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3. Sleep Assessment in Critically Ill Patients With Acute Hypoxemic Respiratory Failure.

Author

Thille, Arnaud W., Marie, Damien, Reynaud, Faustine, Barrau, Stéphanie, Beuvon, Clément, Bironneau, Vanessa, Jutant, Etienne-Marie, Coudroy, Rémi, Frat, Jean-Pierre, Rault, Christophe, and Drouot, Xavier

Subjects
INTENSIVE care units, SLEEP quality, RESPIRATORY insufficiency, SCIENTIFIC observation, INTUBATION, CRITICALLY ill, PATIENTS, POLYSOMNOGRAPHY, RAPID eye movement sleep, FISHER exact test, MANN Whitney U Test, SLEEP duration, SLEEP deprivation, KAPLAN-Meier estimator, DESCRIPTIVE statistics, DATA analysis software, HYPOXEMIA, LONGITUDINAL method
Abstract

Background: Sleep deprivation alters respiratory muscle performance and may precipitate respiratory failure. This study aimed to assess sleep in subjects admitted to ICU for acute hypoxemic respiratory failure and its role in the risk of intubation. Methods: This was a prospective observational single-center cohort study including subjects admitted to ICU for de novo acute hypoxemic respiratory failure defined as breathing frequency ≥ 25 breaths/min or clinical signs of respiratory distress and ... < 300 mm Hg while receiving high-flow nasal oxygen. Subjects with altered consciousness, central nervous or psychiatric disorders, continuous sedation or neuroleptic medication, or were uncooperative were excluded. Sleep was assessed by complete polysomnography (PSG) the night following ICU admission. The main outcome was to assess sleep among subjects with acute hypoxemic respiratory failure and to compare sleep between subjects who eventually required intubation to those who did not. Results: Over a 24-month inclusion period, 34 subjects had complete PSG, among whom 5 (15%) required intubation in the ICU. Total sleep time was 4.2 h in median (interquartile range 2.9-6.8); deep-sleep duration was 70 min (34-127), and rapid eye movement (REM) sleep duration was 9 min (0-28). Among them, 13 subjects (38%) had no REM sleep. Total sleep time and duration of deep and REM sleep stages did not differ between subjects who required intubation and those successfully treated with high-flow nasal oxygen. Conclusions: Whereas total sleep time remained relatively preserved in critically ill subjects with acute hypoxemic respiratory failure, REM sleep time was uncommon or completely absent in a large number of subjects. Sleep did not differ between subjects who required intubation and those who did not. However, given a trend toward an increased risk of intubation in subjects with a complete absence of REM sleep, further studies are needed to better explore the impact of REM sleep on the risk of intubation. [ABSTRACT FROM AUTHOR]

Published
2023
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4. NebulizationWith Vibrating Mesh Through High-Flow Nasal Cannula: Why Is It Better?

Author

Le Pape, Sylvain, Thille, Arnaud W., and Frat, Jean-Pierre

Subjects
LENGTH of stay in hospitals, NASAL cannula, AIRWAY (Anatomy), POSITIVE end-expiratory pressure, RESPIRATORY measurements, NEBULIZERS & vaporizers, ARTIFICIAL respiration, BRONCHODILATOR agents, OBSTRUCTIVE lung diseases, DISEASE exacerbation
Abstract

The authors comment on a study published within the issue which compared the efficacy of bronchodilators delivered through a standard face mask with a jet nebulizer or through a high-flow nasal cannula (HFNC) system with vibrating mesh nebulizer (VMN) in stable chronic obstructive pulmonary disease (COPD) subjects. Cited are the potential improved pulmonary deposition using VMN, and the role played by systemic absorption during delivery using HFNC.

Published
2024
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5. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Author

Pham, Tài, Heunks, Leo, Bellani, Giacomo, Madotto, Fabiana, Aragao, Irene, Beduneau, Gaëtan, Goligher, Ewan C, Grasselli, Giacomo, Laake, Jon Henrik, Mancebo, Jordi, Peñuelas, Oscar, Piquilloud, Lise, Pesenti, Antonio, Wunsch, Hannah, van Haren, Frank, Brochard, Laurent, Laffey, John G, Abrough, Fekri, Acharya, Subhash P, Amin, Pravin, Arabi, Yaseen, Aragao, Irene, Bauer, Philippe, Beduneau, Gaëtan, Beitler, Jeremy, Berkius, Johan, Bugedo, Guillermo, Camporota, Luigi, Cerny, Vladimir, Cho, Young-Jae, Clarkson, Kevin, Estenssoro, Elisa, Goligher, Ewan, Grasselli, Giacomo, Gritsan, Alexey, Hashemian, Seyed Mohammadreza, Hermans, Greet, Heunks, Leo M, Jovanovic, Bojan, Kurahashi, Kiyoyasu, Laake, Jon Henrik, Matamis, Dimitrios, Moerer, Onnen, Molnar, Zsolt, Ozyilmaz, Ezgi, Panka, Bernardo, Papali, Alfred, Peñuelas, Óscar, Perbet, Sébastien, Piquilloud, Lise, Qiu, Haibo, Razek, Assem Abdel, Rittayamai, Nuttapol, Roldan, Rollin, Serpa Neto, Ary, Szuldrzynski, Konstanty, Talmor, Daniel, Tomescu, Dana, Van Haren, Frank, Villagomez, Asisclo, Zeggwagh, Amine Ali, Abe, Toshikazu, Aboshady, Abdelrhman, Acampo-de Jong, Melanie, Acharya, Subhash, Adderley, Jane, Adiguzel, Nalan, Agrawal, Vijay Kumar, Aguilar, Gerardo, Aguirre, Gaston, Aguirre-Bermeo, Hernan, Ahlström, Björn, Akbas, Türkay, Akker, Mustafa, Al Sadeh, Ghamdan, Alamri, Sultan, Algaba, Angela, Ali, Muneeb, Aliberti, Anna, Allegue, Jose Manuel, Alvarez, Diana, Amador, Joaquin, Andersen, Finn H, Ansari, Sharique, Apichatbutr, Yutthana, Apostolopoulou, Olympia, Arabi, Yaseen, Arellano, Daniel, Arica, Mestanza, Arikan, Huseyin, Arinaga, Koichi, Arnal, Jean-Michel, Asano, Kengo, Asín-Corrochano, Marta, Avalos Cabrera, Jesus Milagrito, Avila Fuentes, Silvia, Aydemir, Semih, Aygencel, Gulbin, Azevedo, Luciano, Bacakoglu, Feza, Badie, Julio, Baedorf Kassis, Elias, Bai, Gabriela, Balaraj, Govindan, Ballico, Bruno, Banner-Goodspeed, Valerie, Banwarie, Preveen, Barbieri, Rosella, Baronia, Arvind, Barrett, Jonathan, Barrot, Loïc, Barrueco-Francioni, Jesus Emilio, Barry, Jeffrey, Bauer, Philippe, Bawangade, Harshal, Beavis, Sarah, Beck, Eduardo, Beehre, Nina, Belenguer Muncharaz, Alberto, Bellani, Giacomo, Belliato, Mirko, Bellissima, Agrippino, Beltramelli, Rodrigo, Ben Souissi, Asma, Benitez-Cano, Adela, Benlamin, Mohamed, Benslama, Abdellatif, Bento, Luis, Benvenuti, Daniela, Berkius, Johan, Bernabe, Laura, Bersten, Andrew, Berta, Giacomo, Bertini, Pietro, Bertram-Ralph, Elliot, Besbes, Mohamed, Bettini, Lisandro Roberto, Beuret, Pascal, Bewley, Jeremy, Bezzi, Marco, Bhakhtiani, Lakshay, Bhandary, Rakesh, Bhowmick, Kaushik, Bihari, Shailesh, Bissett, Bernie, Blythe, David, Bocher, Simon, Boedjawan, Narain, Bojanowski, Christine M, Boni, Elisa, Boraso, Sabrina, Borelli, Massimo, Borello, Silvina, Borislavova, Margarita, Bosma, Karen J, Bottiroli, Maurizio, Boyd, Owen, Bozbay, Suha, Briva, Arturo, Brochard, Laurent, Bruel, Cédric, Bruni, Andrea, Buehner, Ulrike, Bugedo, Guillermo, Bulpa, Pierre, Burt, Karen, Buscot, Mathieu, Buttera, Stefania, Cabrera, Jorge, Caccese, Roberta, Caironi, Pietro, Canchos Gutierrez, Ivan, Canedo, Nancy, Cani, Alma, Cappellini, Iacopo, Carazo, Jesus, Cardonnet, Luis Pablo, Carpio, David, Carriedo, Demetrio, Carrillo, Ramón, Carvalho, João, Caser, Eliana, Castelli, Antonio, Castillo Quintero, Manuel, Castro, Heloisa, Catorze, Nuno, Cengiz, Melike, Cereijo, Enrique, Ceunen, Helga, Chaintoutis, Christos, Chang, Youjin, Chaparro, Gustavogcha, Chapman, Carmel, Chau, Simon, Chavez, Cecilia Eugenia, Chelazzi, Cosimo, Chelly, Jonathan, Chemouni, Frank, Chen, Kai, Chena, Ariel, Chiarandini, Paolo, Chilton, Phil, Chiumello, Davide, Cho, Young-Jae, Chou-Lie, Yvette, Chudeau, Nicolas, Cinel, Ismail, Cinnella, Gilda, Clark, Michele, Clark, Thomas, Clarkson, Kevin, Clementi, Stefano, Coaguila, Luis, Codecido, Alexis Jaspe, Collins, Amy, Colombo, Riccardo, Conde, Juan, Consales, Guglielmo, Cook, Tim, Coppadoro, Andrea, Cornejo, Rodrigo, Cortegiani, Andrea, Coxo, Cristina, Cracchiolo, Andrea Neville, Crespo Ramirez, Mónica, Crova, Philippe, Cruz, José, Cubattoli, Lucia, Çukurova, Zafer, Curto, Francesco, Czempik, Piotr, D'Andrea, Rocco, da Silva Ramos, Fernando, Dangers, Laurence, Danguy des Déserts, Marc, Danin, Pierre-Eric, Dantas, Fabianne, Daubin, Cédric, Dawei, Wu, de Haro, Candelaria, de Jesus Montelongo, Felipe, De Mendoza, Diego, de Pablo, Raúl, De Pascale, Gennaro, De Rosa, Silvia, Decavèle, Maxens, Declercq, Pierre-Louis, Deicas, Alberto, del Carmen Campos Moreno, María, Dellamonica, Jean, Delmas, Benjamin, Demirkiran, Oktay, Demirkiran, Hilmi, Dendane, Tarek, di Mussi, Rossella, Diakaki, Chrysi, Diaz, Anatilde, Diaz, Willy, Dikmen, Yalim, Dimoula, Aikaterini, Doble, Patricia, Doha, Nagwa, Domingos, Guilherme, Dres, Martin, Dries, David, Duggal, Abhijit, Duke, Graeme, Dunts, Pavel, Dybwik, Knut, Dykyy, Maksym, Eckert, Philippe, Efe, Serdar, Elatrous, Souheil, Elay, Gülseren, Elmaryul, Abubaker S, Elsaadany, Mohamed, Elsayed, Hany, Elsayed, Samar, Emery, Malo, Ena, Sébastien, Eng, Kevin, Englert, Joshua A, Erdogan, Elif, Ergin Ozcan, Perihan, Eroglu, Ege, Escobar, Miguel, Esen, Figen, Esen Tekeli, Arzu, Esquivel, Alejandro, Esquivel Gallegos, Helbert, Ezzouine, Hanane, Facchini, Alberto, Faheem, Mohammad, Fanelli, Vito, Farina, Maria Fernanda, Fartoukh, Muriel, Fehrle, Lutz, Feng, Feng, Feng, Yufeng, Fernandez, Irene, Fernandez, Borja, Fernandez-Rodriguez, Maria Lorena, Ferrando, Carlos, Ferreira da Silva, Maria João, Ferreruela, Mireia, Ferrier, Janet, Flamm Zamorano, Matias Jesús, Flood, Laura, Floris, Leda, Fluckiger, Martin, Forteza, Catalina, Fortunato, Antonella, Frans, Eric, Frattari, Antonella, Fredes, Sebastian, Frenzel, Tim, Fumagalli, Roberto, Furche, Mariano Andres, Fusari, Maurizio, Fysh, Edward, Galeas-Lopez, Juan Luis, Galerneau, Louis-Marie, Garcia, Analía, Garcia, María Fernanda, Garcia, Elisabet, Garcia Olivares, Pablo, Garlicki, Jaroslaw, Garnero, Aude, Garofalo, Eugenio, Gautam, Prabha, Gazenkampf, Andrey, Gelinotte, Stéphanie, Gelormini, Domenico, Ghrenassia, Etienne, Giacomucci, Angelo, Giannoni, Robert, Gigante, Andrea, Glober, Nancy, Gnesin, Paolo, Gollo, Yari, Gomaa, Dina, Gomero Paredes, Rosita, Gomes, Rui, Gomez, Raúl Alejandro, Gomez, Oscar, Gomez, Aroa, Gondim, Louise, Gonzalez, Manuel, Gonzalez, Isabel, Gonzalez-Castro, Alejandro, Gordillo Romero, Orlando, Gordo, Federico, Gouin, Philippe, Graf Santos, Jerónimo, Grainne, Rooney, Grando, Matilde, Granov Grabovica, Sanja, Grasselli, Giacomo, Grasso, Salvatore, Grasso, Rinaldo, Grimmer, Lisa, Grissom, Colin, Gritsan, Alexey, Gu, Qing, Guan, Xiang-Dong, Guarracino, Fabio, Guasch, Neus, Guatteri, Luca, Gueret, Renaud, Guérin, Claude, Guerot, Emmanuel, Guitard, Pierre-Gildas, Gül, Fethi, Gumus, Ayca, Gurjar, Mohan, Gutierrez, Patricia, Hachimi, Abdelhamid, Hadzibegovic, Adi, Hagan, Samantha, Hammel, Clare, Han Song, Joo, Hanlon, Gabrielle, Hashemian, Seyed Mohammadreza, Heines, Serge, Henriksson, Johanna, Herbrecht, Jean-Etienne, Heredia Orbegoso, Gabriel Omar, Hermans, Greet, Hermon, Andrew, Hernandez, Rosana, Hernandez, Carmen, Herrera, Luis, Herrera-Gutierrez, Manuel, Heunks, Leo, Hidalgo, Juan, Hill, Dianne, Holmquist, Dagmar, Homez, Marcela, Hongtao, Xia, Hormis, Anil, Horner, Daniel, Hornos, M Carmen, Hou, Meihong, House, Stacy, Housni, Brahim, Hugill, Keith, Humphreys, Sally, Humbert, Louis, Hunter, Stephanie, Hwa Young, Lee, Iezzi, Nicolas, Ilutovich, Santiago, Inal, Volkan, Innes, Richard, Ioannides, Panagiotis, Iotti, Giorgio Antonio, Ippolito, Mariachiara, Irie, Hiromasa, Iriyama, Hiroki, Itagaki, Taiga, Izura, Javier, Izza, Santiago, Jabeen, Rakhshanda, Jamaati, Hamidreza, Jamadarkhana, Sunil, Jamoussi, Amira, Jankowski, Milosz, Jaramillo, Luis Alberto, Jeon, Kyeongman, Jeong Lee, Seok, Jeswani, Deepak, Jha, Simant, Jiang, Liangyan, Jing, Chen, Jochmans, Sébastien, Johnstad, Bror Anders, Jongmin, Lee, Joret, Aurélie, Jovanovic, Bojan, Junhasavasdikul, Detajin, Jurado, Maria Teresa, Kam, Elisa, Kamohara, Hidenobu, Kane, Caroline, Kara, Iskender, Karakurt, Sait, Karnjanarachata, Cherdkiat, Kataoka, Jun, Katayama, Shinshu, Kaushik, Shuchi, Kelebek Girgin, Nermin, Kerr, Kathryn, Kerslake, Ian, Khairnar, Prakash, Khalid, Abidi, Khan, Akram, Khanna, Ashish K, Khorasanee, Reza, Kienhorst, Dieneke, Kirakli, Cenk, Knafelj, Rihard, Kol, Mark Kol, Kongpolprom, Napplika, Kopitko, Csaba, Korkmaz Ekren, Pervin, Kubisz-Pudelko, Agnieszka, Kulcsar, Zoltan, Kumasawa, Junji, Kurahashi, Kiyoyasu, Kuriyama, Akira, Kutchak, Fernanda, Laake, Jon Henrik, Labarca, Eduardo, Labat, Françoise, Laborda, César, Laca Barrera, Manuel Alberto, Lagache, Laurie, Landaverde Lopez, Antonio, Lanspa, Michael, Lascari, Valeria, Le Meur, Matthieu, Lee, Su Hwan, Lee, Young Ju, Lee, Jinwoo, Lee, Won-Yeon, Lee, Jarone, Legernaes, Terje, Leiner, Tamaas, Lemiale, Virginie, Leonor, Tiago, Lepper, Philipp M, Li, Dahuan, Li, Hongbin, Li, Oleg, Lima, Ana Raquel, Lind, Dan, Litton, Edward, Liu, Ning, Liu, Ling, Liu, Jialin, Llitjos, Jean-François, Llorente, Beatriz, Lopez, Rodolfo, Lopez, Claudia Elizabeth, Lopez Nava, Claudia, Lovazzano, Pablo, Lu, Min, Lucchese, Francesca, Lugano, Manuela, Lugo Goytia, Gustavo, Luo, Hua, Lynch, Ceri, Macheda, Sebastiano, Madrigal Robles, Victor Hugo, Maggiore, Salvatore Maurizio, Magret Iglesias, Mònica, Malaga, Peter, Mallapura Maheswarappa, Harish, Malpartida, Guillermo, Malyarchikov, Andrey, Mansson, Helena, Manzano, Anaid, Marey, Ismael, Marin, Nathalie, Marin, Maria del Carmen, Markman, Eliana, Martin, Felix, Martin, Alex, Martin Dal Gesso, Cristina, Martinez, Felipe, Martínez-Fidalgo, Conchita, Martin-Loeches, Ignacio, Mas, Arantxa, Masaaki, Sakuraya, Maseda, Emilio, Massa, Eleni, Mattsson, Anna, Maugeri, Jessica, McCredie, Victoria, McCullough, James, McGuinness, Shay, McKown, Andrew, Medve, László, Mei, Chengqing, Mellado Artigas, Ricard, Mendes, Vitor, Mervat, Mohamed Khalaf Ebraheim, Michaux, Isabelle, Mikhaeil, Michael, Milagros, Olga, Milet, Igor, Millan, Maria Teresa, Minwei, Zhang, Mirabella, Lucia, Mishra, Sanghamitra, Mistraletti, Giovanni, Mochizuki, Katsunori, Moerer, Onnen, Moghal, Arif, Mojoli, Francesco, Molin, Alexandre, Molnar, Zsolt, Montiel, Raquel, Montini, Luca, Monza, Gianmario, Mora Aznar, Maria, Morakul, Sunthiti, Morales, Maria, Moreno Torres, Daniel, Morocho Tutillo, Diego Rolando, Motherway, Catherine, Mouhssine, Doumiri, Mouloudi, Eleni, Muñoz, Tapia, Munoz de Cabo, Carlos, Mustafa, Mohamed, Muthuchellappan, Radhakrishnan, Muthukrishnan, Muraleekrishnan, Muttini, Stefano, Nagata, Isao, Nahar, Dick, Nakanishi, Misuzu, Nakayama, Izumi, Namendys-Silva, Silvio Antonio, Nanchal, Rahul, Nandakumar, Sivakumar, Nasi, Alessandra, Nasir, Kamal, Navalesi, Paolo, Naz Aslam, Tayyba, Nga Phan, Thuy, Nichol, Alistair, Niiyama, Shuhei, Nikolakopoulou, Sofia, Nikolic, Elena, Nitta, Kenichi, Noc, Marko, Nonas, Stephanie, Nseir, Saad, Nur Soyturk, Ayse, Obata, Yukako, Oeckler, Richard, Oguchi, Moe, Ohshimo, Shinichiro, Oikonomou, Marina, Ojados, Agueda, Oliveira, Maria Teresa, Oliveira Filho, Wilson, Oliveri, Carlo, Olmos, Aitor, Omura, Kazuya, Orlandi, Maria Cristina, Orsenigo, Francesca, Ortiz-Ruiz De Gordoa, Laura, Ota, Kei, Ovalle Olmos, Rainier, Öveges, Nándo, Oziemski, Peter, Ozkan Kuscu, Ozlem, Pachas Alvarado, Fernando, Pagella, Gonzalo, Palaniswamy, Vijayanand, Palazon Sanchez, Eugenio Luis, Palmese, Salvatore, Pan, Guojun, Pan, Wensen, Panka, Bernardo, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Parekh, Ameet, Parke, Rachael, Parrilla, Francisco J, Parrilla, Dácil, Pasha, Taha, Pasin, Laura, Patão, Luis, Patel, Mayur, Patel, Grisma, Pati, Basanta Kumar, Patil, Jayaprakash, Pattnaik, Saroj, Paul, Daniel, Pavesi, Maurizio, Pavlotsky, Vanesa Alejandra, Paz, Graciela, Paz, Enrique, Pecci, Elisabetta, Pellegrini, Carlos, Peña Padilla, Andrea Gabriela, Perchiazzi, Gaetano, Pereira, Tiago, Pereira, Vera, Perez, Manuel, Perez Calvo, Cesar, Perez Cheng, Meisy, Perez Maita, Ronald, Pérez-Araos, Rodrigo, Perez-Teran, Purificación, Perez-Torres, David, Perkins, Gavin, Persona, Paolo, Petnak, Tananchai, Petrova, Marina, Pham, Tai, Philippart, François, Picetti, Edoardo, Pierucci, Elisabetta, Piervincenzi, Edoardo, Pinciroli, Riccardo, Pintado, Maria-Consuelo, Piquilloud, Lise, Piraino, Thomas, Piras, Stephanie, Piras, Claudio, Pirompanich, Pattarin, Pisani, Luigi, Platas, Enrique, Plotnikow, Gustavo, Porras, Willy, Porta, Virginia, Portilla, Mariana, Portugal, José, Povoa, Pedro, Prat, Gwenael, Pratto, Romina, Preda, Gabriel, Prieto, Isidro, Prol-Silva, Estefania, Pugh, Richard, Qi, Yupeng, Qian, Chuanyun, Qin, Tiehe, Qiu, Haibo, Qu, Hongping, Quintana, Teobaldo, Quispe Sierra, Rosari, Quispe Soto, Rocio, Rabbani, Raihan, Rabee, Mohamed, Rabie, Ahmed, Rahe Pereira, Maria Augusta, Rai, Ashish, Raj Ashok, Sundar, Rajab, Mostafa, Ramdhani, Navin, Ramey, Elizabeth, Ranieri, Marco, Rathod, Darshana, Ray, Banambar, Redwanul Huq, Shihan Mahmud, Regli, Adrian, Reina, Rosa, Resano Sarmiento, Natalia, Reynaud, Faustine, Rialp, Gemma, Ricart, Pilar, Rice, Todd, Richardson, Angus, Rieder, Marcelo, Rinket, Martin, Rios, Fernando, Rios, Fernando, Risso Vazquez, Alejandro, Rittayamai, Nuttapol, Riva, Ivano, Rivette, Monaly, Roca, Oriol, Roche-Campo, Ferran, Rodriguez, Covadonga, Rodriguez, Gabriel, Rodriguez Gonzalez, Daniel, Rodriguez Tucto, Xandra Yanina, Rogers, Angela, Romano, María Elena, Rørtveit, Linda, Rose, Alastair, Roux, Damien, Rouze, Anahita, Rubatto Birri, Paolo Nahuel, Ruilan, Wang, Ruiz Robledo, Aldana, Ruiz-Aguilar, Antonio Luis, Sadahiro, Tomohito, Saez, Ignacio, Sagardia, Judith, Saha, Rajnish, Saha, Rohit, Saiphoklang, Narongkorn, Saito, Shigeki, Salem, Maie, Sales, Gabriele, Salgado, Patricia, Samavedam, Srinivas, Sami Mebazaa, Mhamed, Samuelsson, Line, San Juan Roman, Nandyelly, Sanchez, Patricia, Sanchez-Ballesteros, Jesus, Sandoval, Yazcitk, Sani, Emanuele, Santos, Martin, Santos, Carla, Sanui, Masamitsu, Saravanabavan, Lakshmikanthcharan, Sari, Sema, Sarkany, Agnes, Sauneuf, Bertrand, Savioli, Monica, Sazak, Hilal, Scano, Riccardo, Schneider, Francis, Schortgen, Frédérique, Schultz, Marcus J, Schwarz, Gabriele Leonie, Seçkin Yücesoy, Faruk, Seely, Andrew, Seiler, Frederik, Seker Tekdos, Yasemin, Seok Chan, Kim, Serano, Luca, Serednicki, Wojciech, Serpa Neto, Ary, Setten, Mariano, Shah, Asim, Shah, Bhagyesh, Shang, You, Shanmugasundaram, Pradeep, Shapovalov, Konstantin, Shebl, Eman, Shiga, Takuya, Shime, Nobuaki, Shin, Phil, Short, Jack, Shuhua, Chen, Siddiqui, Sughrat, Silesky Jimenez, Juan Ignacio, Silva, Daniel, Silva Sales, Betania, Simons, Koen, Sjøbø, Brit Ågot, Slessor, David, Smiechowicz, Jakub, Smischney, Nathan, Smith, Paul, Smith, Tim, Smith, Mark, Snape, Sarah, Snyman, Lindi, Soetens, Filiep, Sook Hong, Kyung, Sosa Medellin, Miguel Ángel, Soto, Giovanna, Souloy, Xavier, Sousa, Elsa, Sovatzis, Stefania, Sozutek, Didem, Spadaro, Savino, Spagnoli, Marco, Spångfors, Martin, Spittle, Nick, Spivey, Mike, Stapleton, Andrew, Stefanovic, Branislava, Stephenson, Lorraine, Stevenson, Elizabeth, Strand, Kristian, Strano, Maria Teresa, Straus, Slavenka, Sun, Chenliang, Sun, Rongqing, Sundaram, Venkat, SunPark, Tai, Surlemont, Elisabeth, Sutherasan, Yuda, Szabo, Zsuzsanna, Szuldrzynski, Konstanty, Tainter, Christopher, Takaba, Akihiro, Tallott, Mandy, Tamasato, Tamasato, Tang, Zhanhong, Tangsujaritvijit, Viratch, Taniguchi, Leandro, Taniguchi, Daisuke, Tarantino, Fabio, Teerapuncharoen, Krittika, Temprano, Susana, Terragni, Pierpaolo, Terzi, Nicolas, Thakur, Anand, Theerawit, Pongdhep, Thille, Arnaud W, Thomas, Matt, Thungtitigul, Poungrat, Thyrault, Martial, Tilouch, Nejla, Timenetsky, Karina, Tirapu, Juna, Todeschini, Manuel, Tomas, Roser, Tomaszewski, Christian, Tonetti, Tommaso, Tonnelier, Alexandre, Trinder, John, Trongtrakul, Konlawij, Truwit, Jonathon, Tsuei, Betty, Tulaimat, Aiman, Turan, Sema, Turkoglu, Melda, Tyagi, Sanjeev, Ubeda, Alejandro, Vagginelli, Federica, Valenti, María Florencia, Vallverdu, Imma, Van Axel, Alisha, van den Hul, Ingrid, van der Hoeven, Hans, Van Der Meer, Nardo, Van Haren, Frank, Vanhoof, Marc, Vargas-Ordoñez, Mónica, Vaschetto, Rosanna, Vascotto, Ettore, Vatsik, Maria, Vaz, Ana, Vazquez-Sanchez, Antonia, Ventura, Sara, Vermeijden, Jan Wytze, Vidal, Anxela, Vieira, Jocyelle, Vilela Costa Pinto, Bruno, Villagomez, Asisclo, Villagra, Ana, Villegas Succar, Cristina, Vinorum, Ole Georg, Vitale, Giovanni, Vj, Ramesh, Vochin, Ana, Voiriot, Guillaume, Volta, Carlo Alberto, von Seth, Magnus, Wajdi, Maazouzi, Walsh, Don, Wang, Shouhong, Wardi, Gabriel, Ween-Velken, Nils Christian, Wei, Bi-Lin, Weller, Dolf, Welsh, Deborah, Welters, Ingeborg, Wert, Michael, Whiteley, Simon, Wilby, Elizabeth, Williams, Erin, Williams, Karen, Wilson, Antoinette, Wojtas, Jadwiga, Won Huh, Jin, Wrathall, David, Wright, Christopher, Wu, Jian-Feng, Xi, Guo, Xing, Zheng-Jiang, Xu, Hongyang, Yamamoto, Kotaro, Yan, Jie, Yáñez, Julio, Yang, Xiaobo, Yates, Elliot, Yazicioglu Mocin, Ozlem, Ye, Zhenglong, Yildirim, Fatma, Yoshida, Norifumi, Yoshido, Hector Higo Leon, Young Lee, Bo, Yu, Rongguo, Yu, Gong, Yu, Tao, Yuan, Boyun, Yuangtrakul, Nadwipa, Yumoto, Tetsuya, Yun, Xie, Zakalik, Graciela, Zaki, Ahmad, Zalba-Etayo, Begoña, Zambon, Massimo, Zang, Bin, Zani, Gianluca, Zarka, Jonathan, Zerbi, Simone Maria, Zerman, Avsar, Zetterquist, Harald, Zhang, Jiuzhi, Zhang, Hongwen, Zhang, Wei, Zhang, Guoxiu, Zhang, Weixin, Zhao, Hongsheng, Zheng, Jia, Zhu, Bin, and Zumaran, Ronald

Abstract

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

Published
2023
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6. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial

Author

Landais, Mickaël, Nay, Mai-Anh, Auchabie, Johann, Hubert, Noemie, Frerou, Aurélien, Yehia, Aihem, Mercat, Alain, Jonas, Maud, Martino, Frédéric, Moriconi, Mikael, Courte, Anne, Robert-Edan, Vincent, Conia, Alexandre, Bavozet, Florent, Egreteau, Pierre-Yves, Bruel, Cédric, Renault, Anne, Huet, Olivier, Feller, Marc, Chudeau, Nicolas, Ferrandiere, Martine, Rebion, Anne, Robert, Alain, Giraudeau, Bruno, Reignier, Jean, Thille, Arnaud W, Tavernier, Elsa, Ehrmann, Stephan, MORTAZA, Satar, DEMISELLE, Julien, SASSI, Taoufik, DELALE, Charles, GROUILLE, Julien, DE TINTENIAC, Anne, GESLAIN, Marie, FLOCH, Herve, BAILLY, Pierre, BODENES, Laetitia, PRAT, Gwenaël, KALFON, Pierre, BADRE, Gaetan, JOURDAIN, Cecile, MAZZONI, Thierry, LE MEUR, Anthony, FAYOLLE, Pierre Marie, HERON, Anne, MAILLET, Odile, LEDOUX, Nelly, ROLLE, Amélie, RICHARD, Régine, VALETTE, Marc, AZAIS, Marie-Ange, POUPLET, Caroline, BACHOUMAS, Konstantinos, CALLAHAN, Jean Christophe, GUITTON, Christophe, DARREAU, Cedric, LEFEVRE, Montaine, LELOUP, Guillaume, BERTEL, Mélanie, DAUVERGNE, Jerome, PACAUD, Laurence, LAKHAL, Karim, MARTIN, Maelle, GARRET, Charlotte, LASCARROU, Jean-Baptiste, BOULAIN, Thierry, MATHONNET, Armelle, MULLER, Grégoire, PHILIPPART, François, TRAN, Marc, FOURNIER, Julien, FRAT, Jean-Pierre, COUDROY, Remi, CHATELLIER, Delphine, HALLEY, Guillaume, GACOUIN, Arnaud, HOFF, Jerome, VASTAL, Servane, TELLIER, Anne-Charlotte, BARBAZ, Mathilde, SALMON GANDONNIERE, Charlotte, MERCIER, Emmanuelle, and DARWICHE, Walid

Abstract

Fasting is frequently imposed before extubation in patients in intensive care units, with the aim to reduce risk of aspiration. This unevaluated practice might delay extubation, increase workload, and reduce caloric intake. We aimed to compare continued enteral nutrition until extubation with fasting before extubation in patients in the intensive care unit.

Published
2023
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7. Decline in Ventilatory Ratio as a Predictor of Mortality in Adults With ARDS Receiving Prone Positioning.

Author

Tisminetzky, Manuel, Ferreyro, Bruno L., Frutos-Vivar, Fernando, Esteban, Andrés, Ríos, Fernando, Thille, Arnaud W., Raymondos, Konstantinos, Del Sorbo, Lorenzo, Peñuelas, Öscar, and Fan, Eddy

Subjects
INTENSIVE care units, STATISTICS, STATISTICAL significance, CONFIDENCE intervals, CROSS-sectional method, TIME, CONTINUING education units, RETROSPECTIVE studies, HEALTH outcome assessment, MANN Whitney U Test, FISHER exact test, ADULT respiratory distress syndrome, ARTIFICIAL respiration, T-test (Statistics), DESCRIPTIVE statistics, SOCIODEMOGRAPHIC factors, LOGISTIC regression analysis, DATA analysis software, ODDS ratio, LYING down position
Abstract

BACKGROUND: Prone positioning reduces mortality in patients with moderate/severe ARDS. It remains unclear which physiological parameters could guide clinicians to assess which patients are likely to benefit from prone position. This study aimed to determine the association between relative changes in physiological parameters at 24 h of prone positioning and ICU mortality in adult subjects with ARDS. METHODS: We conducted a cohort study using the VENTILA database, including adults with ARDS receiving prone positioning. We used multivariable logistic regression to assess the association between relative changes in physiological parameters (P.../F..., dynamic driving pressure, P..., and ventilatory ratio defined as [minute ventilation [mL/min] x P... [mm Hg]]/[predicted body weight X 100 [mL/min] x 37.5 [mm Hg] with ICU mortality) (primary outcome). We report adjusted odds ratios with 95% CI as measures of association. RESULTS: We included 156 subjects of which 82 (53%) died in the ICU. A relative decline in the ventilatory ratio at 24 h was associated with lower ICU mortality (odds ratio 0.80 [95% CI 0.66-0.97], every 10% decrease). Relative changes in P.../F... (odds ratio 0.89 [95% CI 0.77-1.03], every 25% increase), P... (odds ratio 0.97 [95% CI 0.82-1.16], every 10% decrease), and dynamic driving pressure (odds ratio 0.98 [95% CI 0.89-1.07], every 10% decrease) were not associated with ICU mortality. CONCLUSIONS: In subjects with ARDS receiving prone positioning, a relative decline in the ventilatory ratio at 24 h was associated with lower ICU mortality. [ABSTRACT FROM AUTHOR]

Published
2022
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8. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale.

Author

Rakhit, Shayan, Wang, Li, Lindsell, Christopher J., Hosay, Morgan A., Stewart, James W., Owen, Gary D., Frutos-Vivar, Fernando, Pen~uelas, Oscar, Esteban, Andre´s, Anzueto, Antonio R., Raymondos, Konstantinos, Rios, Fernando, Thille, Arnaud W., Gonza´lez, Marco, Du, Bin, Maggiore, Salvatore M., Matamis, Dimitrios, Abroug, Fekri, Amin, Pravin, and Zeggwagh, Amine A.

Abstract

Objective: In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Failure Assessment (SOFA). Summary Background Data: The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. Methods: Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 ventilated patients with daily RASS and GCS assessments (20,023 patient-days, 32 countries). We estimated GCS from RASS via a proportional odds model without adjustment. ICU mortality logistic regression models and c-statistics were constructed using SOFA (measured GCS) and mSOFA (measured RASS-estimated GCS), adjusted for age, sex, body-mass index, region (Europe, USA-Canada, Latin America, Africa, Asia, Australia-New Zealand), and postoperative status (medical/surgical). Results: Cohort-wide, the mean SOFA=9.4+/−2.8 and mean mSOFA = 10.0+/−2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769–0.799; mSOFA: AUC = 0.778, 95% CI = 0.763–0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). Conclusions: We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA. [ABSTRACT FROM AUTHOR]

Published
2022
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9. β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation.

Author

Beuvon, Clément, Coudroy, Rémi, Bardin, Justine, Marjanovic, Nicolas, Rault, Christophe, Bironneau, Vanessa, Drouot, Xavier, Robert, René, Thille, Arnaud W., and Frat, Jean-Pierre

Subjects
OXYGEN therapy equipment, OBSTRUCTIVE lung disease treatment, INTENSIVE care units, COMPUTER software, RESPIRATORY therapy equipment, NASAL cannula, CONFIDENCE intervals, ALBUTEROL, AGE distribution, RESPIRATORY measurements, QUANTITATIVE research, DIAGNOSTIC imaging, DYSPNEA, COMPARATIVE studies, T-test (Statistics), SEX distribution, SURGICAL meshes, PULMONARY function tests, FORCED expiratory volume, GLASGOW Coma Scale, DESCRIPTIVE statistics, PHYSIOLOGICAL research, CROSSOVER trials, SPIROMETRY, DATA analysis software, DISEASE exacerbation, LONGITUDINAL method
Abstract

BACKGROUND: Whereas high-flow nasal cannula (HFNC) oxygen therapy is increasingly used in patients with exacerbation of COPD, the effectiveness of β2 agonist nebulization through HFNC has been poorly assessed. We hypothesized that salbutamol vibrating-mesh nebulization through HFNC improves pulmonary function tests in subjects with COPD. METHODS: We conducted a physiological crossover study including subjects admitted to the ICU for severe exacerbation of COPD. After subject improvement allowing a 3-h washout period without bronchodilator, pulmonary function tests were performed while breathing through HFNC alone and after salbutamol vibrating-mesh nebulization through HFNC. The primary end point consisted in the changes in FEV1 before and after salbutamol nebulization. Secondary end points included the changes in FVC, peak expiratory flow (PEF), airway resistance, and clinical parameters. RESULTS: Among the 15 subjects included, mean (SD) FEV1 significantly increased after salbutamol nebulization from 931 mL (383) to 1,019 (432), mean difference +87 mL (95% CI 30-145) (P 5 .006). Similarly, FVC and PEF significantly increased, +174 mL (95% CI 66-282) (P 5 .004) and +0.3 L/min (95% CI 0-0.6) (P 5 .037), respectively. Airway resistances and breathing frequency did not significantly differ, whereas heart rate significantly increased after nebulization. CONCLUSIONS: In subjects with severe exacerbation of COPD, salbutamol vibrating-mesh nebulization through HFNC induced a significant bronchodilator effect with volume and flow improvement. [ABSTRACT FROM AUTHOR]

Published
2022
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10. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale

Author

Rakhit, Shayan, Wang, Li, Lindsell, Christopher J., Hosay, Morgan A., Stewart, James W., Owen, Gary D., Frutos-Vivar, Fernando, uelas, Esteban, Andre´s, Anzueto, Antonio R., Raymondos, Konstantinos, Rios, Fernando, Thille, Arnaud W., Gonza´lez, Marco, Du, Bin, Maggiore, Salvatore M., Matamis, Dimitrios, Abroug, Fekri, Amin, Pravin, Zeggwagh, Amine A., Ely, E. Wesley, Vasilevskis, Eduard E., Patel, Mayur B., and uelas

Published
2022
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11. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Author

Coudroy, Rémi, Frat, Jean-Pierre, Ehrmann, Stephan, Pène, Frédéric, Decavèle, Maxens, Terzi, Nicolas, Prat, Gwenaël, Garret, Charlotte, Contou, Damien, Gacouin, Arnaud, Bourenne, Jeremy, Girault, Christophe, Vinsonneau, Christophe, Dellamonica, Jean, Labro, Guylaine, Jochmans, Sébastien, Herbland, Alexandre, Quenot, Jean-Pierre, Devaquet, Jérôme, Benzekri, Dalila, Vivier, Emmanuel, Nseir, Saad, Colin, Gwenhaël, Thevenin, Didier, Grasselli, Giacomo, Bougon, David, Assefi, Mona, Guérin, Claude, Lherm, Thierry, Kouatchet, Achille, Ragot, Stephanie, Thille, Arnaud W, Delphine, Chatellier, Anne, Veinstein, Florence, Boissier, Faustine, Reynaud, Maeva, Rodriguez, Florent, Joly, François, Arrivé, Victor, De Roubin, René, Robert, Laetitia, Bodet-Contentin, Charlotte, Salmon Gandonnière, Emmanuelle, Mercier, Paul, Jaubert, Nathalie, Marin, Marine, Paul, Morgane, Faure, Suela, Demiri, Alexandre, Demoule, Clara, Candille, Anaïs, Dartevel, Florian, Sigaud, Vanessa, Jean Michel, Raphaël, Le Mao, Pierre, Bailly, Amélie, Seguin, Jean-Baptiste, Lascarrou, Emmanuel, Canet, Gaëtan, Plantefève, Radj, Cally, Joanna, Tirolien, Adel, Maamar, Benoit, Painvin, Julien, Carvelli, Marc, Gainnier, Gaëtan, Béduneau, Dorothée, Carpentier, Dominique, Malacrino, Mehdi, Marzouk, Clément, Saccheri, Nicolas, Mahr, Pauline, Soulier, Quentin, Levrat, Pascal, Andreu, David, Cortier, and Mai Anh, Nay

Abstract

Although non-invasive ventilation (NIV) is recommended for immunocompromised patients with acute respiratory failure in the intensive care unit (ICU), it might have deleterious effects in the most severe patients. High-flow nasal oxygen (HFNO) alone might be an alternative method to reduce mortality. We aimed to determine whether HFNO alone could reduce the rate of mortality at day 28 compared with HFNO alternated with NIV.

Published
2022
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12. Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS.

Author

Roca, Oriol, Peñuelas, Oscar, Muriel, Alfonso, García-de-Acilu, Marina, Laborda, César, Sacanell, Judit, Riera, Jordi, Raymondos, Konstantinos, Bin Du, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Marín, Maria del Carmen, Soares, Marco Antonio, Valle Pinheiro, Bruno, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, and Amin, Pravin

Subjects
LUNG injuries, STATISTICS, RESEARCH, SCIENTIFIC observation, CONFIDENCE intervals, MECHANICAL ventilators, POSITIVE end-expiratory pressure, AIRWAY (Anatomy), PATIENTS, RESPIRATORY measurements, CONTINUING education units, MEDICAL cooperation, MANN Whitney U Test, FISHER exact test, ADULT respiratory distress syndrome, ARTIFICIAL respiration, RISK assessment, T-test (Statistics), CHI-squared test, DATA analysis, LOGISTIC regression analysis, ODDS ratio, LONGITUDINAL method, DISEASE risk factors
Abstract

BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for > 12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P < .001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P < .001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P < .001). When taking the prevalence of ARDS in the lowest quartile of DP (≤9 cm H2O) as a reference, the subjects with DP > 12-15 cm H2O and those with DP > 15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5 .01] and OR 7.31, 95% CI, 2.89-18.50 [P < .001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.) [ABSTRACT FROM AUTHOR]

Published
2021
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14. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial

Author

Ehrmann, Stephan, Li, Jie, Ibarra-Estrada, Miguel, Perez, Yonatan, Pavlov, Ivan, McNicholas, Bairbre, Roca, Oriol, Mirza, Sara, Vines, David, Garcia-Salcido, Roxana, Aguirre-Avalos, Guadalupe, Trump, Matthew W, Nay, Mai-Anh, Dellamonica, Jean, Nseir, Saad, Mogri, Idrees, Cosgrave, David, Jayaraman, Dev, Masclans, Joan R, Laffey, John G, Tavernier, Elsa, Li, Jie, Mirza, Sara, Vines, David, Elshafei, Ahmad A, Scott, Brady J, Weiss, Tyler, Kaur, Ramandeep, Harnois, Lauren J, Miller, Amanda, Cerda, Flor, Klein, Andrew, Burd, Jacob R, Posa-Kearney, Kathleen, Trump, Matthew, Jackson, Julie, Oetting, Trevor, Greenwood, Mark, Hazel, Lindsay, Kingery, Lisa, Mogri, Idrees, Morris, Lindsey, Moon, Joon Yong, Garnett, Julianne, Jia, Shijing, Nelson, Kristine, McNicholas, Bairbre, Cosgrave, David, Giacomini, Camilla, Laffey, John, Brennan, Aoife, Judge, Conor, Kernan, Maeve, Kelly, Claire, Ranjan, Ritika, Casey, Siobhan, O'Connell, Kevin, Newell, Evelyn, Gallagher, David, Nichol, Alistair, Curley, Ger, Estrada, Miguel Ibarra, García-Salcido, Roxana, Vargas-Obieta, Alexandra, Aguirre-Avalos, Guadalupe, Aguirre-Díaz, Sara A, Alcántar-Vallín, Luz, Alvarado-Padilla, Montserrat, Chávez-Peña, Quetzalcóatl, López-Pulgarín, José A, Mijangos-Méndez, Julio C, Marín-Rosales, Miguel, García-Alvarado, Jorge E, Baltazar-González, Oscar G, González-Guerrero, Maura C, Gutiérrez Ramírez, Paola G, Pavlov, Ivan, Gilman, Sean, Plamondon, Patrice, Roy, Rachel, Jayaraman, Dev, Shahin, Jason, Ragoshai, Raham, Kaur, Aasmine, Campisi, Josie, Dahine, Joseph, Perron, Stefanie, Achouri, Slimane, Racette, Ronald, Kulenkamp, Anne, Roca, Oriol, Pacheco, Andrés, García-de-Acilu, Marina, Masclans, Joan R, Dot, Irene, Perez, Yonatan, Bodet-Contentin, Laetitia, Garot, Denis, Ehrmann, Stephan, Mercier, Emmanuelle, Salmon Gandonnière, Charlotte, Morisseau, Marlène, Jouan, Youenn, Darwiche, Walid, Legras, Annick, Guillon, Antoine, Tavernier, Elsa, Dequin, Pierre-François, Tellier, Anne-Charlotte, Reignier, Jean, Lascarrou, Jean-Baptiste, Seguin, Amélie, Desmedt, Luc, Canet, Emmanuel, Guitton, Christophe, Marnai, Rémy, Callahan, Jean-Christophe, Landais, Mickaël, Chudeau, Nicolas, Darreau, Cédric, Tirot, Patrice, Saint Martin, Marjorie, Le Moal, Charlene, Nay, Mai-Anh, Muller, Grégoire, Jacquier, Sophie, Prat, Gwenaël, Bailly, Pierre, Ferrière, Nicola, Thille, Arnaud W, Frat, Jean-Pierre, Dellamonica, Jean, Saccheri, Clément, Buscot, Matthieu, Plantefève, Gaëtan, Contou, Damien, Roux, Damien, Ricard, Jean-Damien, Federici, Laura, Zucman, Noémie, Freita Ramos, Santiago, Amouretti, Marc, Besset, Sébastien, Gernez, Coralie, Delbove, Agathe, Voiriot, Guillaume, Elabbadi, Alexandre, Fartoukh, Muriel, Nseir, Saad, Préau, Sébastien, Favory, Raphaël, Pierre, Alexandre, Sement, Arnaud, Terzi, Nicolas, Sigaud, Florian, Candille, Clara, Turbil, Emanuele, Maizel, Julien, Brault, Clément, Zerbib, Yoan, Joret, Aurélie, Daubin, Cédric, Lefebvre, Laurent, Giraud, Alais, Auvet, Adrien, Vinsonneau, Christophe, Marzouk, Mehdi, Quenot, Jean-Pierre, Andreu, Pascal, Labruyère, Marie, Roudaut, Jean-Baptiste, Aptel, François, Boyer, Alexandre, Boyer, Philippe, Lacherade, Jean-Claude, Hille, Hugo, Bouteloup, Marie, Jeannot, Matthieu, Feller, Marc, Grillet, Guillaume, Levy, Bruno, and Kimmoun, Antoine

Abstract

Awake prone positioning has been reported to improve oxygenation for patients with COVID-19 in retrospective and observational studies, but whether it improves patient-centred outcomes is unknown. We aimed to evaluate the efficacy of awake prone positioning to prevent intubation or death in patients with severe COVID-19 in a large-scale randomised trial.

Published
2021
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15. Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients.

Author

Wernly, Bernhard, Bruno, Raphael Romano, Frutos-Vivar, Fernando, Peñuelas, Oscar, Rezar, Richard, Raymondos, Konstantinos, Muriel, Alfonso, Bin Du, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Marín, Maria del Carmen, Pinheiro, Bruno Valle, Soares, Marco Antonio, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, Kelm, Malte, and Amin, Pravin

Subjects
MORTALITY risk factors, STATISTICS, SURVIVAL, CONFIDENCE intervals, ANALYSIS of variance, MORTALITY, MULTIPLE regression analysis, AGE distribution, RETROSPECTIVE studies, ARTIFICIAL respiration, TREATMENT effectiveness, RISK assessment, CRITICAL care medicine, DESCRIPTIVE statistics, DATA analysis, LOGISTIC regression analysis, ODDS ratio, DATA analysis software, LONGITUDINAL method, OLD age
Abstract

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.) [ABSTRACT FROM AUTHOR]

Published
2021
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16. Oxygenation strategies after extubation of critically ill and postoperative patients

Author

Thille, Arnaud W., Wairy, Mathilde, Pape, Sylvain Le, and Frat, Jean-Pierre

Abstract

In intensive care units (ICUs), the decision to extubate is a critical one because mortality is particularly high in case of reintubation. Around 15% of patients ready to be weaned off a ventilator experience extubation failure leading to reintubation. The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation. High-flow nasal oxygen and non-invasive ventilation, may be used to prevent reintubation in patients with low (e.g., patients without comorbidities and with short durations of mechanical ventilation) and high risk (e.g., patients >65 years and those with underlying cardiac disease, chronic respiratory disorders, and/or hypercapnia at the time of extubation) of reintubation, respectively. However, non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation, and should therefore be used very carefully in this setting. The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs. Standard oxygen after a surgical procedure is adequate, even following major abdominal or cardiothoracic surgery, but should probably be switched to high-flow nasal oxygen in patients with hypoxemic. Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects, it may actually improve the outcomes in postoperative patients with respiratory failure. This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.

Published
2021
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17. High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review.

Author

Marjanovic, Nicolas, Guénézan, Jérémy, Frat, Jean-Pierre, Mimoz, Olivier, and Thille, Arnaud W.

Abstract

Objectives: The use of high-flow oxygen therapy (HFOT) through nasal cannula for the management of acute respiratory failure at the emergency department (ED) has been only sparsely studied. We conducted a systematic review of randomized-controlled and quasi-experimental studies comparing the early use of HFOT versus conventional oxygen therapy (COT) in patients with acute respiratory failure admitted to EDs.Methods: A systematic research of literature was carried out for all published control trials comparing HFOT with COT in adult patients admitted in EDs. Eligible data were extracted from Medline, Embase, Pascal, Web of Science and the Cochrane database. The primary outcome was the need for mechanical ventilation, i.e. intubation or non-invasive ventilation as rescue therapy. Secondary outcomes included respiratory rate, dyspnea level, ED length of stay, intubation and mortality.Results: Out of 1829 studies screened, five studies including 673 patients were retained in the analysis (350 patients treated with HFOT and 323 treated with COT). The need for mechanical ventilation was similar in both treatments (RR = 0.75; 95% CI 0.41 to 1.35; P = 0.31; I2 = 16%). Respiratory rate was lower with HFOT (Mean difference (MD) = -3.14 breaths/min; 95% CI = -4.9 to -1.4; P < 0.001; I2 = 39%), whereas sensation of dyspnea did not differ. (MD = -1.04; 95% CI = -2.29 to -0.22; P = 0.08; I2 = 67%). ED length of stay and mortality were similar between groups.Conclusion: The early use of HFOT in patients admitted to an ED for acute respiratory failure did not reduce the need for mechanical ventilation as compared to COT. However, HFOT decreased respiratory rate.Registration: PROSPERO ID CRD42019125696. [ABSTRACT FROM AUTHOR]

Published
2020
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18. Influence of Noninvasive Ventilation Protocol on Intubation Rates in Subjects With De Novo Respiratory Failure.

Author

Coudroy, Rèmi, Hoppe, Marie-Anne, Robert, René, Frat, Jean-Pierre, and Thille, Arnaud W.

Subjects
ARTIFICIAL respiration, CONFIDENCE intervals, LENGTH of stay in hospitals, MEDICAL information storage & retrieval systems, INTENSIVE care units, INTUBATION, MEDICAL protocols, MEDLINE, HEALTH outcome assessment, ADULT respiratory distress syndrome, RESPIRATORY insufficiency, TRACHEA intubation, SYSTEMATIC reviews, DATA analysis software, DESCRIPTIVE statistics
Abstract

BACKGROUND: The use of noninvasive ventilation (NIV) is debated in de novo respiratory failure. Prolonged sessions, using a dedicated NIV ventilator, with high PEEP levels could be associated with better outcomes than shorter sessions using an ICU ventilator, with low PEEP levels. We performed a systematic review of randomized controlled trials to test whether the incidence of intubation was influenced by the NIV protocol in subjects admitted to the ICU for de novo respiratory failure. METHODS: We selected randomized trials on NIV indexed in medical literature databases from their inception to April 2018. Pediatric studies, those performed outside of the ICU, trials with subjects on NIV for a reason other than de novo respiratory failure, and studies in which NIV protocol was not specified were excluded. Two authors independently extracted intubation rates and the NIV protocol (prolonged or short sessions, type of ventilator, and PEEP levels). RESULTS: Fourteen studies, which included 750 subjects treated with NIV for de novo respiratory failure in ICU, were analyzed. Overall intubation rate was 38%, 95% CI 31-45% and was not influenced by prolonged NIV sessions or the type of ventilator. The 154 subjects treated with PEEP greater than the median overall PEEP (6 cm H2O) had a PEEP level of 8 = 2 cmH2O and a pressure support level of 7 = 2 cmH2O. Their intubation rate was lower than the 293 subjects treated with lower PEEP levels (25%, 95% CI 15--37% vs 43%, 95% CI 33--54%, respectively, P = .03). Inclusion criteria were heterogeneous, and critical information on NIV application were frequently lacking. CONCLUSIONS: Except for high PEEP levels that might be associated with lower intubation rates, the protocol for carrying out NIV does not seem to influence intubation rate in patients with de novo respiratory failure. [ABSTRACT FROM AUTHOR]

Published
2020
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19. Diagnostic accuracy of portable chest radiograph in mechanically ventilated patients when compared with autopsy findings

Author

Panizo-Alcañiz, Julián, Frutos-Vivar, Fernando, Thille, Arnaud W., Peñuelas, Óscar, Aguilar-Rivilla, Eva, Muriel, Alfonso, Rodríguez-Barbero, José María, Jaramillo, Carlos, Nin, Nicolás, and Esteban, Andrés

Abstract

Evaluate diagnostic accuracy of portable chest radiograph in mechanically ventilated patients taking autopsy findings as the gold standard and the interobserver agreement among intensivists and radiologists.

Published
2020
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20. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure

Author

Thille, Arnaud W., Coudroy, Rémi, Nay, Mai-Anh, Gacouin, Arnaud, Demoule, Alexandre, Sonneville, Romain, Beloncle, François, Girault, Christophe, Dangers, Laurence, Lautrette, Alexandre, Levrat, Quentin, Rouzé, Anahita, Vivier, Emmanuel, Lascarrou, Jean-Baptiste, Ricard, Jean-Damien, Razazi, Keyvan, Barberet, Guillaume, Lebert, Christine, Ehrmann, Stephan, Massri, Alexandre, Bourenne, Jeremy, Pradel, Gael, Bailly, Pierre, Terzi, Nicolas, Dellamonica, Jean, Lacave, Guillaume, Robert, René, Ragot, Stéphanie, Frat, Jean-Pierre, Boissier, Florence, Chatellier, Delphine, Deletage, Céline, Guignon, Carole, Joly, Florent, Olivry, Morgane, Veinstein, Anne, Benzekri-Lefevre, Dalila, Boulain, Thierry, Muller, Grégoire, Le Tulzo, Yves, Tadié, Jean-Marc, Maamar, Adel, Demiri, Suela, Mayaux, Julien, Decavèle, Maxens, Bouadma, Lila, Dupuis, Claire, Asfar, Pierre, Pierrot, Marc, Béduneau, Gaëtan, Boyer, Déborah, Delmas, Benjamin, Puech, Bérénice, Bachoumas, Konstantinos, Soum, Edouard, Cabasson, Séverin, Hoppe, Marie-Anne, Nseir, Saad, Pouly, Olivier, Bourdin, Gaël, Rosselli, Sylvène, Le Meur, Anthony, Garret, Charlotte, Martin, Maelle, Berquier, Guillaume, Thiagarajah, Abirami, Carteaux, Guillaume, Mekontso-Dessap, Armand, Poidevin, Antoine, Dureau, Anne-Florence, Azais, Marie-Ange, Colin, Gwenhaël, Mercier, Emmanuelle, Morisseau, Marlène, Sabatier, Caroline, Picard, Walter, Gainnier, Marc, Nguyen, Thi-My-Hue, Prat, Gwenaël, Schwebel, Carole, and Buscot, Matthieu

Abstract

Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs.

Published
2020
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21. Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study.

Author

Macé, Jean, Marjanovic, Nicolas, Faranpour, Farnam, Mimoz, Olivier, Frerebeau, Marc, Violeau, Mathieu, Bourry, Pierre-Alexis, Guénézan, Jérémy, Thille, Arnaud W., and Frat, Jean-Pierre

Abstract

Objectives: To compare clinical impact after early initiation of high-flow nasal cannula oxygen therapy (HFNC) versus standard oxygen in patients admitted to an emergency department (ED) for acute hypoxemic respiratory failure.Methods: We performed a prospective before-after study at EDs in two centers including patients with acute hypoxemic respiratory failure defined by a respiratory rate above 25 breaths/min or signs of increased breathing effort under additional oxygen for a pulse oximetry above 92%. Patients with cardiogenic pulmonary edema or exacerbation of chronic lung disease were excluded. All patients were treated with standard oxygen during the first period and with HFNC during the second. The primary outcome was the proportion of patients with improved respiratory failure 1 h after treatment initiation (respiratory rate ≤ 25 breaths/min without signs of increased breathing effort). Dyspnea and blood gases were also assessed.Results: Among the 102 patients included, 48 were treated with standard oxygen and 54 with HFNC. One hour after treatment initiation, patients with HFNC were much more likely to recover from respiratory failure than those treated with standard oxygen: 61% (33 of 54 patients) versus 15% (7 of 48 patients), P < 0.001. They also showed greater improvement in oxygenation (increase in PaO2 was 31 mm Hg [0-67] vs. 9 [-9-36], P = 0.02), and in feeling of breathlessness.Conclusions: As compared to standard oxygen, patients with acute hypoxemic respiratory failure treated with HFNC at the ED had better oxygenation, less breathlessness and were more likely to show improved respiratory failure 1 h after initiation. [ABSTRACT FROM AUTHOR]

Published
2019
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22. Effects of High-Flow Nasal Cannula on End-Expiratory Lung Impedance in Semi-Seated Healthy Subjects.

Author

Plotnikow, Gustavo A., Thille, Arnaud W., Vasquez, Daniela N., Pratto, Romina A., Quiroga, Corina M., Andrich, Maria E., Dorado, Javier H., Gomez, Ramiro S., D'Annunzio, Pablo A., Scapellato, Jose L., and Intile, Dante

Subjects
BIOELECTRIC impedance, LONGITUDINAL method, OXYGEN therapy, STATISTICS, TOMOGRAPHY, DATA analysis, DATA analysis software, DESCRIPTIVE statistics, NASAL cannula
Abstract

BACKGROUND: High-flow nasal cannula (HFNC) enables delivery of humidified gas at high flow while controlling the .... Although its use is growing in patients with acute respiratory failure, little is known about the impact of HFNC on lung volume. Therefore, we aimed to assess lung volume changes in healthy subjects at different flows and positions. METHODS: This was a prospective physiological study performed in 16 healthy subjects. The changes in lung volumes were assessed by measuring end-expiratory lung impedance by using electrical impedance tomography. All the subjects successively breathed during 5 min in these following conditions: while in a supine position without HFNC (T0) and 3 measurements in a semi-seated position at 45° without HFNC (T1), and with HFNC at a flow of 30 L/min (T2), and 50 L/min (T3). RESULTS: Compared with the supine position, the values of end-expiratory lung impedance significantly increased with the subjects in a semi-seated position. End-expiratory lung impedance significantly increased after HFNC initiation in subjects in a semi-seated position and further increased by increasing flow at 50 L/min. When taking the end-expiratory lung impedance measurement in subjects in a semiseated position (T1) as reference, the differences among the medians of global end-expiratory lung impedance were statistically significant (P < .001), which amounted to 1.05 units in T1; 1.12 units in T2; and 1.44 units in T3 (P < .05 for all comparisons, Wilcoxon test). The breathing frequency did not differ between the supine and semi-seated position (T0 and T1) but significantly decreased after initiation of HFNC and further decreased at high flow. T0 and T1 were not different (P = .13); whereas there was a statistically significant difference among T1, T2, and T3 (P < .05, post hoc test with Bonferroni correction). CONCLUSIONS: In healthy subjects, the semi-seated position and the use of HFNC increased end-expiratory lung impedance globally. These changes were accompanied by a significant decrease in the breathing frequency. [ABSTRACT FROM AUTHOR]

Published
2018
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23. Inability of Diaphragm Ultrasound to Predict Extubation Failure

Author

Vivier, Emmanuel, Muller, Michel, Putegnat, Jean-Baptiste, Steyer, Julie, Barrau, Stéphanie, Boissier, Florence, Bourdin, Gaël, Mekontso-Dessap, Armand, Levrat, Albrice, Pommier, Christian, and Thille, Arnaud W.

Abstract

Diaphragmatic dysfunction may promote weaning difficulties in patients who are mechanically ventilated.

Published
2019
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24. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial

Author

Frat, Jean-Pierre, Ricard, Jean-Damien, Quenot, Jean-Pierre, Pichon, Nicolas, Demoule, Alexandre, Forel, Jean-Marie, Mira, Jean-Paul, Coudroy, Rémi, Berquier, Guillaume, Voisin, Benoit, Colin, Gwenhaël, Pons, Bertrand, Danin, Pierre Eric, Devaquet, Jérome, Prat, Gwenael, Clere-Jehl, Raphaël, Petitpas, Franck, Vivier, Emmanuel, Razazi, Keyvan, Nay, Mai-Anh, Souday, Vincent, Dellamonica, Jean, Argaud, Laurent, Ehrmann, Stephan, Gibelin, Aude, Girault, Christophe, Andreu, Pascal, Vignon, Philippe, Dangers, Laurence, Ragot, Stéphanie, Thille, Arnaud W, Chatellier, Delphine, Boissier, Florence, Veinstein, Anne, Robert, René, Deletage-Métreau, Céline, Olivry, Morgane, Dahyot-Fizelier, Claire, Dargent, Auguste, Large, Audrey, Begot, Emmanuelle, Mancia, Claire, Decavele, Maxence, Dres, Martin, Lehingue, Samuel, Papazian, Laurent, Paul, Marine, Marin, Nathalie, Le Meur, Matthieu, Laissy, Mohammed, Rouzé, Anaita, Nseir, Saad, Henry-Lagarrigue, Matthieu, Yehia, Aihem, Martino, Frédéric, Cerf, Charles, Bailly, Pierre, Helms, Julie, Putegnat, Jean Baptiste, Mekontso-Dessap, Armand, Boulain, Thierry, Asfar, Pierre, Cabasson, Séverin, Wallet, Florent, Klouche, Kada, Bellec, Frédéric, Chatellier, Delphine, Boissier, Florence, Veinstein, Anne, Robert, René, Deletage-Métreau, Céline, Olivry, Morgane, Decavele, Maxence, Dres, Martin, Lehingue, Samuel, Papazian, Laurent, Le Meur, Matthieu, Laissy, Mohammed, Rouzé, Anaita, Nseir, Saad, Henry-Lagarrigue, Matthieu, Yehia, Aihem, Cerf, Charles, Mekontso-Dessap, Armand, Boulain, Thierry, and Asfar, Pierre

Abstract

Non-invasive ventilation has never been compared with high-flow oxygen to determine whether it reduces the risk of severe hypoxaemia during intubation. We aimed to determine if preoxygenation with non-invasive ventilation was more efficient than high-flow oxygen in reducing the risk of severe hypoxaemia during intubation.

Published
2019
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25. Physiological Effects of Reconnection to the Ventilator for 1 Hour Following a Successful Spontaneous Breathing Trial

Author

Coudroy, Rémi, Lejars, Alice, Rodriguez, Maeva, Frat, Jean-Pierre, Rault, Christophe, Arrivé, François, Le Pape, Sylvain, and Thille, Arnaud W.

Abstract

Reconnection to the ventilator for 1 h following a successful spontaneous breathing trial (SBT) may reduce reintubation rates compared with direct extubation. However, the physiological mechanisms leading to this effect are unclear.

Published
2024
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27. Intubation et extubation du patient de réanimation

Author

Quintard, Hervé, l’Her, Erwan, Pottecher, Julien, Adnet, Frédéric, Constantin, Jean-Michel, Dejong, Audrey, Diemunsch, Pierre, Fesseau, Rose, Freynet, Anne, Girault, Christophe, Guitton, Christophe, Hamonic, Yan, Maury, Eric, Mekontso-Dessap, Armand, Michel, Fabrice, Nolent, Paul, Perbet, Sébastien, Prat, Gwenaël, Roquilly, Antoine, Tazarourte, Karim, Terzi, Nicolas, Thille, Arnaud W., Alves, Mikael, Gayat, Etienne, and Donetti, Laurence

Abstract

L’intubation et l’extubation ne sont pas des procédures sans risque en réanimation et peuvent être associées à une augmentation de la morbidité et de la mortalité. L’intubation en soins intensifs est souvent nécessaire dans des situations d’urgence pour des patients instables sur le plan respiratoire et hémodynamique. Dans ces circonstances, il s’agit d’une intervention à haut risque avec des complications mettant en jeu le pronostic vital du patient (20 à 50 %). En outre, des problèmes d’intubation difficile peuvent également être présent et donner lieu à des complications. Plusieurs nouvelles techniques, telles que la vidéolaryngoscopie, ont été développées récemment et méritent d’être positionnés dans notre arsenal technique. L’extubation est une autre période à risque, avec 10 % d’échec qui peut être associée également à un mauvais pronostic. Une meilleure compréhension des causes de ces échecs est essentielle pour optimiser le geste. En élaborant ces recommandations, les experts SFAR/SRLF ont utilisé les nouvelles données sur l’intubation et l’extubation publiées depuis une dizaine d’années pour actualiser les procédures existantes, incorporer les avancées plus récentes et proposer des algorithmes.

Published
2018
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28. Comment réaliser une épreuve de sevrage en réanimation

Author

Thille, Arnaud W.

Abstract

En réanimation, le taux de réintubation après extubation programmée est d’environ 15 %. Afin de réduire le risque d’échec, les sociétés savantes (SFAR-SRLF) recommandent la réalisation systématique d’une épreuve de sevrage chez tous les patients intubés plus de 48h. L’épreuve de sevrage a pour but de simuler les conditions physiologiques de la respiration spontanée après l’extubation. Elle peut être réalisée soit en ventilation spontanée sur pièce en T, soit avec en aide inspiratoire sur le ventilateur (AI entre 5 à 8cm H2O). Le travail respiratoire après extubation est identique au travail respiratoire lors d’une pièce en T. En effet, les résistances des voies aériennes supérieures restent élevées même après l’extubation, et le travail respiratoire n’est pas diminué malgré l’ablation de la sonde d’intubation. L’épreuve de pièce en T reflète donc parfaitement les conditions physiologiques de la respiration spontanée. Par comparaison, le travail respiratoire est plus faible lors d’une épreuve en AI que lors d’une pièce en T et certaines études suggèrent que l’épreuve en AI pourrait accélérer l’extubation. Dans ces études, le taux de réintubation n’était pas augmenté malgré une épreuve en AI plus facile que l’épreuve de pièce en T ou la respiration spontanée. Les recommandations américaines proposent donc de réaliser la première épreuve de sevrage en AI plutôt qu’en pièce en T afin de favoriser l’extubation précoce. Cependant, aucune étude n’a comparé le taux de réintubation selon l’épreuve de sevrage chez les patients à haut risque, et les résultats actuels devraient être interprétés avec prudence chez ces patients.

Published
2018
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30. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial.

Author

Frat, Jean-Pierre, Ragot, Stéphanie, Girault, Christophe, Perbet, Sébastien, Prat, Gwénael, Boulain, Thierry, Demoule, Alexandre, Ricard, Jean-Damien, Coudroy, Rémi, Robert, René, Mercat, Alain, Brochard, Laurent, and Thille, Arnaud W

Subjects
OXYGEN therapy, RESPIRATORY insufficiency treatment, IMMUNOCOMPROMISED patients
Abstract

Summary Background The use of non-invasive ventilation is controversial in immunocompromised patients with acute respiratory failure, whereas the use of high-flow nasal cannula oxygen therapy is growing as an alternative to standard oxygen. We aimed to compare outcomes of immunocompromised patients with acute respiratory failure treated with standard oxygen with those treated with high-flow nasal cannula oxygen alone or high-flow nasal cannula oxygen associated with non-invasive ventilation. Methods We did a post-hoc subgroup analysis in a subset of immunocompromised patients with non-hypercapnic acute respiratory failure from a multicentre, randomised, controlled trial. In the trial, patients from 23 intensive care units in France and Belgium were randomly assigned (1:1:1) to receive either standard oxygen, high-flow nasal cannula alone, or non-invasive ventilation interspaced with high-flow nasal cannula between non-invasive ventilation sessions (non-invasive ventilation group). Patients with profound neutropenia, acute-on-chronic respiratory failure, cardiogenic pulmonary oedema, shock, or altered consciousness were excluded. The primary outcome was the proportion of patients who required endotracheal intubation within 28 days after randomisation. Findings Of the 82 immunocompromised patients, 30 were treated with standard oxygen, 26 with high-flow nasal cannula alone, and 26 with non-invasive ventilation plus interspaced high-flow nasal cannula. 8 (31%) of 26 patients treated with high-flow nasal cannula alone, 13 (43%) of 30 patients treated with standard oxygen, and 17 (65%) of 26 patients treated with non-invasive ventilation required intubation at 28 days (p=0·04). Odds ratios (ORs) for intubation were higher in patients treated with non-invasive ventilation than in those treated with high-flow nasal cannula: OR 4·25 (95% CI 1·33–13·56). ORs were not significantly different between patients treated with high-flow nasal cannula alone and standard oxygen: OR 1·72 (0·57–5·18). After multivariable logistic regression, the two factors independently associated with endotracheal intubation and mortality were age and use of non-invasive ventilation as first-line therapy. Interpretation Non-invasive ventilation might be associated with an increased risk of intubation and mortality and should be used cautiously in immunocompromised patients with acute hypoxaemic respiratory failure. Funding French Ministry of Health, the French societies of intensive care (Société de Réanimation de Langue Française, SRLF) and pneumology (Société de Pneumologie de Langue Française, SPLF), La Mutuelle de Poitiers, AADAIRC (Association pour l'Assistance à Domicile Aux Insuffisants Respiratoires Chroniques), and Fisher&Paykel Healthcare. [ABSTRACT FROM AUTHOR]

Published
2016
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31. Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Author

Tejerina, Eva, Pelosi, Paolo, Muriel, Alfonso, Peñuelas, Oscar, Sutherasan, Yuda, Frutos-Vivar, Fernando, Nin, Nicolás, Davies, Andrew R., Rios, Fernando, Violi, Damian A., Raymondos, Konstantinos, Hurtado, Javier, González, Marco, Du, Bin, Amin, Pravin, Maggiore, Salvatore M., Thille, Arnaud W., Soares, Marco Antonio, Jibaja, Manuel, Villagomez, Asisclo J., Kuiper, Michael A., Koh, Younsuck, Moreno, Rui P., Zeggwagh, Amine Ali, Matamis, Dimitrios, Anzueto, Antonio, Ferguson, Niall D., and Esteban, Andrés

Abstract

In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury.

Published
2017
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32. Reliability of methods to estimate the fraction of inspired oxygen in patients with acute respiratory failure breathing through non-rebreather reservoir bag oxygen mask

Author

Coudroy, Rémi, Frat, Jean-Pierre, Girault, Christophe, and Thille, Arnaud W

Abstract

Severity of hypoxaemia can be assessed using the partial pressure of arterial oxygen to fraction of inspired oxygen ratio (FiO2). However, in patients breathing through non-rebreather reservoir bag oxygen mask, accuracy of bedside FiO2estimation methods remains to be tested. In a post-hoc analysis of a multicentre clinical trial, three FiO2estimation methods were compared with FiO2measured with a portable oxygen analyser introduced in the oxygen mask. Among 262 patients analysed, mean (SD) measured FiO2was 65% (13). The 3%-formula (21% + oxygen flow rate in L/min × 3) was the most accurate method to estimate FiO2. Other methods overestimated FiO2and hypoxaemia severity, so they should be avoided.

Published
2020
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33. La privation de sommeil majore la perception d’effort, inhibant la préparation motrice et précipitant l’interruption de tâche

Author

Rault, Christophe, Heraud, Quentin, Ansquer, Solène, Ragot, Stéphanie, Kostencovska, Angela, Thille, Arnaud W., Stancu, Alexandra, Saulnier, Pierre-Jean, Robert, René, and Drouot, Xavier

Abstract

La privation de sommeil réduit drastiquement l’endurance musculaire squelettique mais la physiopathologique reste méconnue. Notre objectif était d’identifier l’élément dysfonctionnel parmi : une commande musculaire insuffisante, une altération des processus musculaires ou une perception excessive de l’effort.

Published
2023
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34. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial

Author

Frat, Jean-Pierre, Ragot, Stéphanie, Girault, Christophe, Perbet, Sébastien, Prat, Gwénael, Boulain, Thierry, Demoule, Alexandre, Ricard, Jean-Damien, Coudroy, Rémi, Robert, René, Mercat, Alain, Brochard, Laurent, and Thille, Arnaud W

Abstract

The use of non-invasive ventilation is controversial in immunocompromised patients with acute respiratory failure, whereas the use of high-flow nasal cannula oxygen therapy is growing as an alternative to standard oxygen. We aimed to compare outcomes of immunocompromised patients with acute respiratory failure treated with standard oxygen with those treated with high-flow nasal cannula oxygen alone or high-flow nasal cannula oxygen associated with non-invasive ventilation.

Published
2016
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35. Sequential Application of Oxygen Therapy Via High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: An Observational Pilot Study.

Author

Frat, Jean-Pierre, Brugiere, Benjamin, Ragot, Stéphanie, Chatellier, Delphine, Veinstein, Anne, Goudet, Véronique, Coudroy, Rémi, Petitpas, Franck, Robert, René, Thille, Arnaud W., and Girault, Christophe

Subjects
OXYGEN therapy, RESPIRATORY insufficiency treatment, ACADEMIC medical centers, ANALYSIS of variance, ARTIFICIAL respiration, FISHER exact test, LONGITUDINAL method, SCIENTIFIC observation, RESPIRATORY insufficiency, RESPIRATORY therapy equipment, STATISTICS, PILOT projects, DATA analysis, VISUAL analog scale, CONTINUING education units, REPEATED measures design, RECEIVER operating characteristic curves, DATA analysis software, DESCRIPTIVE statistics, GLASGOW Coma Scale
Abstract

BACKGROUND: The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF). METHODS: We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2 /FIO2 of ≤ 300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy. RESULTS: Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2- significantly increased from 83 (68-97) mm Hg to 108 (83-140) mm Hg using HFNC and to 125 (97-200) mm Hg using NIV (P < .01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27-127) h and NIV for 23 (8-31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥ 30 breaths/min was an early factor associated with intubation. CONCLUSIONS: HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation. [ABSTRACT FROM AUTHOR]

Published
2015
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36. Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome: A retrospective, observational cohort study

Author

Le Pape, Sylvain, Joly, Florent, Arrivé, François, Frat, Jean-Pierre, Rodriguez, Maeva, Joos, Maïa, Marchasson, Laura, Wairy, Mathilde, Thille, Arnaud W., and Coudroy, Rémi

Abstract

Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.

Published
2023
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37. Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies.

Author

Thille, Arnaud W, Esteban, Andrés, Fernández-Segoviano, Pilar, Rodriguez, José-María, Aramburu, José-Antonio, Vargas-Errázuriz, Patricio, Martín-Pellicer, Ana, Lorente, José A, and Frutos-Vivar, Fernando

Subjects
CHRONOLOGY, HISTOLOGY, RESPIRATORY distress syndrome, ALVEOLAR nerve, AUTOPSY, LONGITUDINAL method, COHORT analysis
Abstract

Summary: Background: Diffuse alveolar damage is the histological hallmark of acute respiratory distress syndrome (ARDS). However, the chronology of histological lesions is not well established. We aimed to determine the time to onset of exudative or proliferative changes and end-stage fibrosis in ARDS. Methods: We analysed all patients who died between Jan 1, 1991, and Dec 31, 2010, in the intensive-care unit at the Hospital Universitario de Getafe, Madrid, Spain, and who had a clinical autopsy. Patients had to have clinical criteria for ARDS at time of death and histological features of diffuse alveolar damage at autopsy examination. Capillary congestion and intra-alveolar oedema characterised the exudative phase whereas proliferation of alveolar cell type 2 or fibroblasts, or fibrosis characterised the proliferative phase. Findings: We analysed 159 patients. The prevalence of exudative changes decreased over time, being reported in 74 (90%) of 82 patients with ARDS of less than 1 week duration, 40 (74%) of 54 patients with disease of 1–3 week duration, and only four (17%) of 23 patients with disease of longer than 3 weeks' duration (p<0·0001). The incidence of proliferative changes increased over time, and was reported in 44 (54%) of 82 patients with ARDS of less than 1-week duration, 42 (78%) of 54 patients with disease duration of 1–3 weeks, and 23 (100%) of 23 patients with disease duration longer than 3 weeks (p<0·0001). Fibrosis was noted in three (4%) of 82 patients with disease of less than 1 week duration, 13 (24%) of 54 patients with disease of 1–3-weeks' duration, and 14 (61%) of 23 patients with disease longer than 3-week duration (p<0·0001). Fibrosis was more frequent in ARDS of pulmonary origin than in that of extrapulmonary origin. Interpretation: Histological features of the lungs were related to duration of ARDS. Within the first week of evolution, exudative changes were predominant and fibrosis was rarely noted. Beyond the third week of evolution, proliferative changes were noted in all patients and fibrosis in two-thirds of them. Treatments with a potential effect on inflammation or fibrosis, or both, should probably focus on the first week after the onset of ARDS. Funding: None. [ABSTRACT FROM AUTHOR]

Published
2013
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38. Small-bore catheter versus chest tube drainage for pneumothorax.

Author

Contou, Damien, Razazi, Keyvan, Katsahian, Sandrine, Maitre, Bernard, Mekontso-Dessap, Armand, Brun-Buisson, Christian, and Thille, Arnaud W.

Abstract

Abstract: Study Objective: The aim of the study was to compare the effectiveness of drainage via a single-lumen (5F catheter) central venous catheter (CVC) to a conventional (14-20F catheter) chest tube (CT) for the management of pneumothoraces, including primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), and traumatic and iatrogenic pneumothoraces. Patients: All consecutive patients admitted to the intermediate intensive care unit of a university hospital for pneumothorax were retrospectively screened over an 8-year period. Patients were preferentially treated using CT from 2003 to 2007 and using CVC from 2008 to 2010. Drainage failure was defined as the need for a second drainage procedure or for surgery. Results: Of 212 patients included, 117 (55%) had PSP, 28 (13%) had SSP associated with chronic obstructive pulmonary disease, 19 (9%) had traumatic pneumothorax, and 48 (23%) had iatrogenic pneumothorax. The failure rate was 23% in PSP, 36% in SSP, 16% in traumatic pneumothorax, and only 2% in iatrogenic pneumothorax. After adjustment, iatrogenic pneumothorax was the only factor that had an influence on drainage failure. The failure rate was similar between the 112 patients treated using CVC and the 100 patients treated using CT (18% vs 21%, P = .60). However, the durations of drainage (3.3 ± 1.9 vs 4.6 ± 2.6 days, P < .01) and of hospital stay were significantly shorter in patients treated using CVC as compared with CT. Conclusion: Our findings suggest that drainage via a catheter or via a CT is similarly effective in the management of pneumothorax. We recommend considering drainage via a small-bore catheter as a first-line treatment in patients with pneumothorax, whatever its cause. [Copyright &y& Elsevier]

Published
2012
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39. Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device.

Author

Thille, Arnaud W., Bertholon, Jean-Fran&ccedil.ois, Becquemin, Marie-Hélène, Roy, Monique, Lyazidi, Aissam, Lellouche, François, Pertusini, Esther, Boussignac, Georges, Maître, Bernard, and Brochard, Laurent

Subjects
OBSTRUCTIVE lung disease treatment, RESPIRATORY insufficiency treatment, CONTINUOUS positive airway pressure, ACTIVE oxygen in the body, AEROSOL therapy, ANALYSIS of variance, NONPARAMETRIC statistics, OXYGEN therapy, RESEARCH funding, RESPIRATION, RESPIRATORY muscles, RESPIRATORY therapy equipment, STATISTICS, PILOT projects, DATA analysis, CONTINUING education units, TERBUTALINE, EQUIPMENT & supplies
Abstract

BACKGROUND: A simple method for effective bronchodilator aerosol delivery while administering continuing continuous positive airway pressure (CPAP) would be useful in patients with severe bronchial obstruction. OBJECTIVE: To assess the effectiveness of bronchodilator aerosol delivery during CPAP generated by the Boussignac CPAP system and its optimal humidification system. METHODS: First we assessed the relationship between flow and pressure generated in the mask with the Boussignac CPAP system. Next we measured the inspired-gas humidity during CPAP, with several humidification strategies, in 9 healthy volunteers. We then measured the bronchodilator aerosol particle size during CPAP, with and without heat-and-moisture exchanger, in a bench study. Finally, in 7 patients with acute respiratory failure and airway obstruction, we measured work of breathing and gas exchange after a β-2-agonist bronchodilator aerosol (terbutaline) delivered during CPAP or via standard nebulization. RESULTS: Optimal humidity was obtained only with the heat-and-moisture exchanger or heated humidifier. The heat-and-moisture exchanger had no influence on bronchodilator aerosol particle size. Work of breathing decreased similarly after bronchodilator via either standard nebulization or CPAP, but PaO2 increased significantly only after CPAP aerosol delivery. CONCLUSIONS: CPAP bronchodilator delivery decreases the work of breathing as effectively as does standard nebulization, but produces a greater oxygenation improvement in patients with airway obstruction. To optimize airway humidification, a heat-and-moisture exchanger could be used with the Boussignac CPAP system, without modifying aerosol delivery. [ABSTRACT FROM AUTHOR]

Published
2011
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40. Discontinuation of ventilatory support

Author

Peñuelas, Óscar, Thille, Arnaud W., and Esteban, Andrés

Abstract

Weaning from mechanical ventilation implies two separate but closely related aspects of care, the discontinuation of mechanical ventilation and removal of artificial airway, which implies routine clinical dilemmas. Extubation delay and extubation failure are associated with poor clinical outcomes. We sought to summarize recent evidence on weaning.

Published
2015
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42. Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies

Author

Thille, Arnaud W, Esteban, Andrés, Fernández-Segoviano, Pilar, Rodriguez, José-María, Aramburu, José-Antonio, Vargas-Errázuriz, Patricio, Martín-Pellicer, Ana, Lorente, José A, and Frutos-Vivar, Fernando

Abstract

Diffuse alveolar damage is the histological hallmark of acute respiratory distress syndrome (ARDS). However, the chronology of histological lesions is not well established. We aimed to determine the time to onset of exudative or proliferative changes and end-stage fibrosis in ARDS.

Published
2013
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43. Weaning from the ventilator and extubation in ICU

Author

Thille, Arnaud W., Cortés-Puch, Irene, and Esteban, Andrés

Abstract

The decision to extubate is a crucial moment for intubated patients. In most cases, the transition to spontaneous breathing is uneventful, but in some patients, it implies a more challenging decision. Both extubation delay and especially the need for reintubation are associated with poor outcomes. We aim to review the recent literature on weaning and to clarify the role of certain interventions intending to help in this process.

Published
2013
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44. Patient-Ventilator Asynchrony During Noninvasive Ventilation

Author

Carteaux, Guillaume, Lyazidi, Aissam, Cordoba-Izquierdo, Ana, Vignaux, Laurence, Jolliet, Philippe, Thille, Arnaud W., Richard, Jean-Christophe M., and Brochard, Laurent

Abstract

Different kinds of ventilators are available to perform noninvasive ventilation (NIV) in ICUs. Which type allows the best patient-ventilator synchrony is unknown. The objective was to compare patient-ventilator synchrony during NIV between ICU, transport—both with and without the NIV algorithm engaged—and dedicated NIV ventilators.

Published
2012
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45. Promoting Patient-Ventilator Synchrony

Author

Thille, Arnaud W. and Brochard, Laurent

Abstract

Patient-ventilator asynchrony, in which the patient's inspiration fails to coincide exactly with the ventilator's insufflation, is common in clinical practice. Studies suggest that nearly one-fourth of intubated patients exhibit frequent asynchrony during assisted ventilation. Frequent asynchrony is associated with longer duration of mechanical ventilation, because it may reflect not only greater disease severity, but also inappropriate ventilator settings. New-generation ventilators with large screens facilitate the detection of gross asynchronies by careful examination of flow and airway-pressure tracings. The main asynchrony is ineffective triggering, defined as failure of a patient's inspiratory effort to trigger a ventilator breath. Ineffective triggering is caused by dynamic hyperinflation at the time of a triggering attempt. Other major asynchronies include double triggering, in which 2 consecutive ventilator cycles are triggered by a single patient effort; and auto-triggering, in which the ventilator is triggered by signals that do not come from the patient. More discreet asynchronies such as prolonged insufflation during pressure-support ventilation or inadequate flow rate during assist-control ventilation can also be suspected from the flow and airway-pressure traces. Simple delays in triggering or cycling are extremely common but difficult to detect. Optimizing the ventilator settings, most notably by reducing ventilatory support or insufflation time, can minimize ineffective triggering. New ventilatory modes such as proportional-assist ventilation and neurally adjusted ventilatory assist may improve patient-ventilator synchrony. Whether optimizing ventilation shortens the duration of mechanical ventilation by reducing the occurrence of asynchrony is still an open question.

Published
2007
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47. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study

Author

Gangneux, Jean-Pierre, Dannaoui, Eric, Fekkar, Arnaud, Luyt, Charles-Edouard, Botterel, Françoise, De Prost, Nicolas, Tadié, Jean-Marc, Reizine, Florian, Houzé, Sandrine, Timsit, Jean-François, Iriart, Xavier, Riu-Poulenc, Béatrice, Sendid, Boualem, Nseir, Saad, Persat, Florence, Wallet, Florent, Le Pape, Patrice, Canet, Emmanuel, Novara, Ana, Manai, Melek, Cateau, Estelle, Thille, Arnaud W, Brun, Sophie, Cohen, Yves, Alanio, Alexandre, Mégarbane, Bruno, Cornet, Muriel, Terzi, Nicolas, Lamhaut, Lionel, Sabourin, Estelle, Desoubeaux, Guillaume, Ehrmann, Stephan, Hennequin, Christophe, Voiriot, Guillaume, Nevez, Gilles, Aubron, Cécile, Letscher-Bru, Valérie, Meziani, Ferhat, Blaize, Marion, Mayaux, Julien, Monsel, Antoine, Boquel, Frédérique, Robert-Gangneux, Florence, Le Tulzo, Yves, Seguin, Philippe, Guegan, Hélène, Autier, Brice, Lesouhaitier, Matthieu, Pelletier, Romain, Belaz, Sorya, Bonnal, Christine, Berry, Antoine, Leroy, Jordan, François, Nadine, Richard, Jean-Christophe, Paulus, Sylvie, Argaud, Laurent, Dupont, Damien, Menotti, Jean, Morio, Florent, Soulié, Marie, Schwebel, Carole, Garnaud, Cécile, Guitard, Juliette, Le Gal, Solène, Quinio, Dorothée, Morcet, Jeff, Laviolle, Bruno, Zahar, Jean-Ralph, and Bougnoux, Marie-Elisabeth

Abstract

Patients with severe COVID-19 have emerged as a population at high risk of invasive fungal infections (IFIs). However, to our knowledge, the prevalence of IFIs has not yet been assessed in large populations of mechanically ventilated patients. We aimed to identify the prevalence, risk factors, and mortality associated with IFIs in mechanically ventilated patients with COVID-19 under intensive care.

Published
2021
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49. Should We Use Volume-Targeted Noninvasive Ventilation in Patients With Acute Hypercapnic Respiratory Failure?

Author

Frat, Jean-Pierre and Thille, Arnaud W.

Subjects
ARTIFICIAL respiration, HYPERCAPNIA, OBSTRUCTIVE lung diseases, RESPIRATORY insufficiency, POSITIVE end-expiratory pressure
Abstract

The authors discusses a study on noninvasive ventilation (NIV) and its benefits as first-line therapy for patients diagnosed with severe chronic obstructive pulmonary disease (COPS) exacerbation. Topics include NIV's uses for acute hypercapnic respiratory failure, pressure-limited NIV such as support ventilation and bi-level positive airway pressure in home NIV ventilators, and a proposed volume-targeted mode of NIV which is a hybrid mode that factors in tidal volume and pressure support.

Published
2016
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