scholarly journals Adult Pulmonary Intensive and Intermediate Care Units: The Italian Thoracic Society (ITS-AIPO) Position Paper

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Teresa Renda ◽  
Raffaele Scala ◽  
Antonio Corrado ◽  
Nicolino Ambrosino ◽  
Adriano Vaghi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Ventilatory Support ◽  
Position Paper ◽  
Intermediate Care ◽  
Pulmonary Dysfunction ◽  
Non Invasive ◽  
Step Down ◽  
Operating Methods

The imbalance between the prevalence of patients with acute respiratory failure (ARF) and acute-on-chronic respiratory failure and the number of intensive care unit (ICU) beds requires new solutions. The increasing use of non-invasive respiratory tools to support patients at earlier stages of ARF and the increased expertise of non-ICU clinicians in other types of supportive care have led to the development of adult pulmonary intensive care units (PICUs) and pulmonary intermediate care units (PIMCUs). As in other European countries, Italian PICUs and PIMCUs provide an intermediate level of care as the setting designed for managing ARF patients without severe non-pulmonary dysfunction. The PICUs and PIMCUs may also act as step-down units for weaning patients from prolonged mechanical ventilation and for discharging patients still requiring ventilatory support at home. These units may play an important role in the on-going coronavirus disease 2019 pandemic. This position paper promoted by the Italian Thoracic Society (ITS-AIPO) describes the models, facilities, staff, equipment, and operating methods of PICUs and PIMCUs.

scholarly journals Relationship between functional independence and grip strength in adult patients treated at intermediate care

2020 ◽  
Vol 27 (4) ◽  
pp. 399-404
Author(s):  
Lina Margarita Rentería-Sierra ◽  
Geraldine Hernández-Zorrilla ◽  
Esther Cecilia Wilches-Luna
Keyword(s):  
Intensive Care ◽  
Grip Strength ◽  
Handgrip Strength ◽  
Ventilatory Support ◽  
Functional Independence ◽  
Adult Patients ◽  
Intermediate Care ◽  
Positive Correlation ◽  
Non Invasive ◽  
The One

ABSTRACT Patients that leave intensive care for intermediate care present compromised muscle strength and functionality. In this context, our main objective was to describe the correlation between functional independence and handgrip strength in adult patients at intermediate care unit (IMCU). This was an analytical, correlational, and prospective study that compared patients admitted to IMCU after a stay of more than 24 hours in intensive care, with invasive or non-invasive ventilatory support. We used Barthel index (BI) and hand dynamometry at admission/discharge from IMCU. In total, 69 patients were included, 62.3% were men, with an average age of 63 years and a stay in intermediate care of five days. On admission to IMCU, 31.9% had complete dependence and 66.7% severe dependence. The most compromised categories were "bathroom use" and "stairs". On the other hand, "dressing" was the one with the greatest improvement (admission 24.6%, discharge 82.5%). A positive correlation [(r=0.4) and (p=0.000)] was identified between functionality and grip strength at admission and was maintained at discharge [(r=0.6) and (p=0.000)]. We identified a positive correlation between BI scores and handgrip strength, remaining stronger at IMCU discharge.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

scholarly journals A prospective cohort study of thoracic ultrasound in acute respiratory failure: the C3PO protocol

JRSM Open ◽  
2017 ◽  
Vol 8 (5) ◽  
pp. 205427041769505 ◽  
Author(s):  
Peter D Wallbridge ◽  
Simon A Joosten ◽  
Liam M Hannan ◽  
Daniel P Steinfort ◽  
L Irving ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Clinical Diagnosis ◽  
Prospective Cohort ◽  
Clinical Utility ◽  
Intermediate Care ◽  
Diagnostic Confidence ◽  
Thoracic Ultrasound

Objectives This study was performed to assess the clinical utility of a standardised thoracic ultrasound examination when added to standard care in patients with acute respiratory failure admitted to an intermediate care unit. This study aimed to assess the impact on clinical diagnosis, clinician confidence and management. Ultrasound has been shown to have utility in patients admitted to intensive care and emergency; however, utility in a ward setting is unknown. Design Prospective cohort study. Setting Tertiary hospital in Melbourne, Australia. Participants 50 patients with acute respiratory failure requiring admission to an intermediate care unit. Main outcome measures (1) Change in clinical diagnosis or additional clinical diagnosis following thoracic ultrasound. (2) Change in diagnostic confidence following thoracic ultrasound. (3) Change to management following thoracic ultrasound. Results In 34% of patients, ultrasound detected unexpected findings that changed or added to the clinical diagnosis. Diagnostic confidence was increased in 44%, and the treating clinician altered the management plan in 30% as a result of the ultrasound. Ultrasound was particularly useful in clarifying the diagnosis in patients with multiple initial diagnoses, reducing to a single diagnosis in 69%. Conclusions Thoracic ultrasound has clinical utility in non-intubated adults with acute respiratory failure managed outside intensive care settings. It changed aetiological diagnosis, increases diagnostic confidence and altered clinical management in one out of three patients scanned. Our results suggest extended utility of thoracic ultrasound in acute respiratory failure to a broader context outside the intensive care unit population.

scholarly journals Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

2020 ◽  
Vol 15 ◽  
Author(s):  
Valentina Di Lecce ◽  
Giovanna Elisiana Carpagnano ◽  
Paola Pierucci ◽  
Vitaliano Nicola Quaranta ◽  
Federica Barratta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
Non Invasive ◽  
Baseline Characteristics ◽  
Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

scholarly journals PERSONALIZED INTENSIVE CARE OF CARDIOVASCULAR DISORDERS IN CHILDREN WITH RESPIRATORY FAILURE

2020 ◽  
Vol 117 (3) ◽  
pp. 46-57
Author(s):  
Olha Filyk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Stroke Index ◽  
Cardiovascular Dysfunction ◽  
Non Invasive ◽  
Group I ◽  
Hemodynamic Assessment ◽  
Group Ii

This article presents data on the frequency of incidence and duration of cardiovascular dysfunction in children with acute respiratory failure. The information on expediency of carrying out of personalized hemodynamic management in case of its insufficiency with use of multiparametric approach to estimate haemodynamic data are presented. The aim of the study was to compare the effectiveness of the standard approach and proposed by us additions to treatment of haemodynamic disorders in children with respiratory failure. It was summarized from the literature reviews that the presence and maintenance of patient`s spontaneous breathing pattern with use of non-invasive estimated cardiovascular monitoring, evaluation of preload with ultrasonography and reassessment of rate and volume of fluid replacement with taking into account solution`s composition might improve treatment results in children with acute respiratory failure. We conducted a prospective single-center non-interventional cohort study in children with acute respiratory failure 1 month - 18 years old. Patients were randomly divided into I and II groups. The data analysis included 43 patients of group I, who received conventional for this intensive care unit monitoring and treatment and 53 patients of group II, in whom we took into account the results of multiparametric monitoring during the correction of hemodynamics.Monitoring of hemodynamics included heart rate, non-invasive systolic, diastolic and mean blood pressure capillary refill time and presence of peripheral arteries pulsation with clinical verification of "warm" or "cold" shock, ScvO2 and lactate levels in the central venous blood; non-invasive estimated monitoring of stroke volume, cardiac output, cardiac index, stroke index using the esCCO technology, NIHON COHDEN (Japan) and the ratio of inferior vena cava diameter at inspiration and exhalation. Hemodynamic support in groups I and II included early goal-directad therapy, individualized and personalized treatment. In II group of patients there were taken into account the dynamics of changes of non-invasive esCCO data about stroke volume, cardiac output, cardiac index and stroke index, cumulative hydrobalance and the ratio of the of inferior vena cava diameter at inspiration and exhalation. Early goal-directed therapy was aimed to (supra) normalize of blood flow and was based on normal hemodynamic data for population, according to percentiles for specific age groups of patients. Individualized hemodynamic therapy included functional hemodynamic monitoring with assessment of to volemic therapy answer, individualization of target points and maximization of blood flow. Personalized hemodynamic management consisted of applying an adaptive multiparametric approach to hemodynamic assessment. Spontaneous diaphragmatic activity was maintained along all time of mechanical ventilation. The primary endpoint was 28-day mortality rate; secondary endpoints were the duration of cardiovascular dysfunction and the duration of intensive care unit stay. To assess age-dependent data, patients were divided into age subgroups: 1st subgroup - children 1 month - 1 year old; 2nd subgroup - children 1 - 3 years old; 3rd subgroup - children 3 - 6 years old; 4th subgroup - children 6 - 12 years old; 5th subgroup - children 12 - 18 years old. It was determined that the level of 28-day mortality was: in 1st age subgroup - 18.2% in group I and 3.1% in group II (p = 0.02), in the 2nd age subgroup - 11.1% and 0%, respectively (p = 0.11); in the 4th age subgroup - 10% and 0%, respectively (p = 0.28); in the 3rd and 5th age subgroups - was 0% in I and II groups. The prevalence of hemodynamic disorders was: in 1st age subgroup in patients of group I - 100%, while in group II - 62.5% (p = 0.001); in 2nd age subgroup - 55.6% in patients from group I and 42.9% in patients from group II (p = 0.05); in 3rd age subgroup in 100% of patients of group II and only in 75% of patients of group I (p = 0.02). In the 4th age subgroup no significant differences were found between I (30% of patients) and II groups (25% of patients), p = 0.28; in 5th age subgroup the frequency of cardiovascular dysfunction was 40% in group I, compared with 75% in group II (p = 0.008). It was found that duration of hemodynamic insufficiency was longer in patients of 1st and 4th age subgroups, and relatively shorter in patients of 5th age subgroup: in the 1st age subgroup it was 7.6 ± 0.5 days in group I and 8.8 ± 0.9 days in group II (p> 0.05); in 4th age subgroup - 6.7 ± 0.4 days in group I and 10.1 ± 1.2 days in group II (p> 0.05), while in 5th age subgroup - 4.1 ± 0.3 days in group I and 4.7 ± 0.5 days in group II (p> 0.05). We found that there were significant differences in the duration of stay in intensive care unit among patients of the 1st and 5th age subgroups. Specifically, in 1st age subgroup this indicator was in 1.3 times less in group II, compared with group I (p <0.05); in 5th age subgroup the situation was the opposite- the duration of intensive care unit stay in group II was in 1.4 times more in group I (p <0.05). Thus, obtained data demonstrated the results of the use of personalized management of hemodynamic disorders in children with acute respiratory failure. The use of a multiparametric approach to hemodynamic assessment in clinical practice may allow more differentiated use of volume replacement therapy as loop diuretics and will have a beneficial effect on the final clinical outcomes in patients with acute respiratory failure.

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

2020 ◽  
Vol 37 (S 02) ◽  
pp. S10-S13
Author(s):  
Ilia Bresesti ◽  
Gianluca Lista
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Medical Emergency ◽  
High Frequency Ventilation ◽  
Pulmonary Mechanics

Acute respiratory infections are very common medical emergency in early infancy, often requiring hospitalization. The most frequent respiratory infection at this stage of life is bronchiolitis, with a benign course in the majority of cases. However, especially during neonatal period, infants are at higher risk for developing complications, and ventilatory support of various degrees is needed. The two most widespread methods to provide noninvasive respiratory support are heated humidified high-flow nasal cannula and nasal continuous positive airway pressure. They are both used in neonatal intensive care unit to treat respiratory distress syndrome of the premature infants, and the main concept of recruiting and distending alveoli is valid also for respiratory failure occurring during bronchiolitis. However, there is still ongoing debate about the superiority of one method, and their real efficacy still need to be confirmed. Once respiratory failure does not respond to noninvasive ventilation, more intensive care must be provided in the form of conventional mechanical ventilation or high-frequency ventilation. There is currently no evidence of the optimal ventilation strategy to use, and a deeper comprehension of the pulmonary mechanics during bronchiolitis would be desirable to tailor ventilation according to the degree of severity. Further research is then urgently needed to better clarify these aspects. Key Points

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