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Rationale: Because of the effects of aging on the respiratory system, it is conceivable that the association between driving pressure and mortality depends on age. Objectives: We endeavored to evaluate whether the association between driving pressure and mortality of patients with acute respiratory distress syndrome (ARDS) varies across the adult lifespan, hypothesizing that it is stronger in older, including very old (⩾80 yr), patients. Methods: We performed a secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials ("ARDSNet cohort"). We tested our hypothesis in a second, independent, national cohort ("Hellenic cohort"). We performed both binary logistic and Cox regression analyses including the interaction term between age (as a continuous variable) and driving pressure at baseline (i.e., the day of trial enrollment) as the predictor and 90-day mortality as the dependent variable. Measurements and Main Results: On the basis of data from 4,567 patients with ARDS included in the ARDSNet cohort, we found that the effect of driving pressure on mortality depended on age (P = 0.01 for the interaction between age as a continuous variable and driving pressure). The difference in driving pressure between survivors and nonsurvivors significantly changed across the adult lifespan (P < 0.01). In both cohorts, a driving pressure threshold of 11 cm H2O was associated with mortality in very old patients. Conclusions: Data from randomized controlled trials with strict inclusion criteria suggest that the effect of driving pressure on the mortality of patients with ARDS may depend on age. These results may advocate for a personalized age-dependent mechanical ventilation approach. [ABSTRACT FROM AUTHOR]

Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to investigate the role of ineffective efforts (IEs), specifically clusters of IEs, during mechanical ventilation on the outcome of critically ill patients. Methods In a prospective observational study, 24-h recordings were obtained in 110 patients on the 1st day of assisted ventilation (pressure support or proportional assist), using a prototype monitor validated to identify IEs. Patients remaining on assisted ventilation were studied again on the 3rd day (n = 37) and on the 6th day (n = 13). To describe the clusters of IEs, the concept of an IEs event was developed, defined as a 3-min period of time containing more than 30 IEs. Along with all patient data, to minimize selection bias by time of recording, analysis was performed only on 1st day data of patients with [greater than or equal to]16 h of recording (1st day group). Results The analysis included 2931 h of assisted ventilation and 4,456,537 breaths. Neither the IEs index (IEs as a percentage of total breaths) in general nor a value above 10 % was correlated with patient outcome. Overall, IEs events were identified in 38 % of patients. In multivariate analysis, the presence of events in the 1st day group (n = 79) was associated with the risk of being on mechanical ventilation [greater than or equal to]8 days after first recording [odds ratio 6.4, 95 % confidence interval (1.1-38.30)] and hospital mortality [20 (2.3-175)]. Analysis of the data for all patients revealed similarly increased risks for prolonged ventilation [3.4 (1.1-10.7)] and mortality [4.9 (1.3-18)]. Conclusions Clusters of IEs are often present in mechanically ventilated critically ill patients and are associated with prolonged mechanical ventilation and increased mortality. Studies to find ways of improving patient-ventilator interaction are warranted., Author(s): Katerina Vaporidi [sup.1], Dimitris Babalis [sup.1], Achilleas Chytas [sup.2] [sup.3], Emmanuel Lilitsis [sup.1], Eumorfia Kondili [sup.1], Vasilis Amargianitakis [sup.1], Ioanna Chouvarda [sup.2] [sup.3], Nicos Maglaveras [sup.2] [sup.3], Dimitris Georgopoulos [...]

Hiccups-like contractions, including hiccups, respiratory myoclonus, and diaphragmatic tremor, refer to involuntary, spasmodic, and inspiratory muscle contractions. They have been repeatedly described in mechanically ventilated patients, especially those with central nervous damage. Nevertheless, their effects on patient-ventilator interaction are largely unknown, and even more overlooked is their contribution to lung and diaphragm injury. We describe, for the first time, how the management of hiccup-like contractions was individualized based on esophageal and transpulmonary pressure measurements in three mechanically ventilated patients. The necessity or not of intervention was determined by the effects of these contractions on arterial blood gases, patient-ventilator synchrony, and lung stress. In addition, esophageal pressure permitted the titration of ventilator settings in a patient with hypoxemia and atelectasis secondary to hiccups and in whom sedatives failed to eliminate the contractions and muscle relaxants were contraindicated. This report highlights the importance of esophageal pressure monitoring in the clinical decision making of hiccup-like contractions in mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

Purpose To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients. Methods One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplained deterioration of arterial blood gases and (2) a suspected pathologic entity [pneumothorax, significant pleural effusion (including parapneumonic effusion, empyema, or hemothorax), unilateral atelectasis (lobar or total), pneumonia and diffuse interstitial syndrome (pulmonary edema)]. Results Two hundred and fifty-three LU examinations were performed; 108 studies (42.7 %) were performed for unexplained deterioration of arterial blood gases, and 145 (57.3 %) for a suspected pathologic entity (60 for pneumothorax, 34 for significant pleural effusion, 22 for diffuse interstitial syndrome, 15 for unilateral lobar or total lung atelectasis, and 14 for pneumonia). The net reclassification index was 85.6 %, indicating that LU significantly influenced the decision-making process. The management was changed directly as a result of information provided by the LU in 119 out of 253 cases (47 %). In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous-venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, non-invasive (PEEP change/titration, recruitment maneuver, diuretics, physiotherapy, change in bed position, antibiotics initiation/change). In 53 out of 253 cases (21 %), LU revealed findings which supported diagnoses not suspected by the primary physician (7 cases of pneumothorax, 9 of significant pleural effusion, 9 of pneumonia, 16 of unilateral atelectasis, and 12 of diffuse interstitial syndrome). Conclusion Our study shows that LU has a significant impact on decision making and therapeutic management., Author(s): Nektaria Xirouchaki [sup.1], Eumorfia Kondili [sup.1], George Prinianakis [sup.1], Polychronis Malliotakis [sup.1], Dimitrios Georgopoulos [sup.1] Author Affiliations: (1) grid.8127.c, 0000000405763437, Department of Intensive Care Medicine, University Hospital of Heraklion, [...]

Background: Constant exposure of health professionals to the pain and suffering of patients can adversely affect their emotional wellbeing. Aim: The study aimed to investigate the prevalence and the factors affecting the levels of secondary traumatic stress/compassion fatigue (STS/CF), burnout (BO) and compassion satisfaction (CS) of health professionals working in adult and paediatric Intensive Care Units (ICU) as well as in departments treating patients with serious illness in five hospitals in Crete. Study Design: A descriptive cross‐sectional survey with the use of the Professional Quality of Life Scale (ProQOL‐CSF‐R‐IV) questionnaire. Methods: We enrolled medical, nursing and support staff working in the adult and paediatric ICU, emergency, oncology, haematology and neurosurgical departments, haemodialysis unit and operating theatre. Results: 598 health professionals completed the questionnaire (response rate 73.2%). Significantly increased levels of STS/CF were observed in non – ICU as compared to ICU staff (p =.009) females compared to males (p <.001), those who have previously experienced a traumatic event (p <.004), nurses and support staff compared to doctors (p =.007 and p =.028 respectively), and people not working in a department by choice (p <.001). CS was higher for older professionals, personnel subjected to stress reduction techniques (p <.019) and professionals working with children or mixed adults and children population (p =.009). Rolling schedule and bad working conditions negatively affected CS (p =.02, p =.001). Increased BO levels were associated with younger age (p =.029) and showed a positive correlation with STS/CF (r =.356, p <.001). Conclusions: STS/CF is common in health professionals regardless of their profession, working department or hospital level. Non‐ICU staff displayed higher STS/CF levels. Working in a department by choice ameliorates CS, BO and STS/CF. Relevance to Clinical Practice: Health professionals need to be informed about the risks of projecting patients' suffering on themselves. Hospital managers and department heads are responsible to provide appropriate support. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory conditions are a prominent public health issue and thus, building a patient registry might facilitate both policy decision making and improvement of clinical management processes. Hellenic Registry of patients with Home Mechanical Ventilation (HR-HMV) was initiated in 2017 and a web-based platform is used to support patient data collection. Eighteen hospital departments (including sleep labs) across Greece participate in this initiative, focusing on recording data for both children and adult patients supported by mechanical ventilation at home, including patients with Sleep Apnea-Hypopnea Syndrome (SAHS) under Positive Airway Pressure (PAP) therapy.Methods: The HR-HMV initiative ultimately aims to provide a database for evidence-based care and policy making in this specific domain. To this end, a web information system was developed and data were manually collected by clinics and hospital departments. Legal and privacy issues (such as General Data Protection Rule compliance and technical information security measures) have been considered while designing the web application. Based on the collected data, an exploratory statistical report of SAHS patients in Greece is presented.Results: Eleven out of the eighteen participating clinics and hospital departments have contributed with data by the time of the current study. More than 5000 adult and children patient records have been collected so far, the vast majority of which (i.e., 4900 patients) diagnosed with SAHS.Conclusion: The development and maintenance of patient registries is a valuable tool for policy decision making, observational/epidemiological research and beyond (e.g., health technology assessment procedures). However, as all data collection and processing approaches, registries are also related with potential biases. Along these lines, strengths and limitations must be considered when interpreting the collected data, and continuous validation of the collected clinical data per se should be emphasized. Especially for Greece, where the lack of national registries is eminent, we argue that HR-HMV could be a useful tool for the development and the update of related policies regarding the healthcare services for patients with home mechanical ventilation support and SAHS patients, which could be useful for related initiatives at a European level as well. [ABSTRACT FROM AUTHOR]