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1. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

Author

Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., and Zellweger N.

Abstract

Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in

Published
2021

2. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author

Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., Alfaro-Farias M., Vizmanos-Lamotte G., Tschoellitsch T., Meier J., Aguirre-Bermeo H., Apolo J., Martinez A., Jurkolow G., Delahaye G., Novy E., Losser M. -R., Wengenmayer T., Rilinger J., Staudacher D. L., David S., Welte T., Stahl K., Pavlos A., Aslanidis T., Korsos A., Babik B., Nikandish R., Rezoagli E., Giacomini M., Nova A., Fogagnolo A., Spadaro S., Ceriani R., Murrone M., Wu M. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., Fabbri S., Potalivo A., Facondini F., Gangitano G., Perin T., Grazia Bocci M., Antonelli M., Gommers D., Rodriguez-Garcia R., Gamez-Zapata J., Taboada-Fraga X., Castro P., Tellez A., Lander-Azcona A., Escos-Orta J., Martin-Delgado M. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. M., Jenni-Moser B., Wiegand J., Yuen B., Lienhardt-Nobbe B., Westphalen A., Salomon P., Drvaric I., Hillgaertner F., Sieber M., Dullenkopf A., Petersen L., Chau I., Ksouri H., Sridharan G. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., Colak E., Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., Alfaro-Farias M., Vizmanos-Lamotte G., Tschoellitsch T., Meier J., Aguirre-Bermeo H., Apolo J., Martinez A., Jurkolow G., Delahaye G., Novy E., Losser M. -R., Wengenmayer T., Rilinger J., Staudacher D. L., David S., Welte T., Stahl K., Pavlos A., Aslanidis T., Korsos A., Babik B., Nikandish R., Rezoagli E., Giacomini M., Nova A., Fogagnolo A., Spadaro S., Ceriani R., Murrone M., Wu M. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., Fabbri S., Potalivo A., Facondini F., Gangitano G., Perin T., Grazia Bocci M., Antonelli M., Gommers D., Rodriguez-Garcia R., Gamez-Zapata J., Taboada-Fraga X., Castro P., Tellez A., Lander-Azcona A., Escos-Orta J., Martin-Delgado M. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. M., Jenni-Moser B., Wiegand J., Yuen B., Lienhardt-Nobbe B., Westphalen A., Salomon P., Drvaric I., Hillgaertner F., Sieber M., Dullenkopf A., Petersen L., Chau I., Ksouri H., Sridharan G. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., and Colak E.

Abstract

Background: Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods: We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results: The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs. 0.69, P < 0.01 [paired t-test with 95% confidence interval]). Conclusions: The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.

Published
2021

3. Prolonged continuous monitoring of regional lung function in infants with respiratory failure

Author

Becher, T. H. (Tobias H.), Miedema, M. (Martijn), Kallio, M. (Merja), Papadouri, T. (Thalia), Karaoli, C. (Christina), Sophocleous, L. (Louiza), Rahtu, M. (Marika), van Leuteren, R. W. (Ruud W.), Waldmann, A. D. (Andreas D.), Strodthoff, C. (Claas), Yerworth, R. (Rebecca), Dupré, A. (Antoine), Benissa, M.-R. (Mohamed-Rida), Nordebo, S. (Sven), Khodadad, D. (Davood), Bayford, R. (Richard), Vliegenthart, R. (Roseanne), Rimensberger, P. C. (Peter C.), van Kaam, A. H. (Anton H.), Frerichs, I. (Inéz), Becher, T. H. (Tobias H.), Miedema, M. (Martijn), Kallio, M. (Merja), Papadouri, T. (Thalia), Karaoli, C. (Christina), Sophocleous, L. (Louiza), Rahtu, M. (Marika), van Leuteren, R. W. (Ruud W.), Waldmann, A. D. (Andreas D.), Strodthoff, C. (Claas), Yerworth, R. (Rebecca), Dupré, A. (Antoine), Benissa, M.-R. (Mohamed-Rida), Nordebo, S. (Sven), Khodadad, D. (Davood), Bayford, R. (Richard), Vliegenthart, R. (Roseanne), Rimensberger, P. C. (Peter C.), van Kaam, A. H. (Anton H.), and Frerichs, I. (Inéz)

Abstract

Rationale: Electrical impedance tomography (EIT) allows instantaneous and continuous visualization of regional ventilation and changes in end-expiratory lung volume at the bedside. There is particular interest in using EIT for monitoring in critically ill neonates and young children with respiratory failure. Previous studies have focused only on short-term monitoring in small populations. The feasibility and safety of prolonged monitoring with EIT in neonates and young children has not been demonstrated yet. Objectives: To evaluate the feasibility and safety of long-term EIT monitoring in a routine clinical setting and to describe changes in ventilation distribution and homogeneity over time and with positioning in a multi-center cohort of neonates and young children with respiratory failure. Methods: At four European University Hospitals, we conducted an observational study (NCT02962505) on 200 patients with post-menstrual ages (PMA) between 25 weeks and 36 months, at risk for or suffering from respiratory failure. Continuous EIT data were obtained using a novel textile 32-electrode interface and recorded at 48 images/s for up to 72 hours. Clinicians were blinded to EIT images during the recording. EIT parameters and the effects of body position on ventilation distribution were analyzed offline. Results: The average duration of EIT measurements was 53 ± 20 hours. Skin contact impedance was sufficient to allow image reconstruction for valid ventilation analysis during a median of 92% (interquartile range, 77–98%) of examination time. EIT examinations were well tolerated, with minor skin irritations (temporary redness or imprint) occurring in 10% of patients and no moderate or severe adverse events. Higher ventilation amplitude was found in the dorsal and right lung areas when compared with the ventral and left regions, respectively. Prone positioning resulted in an increase in the ventilation-related EIT signal in the dorsal hemithorax, indicating increased

Published
2022

4. Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps

Author

De Luca, D., Cogo, P., Kneyber, M. C., Biban, P., Semple, M. G., Perez-Gil, J., Conti, Giorgio, Tissieres, P., Rimensberger, P. C., Conti G. (ORCID:0000-0002-8566-9365), De Luca, D., Cogo, P., Kneyber, M. C., Biban, P., Semple, M. G., Perez-Gil, J., Conti, Giorgio, Tissieres, P., Rimensberger, P. C., and Conti G. (ORCID:0000-0002-8566-9365)

Abstract

Pediatric (PARDS) and neonatal (NARDS) acute respiratory distress syndrome have different age-specific characteristics and definitions. Trials on surfactant for ARDS in children and neonates have been performed well before the PARDS and NARDS definitions and yielded conflicting results. This is mainly due to heterogeneity in study design reflecting historic lack of pathobiology knowledge. We reviewed the available clinical and preclinical data to create an expert consensus aiming to inform future research steps and advance the knowledge in this area. Eight trials investigated the use of surfactant for ARDS in children and ten in neonates, respectively. There were improvements in oxygenation (7/8 trials in children, 7/10 in neonates) and mortality (3/8 trials in children, 1/10 in neonates) improved. Trials were heterogeneous for patients’ characteristics, surfactant type and administration strategy. Key pathobiological concepts were missed in study design. Consensus with strong agreement was reached on four statements:1.There are sufficient preclinical and clinical data to support targeted research on surfactant therapies for PARDS and NARDS. Studies should be performed according to the currently available definitions and considering recent pathobiology knowledge.2.PARDS and NARDS should be considered as syndromes and should be pre-clinically studied according to key characteristics, such as direct or indirect (primary or secondary) nature, clinical severity, infectious or non-infectious origin or patients’ age.3.Explanatory should be preferred over pragmatic design for future trials on PARDS and NARDS.4.Different clinical outcomes need to be chosen for PARDS and NARDS, according to the trial phase and design, trigger type, severity class and/or surfactant treatment policy. We advocate for further well-designed preclinical and clinical studies to investigate the use of surfactant for PARDS and NARDS following these principles.[Figure not available: see

Published
2021

5. Electrical impedance tomography reveals pathophysiology of neonatal pneumothorax during NAVA

Author

Kallio, M. (Merja), Rahtu, M. (Marika), van Kaam, A. H. (Anton H.), Bayford, R. (Richard), Rimensberger, P. C. (Peter C.), Frerichs, I. (Inéz), Kallio, M. (Merja), Rahtu, M. (Marika), van Kaam, A. H. (Anton H.), Bayford, R. (Richard), Rimensberger, P. C. (Peter C.), and Frerichs, I. (Inéz)

Abstract

Pneumothorax is a potentially life‐threatening complication of neonatal respiratory distress syndrome (RDS). We describe a case of a tension pneumothorax that occurred during neurally adjusted ventilatory assist (NAVA) in a preterm infant suffering from RDS. The infant was included in a multicenter study examining the role of electrical impedance tomography (EIT) in intensive care and therefore continuously monitored with this imaging method. The attending physicians were blinded for EIT findings but offline analysis revealed the potential of EIT to clarify the underlying cause of this complication, which in this case was heterogeneous lung disease resulting in uneven ventilation distribution. Instantaneous increase in end‐expiratory lung impedance on the affected side was observed at time of the air leak. Real‐time bedside availability of EIT data could have modified the treatment decisions made.

Published
2020

7. Diaphragmatic palsy

Author

Rimensberger, Peter C, Rimensberger, P C ( Peter C ), Bernet, Vera, Rimensberger, Peter C, Rimensberger, P C ( Peter C ), and Bernet, Vera

Abstract

Diaphragmatic palsy or paralysis (DP) due to phrenic nerve injury is a rare respiratory condition which may be life-threatening in newborn and young children (Affatato et al. 1988; Haller et al. 1979; de Leeuw et al. 1999). This entity was first described in 1906 in an adult (Stauffer 1979). In newborn patients in the middle of the last century, it was most often due to birth trauma. In the days of advanced neonatal and cardiac surgery, DP is mostly a complication of thoracic surgery (Greene et al. 1975; Schwartz and Filler 1978; Stauffer and Rickham 1972; Stone et al. 1987; Zhao et al. 1985). The incidence is described between 0.3 and 12.8 % and can be unilateral or bilateral (de Leeuw et al. 1999; Schwartz and Filler 1978; Kunovsky et al. 1993; van Onna et al. 1998). DP due to inflammation, neuropathic or idiopathic is rarely seen in this age group.

Published
2015

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