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16 results on '"Interdepartmental Division of Critical Care Medicine"'

1. Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

Author

Giacomo Bellani, Leo M. A. Heunks, Katerina Vaporidi, Martin Dres, Bhakti K. Patel, Alexandre Demoule, Takeshi Yoshida, Tommaso Mauri, Samir Jaber, Jeremy R. Beitler, Jose Dianti, Ewan C. Goligher, Laurent Brochard, Annemijn H. Jonkman, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada., University of Crete [Heraklion] (UOC), Columbia University College of Physicians and Surgeons, New York, NY, USA., University of Illinois [Chicago] (UIC), University of Illinois System, Osaka University Graduate School of Medicine, Suita, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico [Milan, Italy], Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), University of Toronto, Toronto, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, University of Toronto, University Health Network, Toronto General Hospital Research Institute [Canada] (TGHRI), Amsterdam UMC - Amsterdam University Medical Center, St. Michael's Hospital, Columbia University College of Physicians and Surgeons, University of Chicago, University Graduate School of Medicine [Osaka, Japan], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hôpital Saint Eloi (CHRU Montpellier), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano = University of Milan (UNIMI), Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), dres, martin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), MORNET, Dominique, Goligher, E, Jonkman, A, Dianti, J, Vaporidi, K, Beitler, J, Patel, B, Yoshida, T, Jaber, S, Dres, M, Mauri, T, Bellani, G, Demoule, A, Brochard, L, and Heunks, L

Subjects
medicine.medical_specialty, Mechanical ventilation’, medicine.medical_treatment, Respiratory effort, [SDV]Life Sciences [q-bio], Diaphragm, Diaphragm weakne, Lung injury, Critical Care and Intensive Care Medicine, Diaphragm weakness, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Respiratory system, Intensive care medicine, Lung, ComputingMilieux_MISCELLANEOUS, Mechanical ventilation, Neuromuscular Blockade, Ventilators, Mechanical, business.industry, Respiration, 030208 emergency & critical care medicine, Respiration, Artificial, Diaphragm (structural system), [SDV] Life Sciences [q-bio], medicine.anatomical_structure, 030228 respiratory system, Control of respiration, Breathing, Narrative Review, business
Abstract

International audience; Mechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. This review summarizes practical strategies for achieving lung and diaphragm-protective targets at the bedside, focusing on inspiratory and expiratory ventilator settings, monitoring of inspiratory effort or respiratory drive, management of dyssynchrony, and sedation considerations. A number of potential future adjunctive strategies including extracorporeal CO2 removal, partial neuromuscular blockade, and neuromuscular stimulation are also discussed. While clinical trials to confirm the benefit of these approaches are awaited, clinicians should become familiar with assessing and managing patients' respiratory effort, based on existing physiological principles. To protect the lung and the diaphragm, ventilation and sedation might be applied to avoid excessively weak or very strong respiratory efforts and patient-ventilator dysynchrony.

Published
2020

2. Research in Extracorporeal Life Support: A Call to Action

Author

Ferguson, Niall, Hodgson, Carol, Laffey, John, Mercat, Alain, Pesenti, Antonio, Quintel, Michael, Slutsky, Arthur, Ranieri, V. Marco, Brodie, Daniel, Vincent, Jean-Louis, Brochard, Laurent, Combes, Alain, Division of Respirology, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Toronto General Hospital Research Institute [Canada] (TGHRI), The Australian & New Zealand Intensive Care Research Centre and the Intensive Care Department, Alfred Hospital, Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], St. Michael's Hospital, University of Toronto, Columbia University Medical Center (CUMC), Columbia University [New York], Department of Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Interdepartmental Division of Critical Care Medicine, Keenan Research Centre for Biomedical Science [Toronto, ON, Canada], Li Ka Shing Knowledge Institute [Toronto, ON, Canada]-St. Michael’s Hopsital [Toronto, ON, Canada], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP]

Subjects
research networks, evidence, [SDV]Life Sciences [q-bio], ECLS, extracorporeal life support, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2018

3. Extracorporeal life support for adults with acute respiratory distress syndrome

Author

Daniel Brodie, Niall D. Ferguson, Kathryn M Rowan, Antonio Pesenti, Kiran Shekar, Alain Combes, Arthur S. Slutsky, John F. Fraser, Eddy Fan, Marco Ranieri, Carol L. Hodgson, Matthieu Schmidt, Samir Jaber, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, University of Toronto, Toronto, ON, University Health Network, Toronto, ON, University of Queensland [Brisbane], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Milan, University of Bologna, Clinical Trials Unit, Intensive Care National Audit and Research Centre (ICNARC), London, the Prince Charles Hospital, Brisbane, QLD, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Università degli Studi di Milano = University of Milan (UNIMI), University of Bologna/Università di Bologna, The Prince Charles Hospital, and MORNET, Dominique

Subjects
Adult, Extracorporeal Circulation, ARDS, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Review, Acute respiratory failure, Critical Care and Intensive Care Medicine, Extracorporeal, 03 medical and health sciences, Plateau pressure, Mechanical ventilation, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Tidal Volume, Extracorporeal membrane oxygenation, Humans, Medicine, ComputingMilieux_MISCELLANEOUS, Tidal volume, Outcome, Respiratory Distress Syndrome, business.industry, 030208 emergency & critical care medicine, medicine.disease, Respiration, Artificial, Cannula, 3. Good health, [SDV] Life Sciences [q-bio], 030228 respiratory system, Anesthesia, Breathing, business
Abstract

Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO2R) uses lower blood flow rates through smaller cannulae and provides substantial CO2 elimination (~ 20–70% of total CO2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO2R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.

Published
2020

4. Postextubation Respiratory Support: Of Clinical Trials and Clinical Decisions

Author

Oscar Peñuelas, Ewan C. Goligher, Interdepartmental Division of Critical Care Medicine University of Toronto Toronto, Ontario, Canada, Division of Respirology University Health Network Toronto, Ontario, Canada, Toronto General Hospital Research Institute Toronto, Ontario, Canada, Intensive Care Unit Hospital Universitario de Getafe Madrid, Spain, and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias Madrid, Spain

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Respiratory Distress Syndrome, Insuficiencia del Tratamiento, Toma de decisiones clínicas, business.industry, Clinical Decision-Making, COVID-19, Síndrome de Dificultad Respiratoria del Adulto, Critical Care and Intensive Care Medicine, Respiration, Artificial, Respiratory support, Clinical trial, Intensive Care Units, Text mining, Soporte respiratorio postextubación, Treatment Outcome, Intubation, Intratracheal, Medicine, Intubación Intratraqueal, Unidad de Cuidados Intensivos, Treatment Failure, Unidades de Cuidados Intensivos, business, Intensive care medicine
Abstract

Sí

Published
2021

5. Impact of Respiratory Rate and Dead Space in the Current Era of Lung Protective Mechanical Ventilation

Author

Laurent Brochard, François Lellouche, Mathieu Delorme, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculty of Medicine, Université Laval, Québec, QC, Canada., Equipe de Recherche Paramédicale sur le Handicap NeuroMoteur (ERPHAN), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay, Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Centre for Biomedical Science [Toronto, ON, Canada], and Li Ka Shing Knowledge Institute [Toronto, ON, Canada]-St. Michael’s Hopsital [Toronto, ON, Canada]

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, Respiratory rate, medicine.medical_treatment, Dead space, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, 03 medical and health sciences, MESH: Positive-Pressure Respiration, 0302 clinical medicine, Respiratory Rate, Internal medicine, Tidal Volume, medicine, Humans, 030212 general & internal medicine, Mechanical ventilation, Lung, MESH: Adult Respiratory Distress Syndrome, Pulmonary Gas Exchange, business.industry, MESH: Ventilator-Induced Lung Injury, Respiratory Dead Space, Respiration, Artificial, 3. Good health, medicine.anatomical_structure, 030228 respiratory system, Cardiology, Current (fluid), Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Protective ventilation should potentially be applied in most or all patients undergoing invasive mechanical ventilation.1,2 Reduction of tidal volume (VT) has progressively been incorporated over the years.3 Protective ventilation is not limited to VT reduction, however, but needs a combination of ventilator settings and associated procedures.1,4 The progressive reduction of VT has necessitated to increase the respiratory rate (RR), but no clear recommendation for setting the rate exists. In addition, the impact of dead space, including instrumental dead space (VDinstr), became highly relevant. Reducing the VDinstr should be recommended as part of lung protective ventilation,4 especially for patients requiring VT ≤ 6 mL/kg of predicted body weight (PBW).5 In this report, we reviewed data from the literature of the last 20 years to try to offer some clues to physicians on the questions of rate setting and the impact of dead space.

Published
2020

6. Lung- and Diaphragm-Protective Ventilation

Author

Robinder G. Khemani, Eddy Fan, Samir Jaber, Giacomo Grasselli, Alexandre Demoule, Sarina K. Sahetya, Jose Dianti, Dimitrios Georgopoulos, Francesco Mojoli, Tommaso Mauri, Laurent Brochard, Katerina Vaporidi, Claude Guérin, Coen A.C. Ottenheijm, Jeremy R. Beitler, Tom Schepens, Savino Spadaro, Takeshi Yoshida, Antonio Pesenti, Franco Laghi, Marcelo B. P. Amato, Ewan C. Goligher, Alain Mercat, Domenico Luca Grieco, Giacomo Bellani, L.M.A. Heunks, Irene Telias, Niall D. Ferguson, Martin Dres, Jordi Mancebo, Bhakti K. Patel, Physiology, ACS - Pulmonary hypertension & thrombosis, Intensive care medicine, University Health Network, Toronto General Hospital Research Institute [Canada] (TGHRI), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), University of Chicago, Johns Hopkins University (JHU), Columbia University [New York], St. Michael's Hospital, Osaka University, University of Crete [Heraklion] (UOC), Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Antwerp University Hospital [Edegem] (UZA), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano = University of Milan (UNIMI), Università degli Studi di Ferrara = University of Ferrara (UniFE), Italian Hospital of Buenos Aires, Universidade de São Paulo = University of São Paulo (USP), Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), University of Toronto, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18) (Inserm U955), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Children’s Hospital Los Angeles [Los Angeles], University of Southern California (USC), Loyola University [Chicago], Endocrinologie pédiatrique[CHU Angers], Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Università degli Studi di Pavia = University of Pavia (UNIPV), Amsterdam UMC - Amsterdam University Medical Center, Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hospital de la Santa Creu i Sant Pau, dres, martin, Interdepartmental Division of Critical Care Medicine, Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), VU University Medical Center [Amsterdam], European Soc Intensive Care Med, Goligher, E, Dres, M, Patel, B, Sahetya, S, Beitler, J, Telias, I, Yoshida, T, Vaporidi, K, Grieco, D, Schepens, T, Grasselli, G, Spadaro, S, Dianti, J, Amato, M, Bellani, G, Demoule, A, Fan, E, Ferguson, N, Georgopoulos, D, Guérin, C, Khemani, R, Laghi, F, Mercat, A, Mojoli, F, Ottenheijm, C, Jaber, S, Heunks, L, Mancebo, J, Mauri, T, Pesenti, A, Brochard, L, Sorbonne Université - Faculté de médecine [CHU Pitié Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), The University of Chicago Medicine [Chicago], Johns Hopkins University School of Medicine [Baltimore], Columbia University College of Physicians and Surgeons, Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], Graduate School of Medicine [Osaka], Osaka University [Osaka], Department of Physiopatology and Transplantation, University of Milan (DEPT), Universidade de São Paulo Medical School (FMUSP), Service de Pneumologie - R3S [CHU Pitié-Salpêtrière] (SPMIR-R3S), IMRB - 'Biomechanics and Respiratory Apparatus' [Créteil] (U955 Inserm - UPEC), Stritch School of Medicine, Edward Hines, Jr. VA Hospital, and Fondazione IRCCS Policlinico San Matteo [Pavia]

Subjects
Pulmonary and Respiratory Medicine, Artificial ventilation, medicine.medical_specialty, Consensus, Critical Care, Ventilator-Induced Lung Injury, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Diaphragm, Electric Stimulation Therapy, Lung injury, Critical Care and Intensive Care Medicine, Artificial respiration, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, NO, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Mechanical ventilation, Intensive care, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine, Extracorporeal membrane oxygenation, Humans, Myotrauma, 030212 general & internal medicine, Intensive care medicine, business.industry, Decision Support Systems, Clinical, Respiration, Artificial, 3. Good health, Diaphragm (structural system), Phrenic Nerve, [SDV] Life Sciences [q-bio], Muscular Atrophy, 030228 respiratory system, Breathing, Human medicine, business, Critical Care Perspective
Abstract

International audience; Mechanical ventilation can cause acute diaphragm atrophy and injury, and this is associated with poor clinical outcomes. Although the importance and impact of lung-protective ventilation is widely appreciated and well established, the concept of diaphragm-protective ventilation has recently emerged as a potential complementary therapeutic strategy. This Perspective, developed from discussions at a meeting of international experts convened by PLUG (the Pleural Pressure Working Group) of the European Society of Intensive Care Medicine, outlines a conceptual framework for an integrated lung- and diaphragm-protective approach to mechanical ventilation on the basis of growing evidence about mechanisms of injury. We propose targets for diaphragm protection based on respiratory effort and patient–ventilator synchrony. The potential for conflict between diaphragm protection and lung protection under certain conditions is discussed; we emphasize that when conflicts arise, lung protection must be prioritized over diaphragm protection. Monitoring respiratory effort is essential to concomitantly protect both the diaphragm and the lung during mechanical ventilation. To implement lung- and diaphragm-protective ventilation, new approaches to monitoring, to setting the ventilator, and to titrating sedation will be required. Adjunctive interventions, including extracorporeal life support techniques, phrenic nerve stimulation, and clinical decision-support systems, may also play an important role in selected patients in the future. Evaluating the clinical impact of this new paradigm will be challenging, owing to the complexity of the intervention. The concept of lung- and diaphragm-protective ventilation presents a new opportunity to potentially improve clinical outcomes for critically ill patients.

Published
2020

7. Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period

Author

Chaudhuri, Dipayan, Granton, David, Wang, Dominic Xiang, Einav, Sharon, Helviz, Yigal, Mauri, Tommaso, Ricard, Jean-Damien, Mancebo, Jordi, Frat, Jean-Pierre, Jog, Sameer, Hernández, Gonzalo, Maggiore, Salvatore, Hodgson, Carol, Jaber, Samir, Brochard, Laurent, Burns, Karen, Rochwerg, Bram, McMaster University [Hamilton, Ontario], Università degli Studi di Milano [Milano] (UNIMI), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), McMaster University, Hamilton, ON, Canada., Schulich School of Medicine, Western University, London, ON, Canada, Hebrew University Faculty of Medicine, Jerusalem, General Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel., Dipartimento dei trapianti, Università degli Studi di Milano, Milan, Italy., Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Nord, Hôpital Louis-Mourier, Colombes, France., Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain, CIC-1402, équipe ALIVE, Poitiers, France, Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India., Hospital Infanta Sofía, Madrid, Spain, Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, AND Department of Anesthesiology and Critical Care, SS. Annunziata Hospital, Chieti, Italy, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada, and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

Subjects
systematic review, hypoxia, [SDV]Life Sciences [q-bio], digestive, oral, and skin physiology, otorhinolaryngologic diseases, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], noninvasive ventilation, artificial respiration, oxygen inhalation therapy, intubation
Abstract

International audience; Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.Data Sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).Study Selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.Data Extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, Pao2 before and after intubation, Paco2 after intubation, ICU length of stay, and short-term mortality.Data Synthesis: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco2, ICU length of stay, or 28-day mortality.Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.

Published
2020

8. A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver

Author

Adrien Drouet, Paul Ouellet, Laurent Brochard, Gilles Bronchti, Stéphane Delisle, Jean-Christophe M. Richard, Dominique Savary, Emmanuel Charbonney, Alain Mercat, Rigollot Marceau, Bilal Badat, Patrice Gosselin, Centre de Recherche Hôpital du Sacré-Coeur de Montréal [Canada] (HSCM), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Centre for Biomedical Science [Toronto, ON, Canada], Li Ka Shing Knowledge Institute [Toronto, ON, Canada]-St. Michael’s Hopsital [Toronto, ON, Canada], and Hospices Civils de Lyon (HCL)

Subjects
medicine.medical_specialty, Resuscitation, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Heart Massage, Respiratory physiology, Emergency Nursing, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cadaver, Intubation, Intratracheal, Humans, Medicine, Lung volumes, Cardiopulmonary resuscitation, Airway Management, Respiratory system, Lung, Positive end-expiratory pressure, Embalming, business.industry, Respiration, 030208 emergency & critical care medicine, respiratory system, Respiration, Artificial, Cardiopulmonary Resuscitation, Heart Arrest, respiratory tract diseases, Intratracheal, 030228 respiratory system, Artificial, Emergency Medicine, Cardiology, Breathing, Intubation, Cardiology and Cardiovascular Medicine, business, Airway
Abstract

International audience; BACKGROUND: Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model.METHODS: We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model. An oesophageal catheter was inserted to assess chest wall compliance, and ITP variation (ΔITP). Airway pressure variation (ΔPaw) at airway opening and ΔITP generated by CC were measured at decremental positive end expiratory pressure (PEEP) to test its impact on flow and ΔPaw. The patient's data were derived from flow and airway pressure captured via the ventilator during resuscitation.RESULTS: Resistance and Compliance of the respiratory system were comparable to those of the out-of-hospital cardiac arrest patients (C 42 ± 12 vs C 37.3 ± 10.9 mL/cmHO and Res 17.5 ± 7.5 vs Res 20.2 ± 5.3 cmHO/L/sec), and remained stable over time. During CC, ΔITP varied from 32 ± 12 cmHO to 69 ± 14 cmHO with manual and automatic CC respectively. Transmission of ΔITP at the airway opening was significantly affected by PEEP, suggesting dynamic small airway closure at low lung volumes. This phenomenon was similarly observed in patients.CONCLUSION: Respiratory mechanics and dynamic pressures during CC of cadavers behave as predicted by a theoretical model and similarly to patients. The Thiel model is a suitable to assess ITP variations induced by ventilation during CC.

Published
2018

9. Focus on ventilation and ARD: recent insights

Author

Samir Jaber, Audrey De Jong, Niall D. Ferguson, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Division of Respirology, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Toronto General Hospital Research Institute [Canada] (TGHRI), MORNET, Dominique, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Respiratory Distress Syndrome, Focus (computing), medicine.medical_specialty, business.industry, Pain medicine, [SDV]Life Sciences [q-bio], MEDLINE, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Respiration, Artificial, Body Mass Index, law.invention, [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, law, Anesthesiology, Ventilation (architecture), Humans, Medicine, business, Intensive care medicine, Biomarkers, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019

10. Using research to prepare for outbreaks of severe acute respiratory infection

Author

Mich, Vann, Pho, Yaty, Bory, Sotharith, Vann, Mich, Teav, Bunlor, Som, Leakhann, Jarrvisalo, Mikko J, Pulkkinen, Anni, Kuitunen, Anne, Ala-kokko, Tero, Melto, Sari, Daix, Thomas, Philippart, Francois, Antoine, Marchalot, Tiercelet, Kelly, Bruel, Cedric, Nicholas, Sedillot, Siami, Shidasp, Fabienne, Taimon, Bruyere, Raomi, Forceville, Xavier, Erickson, Simon, Campbell, Lewis, Sonawane, Ravikiran, Santamaria, John, Kol, Mark, Awasthi, Shally, Powis, Jeff, Hall, Richard, McCarthy, Anne E, Jouvet, Philippe, Opaysky, Mary Anne, Gilfoyle, Elaine, Farshait, Nataly, Martin, Dori-Ann, Griesdale, Donald, Katz, Kevin, Ruberto, Aaron J, Carrier, Francois Martin, Lamontagne, Francois, Muscedere, John, Rishu, Asgar, Sin, Wai Ching, Ngai, Wallace Chun Wai, Young, Paul, Forrest, Annette, Kazemi, Alex, Henderson, Seton, Browne, Troy, Ganeshalingham, Anusha, McConnochie, Rachael, Cho, Jae Hwa, Park, Tai Sun, Sim, Yun Su, Chang, Youjin, Lee, Heung Bum, Park, Seung Yong, Chan, Wai Ming, Lee, Won-Yeon, Wallace, David J, Angus, Derek C, Charles, Anthony G, van Doom, H Rogier, Kinh, Nguyen Van, Trung, Nguyen Vu, Prin, Meghan, Twagirumugabe, Theogene, Umuhire, Olivier Felix, Sylvain, Habarurema, Al Qasim, Eman, Heraud, Jean-Michel, Raberahona, Mihaja, Rabarison, Joelinotahiana Hasina, Patrigeon, Santiago Perez, Ramirez-Venegas, Alejandra, Melendez, Javier Araujo, Guerrero, M Lourdes, Mambule, Ivan, Ochieng, Otieno George, Nadjm, Behzad, Li, Iris Wai Sum, Choi, Won-Il, Florence, Komurian-Pradel, Arabi, Yaseen M, West, T Eoin, Riviello, Elisabeth D, Parke, Rachael, Djillali, Annane E, Fowler, Robert, Murthy, Srinivas, Nichol, Alistair, Cheng, Allen C, Semple, Calum, George, Maya, Valkonen, Miia, McArthur, Colin, Carson, Gail, O'Neill, Genevieve, Cobb, J Perren, Dunning, Jake, Chiche, Jean-Daniel, Huh, Jin-Won, Marshall, John, Rello, Jordi, Guillebaud, Julia, Razanazatovo, Norosoa, Otieno, Juilett Wambura, Green, Karen, Rowan, Kathy, Baillie, John Kenneth, Merson, Laura, Hsu, Li Yang, Christian, Michael D, Egi, Moritoki, Shindo, Nahoko, Horby, Peter, Pardinaz-Solis, Raul, Ubiergo, Sebastian Ugarte, Webb, Steve AR, Uyeki, Timothy M, Gordon, Anthony C, Paterson, David L, Everett, Dean, Giamarellos-Bourboulis, Evangelos J, Longuere, Kajsa-Stina, Maslove, David, Ohuma, Eric, Growl, Gloria, PedutemHumber, Theresa, EllazarHumber, Edward, Bahinskaya, Ilona, Osbourne-Townsend, Joan, Bentley, Andrew, Goodson, Jennifer, Welters, Ingeborg, Malik, Nadia, Browne, TS, Mahesh, Vinaya, Investigators, SPRINT-SARI, HUS Perioperative, Intensive Care and Pain Medicine, University of Helsinki, Anestesiologian yksikkö, University College Dublin [Dublin] (UCD), Monash University [Melbourne], We acknowledge support from the National Health and Medical Research Council in Australia, the Australia New Zealand Intensive Care Society Clinical Trials Group and the Seventh Framework Program in Europe, which have facilitated the progress that has been made for central project infrastructure. Data collection was funded locally by local research coordinators and investigators, including the International Respiratory and Severe Illness Center, University of Washington., Collaborators Vann Mich, Khmer Soviet Friend Hospital. Yaty Pho, Khmer Soviet Friend Hospital. Sotharith Bory, Calmette Hospital and University of Health Sciences. Mich Vann, Khmer-Soviet Friendship Hospital and University of Health Sciences. Bunlor Teav, Takeo Provincial Hospital. Leakhann Som, National Pediatric Hospital. Mikko J Jarrvisalo, Turku university hospital, ICU. Anni Pulkkinen, Central Hospital of Central Finland. Anne Kuitunen, Tampere University Hospital. Tero Ala-kokko, Oulu University Hospital, Research Group of Anesthesiology, Surgery and Intensive Care Medicine. Sari. Melto, South Karelia Central Hospital. Thomas DAIX, Reanimation polyvalente, CHU Dupuytren, Limoges, France and Inserm CIC 1435, CHU Dupuytren, Limoges, France. Francois Philippart, Intensive Care Unit. Marchalot Antoine, Dieppe General Hospital. Kelly Tiercelet, Groupe hospitalier Paris Saint Joseph. Cedric Bruel, Groupe hospitalier Paris Saint Joseph. BRUYERE Remi, Centre Hospitalier Fleyriat. Sedillot Nicholas, Centre Hospitalier Fleyriat. Shidasp SIAMI, General Intensive Care Medicine, Sud Essonne Hospital Etampes. Marchalot Antoine, Centre Hospitalier Dieppe. Taimon Fabienne, Service de Medecine Intensive et Reanimation, Rouen University Hospital (G.B.), and Normandie University, Universite de Rouen, U1096, Rouen University Hospital. Philippart, Groupe hospitalier Paris Saint joseph. Raomi Bruyere, Service de reanimation. Centre Hospitalier Fleyriat. Xavier Forceville, Grand Hopital de l'Est Francilien. Simon Erickson, Perth Children's Hospital. Lewis Campbell, Royal Darwin Hospital. Ravikiran Sonawane, Rockingham General Hospital. John Santamaria, St Vincent's Hospital (Melbourne). Mark Kol, Concord Hospital. Shally Awasthi, King George's Medical University. Jeff Powis, Michael Garron Hospital. Richard Hall, Dalhousie University. Anne E McCarthy, University of Ottawa and the Ottawa Hospital. Philippe Jouvet, Ste-Justine Hospital and Research Center. Mary Anne Opavsky, Joseph Brant Hospital. Elaine Gilfoyle, University of Calgary. Nataly Farshait, Humber River Hospital. Dori-Ann Martin, University of Calgary. Donald Griesdale, Department of Anesthesiology, Pharmacology & Therapeutics Department of Medicine, Divisions of Critical Care Medicine & Neurology University of British Columbia. Kevin Katz, North York General Hospital. Aaron J. Ruberto, Queen's University & Kingston Health Sciences Centre. Francois Martin Carrier, Centre Hospitalier de l'Universite de Montreal. Francois Lamontagne, Universite de Sherbrooke. John Muscedere, Queens University. Asgar Rishu, Sunnybrook Health Sciences Centre. Wai Ching Sin, Department of Adult Intensive Care Unit, Queen Mary Hospital. Wallace Chun Wai Ngai, Department of Adult Intensive Care Unit, Queen Mary Hospital. Paul Young, Medical Research Institute of New Zealand. Dr Annette Forrest, Waikato Hospital. Alex Kazemi, Middlemore Hospital. Seton Henderson, Christchurch Hospital. Troy Browne, Tauranga Hospital. Anusha Ganeshalingham, Starship Hospital. Rachael McConnochie, Department of Critical Care Medicine, Auckland City Hospital. Jae Hwa Cho, Yonsei University. Tai Sun Park, Hanyang University Guri Hospital. Yun Su Sim, Hallym University Kangnam Sacred Hospital. Youjin Chang, Inje University, College of Medicine, Sanggye Paik Hospital. Heung Bum Lee, Chonbuk National University Hospital. Seung Yong Park, Chonbuk National University Hospital. Wai Ming Chan, Department of Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong. Won-Yeon Lee, Yonsei University Wonju College of Medicine. David J. Wallace, University of Pittsburgh School of Medicine. Derek C. Angus, University of Pittsburgh School of Medicine. Anthony G Charles, University of North Carolina at Chapel Hill. H Rogier van Doorn, Oxford University Clinical Research Unit. Nguyen Van Kinh, National Hospital for Tropical Diseases. Nguyen Vu Trung, National Hospital for Tropical Diseases. Meghan Prin, Columbia University College of Physicians & Surgeons. Theogene Twagirumugabe, University of Rwanda /College of Medicine and Health Sciences. Olivier Felix Umuhire, Department of Anesthesia, Emergency Medicine and Critical Care. University of Rwanda. Habarurema Sylvain, Centre hospitalier Universitaire de Butare(CHUB). Eman Al Qasim, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center. Jean-Michel Heraud, Institut Pasteur de Madagascar. Mihaja Raberahona, University Hospital Joseph Raseta Befelatanana. Joelinotahiana Hasina Rabarison, Insttut Pasteur de Madagascar. Santiago Perez Patrigeon, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Subirán. Alejandra Ramirez-Venegas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas. Javier Araujo Meléndez, Hospital Central 'Dr. Ignacio Morones Prieto'. M. Lourdes Guerrero, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiren. Ivan Mambule, Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health University of Liverpool and Malawi-Liverpool-Wellcome Trust, Clinical Research Programme. Otieno George Ochieng, Kijabe Mission Hospital. Behzad Nadjm, Imperial College Healthcare NHS Trust, GBR. Iris Wai Sum Li, Queen Mary Hospital, School of Public Health, the University of Hong Kong. Won-Il Choi, Department of Medicine, Keimyung University, Dongsan Hospital. Komurian-Pradel Florence, Fondation Merieux. Yaseen M Arabi, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City. T. Eoin West, University of Washington. Elisabeth D Riviello, Harvard Medical School and Beth Israel Deaconess Medical Center. Rachael Parke, Cardiothoracic and Vascular ICU, Auckland City Hospital. AnnaneE Djillali, Raymond Poincare Hospital (APHP) Unievrsity of Versailles SQY/University Paris Saclay. Robert Fowler, Interdepartmental Division of Critical Care Medicine, University of Toronto. Srinivas Murthy, Department of Pediatrics. Alistair Nichol, University College Dublin / Monash University. Allen C Cheng, School of Public Health and Preventive Medicine, Monash University. Calum Semple, University of Liverpool. Maya George, Australian and New Zealand Intensive Care Research Centre, Monash University. Miia Valkonen, University of Helsinki and Helsinki University Hospital. Colin McArthur, Auckland City Hospital (DCCM 82). Gail Carson, University of Oxford. Genevieve O'Neill, Australian and New Zealand Intensive Care Research Centre, Monash University. J. Perren Cobb, University of Southern California. Jake Dunning, University of Oxford, Imperial College London. Jean-Daniel Chiche, Hopitaux Universitaire Paris Centre, site Cochin. Jin-Won Huh, ASAN Medical Center. John Marshall, St. Michael's Hospital. Jordi Rello, Ciberes & Vall d'Hebron University Hospital, Barcelona, Spain. Julia Guillebaud, Institut Pasteur de Madagascar. Norosoa Razanazatovo, Institut Pasteur de Madagascar. Juilett Wambura Otieno, KEMRI-Wellcome Trust Research Programme. Karen Green, Toronto Invasive Bacterial Diseases Network. Kathy Rowan, Intensive Care National Audit and Research Centre. John Kenneth Baillie, Roslin Institute, University of Edinburgh. Laura Merson, Infectious Diseases Data Observatory, Oxford, UK, Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford University, Oxford UK. Li Yang Hsu, National University of Singapore. Michael D. Christian, Essex & Herts Air Ambulance Trust. Miia Valkonen, Helsinki University Central Hospital. Moritoki Egi, Kobe University Hospital. Nahoko Shindo, World Health Organization. Peter Horby, University of Oxford. Raul Pardinaz-Solis, Nuffield Department of Medicine, University of Oxford. Sebastián Ugarte Ubiergo, Universidad Andrés Bello. Steve AR Webb, Monash University. Timothy M. Uyeki, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia USA. Anthony C Gordon, Imperial College London. David L Paterson, University of Queensland Centre. Dean Everett, University of Edinburgh, The Queens Medical Research Institute and Malawi-Liverpool-Wellcome Trust, Clinical Research Programme. Evangelos J. Giamarellos-Bourboulis, National and Kapodistrian University of Athens, Medical School. Kajsa-Stina Longuere, University of Oxford. David Maslove, Queens University. Eric Ohuma, Oxford University. Gloria Crowl, Michael Garron Hospital. Theresa PedutemHumber, River Hospital. Edward EllazarHumber, River Hospital. Ilona Bahinskaya, University Health Network TGH MOT. Joan Osbourne-Townsend, Humber River Hospital. Andrew Bentley, University of Manchester. Ingeborg Welters, University of Liverpool. Nadia Malik, MountSinai Hospital/ William Osler Health Centre. Dr T S Browne, Tauranga Hospital. Jennifer Goodson, Tauranga Hospital. Vinaya Mahesh, North York General Hospital., and Carson, G

Subjects
medicine.medical_specialty, INTENSIVE-CARE-UNIT, global health, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care, Case fatality rate, Epidemiology, Global health, medicine, pneumonia, 030212 general & internal medicine, Public, Environmental & Occupational Health, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Practice, OUTCOMES, Science & Technology, business.industry, Health Policy, Public Health, Environmental and Occupational Health, Outbreak, 030208 emergency & critical care medicine, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, 3126 Surgery, anesthesiology, intensive care, radiology, Intensive care unit, 3. Good health, critical care, REAL-TIME SURVEILLANCE, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Observational study, SOFA score, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, SPRINT-SARI investigators, business, influenza, Life Sciences & Biomedicine, Demography, outbreak preparedness
Abstract

International audience; Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.

Published
2019

11. Competing and conflicting interests in the care of critically ill patients

Author

Dominique Benoit, Alison E. Turnbull, Bertrand Guidet, Gordon D. Rubenfeld, Rik T. Gerritsen, Sarina K. Sahetya, E. Lee Daugherty Biddison, J. Randall Curtis, Mark R. Tonelli, Christiane S. Hartog, Johns Hopkins University (JHU), Jena University Hospital [Jena], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], University of Toronto, Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, Ghent University Hospital, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), and University of Washington [Seattle]

Subjects
Research design, medicine.medical_specialty, Patient-centered care, Pain medicine, media_common.quotation_subject, Critical Illness, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Trust, Article, 03 medical and health sciences, 0302 clinical medicine, Nursing, Anesthesiology, Perception, Physicians, Health care, medicine, Humans, 030212 general & internal medicine, media_common, Physician-Patient Relations, business.industry, Unintended consequences, Conscientious objector, Conflict of interest, Clinical studies as topic, Critical care, 030228 respiratory system, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care.

Published
2018

12. High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Author

Detajin Junhasavasdikul, Nuttapol Rittayamai, Carolyn Campbell, Fabiana Madotto, Martin Dres, Irene Telias, Elizabeth Tullis, Michela Rauseo, Michael C. Sklar, Brent West, Domenico Luca Grieco, Tài Pham, Laurent Brochard, HAL UPMC, Gestionnaire, Department of Anesthesia [Toronto, Canada], University of Toronto, Interdepartmental Division of Critical Care Medicine, Keenan Research Centre for Biomedical Science [Toronto, ON, Canada], Li Ka Shing Knowledge Institute [Toronto, ON, Canada]-St. Michael’s Hopsital [Toronto, ON, Canada], Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Division of Respiratory Diseases and Tuberculosis [Bangkok, Thailand] (Department of Medicine), Faculty of Medicine Siriraj Hospital [Bangkok, Thailand], Division of Respirology [Toronto, ON, Canada], St. Michael's Hospital, Department of Anesthesiology and Intensive Care Medicine [Rome, Italy], Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt)-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Medicine [Bangkok, Thailand] (Faculty of Medicine ), Mahidol University [Bangkok]-Ramathibodi Hospital [Bangkok, Thailand], Department of Anaesthesia and Intensive Care [Foggia, Italy], University of Foggia [Italy], Department of Medicine and Surgery [Monza, Italy] (Research Center on Public Health), Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), This study was supported by a grant from the Canadian Cystic Fibrosis Foundation, and equipment for the study was provided by Fisher & Paykel., Neurophysiologie Respiratoire Expérimentale et Clinique, Catholic University of the Sacred Heart [Rome, Italy] -Fondazione 'Policlinico Universitario A. Gemelli' [Rome], Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), St. Michael’s Hopsital [Toronto, ON, Canada], Siriraj Hospital, Mahidol University, Mahidol University [Bangkok], Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), Università degli Studi di Foggia = University of Foggia (Unifg), dres, martin, Sklar, M, Dres, M, Rittayamai, N, West, B, Grieco, D, Telias, I, Junhasavasdikul, D, Rauseo, M, Pham, T, Madotto, F, Campbell, C, Tullis, E, and Brochard, L

Subjects
Respiratory rate, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Diaphragmatic breathing, Hemodynamics, Critical Care and Intensive Care Medicine, Hypoxemia, cystic fibrosis, 03 medical and health sciences, Work of breathing, 0302 clinical medicine, Oxygen therapy, Heart rate, medicine, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, 3. Good health, [SDV] Life Sciences [q-bio], Editorial, 030228 respiratory system, Anesthesia, high-flow nasal oxygen therapy, medicine.symptom, business, Noninvasive ventilation, Respiratory minute volume
Abstract

Background Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO2 (PtcCO2), hemodynamics, dyspnea and comfort. Methods Adult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order. Results Fifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min, p = 0.01) and minute ventilation (by 2 L/min, p = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (p = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (p ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO2, PtcCO2 or dyspnea. Conclusions In adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation. Clinical trial registration Ethics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871).

Published
2018

13. Year in review in Intensive Care Medicine 2014: I. Cardiac dysfunction and cardiac arrest, ultrasound, neurocritical care, ICU-acquired weakness, nutrition, acute kidney injury, and miscellaneous

Author

J. Randall Curtis, Pierre Singer, Antoni Torres, Matteo Bassetti, Jan Bakker, Samir Jaber, Anders Perner, Elie Azoulay, Antoine Vieillard-Baron, Laurent Papazian, Michael Joannidis, Martin Smith, Gordon S. Doig, Marcio Soares, Giuseppe Citerio, Jean-François Timsit, Margaret S. Herridge, Mark J. Peters, Maurizio Cecconi, Dominique Benoit, Neurointensive Care Unit, Ospedale S. Gerardo, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Infectious Diseases Division, Università degli studi di Genova = University of Genoa (UniGe), Ghent University Hospital, Ghent, Belgium, Department of Anaesthesia, St. Georges Healthcare NHS Trust, Harborview Medical Center and The University of Washington, Northern Clinical School Intensive Care Research Unit, Interdepartmental Division of Critical Care Medicine, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Intensive Care, University Clinic Innsbruck, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Department of Intensive Care [Rigshospitalet], Rigshospitalet [Copenhagen], Copenhagen University Hospital-Copenhagen University Hospital, UCL Institute of Child Health and Great Ormond St Hospital, London, UK, General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center-Beilinson Hospital, The National Hospital for Neurology and Neurosurgery, Intensive Care Unit, Instituto Nacional de Câncer, Pulmonary Intensive Care Unit, Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Intensive Care, Internal Medicine, University of Genoa (UNIGE), INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de réanimation medico-chirurgicale, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Ambroise Paré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Citerio, G, Bakker, J, Bassetti, M, Benoit, D, Cecconi, M, Curtis, J, Doig, G, Herridge, M, Jaber, S, Joannidis, M, Papazian, L, Perner, A, Peters, M, Singer, P, Smith, M, Soares, M, Torres, A, Vieillard Baron, A, Timsit, J, and Azoulay, E

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Pain medicine, [SDV]Life Sciences [q-bio], Acute kidney injury, Neurointensive care, Disease, Year in Review 2014, Critical Care and Intensive Care Medicine, medicine.disease, 3. Good health, Intensive care, Anesthesiology, Review Intensive Care, Medicine, Renal replacement therapy, Cardiopulmonary resuscitation, business, Intensive care medicine, ComputingMilieux_MISCELLANEOUS
Abstract

Intensive Care Medicine is changing. New types of pa pers, such as “What’s New in Intensive Care?”, “Understanding the Disease” and “My Paper 20 Years Later”, form a stable proportion of the articles published in the 2014 issues. This diversification has been received with an extraordinary enthusiasm and appreciation by the worldwide readership, as evidenced by the massive number of hits and downloads. In this first of three 2014 “Year in Review” articles, we cover those papers published in Intensive Care Medicine during the past year which focus on cardiac arrest, ultrasonography in critically ill patients, neurocritical care, ICU-acquired weakness, nutrition, acute kidney injury, as well as a number of miscellaneous topics.

Published
2015

14. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial

Author

Frédéric Vargas, Frédéric Wallet, Camille Rolland-Debord, Alexandre Demoule, Marc Clavel, Thomas Similowski, Sébastien Perbet, Claude Guérin, Achille Kouatchet, Laurent Brochard, Samir Jaber, Nicolas Terzi, Hadrien Rozé, J. Dellamonica, HAL-UPMC, Gestionnaire, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Polyvalente [CHU Limoges], CHU Limoges, Retinoids, Development and Developmental Diseases (R2D2), Université d'Auvergne - Clermont-Ferrand I (UdA), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHU Grenoble], CHU Grenoble, Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Laboratoire des pathogènes émergents -- Emerging Pathogens Laboratory (LPE-Fondation Mérieux), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Réanimation Médicale et Chirurgicale [Centre Hospitalier Lyon-Sud], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Service de Réanimation Médicale [CHU Bordeaux], CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, Lyon, France, Hôpital de la Croix-Rousse [CHU - HCL], Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Service de Réanimation Médicale [Hôpital de l’Archet], Centre Hospitalier Universitaire de Nice (CHU de Nice)-Hôpital de l'Archet, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], Interdepartmental Division of Critical Care Medicine, University of Toronto, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital de l'Archet, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hypoxie et physiopathologies cardiovasculaire et respiratoire, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Time Factors, medicine.medical_treatment, Ventilator-Induced Lung Injury, High-Frequency Ventilation, Pressure support ventilation, Weaning, Critical Care and Intensive Care Medicine, Ventilator-free days, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Statistics, Nonparametric, law.invention, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, law, Intensive care, Neurally adjusted ventilatory assist, Medicine, Humans, Interactive Ventilatory Support, Patient–ventilator asynchrony, ComputingMilieux_MISCELLANEOUS, Aged, business.industry, Mortality rate, 030208 emergency & critical care medicine, Length of Stay, Middle Aged, 3. Good health, Diaphragm (structural system), Intention to Treat Analysis, Intensive Care Units, 030228 respiratory system, Anesthesia, Breathing, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, France, business, Respiratory Insufficiency, Ventilator Weaning, Noninvasive ventilation
Abstract

Purpose: Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation. Methods: A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, ventilator-free days and mortality. Results: In the NAVA and PSV groups respectively, the proportion of patients remaining in partial ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the ventilator-free days at day 7 were 1.0 day [1.0–4.0] vs. 0.0 days [0.0–1.0] (P < 0.01), the ventilator-free days at day 28 were 21 days [4–25] vs. 17 days [0–23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01). Conclusions: NAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial ventilatory mode. However, NAVA decreases patient–ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation.

Published
2016

15. Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics

Author

Marcio Soares, Dominique Benoit, Michael Joannidis, Elie Azoulay, Jean-François Timsit, Matteo Bassetti, Anders Perner, Samir Jaber, Laurent Papazian, Antoni Torres, Pierre Singer, Giuseppe Citerio, Martin Smith, Mark J. Peters, Maurizio Cecconi, Margaret S. Herridge, Gordon S. Doig, Jan Bakker, Antoine Vieillard-Baron, J. Randall Curtis, Hôpital Bichat - Claude Bernard, Department of Intensive Care [Rigshospitalet], Rigshospitalet [Copenhagen], Copenhagen University Hospital-Copenhagen University Hospital, Community and Conservation Ecology Group [Groningen], Université de Groningen, Infectious Diseases Division, Università degli studi di Genova = University of Genoa (UniGe), Ghent University Hospital, Shcool of medicine, University of Washington [Seattle], Northern Clinical School Intensive Care Research Unit, Interdepartmental Division of Critical Care Medicine, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Intensive Care, University Clinic Innsbruck, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), UCL Institute of Child Health and Great Ormond St Hospital, General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center-Beilinson Hospital, The National Hospital for Neurology and Neurosurgery, Intensive Care Unit, Instituto Nacional de Câncer, Pulmonary Intensive Care Unit, Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Neurointensive Care Unit, Ospedale S. Gerardo, Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), University of Genoa (UNIGE), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de réanimation medico-chirurgicale, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Ambroise Paré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Intensive Care, Timsit, J, Perner, A, Bakker, J, Bassetti, M, Benoit, D, Cecconi, M, Randall Curtis, J, Doig, G, Herridge, M, Jaber, S, Joannidis, M, Papazian, L, Peters, M, Singer, P, Smith, M, Soares, M, Torres, A, Vieillard Baron, A, Citerio, G, and Azoulay, E

Subjects
Lung Diseases, medicine.medical_specialty, Pediatrics, viruses, Critical Illness, [SDV]Life Sciences [q-bio], Disease, medicine.disease_cause, Critical Care and Intensive Care Medicine, Infections, Year in Review 2014, SDG 3 - Good Health and Well-being, Intensive care, medicine, Child, Cross Infection, Hemorrhagic Fever, Ebola, Humans, Intensive Care Units, Lung Diseases, Fungal, Infection, Pneumonia, Ventilator-Associated, Shock, Septic, Medicine (all), Endocarditis, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Ebola virus, Septic shock, business.industry, Septic, Ventilator-associated pneumonia, Shock, Pneumonia, medicine.disease, 3. Good health, Ventilator-Associated, Fungal, Infective endocarditis, Ebola, Hemorrhagic Fever, business
Abstract

This third article for the 2014 Year in Review will report publications from intensive care on severe infections (including endocarditis and peritonitis), septic shock, healthcare and ventilator associated pneumonia, highly resistant bacteria, antimicrobial therapy (including antibiotic stewardship, therapeutic drug monitoring and de-escalation), invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics.

Published
2015

16. Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

Author

Jean Chastre, Jordi Mancebo, Duncan MacRae, Daniel De Backer, Marc Bonten, Herwig Gerlach, Haibo Zhang, Giorgio Conti, Giuseppe Citerio, Elie Azoulay, Salvatore Maurizio Maggiore, Jérôme Pugin, François Lemaire, Philipp Metnitz, Massimo Antonelli, Göran Hedenstierna, Alexandre Mebazaa, Jan Wernerman, Johan Groeneveld, Department of Intensive Care and Anesthesiology, Università cattolica del Sacro Cuore [Milano] (Unicatt), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Medical Microbiology Julius Center for Health Sciences and Primary Care, University Medical Center [Utrecht], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neurointensive Care Unit, Ospedale S. Gerardo, Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Department of Anesthesiology, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukoelln, Intensive Care Medicine Unit, Free University Medical Centre, Department of Clinical Physiology, Uppsala University, Pediatric Intensive Care Unit, Royal Brompton Hospital, Hospital de la Santa Creu i Sant Pau, Service d'anesthésie - réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, University Hospital of Geneva, Department of Anesthesiology and Intensive Care Medicine, Karolinska Institutet [Stockholm], Interdepartmental Division of Critical Care Medicine, University of Toronto, Vesin, Aurélien, Intensive care medicine, ICaR - Ischemia and repair, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Antonelli, M, Azoulay, E, Bonten, M, Chastre, J, Citerio, G, Conti, G, De Backer, D, Lemaire, F, Gerlach, H, Groeneveld, J, Hedenstierna, G, Macrae, D, Mancebo, J, Maggiore, S, Mebazaa, A, Metnitz, P, Pugin, J, Wernerman, J, and Zhang, H

Subjects
Resuscitation, ARDS, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Hypoxia-Ischemia, Brain/epidemiology, 0302 clinical medicine, Intubation, Respiratory Insufficiency/*diagnosis/epidemiology/*therapy, Sepsis/epidemiology, MESH: Respiration, Artificial, MESH: Sepsis, ComputingMilieux_MISCELLANEOUS, Respiratory Distress Syndrome, Intensive Care/*methods, ddc:617, Lung Injury, 3. Good health, Reperfusion Injury, Hypoxia-Ischemia, Brain, Acute Disease, MESH: Lung Injury, MESH: Acute Disease, Respiratory Insufficiency, Human, medicine.medical_specialty, Critical Care, Sepsi, Lung injury, Sepsis, 03 medical and health sciences, Intensive care, Anesthesiology, medicine, Intubation, Intratracheal, Humans, MESH: Intensive Care, Intensive care medicine, Lung Injury/epidemiology/therapy, Mechanical ventilation, MESH: Humans, MESH: Intubation, Intratracheal, business.industry, Reperfusion Injury/epidemiology, Intensive Care, Respiratory Distress Syndrome, Adult, Year in Review 2008, 030208 emergency & critical care medicine, medicine.disease, Respiration, Artificial, Intubation, Intratracheal/*methods, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Respiratory Distress Syndrome, Adult, MESH: Hypoxia-Ischemia, Brain, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Respiratory Distress Syndrome, Adult/epidemiology/physiopathology/*therapy, MESH: Reperfusion Injury, business, Respiration, Artificial/*methods, MESH: Respiratory Insufficiency
Abstract

Year in review in Intensive Care Medicine, 2008 : II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

Published
2009

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