Noninvasive ventilation during the weaning process in chronically critically ill patients

Sancho, Jesús; Servera, Emilio; Jara‐Palomares, Luis; Barrot, Emilia; Sánchez-Oro-Gomez, Raquel; Terreros, F. Javier Gómez de; Martín-Vicente, María; Utrabo, Isabel; Núñez, Belén; Binimelis, Alicia; Sala, Ernest; Zamora, Enrique; Segrelles, G.; Ortega‐González, Ángel; Masa, Fernando

doi:10.1183/23120541.00061-2016

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…It was conducted at a single-center hospital, implying a small sample size; also, due to the exploratory nature of the study, not driven by formal hypotheses, the sample size was not calculated. International guidelines recommend that patients with tracheostomy secondary to COVID-19 need to be managed by experienced staff trained in tracheostomy care and management; [ 6 ] (6) in this regard, our Respiratory Care Unit has extensive experience in the management of patients with tracheostomy and patients with CCI [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in patients with COVID-19: predictors and clinical features

Sancho

Ferrer

Lahosa

et al. 2021

Eur Arch Otorhinolaryngol

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Background Around 20% of patients hospitalized for COVID-19 need mechanical ventilation (MV). MV may be prolonged, thus warranting tracheostomy. Methods Observational cohort study enrolling patients admitted due to COVID-19. Demographic and clinical data at hospital and ICU admission were collected. The primary endpoint was to identify parameters associated with a need for tracheostomy; secondary endpoints were to analyze the clinical course of patients who needed tracheostomy. Results 118 patients were enrolled; 37 patients (31.5%) were transferred to ICU, of which 11 (29.72%) needed a tracheostomy due to prolonged MV. Sequential Organ Failure Assessment (SOFA) score at ICU admission (OR 0.65, 95% CI 0.47-0.92, p 0.015) was the only variable found to be associated with increased risk of the need for tracheostomy, with a cut-off point of 4.5 (sensitivity 0.72, specificity 0.73, positive predictive value 0.57 and negative predictive value 0.85). The main complications were nosocomial infection (100%), supraventricular cardiac arrhythmia (45.5%), agitation (54.5%), pulmonary thromboembolism (9.1%) and depression (9.1%). All patients presented with hypoalbuminemia and significant critical illness polyneuropathy. Conclusion SOFA at ICU admission is associated with an increased risk of tracheostomy in patients with COVID-19. Moreover, they present clinical features similar to those with chronic critical illness and suffer SARS-CoV-2-related complications.

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Section: Discussionmentioning

confidence: 99%

Tracheostomy in patients with COVID-19: predictors and clinical features

Sancho

Ferrer

Lahosa

et al. 2021

Eur Arch Otorhinolaryngol

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“…A prospective study included chronically critically ill patients admitted to Spanish respiratory care units [43].…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

2019

Multidis Res Med

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Background: Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field. Main body: There is great variability in terminology and definitions of prolonged mechanical ventilation. There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units. There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients. Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition. There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications. Conclusion: Present medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.

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“…A prospective study included chronically critically ill patients admitted to Spanish respiratory care units [ 43 ]. The weaning method consisted of progressive periods of SBT.…”

Section: Main Textmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

Vitacca

2018

Multidiscip Respir Med

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BackgroundProgress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field.Main bodyThere is great variability in terminology and definitions of prolonged mechanical ventilation.There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units.There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients.Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition.There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications.ConclusionPresent medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.

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Noninvasive ventilation during the weaning process in chronically critically ill patients

Cited by 15 publications

References 30 publications

Tracheostomy in patients with COVID-19: predictors and clinical features

Tracheostomy in patients with COVID-19: predictors and clinical features

The patient needing prolonged mechanical ventilation: a narrative review

The patient needing prolonged mechanical ventilation: a narrative review

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