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Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians., Author(s): Bram Rochwerg [sup.1] [sup.2], Sharon Einav [sup.3] [sup.4], Dipayan Chaudhuri [sup.1], Jordi Mancebo [sup.5], Tommaso Mauri [sup.6] [sup.7], Yigal Helviz [sup.3], Ewan C. Goligher [sup.8] [sup.9], Samir Jaber [sup.10], [...]

Background: The leading causes of maternal mortality include respiratory failure, cardiovascular events, infections, and hemorrhages. The use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in the peripartum period for cardiopulmonary failure is expanding in critical care medicine. Methods: This retrospective observational study was conducted on a nationwide cohort in Israel. During the 3‐year period, between September 1, 2019, and August 31, 2022, all women in the peripartum period who had been supported by ECMO for respiratory or circulatory failure at 10 large Israeli hospitals were identified. Indications for ECMO, maternal and neonatal outcomes, details of ECMO support, and complications were collected. Results: During the 3‐year study period, in Israel, there were 540 234 live births, and 28 obstetric patients were supported by ECMO, with an incidence of 5.2 cases per 100 000 or 1 case per 19 000 births (when excluding patients with COVID‐19, the incidence will be 2.5 cases per 100 000 births). Of these, 25 were during the postpartum period, of which 16 (64%) were connected in the PPD1, and 3 were during pregnancy. Eighteen patients (64.3%) were supported by V‐V ECMO, 9 (32.1%) by V‐A ECMO, and one (3.6%) by a VV‐A configuration. Hypoxic respiratory failure (ARDS) was the most common indication for ECMO, observed in 21 patients (75%). COVID‐19 was the cause of ARDS in 15 (53.7%) patients. The indications for the V‐A configuration were cardiomyopathy (3 patients), amniotic fluid embolism (2 patients), sepsis, and pulmonary hypertension. The maternal and fetal survival rates were 89.3% (n = 25) and 100% (n = 28). The average ECMO duration was 17.6 ± 18.6 days and the ICU stay was 29.8 ± 23.8 days. Major bleeding complications requiring surgical intervention were observed in one patient. Conclusions: The incidence of using ECMO in the peripartum period is low. The maternal and neonatal survival rates in patients treated with ECMO are high. These results show that ECMO remains an important treatment option for obstetric patients with respiratory and/or cardiopulmonary failure. [ABSTRACT FROM AUTHOR]

Author(s): Yigal Helviz [sup.1], Marcus Ong [sup.2], Sharon Einav [sup.1] [sup.3] Author Affiliations: (1) 0000 0004 0470 7791, grid.415593.f, Intensive Care Unit, Shaare Zedek Medical Center, , POB 3235, 91031, [...]

Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure at risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula, noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that: in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately post-extubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the possible correlation between the level of antiphospholipid antibodies particularly lupus anticoagulant (LAC) and coronavirus disease 2019 (COVID-19) severity. Topics explored include the confirmatory assays performed to evaluate LAC, the incidence of LAC observed in COVID-19 patients, and the demographic and laboratory parameters gathered from patients involved in the study.

A letter to the editor is presented in response to the article "A Systematic Review to Inform Institutional Decisions About the Use of Extracorporeal Membrane Oxygenation During the H1N1 Influenza Pandemic," by M. D. Mitchell, M. E. Mikkelsen, C. A. Umscheid and others in a 2010 issue.

Background: The "dying patient" law in Israel deals with end- of-life decisions., Aim: This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients., Methods: During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome., Results: Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questionnaires. Overall, 69, patients died within 14 days. The sensitivity of assessment of short-term prognosis was low (0.38) but the specificity was very high (0.95). The positive predictive value was 0.61. Among physicians, the positive predictive value increased with seniority, but nurses had the highest positive predictive value scores (0.73). The negative predictive value was 0.89 without significant differences among the 4 studied groups., Conclusions: Internal medicine staff has limited capacity to accurately assess short-term prognosis of recently admitted patients.