximeters in critically ill patients. The objective of this study was to assess accuracy and bias of the S values measured by several oximeters in hospitalized subjects.

The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing.

Background: Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study.

Monitoring of Heated Wire Humidifier Hygrometric Performances With Heater Plate Temperature.

Background: Under-humidification and associated complications may occur with heated humidifiers. Hygrometric performances of heated wire humidifiers are reduced by high ambient and high outlet ventilator temperatures. Currently, there is no reliable monitoring tool to evaluate humidification performances of heated wire humidifiers in the daily practice.

Early heart rate variability evaluation enables to predict ICU patients' outcome.

Heart rate variability (HRV) is a mean to evaluate cardiac effects of autonomic nervous system activity, and a relation between HRV and outcome has been proposed in various types of patients. We attempted to evaluate the best determinants of such variation in survival prediction using a physiological data-warehousing program. Plethysmogram tracings (PPG) were recorded at 75 Hz from the standard monitoring system, for a 2 h period, during the 24 h following ICU admission.

Impact of Airway Humidification Strategy in Mechanically Ventilated COVID-19 Patients.

Background: Humidification of inspiratory gases is mandatory in all mechanically ventilated patients in ICUs, either with heated humidifiers (HHs) or with heat and moisture exchangers (HMEs). In patients with COVID-19, the choice of the humidification device may have relevant impact on patients' management as demonstrated in recent studies. We reported data from 2 ICUs using either HME or HH.

Hygrometric Performances of Different High-Flow Nasal Cannula Devices: Bench Evaluation and Clinical Tolerance.

Background: High-flow nasal cannula (HFNC) is increasingly used for the management of respiratory failure. Settings include [Formula: see text], total gas flow, and temperature target. Resulting absolute humidity (AH) at the nasal cannula may affect clinical tolerance, and optimal settings with respect to hygrometry remain poorly documented.