Preparedness and Reorganization of Care for Coronavirus Disease 2019 Patients in a Swiss ICU: Characteristics and Outcomes of 129 Patients.

Objectives: In many countries, large numbers of critically ill patients with coronavirus disease 2019 are admitted to the ICUs within a short period of time, overwhelming usual care capacities. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favorable outcome. The purpose of this study was to report our experience in terms of ICU organization and anticipation, as well as reporting patient characteristics, treatment, and outcomes.

Veno-venous extracorporeal membrane oxygenation: cannulation techniques.

The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection.

["Mobile" ECMO].

ECMO (extracorporeal membrane oxygenation) is a cardiac or respiratory support which uses the principle of extracorporeal circulation (ECC). It consists of a pump generating an output as well as a membrane oxygenating blood and removing CO2. Thanks to an ECMO mobile team, expert caregivers can now perform the circulatory support in primary centers and then transfer patients under assistance to the referral center.

Peri-operative massive pulmonary embolism management: is veno-arterial ECMO a therapeutic option?

Pulmonary embolism remains an important clinical problem with a high mortality rate. The potential for sudden and fatal hemodynamic deterioration highlights the need for a prompt diagnosis and appropriate intervention. The purpose of the present case report is to describe a successful peri-operative veno-arterial extra corporeal membrane oxygenation (VA-ECMO) implantation for assumed massive pulmonary embolism associated with high hemodynamic instability and severe hypoxemia.

A new process-centered description tool to initiate meta-reporting methodology in healthcare - 7CARECAT™. Feasibility study in a post-anesthesia care unit.

Background: In the healthcare domain, different analytic tools focused on accidents appeared to be poorly adapted to sub-accidental issues. Improving local management and intra-institutional communication with simpler methods, allowing rapid and uncomplicated meta-reporting, could be an attractive alternative.

Methods: A process-centered structure derived from the industrial domain - DEPOSE(E) - was selected and modified for its use in the healthcare domain.

[Headache and transient aphasia in a 35-year-old female patient].

We describe the case of a 35-year-old female patient who suffered from fulminant tick-borne encephalitis and subsequently died. Remarkable about this case was that the woman was not living in an endemic area and that the disease occurred outside the usual season. Furthermore, this indicates that an increase in transmission of tick-borne encephalitis can be expected outside the classical endemic areas in higher altitudes, possibly as a consequence of climate changes.

NAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand.

Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation (PS), it improves patient-ventilator synchrony and should allow a better expression of patient's intrinsic respiratory variability. We hypothesize that NAVA provides better matching in ventilator tidal volume (Vt) to patients inspiratory demand.

Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask.

Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask.

Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order.

Clinical review: Update on neurally adjusted ventilatory assist--report of a round-table conference.

Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe.

Bench testing of a new hyperbaric chamber ventilator at different atmospheric pressures.

Purpose: Providing mechanical ventilation is challenging at supra-atmospheric pressure. The higher gas density increases resistance, reducing the flow delivered by the ventilator. A new hyperbaric ventilator (Siaretron IPER 1000) is said to compensate for these effects automatically.

[When the heart and/or the lung fails: the ECMO].

The Extra corporeal membrane oxygenation (ECMO) was initially proposed as a technique of respiratory support using an external membrane oxygenator. With time, it has also become a technique of cardiorespiratory support to ensure both gas exchange and organ perfusion until the restoration of organs function. This technical assistance can be central or peripheral and provides a partial or total circulatory support.

[Neurally adjusted ventilatory assist: a revolution of mechanical ventilation?].

Neurally adjusted ventilatory assist or NAVA is a new assisted ventilatory mode which, in comparison with pressure support, leads to improved patient-ventilator synchrony and a more variable ventilatory pattern. It also improves arterial oxygenation. With NAVA, the electrical activity of the diaphragm is recorded through a nasogastric tube equipped with electrodes.

[Resilience engineering in intensive care].

The process of health care delivery in Intensive Care Units (ICUs) is subject to significant workload fluctuations and unpredictable events. Medical and nursing staff, while relying on protocols, must adjust to these "out of the routine" disturbances by displaying initiative and innovation. The aim is to maintain the ratio risk-performance in admissible margins for the institution despite severe disruptions of operation.

Online estimation of respiratory mechanics in non-invasive pressure support ventilation: a bench model study.

An online algorithm for determining respiratory mechanics in patients using non-invasive ventilation (NIV) in pressure support mode was developed and embedded in a ventilator system. Based on multiple linear regression (MLR) of respiratory data, the algorithm was tested on a patient bench model under conditions with and without leak and simulating a variety of mechanics. Bland-Altman analysis indicates reliable measures of compliance across the clinical range of interest (± 11-18% limits of agreement).

Neurally adjusted ventilatory assist improves patient-ventilator interaction.

Purpose: To determine if, compared with pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces trigger delay, inspiratory time in excess, and the number of patient-ventilator asynchronies in intubated patients.

Methods: Prospective interventional study in spontaneously breathing patients intubated for acute respiratory failure. Three consecutive periods of ventilation were applied: (1) PS1, (2) NAVA, (3) PS2.

Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study.

Objective: To evaluate the impact of noninvasive ventilation (NIV) algorithms available on intensive care unit ventilators on the incidence of patient-ventilator asynchrony in patients receiving NIV for acute respiratory failure.

Design: Prospective multicenter randomized cross-over study.

Setting: Intensive care units in three university hospitals.

[Anesthetic gases for the treatment of acute severe asthma].

Halogenated gases have sometimes been used for treating acute severe asthma when this disorder is refractory to any drug. Presently, we only can rely on some sparsed observations, or to small retrospective series. Isoflurane seems to be the most studied gas: it has clearly a bronchodilating action, and its side-effects seem to be minor.

Automated detection of asynchrony in patient-ventilator interaction.

An automated classification algorithm for the detection of expiratory ineffective efforts in patient-ventilator interaction is developed and validated. Using this algorithm, 5624 breaths from 23 patients in a pulmonary ward were examined. The participants (N = 23) underwent both conventional and non-invasive ventilation.

Evaluation of the user-friendliness of seven new generation intensive care ventilators.

Objective: To explore the user-friendliness and ergonomics of seven new generation intensive care ventilators.

Design: Prospective task-performing study.

Setting: Intensive care research laboratory, university hospital.

Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study.

Objective: To determine the prevalence of patient-ventilator asynchrony in patients receiving non-invasive ventilation (NIV) for acute respiratory failure.

Design: Prospective multicenter observation study.

Setting: Intensive care units in three university hospitals.

[Intensive care medicine in Switzerland].

The authors express their views on the past, present and future of intensive care medicine in Switzerland. They point some past and present concerns in critical care medicine, but they insist on the future needs of this medical specialty: the critical patients necessitate, and have the right to obtain, a highly trained and specialized personnel, working in strong connection with the whole hospital, in a systemic way of treating patients. The authors insist on the very high complexity of the ICU-patients treated today.

[Heliox in acute severe asthma].

In acute severe asthma, the use of heliox can reduce dyspnea, when the patient is spontaneously breathing as well as in mechanical ventilation. This effect is due to a decrease in airway resistance. A better penetration of aerosolized bronchodilators has also been observed.

Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study.

Objective: Noninvasive ventilation (NIV) is often applied with ICU ventilators. However, leaks at the patient-ventilator interface interfere with several key ventilator functions. Many ICU ventilators feature an NIV-specific mode dedicated to preventing these problems.