32 results on '"van Meenen, David M. P."'
Search Results
2. Broadening the Berlin definition of ARDS to patients receiving high-flow nasal oxygen: an observational study in patients with acute hypoxemic respiratory failure due to COVID-19
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van der Ven, Fleur-Stefanie L. I. M., Valk, Christel M. A., Blok, Siebe, Brouwer, Michelle G., Go, Dai Ming, Lokhorst, Amanda, Swart, Pien, van Meenen, David M. P., Paulus, Frederique, and Schultz, Marcus J.
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- 2023
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- View/download PDF
3. A closed-loop ventilation mode that targets the lowest work and force of breathing reduces the transpulmonary driving pressure in patients with moderate-to-severe ARDS
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Buiteman-Kruizinga, Laura A., van Meenen, David M. P., Bos, Lieuwe D. J., van der Heiden, Pim L. J., Paulus, Frederique, and Schultz, Marcus J.
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- 2023
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4. Epidemiology, Ventilation Management and Outcomes of COPD Patients Receiving Invasive Ventilation for COVID-19—Insights from PRoVENT-COVID
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Tripipitsiriwat, Athiwat, primary, Suppapueng, Orawan, additional, van Meenen, David M. P., additional, Paulus, Frederique, additional, Hollmann, Markus W., additional, Sivakorn, Chaisith, additional, and Schultz, Marcus J., additional
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- 2023
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5. Oxygen Consumption with High-Flow Nasal Oxygen versus Mechanical Ventilation- An International Multicenter Observational Study in COVID-19 Patients (PROXY-COVID)
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Botta, Michela, Caritg, Oriol, van Meenen, David M. P., Pacheco, Andrés, Tsonas, Anissa M., Mooij, Willemijn E., Burgener, Alessia, Manrique Hehl, Tosca, Shrestha, Gentle S., Horn, Janneke, Tuinman, Pieter R., Paulus, Frederique, Roca, Oriol, Schultz, Marcus J., Graduate School, Intensive Care Medicine, Anesthesiology, 06 Operations Centre and intensive care, ACS - Pulmonary hypertension & thrombosis, AII - Infectious diseases, AII - Inflammatory diseases, ARD - Amsterdam Reproduction and Development, ANS - Neuroinfection & -inflammation, Nursing, ACS - Diabetes & metabolism, ACS - Microcirculation, Intensive care medicine, Institut Català de la Salut, [Botta M, van Meenen DMP, Tsonas AM, Mooij WE] Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands. [Caritg O, Pacheco A] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Roca O] Department of Intensive Care, Parc Taulí de Sabadell University Hospital, Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Therapeutics::Airway Management::Respiration, Artificial [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Infectious Diseases ,COVID-19 (Malaltia) - Tractament ,terapéutica::manejo de la via aérea::respiración artificial [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Virology ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Metabolism::Oxygen Consumption [PHENOMENA AND PROCESSES] ,Parasitology ,Oxigen ,metabolismo::consumo de oxígeno [FENÓMENOS Y PROCESOS] ,Respiració artificial - Abstract
The COVID–19 pandemic led to local oxygen shortages worldwide. To gain a better understanding of oxygen consumption with different respiratory supportive therapies, we conducted an international multicenter observational study to determine the precise amount of oxygen consumption with high-flow nasal oxygen (HFNO) and with mechanical ventilation. A retrospective observational study was conducted in three intensive care units (ICUs) in the Netherlands and Spain. Patients were classified as HFNO patients or ventilated patients, according to the mode of oxygen supplementation with which a patient started. The primary endpoint was actual oxygen consumption; secondary endpoints were hourly and total oxygen consumption during the first two full calendar days. Of 275 patients, 147 started with HFNO and 128 with mechanical ventilation. Actual oxygen use was 4.9-fold higher in patients who started with HFNO than in patients who started with ventilation (median 14.2 [8.4–18.4] versus 2.9 [1.8–4.1] L/minute; mean difference = 11.3 [95% CI 11.0–11.6] L/minute; P < 0.01). Hourly and total oxygen consumption were 4.8-fold (P < 0.01) and 4.8-fold (P < 0.01) higher. Actual oxygen consumption, hourly oxygen consumption, and total oxygen consumption are substantially higher in patients that start with HFNO compared with patients that start with mechanical ventilation. This information may help hospitals and ICUs predicting oxygen needs during high-demand periods and could guide decisions regarding the source of distribution of medical oxygen.
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- 2023
6. Closed–Loop ventilation using sidestream versus mainstream capnography for automated adjustments of minute ventilation—A randomized clinical trial in cardiac surgery patients
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Nijbroek, Sunny G. L. H., primary, Roozeman, Jan-Paul, additional, Ettayeby, Sarah, additional, Rosenberg, Neeltje M., additional, van Meenen, David M. P., additional, Cherpanath, Thomas G. V., additional, Lagrand, Wim K., additional, Tepaske, Robert, additional, Klautz, Robert J. M., additional, Serpa Neto, Ary, additional, and Schultz, Marcus J., additional
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- 2023
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7. Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)—Interim Analysis of DESIGNATION.
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Nijbroek, Sunny G. L. H., Hol, Liselotte, Serpa Neto, Ary, van Meenen, David M. P., Hemmes, Sabrine N. T., Hollmann, Markus W., and Schultz, Marcus J.
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POSITIVE end-expiratory pressure ,ARTIFICIAL respiration ,ABDOMINAL surgery ,GENERAL anesthesia - Abstract
Uncertainty remains about the best level of intraoperative positive end–expiratory pressure (PEEP). An ongoing RCT ('DESIGNATION') compares an 'individualized high PEEP' strategy ('iPEEP')—titrated to the lowest driving pressure (ΔP) with recruitment maneuvers (RM), with a 'standard low PEEP' strategy ('low PEEP')—using 5 cm H
2 O without RMs with respect to the incidence of postoperative pulmonary complications. This report is an interim analysis of safety and feasibility. From September 2018 to July 2022, we enrolled 743 patients. Data of 698 patients were available for this analysis. Hypotension occurred more often in 'iPEEP' vs. 'low PEEP' (54.7 vs. 44.1%; RR, 1.24 (95% CI 1.07 to 1.44); p < 0.01). Investigators were compliant with the study protocol 285/344 patients (82.8%) in 'iPEEP', and 345/354 patients (97.5%) in 'low PEEP' (p < 0.01). Most frequent protocol violation was missing the final RM at the end of anesthesia before extubation; PEEP titration was performed in 99.4 vs. 0%; PEEP was set correctly in 89.8 vs. 98.9%. Compared to 'low PEEP', the 'iPEEP' group was ventilated with higher PEEP (10.0 (8.0–12.0) vs. 5.0 (5.0–5.0) cm H2 O; p < 0.01). Thus, in patients undergoing general anesthesia for open abdominal surgery, an individualized high PEEP ventilation strategy is associated with hypotension. The protocol is feasible and results in clear contrast in PEEP. DESIGNATION is expected to finish in late 2023. [ABSTRACT FROM AUTHOR]- Published
- 2024
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8. Hyperoxia-Induced Lung Injury in Acute Respiratory Distress Syndrome: What is its Relative Impact?
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Lilien, Thijs A., primary, van Meenen, David M. P., additional, Schultz, Marcus J., additional, Bos, Lieuwe D. J., additional, and Bem, Reinout A., additional
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- 2023
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9. Additional file 1 of A closed-loop ventilation mode that targets the lowest work and force of breathing reduces the transpulmonary driving pressure in patients with moderate-to-severe ARDS
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Buiteman-Kruizinga, Laura A., van Meenen, David M. P., Bos, Lieuwe D. J., van der Heiden, Pim L. J., Paulus, Frederique, and Schultz, Marcus J.
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Additional file 1: Table S1. List of significant pairwise comparisons per time point, significance was determined at a P value < 0.003. Table S2. Specification of the generalized linear mixed model analysis. Figure S1. Line plots showing the mean changes and individual changes over time of transpulmonary ΔP, VT and RR during the two study blocks of the two ventilation modes in the study. Figure S2. CRS vs. VT between closed-loop ventilation and conventional ventilation, and transpulmonary ΔP vs. VT between closed-loop ventilation and conventional ventilation. A negative value means that the parameter decreased with closed-loop ventilation, and a higher value means that the parameter increased with closed-loop ventilation. All dots represent the mean value of an individual patient. Figure S3. Scatterplots of CRS vs. VT and transpulmonary ΔP vs. VT with closed-loop ventilation and conventional ventilation. Each dot was characterized by a single data point. Figure S4. Showing individual patient data of the effect of the change of the ventilation mode on PEEP setting. Figure S5. Showing transpulmonary ΔP per patient during every time point, with closed-loop ventilation and conventional ventilation. The head with number represents the corresponding patient, the x-axis represent the 16 time points per block. Figure S6. Showing PEEP per patient during every time point, with closed-loop ventilation and conventional ventilation. The head with number represents the corresponding patient, the x-axis represent the 16 time points per block. Figure S7. Showing the tidal volumeper patient during every time point, with closed-loop ventilation and conventional ventilation. The head with number represents the corresponding patient, the x-axis represent the 16 time points per block. Figure S8. Showing the respiratory rateper patient during every time point, with closed-loop ventilation and conventional ventilation. The head with number represents the corresponding patient, the x-axis represent the 16 time points per block. Figure S9. Violin plot of pairwise comparisons at individual time points of ΔP. Figure S10. Violin plot of pairwise comparisons at individual time points of transpulmonary ΔP. Figure S11. Violin plot of pairwise comparisons at individual time points of RR. Figure S12. Violin plot of pairwise comparisons at individual time points of MP. Figure S13. Violin plot of pairwise comparisons at individual time points of transpulmonary MP.
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- 2023
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10. Additional file 1 of Broadening the Berlin definition of ARDS to patients receiving high-flow nasal oxygen: an observational study in patients with acute hypoxemic respiratory failure due to COVID-19
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van der Ven, Fleur-Stefanie L. I. M., Valk, Christel M. A., Blok, Siebe, Brouwer, Michelle G., Go, Dai Ming, Lokhorst, Amanda, Swart, Pien, van Meenen, David M. P., Paulus, Frederique, and Schultz, Marcus J.
- Abstract
Additional file 1: Table S1. Demographics mild ARDS according to Berlin definition. Table S2. Demographics moderate ARDS according to Berlin definition. Table S3. Demographics severe ARDS according to Berlin definition. Figure S1. Cumulative frequency distribution of PaO2/FiO2 ratio, FiO2, and PEEP or flow per severity class in HFNO and ventilation. Figure S2. Cumulative incidence of ICU discharge (A) and hospital discharge (B) in HFNO compared to ventilation. Figure S3. Hospital (A), 28–day mortality (B) and all–cause 90–day mortality (C) per severity class.
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- 2023
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11. Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome: An analysis of three randomised clinical trials
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van Meenen, David M. P., Algera, Anna Geke, Schuijt, Michiel T. U., Simonis, Fabienne D., van der Hoeven, Sophia M., Neto, Ary Serpa, Abreu, Marcelo Gama De, Pelosi, Paolo, Paulus, Frederique, Schultz, Marcus J., Anesthesiology, 06 Operations Centre and intensive care, ACS - Pulmonary hypertension & thrombosis, AII - Infectious diseases, AII - Inflammatory diseases, ARD - Amsterdam Reproduction and Development, Intensive Care Medicine, and Nursing
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Anesthesiology and Pain Medicine - Abstract
BACKGROUNDThe mechanical power of ventilation (MP) has an association with outcome in invasively ventilated patients with the acute respiratory distress syndrome (ARDS). Whether a similar association exists in invasively ventilated patients without ARDS is less certain.OBJECTIVETo investigate the association of mechanical power with mortality in ICU patients without ARDS.DESIGNThis was an individual patient data analysis that uses the data of three multicentre randomised trials.SETTINGThis study was performed in academic and nonacademic ICUs in the Netherlands.PATIENTSOne thousand nine hundred and sixty-Two invasively ventilated patients without ARDS were included in this analysis. The median [IQR] age was 67 [57 to 75] years, 706 (36%) were women.MAIN OUTCOME MEASURESThe primary outcome was the all-cause mortality at day 28. Secondary outcomes were the all-cause mortality at day 90, and length of stay in ICU and hospital.RESULTSAt day 28, 644 patients (33%) had died. Hazard ratios for mortality at day 28 were higher with an increasing MP, even when stratified for its individual components (driving pressure (P
- Published
- 2022
12. Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study
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Stilma, Willemke, primary, Valk, Christel M. A., additional, van Meenen, David M. P., additional, Morales, Luis, additional, Remmelzwaal, Daantje, additional, Myatra, Sheila N., additional, Artigas, Antonio, additional, Neto, Ary Serpa, additional, Paulus, Frederique, additional, and Schultz, Marcus J., additional
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- 2022
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13. Effect of On-Demand vs Routine Nebulization of Acetylcysteine With Salbutamol on Ventilator-Free Days in Intensive Care Unit Patients Receiving Invasive Ventilation: A Randomized Clinical Trial
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van Meenen, David M. P., van der Hoeven, Sophia M., Binnekade, Jan M., de Borgie, Corianne A. J. M., Merkus, Maruschka P., Bosch, Frank H., Endeman, Henrik, Haringman, Jasper J., van der Meer, Nardo J. M., Moeniralam, Hazra S., Slabbekoorn, Mathilde, Muller, Marcella C. A., Stilma, Willemke, van Silfhout, Bart, Neto, Ary Serpa, ter Haar, Hans F. M., Van Vliet, Jan, Wijnhoven, Jan Willem, Horn, Janneke, Juffermans, Nicole P., Pelosi, Paolo, Gama de Abreu, Marcelo, Schultz, Marcus J., and Paulus, Frederique
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- 2018
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14. Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic—A Comparison between Two Nationwide Observational Studies in The Netherlands.
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Hol, Liselotte, Schultz, Marcus J., Martin-Loeches, Ignacio, van Meenen, David M. P., Serpa Neto, Ary, and Paulus, Frederique
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COVID-19 pandemic ,VENTILATION ,COVID-19 ,POSITIVE end-expiratory pressure ,PROPENSITY score matching - Abstract
The aim of this analysis was to compare ventilation management and outcomes in invasively ventilated patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) between the first and second wave in the Netherlands. This is a post hoc analysis of two nationwide observational COVID-19 studies conducted in quick succession. The primary endpoint was ventilation management. Secondary endpoints were tracheostomy use, duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), and mortality. We used propensity score matching to control for observed confounding factors. This analysis included 1122 patients from the first and 568 patients from the second wave. Patients in the second wave were sicker, had more comorbidities, and had worse oxygenation parameters. They were ventilated with lower positive end-expiratory pressure and higher fraction inspired oxygen, had a lower oxygen saturation, received neuromuscular blockade more often, and were less often tracheostomized. Duration of ventilation was shorter, but mortality rates were similar. After matching, the fraction of inspired oxygen was lower in the second wave. In patients with acute hypoxemic respiratory failure due to COVID-19, aspects of respiratory care and outcomes rapidly changed over the successive waves. [ABSTRACT FROM AUTHOR]
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- 2023
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15. RELAx – REstricted versus Liberal positive end-expiratory pressure in patients without ARDS: protocol for a randomized controlled trial
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Algera, Anna Geke, Pisani, Luigi, Bergmans, Dennis C. J., den Boer, Sylvia, de Borgie, Corianne A. J., Bosch, Frank H., Bruin, Karina, Cherpanath, Thomas G., Determann, Rogier M., Dondorp, Arjen M., Dongelmans, Dave A., Endeman, Henrik, Haringman, Jasper J., Horn, Janneke, Juffermans, Nicole P., van Meenen, David M., van der Meer, Nardo J., Merkus, Maruschka P., Moeniralam, Hazra S., Purmer, Ilse, Tuinman, Pieter Roel, Slabbekoorn, Mathilde, Spronk, Peter E., Vlaar, Alexander P. J., Gama de Abreu, Marcelo, Pelosi, Paolo, Serpa Neto, Ary, Schultz, Marcus J., Paulus, Frederique, and for the RELAx Investigators and the PROVE Network Investigators
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- 2018
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16. Intensity of Mechanical Ventilation
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van Meenen, David M. P., Schultz, Marcus, Hollmann, Markus, Paulus, Frederique, Dongelmans, Dave, 06 Operations Centre and intensive care, Anesthesiology, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, ARD - Amsterdam Reproduction and Development, and Graduate School
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- 2022
17. Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
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Schuijt, Michiel T. U., primary, van Meenen, David M. P., additional, Martin–Loeches, Ignacio, additional, Mazzinari, Guido, additional, Schultz, Marcus J., additional, Paulus, Frederique, additional, and Serpa Neto, Ary, additional
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- 2021
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18. Effectiveness, efficacy and safety of INTELLiVENT–ASV, a closed-loop ventilation mode for ICU patients - a systematic review
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Botta, Michela, primary, Wenstedt, Eliane F E, additional, Tsonas, Anissa M, additional, Buiteman–kruizinga, Laura A, additional, Van Meenen, David M P, additional, Korsten, Hendrik H M, additional, Horn, Janneke, additional, Paulus, Frederique, additional, Bindels, Alexander G J H, additional, Schultz, Marcus J, additional, and De Bie, Ashley J R, additional
- Published
- 2021
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19. Response to Dr. Alain Braillon
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van Meenen, Laura C. C., van Meenen, David M. P., de Rooij, Sophia E., and ter Riet, Gerben
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- 2015
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20. Risk Prediction Models for Postoperative Delirium: A Systematic Review and Meta-Analysis
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van Meenen, Laura C. C., van Meenen, David M. P., de Rooij, Sophia E., and ter Riet, Gerben
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- 2014
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21. COVID-19-related acute respiratory distress syndrome: lessons learned during the pandemic.
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Schultz, Marcus J, van Meenen, David M, and Bos, Lieuwe D
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ADULT respiratory distress syndrome ,PANDEMICS - Published
- 2022
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22. Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial: A substudy of the targeted temperature management trial
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Harmon, Matthew B. A., van Meenen, David. M. P., van der Veen, Annelou L. I. P., Binnekade, Jan M., Dankiewicz, Josef, Ebner, Florian, Nielsen, Niklas, Pelosi, Paolo, Schultz, Marcus J., Horn, Janneke, Friberg, Hans, Juffermans, Nicole P., Intensive Care Medicine, Graduate School, ACS - Heart failure & arrhythmias, Anesthesiology, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, AII - Infectious diseases, AR&D - Amsterdam Reproduction & Development, ANS - Neurovascular Disorders, ACS - Diabetes & metabolism, and ACS - Microcirculation
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Male ,Out-of-Hospital Cardiac Arrest/mortality ,Survival Rate/trends ,Australia/epidemiology ,Hypothermia, Induced/methods ,Respiration, Artificial/methods ,Hemodynamics/physiology ,Middle Aged ,Europe/epidemiology ,Body Temperature/physiology ,Treatment Outcome ,Humans ,Female ,Rewarming/methods ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
Aims: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. Methods: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36). Mechanical ventilation data were obtained at three time points: 1) before TTM; 2) at the end of TTM (before rewarming) and 3) after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings. Results: Mechanical ventilation data was available for 567 of the 950 TTM patients. Of these, 81% was male with a mean (SD) age of 64 (12) years. At the end of TTM median tidal volume was 7.7 ml/kg predicted body weight (PBW)(6.4–8.7) and 60% of patients were ventilated with a tidal volume ≤ 8 ml/kg PBW. Median PEEP was 7.7cmH2O (6.4–8.7) and mean driving pressure was 14.6 cmH2O (±4.3). The median FiO2 fraction was 0.35 (0.30–0.45). Multivariate analysis showed an independent relationship between increased respiratory rate and 28-day mortality. TTM33 resulted in lower end-tidal CO2 (Pgroup = 0.0003) and higher alveolar dead space fraction (Pgroup = 0.003) compared to TTM36, while PCO2 levels and respiratory minute volume were similar between groups. Conclusions: In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO2 levels and a higher alveolar dead space fraction compared to TTTM36.
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- 2018
23. The predictive validity for mortality of the driving pressure and the mechanical power of ventilation.
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van Meenen, David M. P., Serpa Neto, Ary, Paulus, Frederique, Merkies, Coen, Schouten, Laura R., Bos, Lieuwe D., Horn, Janneke, Juffermans, Nicole P., Cremer, Olaf L., van der Poll, Tom, Schultz, Marcus J., for the MARS Consortium, de Beer, Friso M., Glas, Gerie J., Hoogendijk, Arie J., van Hooijdonk, Roosmarijn T., Huson, Mischa A., Scicluna, Brendon, Straat, Marleen, and van Vught, Lonneke A.
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ARTIFICIAL respiration , *MORTALITY , *PREDICTIVE validity , *POWER transmission , *INTENSIVE care patients - Abstract
Background: Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation. Methods: This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II. Results: The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10−3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10−3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II. Conclusions: In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II. [ABSTRACT FROM AUTHOR]
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- 2020
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24. Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study.
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Stilma, Willemke, van Meenen, David M. P., Valk, Christel M. A., de Bruin, Hendrik, Paulus, Frederique, Serpa Neto, Ary, and Schultz, Marcus J.
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COVID-19 , *ADULT respiratory distress syndrome , *LENGTH of stay in hospitals , *INTENSIVE care units - Abstract
We describe the incidence and practice of prone positioning and determined the association of use of prone positioning with outcomes in invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. Patients were categorized into 4 groups, based on indication for and actual use of prone positioning. The primary outcome was 28-day mortality. Secondary endpoints were 90-day mortality, and ICU and hospital length of stay. In 734 patients, prone positioning was indicated in 60%—the incidence of prone positioning was higher in patients with an indication than in patients without an indication for prone positioning (77 vs. 48%, p = 0.001). Patients were left in the prone position for median 15.0 (10.5–21.0) hours per full calendar day—the duration was longer in patients with an indication than in patients without an indication for prone positioning (16.0 (11.0–23.0) vs. 14.0 (10.0–19.0) hours, p < 0.001). Ventilator settings and ventilation parameters were not different between the four groups, except for FiO2 which was higher in patients having an indication for and actually receiving prone positioning. Our data showed no difference in mortality at day 28 between the 4 groups (HR no indication, no prone vs. no indication, prone vs. indication, no prone vs. indication, prone: 1.05 (0.76–1.45) vs. 0.88 (0.62–1.26) vs. 1.15 (0.80–1.54) vs. 0.96 (0.73–1.26) (p = 0.08)). Factors associated with the use of prone positioning were ARDS severity and FiO2. The findings of this study are that prone positioning is often used in COVID-19 patients, even in patients that have no indication for this intervention. Sessions of prone positioning lasted long. Use of prone positioning may affect outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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25. High PEEP/low FiO 2 ventilation is associated with lower mortality in COVID-19.
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Goossen RL, van Vliet R, Bos LDJ, Buiteman-Kruizinga LA, Hollman MW, Myatra SN, Neto AS, Spronk PE, van der Woude MCE, van Meenen DMP, Paulus F, and Schultz MJ
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- Humans, Retrospective Studies, Male, Female, Middle Aged, Netherlands epidemiology, Aged, Intensive Care Units, SARS-CoV-2, Length of Stay statistics & numerical data, Respiration, Artificial methods, Respiration, Artificial statistics & numerical data, COVID-19 mortality, COVID-19 therapy, Positive-Pressure Respiration methods, Hospital Mortality, Respiratory Distress Syndrome therapy, Respiratory Distress Syndrome mortality
- Abstract
Rationale: The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO
2 ventilation on outcomes during the second wave in the Netherlands., Methods: Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality., Results: This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings., Conclusions: High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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26. Different ventilation intensities among various categories of patients ventilated for reasons other than ARDS--A pooled analysis of 4 observational studies.
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Serafini SC, van Meenen DMP, Pisani L, Neto AS, Ball L, de Abreu MG, Algera AG, Azevedo L, Bellani G, Dondorp AM, Fan E, Laffey JG, Pham T, Tschernko EM, Schultz MJ, and van der Woude MCE
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- Humans, Respiration, Artificial adverse effects, Intensive Care Units, Lung, Respiratory Distress Syndrome therapy, Respiratory Distress Syndrome etiology, Pneumonia, Sepsis therapy, Sepsis etiology
- Abstract
Purpose: We investigated driving pressure (ΔP) and mechanical power (MP) and associations with clinical outcomes in critically ill patients ventilated for reasons other than ARDS., Materials and Methods: Individual patient data analysis of a pooled database that included patients from four observational studies of ventilation. ΔP and MP were compared among invasively ventilated non-ARDS patients with sepsis, with pneumonia, and not having sepsis or pneumonia. The primary endpoint was ΔP; secondary endpoints included MP, ICU mortality and length of stay, and duration of ventilation., Results: This analysis included 372 (11%) sepsis patients, 944 (28%) pneumonia patients, and 2040 (61%) patients ventilated for any other reason. On day 1, median ΔP was higher in sepsis (14 [11-18] cmH
2 O) and pneumonia patients (14 [11-18]cmH2 O), as compared to patients not having sepsis or pneumonia (13 [10-16] cmH2 O) (P < 0.001). Median MP was also higher in sepsis and pneumonia patients. ΔP, as opposed to MP, was associated with ICU mortality in sepsis and pneumonia patients., Conclusions: The intensity of ventilation differed between patients with sepsis or pneumonia and patients receiving ventilation for any other reason; ΔP was associated with higher mortality in sepsis and pneumonia patients., Registration: This post hoc analysis was not registered; the individual studies that were merged into the used database were registered at clinicaltrials.gov: NCT01268410 (ERICC), NCT02010073 (LUNG SAFE), NCT01868321 (PRoVENT), and NCT03188770 (PRoVENT-iMiC)., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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27. Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)-Interim Analysis of DESIGNATION.
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Nijbroek SGLH, Hol L, Serpa Neto A, van Meenen DMP, Hemmes SNT, Hollmann MW, and Schultz MJ
- Abstract
Uncertainty remains about the best level of intraoperative positive end-expiratory pressure (PEEP). An ongoing RCT ('DESIGNATION') compares an 'individualized high PEEP' strategy ('iPEEP')-titrated to the lowest driving pressure (ΔP) with recruitment maneuvers (RM), with a 'standard low PEEP' strategy ('low PEEP')-using 5 cm H
2 O without RMs with respect to the incidence of postoperative pulmonary complications. This report is an interim analysis of safety and feasibility. From September 2018 to July 2022, we enrolled 743 patients. Data of 698 patients were available for this analysis. Hypotension occurred more often in 'iPEEP' vs. 'low PEEP' (54.7 vs. 44.1%; RR, 1.24 (95% CI 1.07 to 1.44); p < 0.01). Investigators were compliant with the study protocol 285/344 patients (82.8%) in 'iPEEP', and 345/354 patients (97.5%) in 'low PEEP' ( p < 0.01). Most frequent protocol violation was missing the final RM at the end of anesthesia before extubation; PEEP titration was performed in 99.4 vs. 0%; PEEP was set correctly in 89.8 vs. 98.9%. Compared to 'low PEEP', the 'iPEEP' group was ventilated with higher PEEP (10.0 (8.0-12.0) vs. 5.0 (5.0-5.0) cm H2 O; p < 0.01). Thus, in patients undergoing general anesthesia for open abdominal surgery, an individualized high PEEP ventilation strategy is associated with hypotension. The protocol is feasible and results in clear contrast in PEEP. DESIGNATION is expected to finish in late 2023.- Published
- 2023
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28. Hyperoxia-induced lung injury in acute respiratory distress syndrome: what is its relative impact?
- Author
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Lilien TA, van Meenen DMP, Schultz MJ, Bos LDJ, and Bem RA
- Subjects
- Humans, Oxygen, Respiration, Artificial adverse effects, Lung Injury, Hyperoxia complications, Respiratory Distress Syndrome etiology
- Abstract
Over the past decade, the interest in oxygen toxicity has led to various observational studies and randomized clinical trials in critically ill patients, assessing the association with outcomes and the potential benefit of restrictive oxygenation targets. Yet to date, no consensus has been reached regarding the clinical impact of hyperoxia and hyperoxemia. In this perspective article, we explore the experimental and clinical evidence on hyperoxia-induced lung injury (HILI) and assess its relative impact in current critical care practice, specifically in patients who require oxygen therapy due to acute respiratory distress syndrome (ARDS). Here, we suggest that in current clinical practice in the setting of ARDS HILI may actually be of less importance than other ventilator-related factors.
- Published
- 2023
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29. Optimal Dosing and Timing of High-Dose Corticosteroid Therapy in Hospitalized Patients With COVID-19: Study Protocol for a Retrospective Observational Multicenter Study (SELECT).
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Daenen K, Huijben JA, Boyd A, Bos LDJ, Stoof SCM, van Willigen H, Gommers DAMPJ, Moeniralam HS, den Uil CA, Juffermans NP, Kant M, Valkenburg AJ, Pillay J, van Meenen DMP, Paulus F, Schultz MJ, Dalm VASH, van Gorp ECM, Schinkel J, and Endeman H
- Abstract
Background: In hospitalized patients with COVID-19, the dosing and timing of corticosteroids vary widely. Low-dose dexamethasone therapy reduces mortality in patients requiring respiratory support, but it remains unclear how to treat patients when this therapy fails. In critically ill patients, high-dose corticosteroids are often administered as salvage late in the disease course, whereas earlier administration may be more beneficial in preventing disease progression. Previous research has revealed that increased levels of various biomarkers are associated with mortality, and whole blood transcriptome sequencing has the ability to identify host factors predisposing to critical illness in patients with COVID-19., Objective: Our goal is to determine the most optimal dosing and timing of corticosteroid therapy and to provide a basis for personalized corticosteroid treatment regimens to reduce morbidity and mortality in hospitalized patients with COVID-19., Methods: This is a retrospective, observational, multicenter study that includes adult patients who were hospitalized due to COVID-19 in the Netherlands. We will use the differences in therapeutic strategies between hospitals (per protocol high-dose corticosteroids or not) over time to determine whether high-dose corticosteroids have an effect on the following outcome measures: mechanical ventilation or high-flow nasal cannula therapy, in-hospital mortality, and 28-day survival. We will also explore biomarker profiles in serum and bronchoalveolar lavage fluid and use whole blood transcriptome analysis to determine factors that influence the relationship between high-dose corticosteroids and outcome. Existing databases that contain routinely collected electronic data during ward and intensive care admissions, as well as existing biobanks, will be used. We will apply longitudinal modeling appropriate for each data structure to answer the research questions at hand., Results: As of April 2023, data have been collected for a total of 1500 patients, with data collection anticipated to be completed by December 2023. We expect the first results to be available in early 2024., Conclusions: This study protocol presents a strategy to investigate the effect of high-dose corticosteroids throughout the entire clinical course of hospitalized patients with COVID-19, from hospital admission to the ward or intensive care unit until hospital discharge. Moreover, our exploration of biomarker and gene expression profiles for targeted corticosteroid therapy represents a first step towards personalized COVID-19 corticosteroid treatment., Trial Registration: ClinicalTrials.gov NCT05403359; https://clinicaltrials.gov/ct2/show/NCT05403359., International Registered Report Identifier (irrid): DERR1-10.2196/48183., (©Katrijn Daenen, Jilske A Huijben, Anders Boyd, Lieuwe D J Bos, Sara C M Stoof, Hugo van Willigen, Diederik A M P J Gommers, Hazra S Moeniralam, Corstiaan A den Uil, Nicole P Juffermans, Merijn Kant, Abraham J Valkenburg, Janesh Pillay, David M P van Meenen, Frederique Paulus, Marcus J Schultz, Virgil A S H Dalm, Eric C M van Gorp, Janke Schinkel, Henrik Endeman, PRoVENT- and PRoAcT-COVID Collaborative Group. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.06.2023.)
- Published
- 2023
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30. Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome: An analysis of three randomised clinical trials.
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van Meenen DMP, Algera AG, Schuijt MTU, Simonis FD, van der Hoeven SM, Neto AS, Abreu MG, Pelosi P, Paulus F, and Schultz MJ
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- Humans, Female, Middle Aged, Aged, Male, Netherlands, Respiratory Distress Syndrome diagnosis, Respiratory Distress Syndrome therapy
- Abstract
Background: The mechanical power of ventilation (MP) has an association with outcome in invasively ventilated patients with the acute respiratory distress syndrome (ARDS). Whether a similar association exists in invasively ventilated patients without ARDS is less certain., Objective: To investigate the association of mechanical power with mortality in ICU patients without ARDS., Design: This was an individual patient data analysis that uses the data of three multicentre randomised trials., Setting: This study was performed in academic and nonacademic ICUs in the Netherlands., Patients: One thousand nine hundred and sixty-two invasively ventilated patients without ARDS were included in this analysis. The median [IQR] age was 67 [57 to 75] years, 706 (36%) were women., Main Outcome Measures: The primary outcome was the all-cause mortality at day 28. Secondary outcomes were the all-cause mortality at day 90, and length of stay in ICU and hospital., Results: At day 28, 644 patients (33%) had died. Hazard ratios for mortality at day 28 were higher with an increasing MP, even when stratified for its individual components (driving pressure ( P < 0.001), tidal volume ( P < 0.001), respiratory rate ( P < 0.001) and maximum airway pressure ( P = 0.001). Similar associations of mechanical power (MP) were found with mortality at day 90, lengths of stay in ICU and hospital. Hazard ratios for mortality at day 28 were not significantly different if patients were stratified for MP, with increasing levels of each individual component., Conclusion: In ICU patients receiving invasive ventilation for reasons other than ARDS, MP had an independent association with mortality. This finding suggests that MP holds an added predictive value over its individual components, making MP an attractive measure to monitor and possibly target in these patients., Trial Registration: ClinicalTrials.gov Identifier: NCT02159196, ClinicalTrials.gov Identifier: NCT02153294, ClinicalTrials.gov Identifier: NCT03167580., (Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)
- Published
- 2023
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31. Association of Time-Varying Intensity of Ventilation With Mortality in Patients With COVID-19 ARDS: Secondary Analysis of the PRoVENT-COVID Study.
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Schuijt MTU, van Meenen DMP, Martin-Loeches I, Mazzinari G, Schultz MJ, Paulus F, and Serpa Neto A
- Abstract
Background: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID-19). We investigated the association of exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients. Methods: PRoVENT-COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID-19 patients under invasive ventilation for ARDS. Dynamic ΔP and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28-day mortality. To assess the effects of time-varying exposure, Bayesian joint models adjusted for confounders were used. Results: Of 1,122 patients included in the PRoVENT-COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in ΔP (HR 1.04, 95% CrI 1.01-1.07) and in MP (HR 1.12, 95% CrI 1.01-1.36). In sensitivity analyses, cumulative exposure to higher levels of ΔP or MP resulted in increased risks for 28-day mortality. Conclusion: Cumulative exposure to higher intensities of ventilation in COVID-19 patients with ARDS have an association with increased risk of 28-day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04346342., Competing Interests: AS reports personal fees from Dräger, outside of the submitted work. MaS reports personal fees from Hamilton and Xenios/Novalung, outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Schuijt, van Meenen, Martin–Loeches, Mazzinari, Schultz, Paulus and Serpa Neto.)
- Published
- 2021
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32. Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial.
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Harmon MBA, van Meenen DMP, van der Veen ALIP, Binnekade JM, Dankiewicz J, Ebner F, Nielsen N, Pelosi P, Schultz MJ, Horn J, Friberg H, and Juffermans NP
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- Aged, Australia epidemiology, Europe epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest physiopathology, Retrospective Studies, Survival Rate trends, Treatment Outcome, Body Temperature physiology, Hemodynamics physiology, Hypothermia, Induced methods, Out-of-Hospital Cardiac Arrest therapy, Respiration, Artificial methods, Rewarming methods
- Abstract
Aims: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings., Methods: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36). Mechanical ventilation data were obtained at three time points: 1) before TTM; 2) at the end of TTM (before rewarming) and 3) after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings., Results: Mechanical ventilation data was available for 567 of the 950 TTM patients. Of these, 81% was male with a mean (SD) age of 64 (12) years. At the end of TTM median tidal volume was 7.7 ml/kg predicted body weight (PBW)(6.4-8.7) and 60% of patients were ventilated with a tidal volume ≤ 8 ml/kg PBW. Median PEEP was 7.7cmH
2 O (6.4-8.7) and mean driving pressure was 14.6 cmH2 O (±4.3). The median FiO2 fraction was 0.35 (0.30-0.45). Multivariate analysis showed an independent relationship between increased respiratory rate and 28-day mortality. TTM33 resulted in lower end-tidal CO2 (Pgroup = 0.0003) and higher alveolar dead space fraction (Pgroup = 0.003) compared to TTM36, while PCO2 levels and respiratory minute volume were similar between groups., Conclusions: In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO2 levels and a higher alveolar dead space fraction compared to TTTM36., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2018
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