Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study.

Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.

Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.

Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU.

Purpose: An International Consensus Conference proposed classifying weaning into simple, difficult, and prolonged weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients from the three weaning groups in a respiratory ICU; and (2) to assess predictors for prolonged weaning and survival.

Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients.

Rationale: Most current information on hospital-acquired pneumonia (HAP) is extrapolated from patients with ventilator-associated pneumonia (VAP). No studies have evaluated HAP in the intensive care unit (ICU) in nonventilated patients.

Objectives: To compare pneumonia acquired in the ICU by mechanically ventilated versus nonventilated patients.

Validation of the American Thoracic Society-Infectious Diseases Society of America guidelines for hospital-acquired pneumonia in the intensive care unit.

Background: The 2005 guidelines of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital for managing hospital-acquired pneumonia classified patients according to time of onset and risk factors for potentially drug-resistant microorganisms to select the empirical antimicrobial treatment. We assessed the microbial prediction and validated the adequacy of these guidelines for antibiotic strategy.

Methods: We prospectively observed 276 patients with intensive care unit-acquired pneumonia.

Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial.

Background: Non-invasive ventilation can prevent respiratory failure after extubation in individuals at increased risk of this complication, and enhanced survival in patients with hypercapnia has been recorded. We aimed to assess prospectively the effectiveness of non-invasive ventilation after extubation in patients with hypercapnia and as rescue therapy when respiratory failure develops.

Methods: We undertook a randomised controlled trial in three intensive-care units in Spain.

Systemic inflammatory response and increased risk for ventilator-associated pneumonia: a preliminary study.

Objective: Inflammatory markers have been assessed for the diagnosis and follow-up of ventilator-associated pneumonia (VAP), but their potential role in predicting the risk for VAP is unknown. We prospectively assessed the evolution of cytokines in mechanically ventilated patients and their predictive and diagnostic role for VAP.

Design: Prospective observational study.

Ventilator-associated pneumonia.

Purpose Of Review: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in patients receiving mechanical ventilation. Despite numerous advances in the understanding of this disorder, the incidence rate continues in an unacceptable range. In this review, we discuss some important findings of recently published studies on diagnosis, prevention and treatment.

Bronchoalveolar lavage to diagnose respiratory infections.

Respiratory samples obtained by bronchoalveolar lavage (BAL) in infectious processes provide important microbiological and cytological information to manage this type of patient. Most of the clinical and experimental BAL investigations have been done in ventilator-associated pneumonia (VAP) and in immunosuppressed conditions. The impact of quantitative BAL bacterial cultures for managing VAP is still controversial.

Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores.

Background: Community-acquired pneumonia (CAP) with a pneumonia severity index (PSI) score in risk class V (PSI-V) is a potentially life-threatening condition, yet the majority of patients are not admitted to the ICU. The aim of this study was to characterize CAP patients in PSI-V to determine the risk factors for ICU admission and mortality, and to assess the performance of CAP severity scores in this population.

Methods: Prospective observational study including hospitalized adults with CAP in PSI-V from 1996 to 2003.

Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial.

Objective: The aspiration of subglottic secretions colonized by bacteria pooled around the tracheal tube cuff due to inadvertent deflation (<20 cm H2O) of the cuff plays a relevant role in the pathogenesis of ventilator-associated pneumonia. We assessed the efficacy of an automatic, validated device for the continuous regulation of tracheal tube cuff pressure in preventing ventilator-associated pneumonia.

Design: Prospective randomized controlled trial.

Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.

Rationale: Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality.

Objectives: To assess the efficacy of noninvasive ventilation in averting respiratory failure after extubation in patients at increased risk.

Methods: A prospective randomized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation.

Respiratory microbiology patterns within the first 24 h of ARDS diagnosis: influence on outcome.

Background: Airway colonization and infection are frequent complications during the course of ARDS. The impact on outcomes of microbiological patterns recovered within the first 24 h after diagnosis has not been evaluated.

Objectives: To describe the incidence and patterns of bronchial colonization and lung infection within the first 24 h of ARDS diagnosis and to evaluate the influence on ICU outcomes.

Does ventilator-associated tracheobronchitis need antibiotic treatment?

It is difficult to define ventilator-associated tracheobronchitis (VAT). The most accepted definition includes fever (temperature > 38 degrees C), new or increased sputum production, a microbiologically positive respiratory sample with counts above the accepted thresholds and absence of pulmonary infiltrates on chest X-ray. Although we have no doubt that this pathologic process exists, the main controversy lies on whether this entity has any impact on the outcome and, thus, a specific therapeutic approach is suitable.

Respiratory nosocomial infections in the medical intensive care unit.

Intensive care unit (ICU)-acquired lower respiratory tract infections include acute tracheobronchitis and hospital-acquired and ventilator-associated pneumonia (VAP). Nosocomial pneumonia is the second most common hospital-acquired infection and the leading cause of death in hospital-acquired infections. The mortality rate in VAP ranges from 24% to 76% in several studies.

Ethics roundtable debate: A patient dies from an ICU-acquired infection related to methicillin-resistant Staphylococcus aureus--how do you defend your case and your team?

An elderly patient dies from septic shock in the intensive care unit. This is perhaps not an unusual scenario, but in this case the sepsis happens to have been due to methicillin-resistant Staphylococcus aureus, possibly related to a catheter, and possibly transmitted from a patient in a neighbouring room by less than adequate compliance with infection control procedures. The family decides to sue.