Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanisms by which proning improves oxygenation as well as the potential risks proning on NIV brings, for which we make specific recommendations.
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http://dx.doi.org/10.1136/bcr-2020-235243 | DOI Listing |
Indian J Crit Care Med
July 2023
Department of Critical Care Medicine, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India.
Introduction: Pandemic influenza H1N1/09 emerged for the first time in April 2009 and has spread widely across India since then. The number of cases have increased over time with the increasing need for respiratory support, causing significant morbidity and mortality. We evaluated the clinical course and outcomes of patients infected with Influenza A (H1N1) admitted to three multidisciplinary intensive care units (ICU) in Chennai.
View Article and Find Full Text PDFBreathe (Sheff)
March 2023
Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes.
View Article and Find Full Text PDFEPMA J
June 2023
Via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele Italy Department of Biomedical Sciences, HUMANITAS University.
Background: Concern exists that noninvasive ventilation (NIV) may promote ventilation-induced lung injury(VILI) and worsen outcome in acute hypoxemic respiratory failure (AHRF). Different individual ventilatory variables have been proposed to predict clinical outcomes, with inconsistent results.Mechanical power (MP), a measure of the energy transfer rate from the ventilator to the respiratory system during mechanical ventilation, might provide solutions for this issue in the framework of predictive, preventive and personalized medicine (PPPM).
View Article and Find Full Text PDFCrit Care Med
September 2023
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Objectives: To study: 1) the effect of prone position (PP) on noninvasive ventilation (NIV)-delivered mechanical power (MP) and 2) the impact of MP on physio-anatomical and clinical responses to early versus late PP in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
Design: Nonrandomized trial with inverse probability of treatment weighted-matched groups.
Setting: HUMANITAS Gradenigo Sub-ICU.
Chest
August 2023
Department of Medicine, University of Cambridge, Cambridge, England.
Background: Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS.
Research Question: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda?
Study Design And Methods: A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded.
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