Nighttime and non-working days are characterized by a shortage of dedicated staff and available resources. Previous studies have highlighted that patients admitted during the weekend had higher mortality than patients admitted on weekdays ("weekend effect"). However, most studies have focused on specific conditions and controversial results were reported.
View Article and Find Full Text PDFBackground: Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO (ECCOR) may enhance the efficacy of NIV to remove CO and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation.
View Article and Find Full Text PDFBackground: The roles of high-flow nasal cannula (HFNC) and CPAP in coronavirus disease 2019 (COVID-19) are controversial. The objective of the study was to evaluate the impact of the application of a noninvasive respiratory support algorithm on clinical outcomes in subjects with COVID-19 and with acute respiratory failure.
Methods: We performed a single-center prospective observational study of subjects with respiratory failure from COVID-19 managed with HFNC and with CPAP plus HFNC (combined therapy).
Introduction: Up to fifteen percent of patients with novel pandemic coronavirus disease (Covid-19) have acute respiratory failure (ARF). Ratio between arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2), P/F, is currently used as a marker of ARF severity in Covid-19. P/F does not reflect the respiratory efforts made by patients to maintain arterial blood oxygenation, such as tachypnea and hyperpnea, leading to hypocapnia.
View Article and Find Full Text PDFUnlabelled: High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure.
Objective: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold.
Design: Multicenter study.
The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controversial. The aim of this observational study was to show the experience of the first month since the creation of a Non-invasive Ventilatory Support Unit (NIVSU) at Hospital Fernández. We describe the creation of the NIVSU, the health professional-patient ratio, the type of room, the modified personal protection equipment; diagnostic, monitoring and ventilatory support equipment for treatment, as well as the inclusion criteria and the treatment algorithm.
View Article and Find Full Text PDFDischarging a chronic critically ill patient is a risky procedure if the clinician does not have full control of his prescription. This is even more important when applying a machine to replace a failing organ, as is the case for home ventilation. Even if modern home ventilators fulfil quality and safety criteria and, 'on paper', ventilators and masks look very similar, performance and scenarios of applicability are not always equivalent.
View Article and Find Full Text PDFObjectives: Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation.
Design: Randomized crossover physiologic study.
Setting: Two ICUs.
High-flow nasal cannula (HFNC) is a device able to deliver heated and humidified oxygen at high flows (up to 60 L/minutes). Potential benefits of HFNC are several and include the improvement of lung mucociliary clearance, the washout of upper airway dead space, the generation of a low level of positive airway pressure (PEEP effect), the decrease in inspiratory resistance and at the same time the increase in expiratory resistance. The present review aimed to describe the evidence surrounding the use of HFNC in stable chronic obstructive pulmonary disease patients.
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