Driving pressure and adjunctive therapies in pulmonary sequelae of COVID-19 patients under invasive ventilation.
Ontology highlight
ABSTRACT:
SUBMITTER: Gonzalez J
PROVIDER: S-EPMC9875751 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
Publications
Driving pressure and adjunctive therapies in pulmonary sequelae of COVID-19 patients under invasive ventilation.
González Jessica J Benítez Iván D ID Motos Anna A Torres Antoni A Barbé Ferran F
Intensive care medicine 20230125 2
Similar Datasets
Project description:BackgroundNon-invasive positive pressure ventilation (NPPV) has been used to treat respiratory distress due to acute cardiogenic pulmonary oedema (ACPE). We performed a systematic review and meta-analysis update on NPPV for adults presenting with ACPE.ObjectivesTo evaluate the safety and effectiveness of NPPV compared to standard medical care (SMC) for adults with ACPE. The primary outcome was hospital mortality. Important secondary outcomes were endotracheal intubation, treatment intolerance, hospital and intensive care unit length of stay, rates of acute myocardial infarction, and adverse event rates.Search methodsWe searched CENTRAL (CRS Web, 20 September 2018), MEDLINE (Ovid, 1946 to 19 September 2018), Embase (Ovid, 1974 to 19 September 2018), CINAHL Plus (EBSCO, 1937 to 19 September 2018), LILACS, WHO ICTRP, and clinicaltrials.gov. We also reviewed reference lists of included studies. We applied no language restrictions.Selection criteriaWe included blinded or unblinded randomised controlled trials in adults with ACPE. Participants had to be randomised to NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care (SMC) compared with SMC alone.Data collection and analysisTwo review authors independently screened and selected articles for inclusion. We extracted data with a standardised data collection form. We evaluated the risks of bias of each study using the Cochrane 'Risk of bias' tool. We assessed evidence quality for each outcome using the GRADE recommendations.Main resultsWe included 24 studies (2664 participants) of adult participants (older than 18 years of age) with respiratory distress due to ACPE, not requiring immediate mechanical ventilation. People with ACPE presented either to an Emergency Department or were inpatients. ACPE treatment was provided in an intensive care or Emergency Department setting. There was a median follow-up of 13 days for hospital mortality, one day for endotracheal intubation, and three days for acute myocardial infarction. Compared with SMC, NPPV may reduce hospital mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; participants = 2484; studies = 21; I2 = 6%; low quality of evidence) with a number needed to treat for an additional beneficial outcome (NNTB) of 17 (NNTB 12 to 32). NPPV probably reduces endotracheal intubation rates (RR 0.49, 95% CI 0.38 to 0.62; participants = 2449; studies = 20; I2 = 0%; moderate quality of evidence) with a NNTB of 13 (NNTB 11 to 18). There is probably little or no difference in acute myocardial infarction (AMI) incidence with NPPV compared to SMC for ACPE (RR 1.03, 95% CI 0.91 to 1.16; participants = 1313; studies = 5; I2 = 0%; moderate quality of evidence). We are uncertain as to whether NPPV increases hospital length of stay (mean difference (MD) -0.31 days, 95% CI -1.23 to 0.61; participants = 1714; studies = 11; I2 = 55%; very low quality of evidence). Adverse events were generally similar between NPPV and SMC groups, but evidence was of low quality.Authors' conclusionsOur review provides support for continued clinical application of NPPV for ACPE, to improve outcomes such as hospital mortality and intubation rates. NPPV is a safe intervention with similar adverse event rates to SMC alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.
| S-EPMC6449889 | biostudies-literature
Project description:The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19), is a worldwide pandemic, as declared by the World Health Organization (WHO). It is a respiratory virus that infects people of all ages. Although it may present with mild to no symptoms in most patients, those who are older, immunocompromised, or with multiple comorbidities may present with severe and life-threatening infections. Throughout history, nutraceuticals, such as a variety of phytochemicals from medicinal plants and dietary supplements, have been used as adjunct therapies for many disease conditions, including viral infections. Appropriate use of these adjunct therapies with antiviral proprieties may be beneficial in the treatment and/or prophylaxis of COVID-19. In this review, we provide a comprehensive summary of nutraceuticals, such as vitamins C, D, E, zinc, melatonin, and other phytochemicals and function foods. These nutraceuticals may have potential therapeutic efficacies in fighting the threat of the SARS-CoV-2/COVID-19 pandemic.
| S-EPMC7920448 | biostudies-literature
Project description:BackgroundThe best ventilator mode for patients receiving non-invasive ventilation (NIV) has not been clarified. This study compared the effectiveness of two pressure-targeted modes, i.e., pressure support ventilation (PSV) and pressure-controlled ventilation (PCV), in patients receiving NIV.MethodsThis was a prospective multicentre observational study of NIV use for acute respiratory failure (ARF) in adult patients. We compared the two pressure-targeted modes in terms of NIV success and complication rates.ResultsAmong 176 patients receiving NIV, 88 patients were included in the study (PCV mode, n=29; PSV mode, n=59). The study population had a median age of 73.0 years and median body mass index of 20.8 kg/m2. The applied inspiratory positive airway pressure (IPAP) was higher in patients with PCV than in those with PSV [18.0 cmH2O (15.0-20.5 cmH2O) vs. 15.0 cmH2O (12.0-17.0 cmH2O), respectively, P=0.001]. More patients with PCV received sedatives and experienced dry mouth than those with PSV; however, the incidences of large leaks were low in both groups (n=5 vs. n=2, respectively). With regard to NIV outcomes, 24 (27.2%) patients experienced NIV failure and 13 (14.8%) died in hospital. PSV mode was a significant factor for NIV success [odds ratio (OR), 2.303; 95% confidence interval (CI), 1.216 to 4.360] in multivariate analyses and this association remained significant in a 1:1 matched cohort (n=29 per group).ConclusionsIn contrast to PCV mode, PSV mode was significantly associated with NIV success in the intensive care unit setting, particularly when large leaks were not a major concern. Nevertheless, further well-designed multicenter, protocol-driven randomized controlled trials are warranted.
| S-EPMC7330335 | biostudies-literature
Project description:ObjectivesThis study aimed to identify the cyclical "on-off" flow of pulmonary microcirculation during inspiration and expiration by sidestream dark field imaging (SDF) technology in vivo and investigate the effects of volume status and driving pressure on cyclical "on-off" flow of microcirculation.Methods24 ARDS-modeled rabbits were randomly divided into high-driving pressure group (HDP group) and low-driving pressure group (LDP group). Lung microcirculation measurements were performed using the SDF microscope at two timepoints (T1 CVP 2-4 mmHg, T2 CVP 8-10 mmHg). From T1 to T2, 10 ml/kg saline was infused to increase CVP. The cyclical "on-off" pulmonary microcirculation was quantitatively assessed by the change of microcirculation between expiration and inspiration.ResultsProportion of perfused vessels (PPV), microvascular flow index (MFI), perfused vessel density (PVD), and total vessel density (TVD) at expiration were significantly higher than inspiration in the HDP group. The HDP group has a higher ΔPPV and ΔPVD. After fluid loading, ΔPPV and ΔMFI decreased. TNF-α, IL-6, Ang-2, and vWF levels in the HDP group were higher. The HDP group also has a higher lung wet-weight/body weight ratio, lung wet-to-dry weight ratio, and more severe damage of pulmonary capillaries than the LDP group.ConclusionsThe difference in alveolar perfused microcirculation between inspiration and expiration defined as cyclical "on-off flow" can be detected. High driving pressure can enhance the cyclical "on-off" flow, and fluid loading can relieve it. High driving pressure can potentially cause injury to pulmonary capillaries due to the phenomenon of "on-off" flow, thereby exacerbating ARDS.
| S-EPMC11618265 | biostudies-literature
Project description:BackgroundDuring passive mechanical ventilation, the driving pressure of the respiratory system is an important mediator of ventilator-induced lung injury. Monitoring of driving pressure during assisted ventilation, similar to controlled ventilation, could be a tool to identify patients at risk of ventilator-induced lung injury. The aim of this study was to describe driving pressure over time and to identify whether and when high driving pressure occurs in critically ill patients during assisted ventilation.MethodsSixty-two patients fulfilling criteria for assisted ventilation were prospectively studied. Patients were included when the treating physician selected proportional assist ventilation (PAV+), a mode that estimates respiratory system compliance. In these patients, continuous recordings of all ventilator parameters were obtained for up to 72 h. Driving pressure was calculated as tidal volume-to-respiratory system compliance ratio. The distribution of driving pressure and tidal volume values over time was examined, and periods of sustained high driving pressure (≥ 15 cmH2O) and of stable compliance were identified and analyzed.ResultsThe analysis included 3200 h of ventilation, consisting of 8.8 million samples. For most (95%) of the time, driving pressure was < 15 cmH2O and tidal volume < 11 mL/kg (of ideal body weight). In most patients, high driving pressure was observed for short periods of time (median 2.5 min). Prolonged periods of high driving pressure were observed in five patients (8%). During the 661 periods of stable compliance, high driving pressure combined with a tidal volume ≥ 8 mL/kg was observed only in 11 cases (1.6%) pertaining to four patients. High driving pressure occurred almost exclusively when respiratory system compliance was low, and compliance above 30 mL/cmH2O excluded the presence of high driving pressure with 90% sensitivity and specificity.ConclusionsIn critically ill patients fulfilling criteria for assisted ventilation, and ventilated in PAV+ mode, sustained high driving pressure occurred in a small, yet not negligible number of patients. The presence of sustained high driving pressure was not associated with high tidal volume, but occurred almost exclusively when compliance was below 30 mL/cmH2O.
| S-EPMC6314935 | biostudies-literature
Project description: Not available
| S-EPMC7924569 | biostudies-literature
Project description:BACKGROUND:Excessive respiratory muscle effort during mechanical ventilation may cause patient self-inflicted lung injury and load-induced diaphragm myotrauma, but there are no non-invasive methods to reliably detect elevated transpulmonary driving pressure and elevated respiratory muscle effort during assisted ventilation. We hypothesized that the swing in airway pressure generated by respiratory muscle effort under assisted ventilation when the airway is briefly occluded (ΔPocc) could be used as a highly feasible non-invasive technique to screen for these conditions. METHODS:Respiratory muscle pressure (Pmus), dynamic transpulmonary driving pressure (ΔPL,dyn, the difference between peak and end-expiratory transpulmonary pressure), and ΔPocc were measured daily in mechanically ventilated patients in two ICUs in Toronto, Canada. A conversion factor to predict ΔPL,dyn and Pmus from ΔPocc was derived and validated using cross-validation. External validity was assessed in an independent cohort (Nanjing, China). RESULTS:Fifty-two daily recordings were collected in 16 patients. In this sample, Pmus and ΔPL were frequently excessively high: Pmus exceeded 10 cm H2O on 84% of study days and ΔPL,dyn exceeded 15 cm H2O on 53% of study days. ΔPocc measurements accurately detected Pmus > 10 cm H2O (AUROC 0.92, 95% CI 0.83-0.97) and ΔPL,dyn > 15 cm H2O (AUROC 0.93, 95% CI 0.86-0.99). In the external validation cohort (n = 12), estimating Pmus and ΔPL,dyn from ΔPocc measurements detected excessively high Pmus and ΔPL,dyn with similar accuracy (AUROC ≥ 0.94). CONCLUSIONS:Measuring ΔPocc enables accurate non-invasive detection of elevated respiratory muscle pressure and transpulmonary driving pressure. Excessive respiratory effort and transpulmonary driving pressure may be frequent in spontaneously breathing ventilated patients.
| S-EPMC6836358 | biostudies-literature
Project description:Interventions: Test group:Minimum driving pressure oriented individualized peep;Control group:Traditional fixed PEEP lung protection strategy
Primary outcome(s): 7-day PPCS incidence rate (= level 2)
Study Design: Parallel
| 40836 | ecrin-mdr-crc
Project description:BackgroundApplication of individualized positive end-expiratory pressure (PEEP) based on minimum driving pressure facilitates to prevent from postoperative pulmonary complications (PPCs). Whether lung protective ventilation strategy can reduce the risk of PPCs in COVID-19 patients remains unclear. In this study, we compared the effects of driving pressure-guided ventilation with conventional mechanical ventilation on PPCs in patients with COVID-19.MethodsPatients infected COVID-19 within 30-day before surgery were retrospectively enrolled consecutively. Patients were divided into two group: driving pressure-guided lung protective ventilation strategy group (LPVS group) and conventional mechanical ventilation group (Control group). Propensity score matching for variables selected was used by logistic regression with the nearest-neighbor method. The outcomes were the incidence of PPCs and hypoxemia in post-anesthesia care unit.ResultsThere was no significant difference in the baseline data between both groups (P > 0.05). The incidence of PPCs (12.73 % vs 36.36 %, χ2 = 7.068, P = 0.008) and hypoxemia [18.18 % vs 38.18 %, χ2 = 4.492, P = 0.034], and lung ultrasound scores [4.68 ± 1.60 vs 8.39 ± 1.87, t = 8.383, P < 0.001] in LPVS group were lower than control group. The PEEP, airway pressure and plateau pressure in LPVS group were higher than control group, but driving pressure and tidal volume was lower than control group, the difference was statistically significant (P < 0.05).ConclusionIndividualized PEEP ventilation strategy guided by minimum driving pressure could improve oxygenation and reduce the incidence of PPCs in surgical patients with COVID-19.
| S-EPMC10850964 | biostudies-literature
Project description:Goal: COSMIC Medical, a Vancouver-based open-source volunteer initiative, has designed an accessible, affordable, and aerosol-confining non-invasive positive-pressure ventilator (NIPPV) device, known as the COSMIC Bubble Helmet (CBH). This device is intended for COVID-19 patients with mild-to-moderate acute respiratory distress syndrome. System Design: CBH is composed of thermoplastic polyurethane, which creates a flexible neck seal and transparent hood. This device can be connected to wall oxygen, NIPPVs including Continuous Positive Airway Pressure and Bi-level Positive Airway Pressure, and mechanical ventilators. Discussion: Justification of CBH design components relied on several factors, predominantly the safety and comfort of patients and healthcare providers. Conclusion: CBH has implications within and outside of the pandemic, as an alternative to invasive mechanical ventilation methods. We have experimentally verified that CBH is effective in minimizing aerosolization risks and performs at specified clinical requirements.
| S-EPMC8545034 | biostudies-literature