BackgroundCatheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. “Mechanical insufflation-exsufflation” exerts positive pressure, followed by an abrupt drop to negative pressure. Potential advantages of this technique are aspiration of distal airway secretions, avoiding trauma, and improving tolerance.MethodsWe applied insufflation of 50 cmH2O for 3 s and exsufflation of − 45 cmH2O for 4 s in patients with an endotracheal tube or tracheostomy cannula requiring secretion suctioning. Cycles of 10 to 12 insufflations-exsufflations were performed and repeated if secretions were aspirated and visible in the proximal artificial airway. Clinical and laboratory parameters were collected before and 5 and 60 min after the procedure. Subjects were followed during their ICU stay until discharge or death.ResultsMechanical insufflation-exsufflation was applied 26 times to 7 male and 6 female subjects requiring suctioning. Mean age was 62.6 ± 20 years and mean Apache II score 23.3 ± 7.4 points. At each session, a median of 2 (IQR 1; 2) cycles on median day of intubation 11.5 (IQR 6.25; 25.75) were performed. Mean insufflation tidal volume was 1043.6 ± 649.9 ml. No statistically significant differences were identified between baseline and post-procedure time points. Barotrauma, desaturation, atelectasis, hemoptysis, or other airway complication and hemodynamic complications were not detected. All, except one, of the mechanical insufflation-exsufflation sessions were productive, showing secretions in the proximal artificial airway, and were well tolerated.ConclusionsOur preliminary data suggest that mechanical insufflation-exsufflation may be safe and effective in patients with artificial airway. Safety and efficacy need to be confirmed in larger studies with different patient populations.Trial registrationEudraCT 2017-005201-13 (EU Clinical Trials Register).

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Introduction LUNG INJURY COVID-19 (clinicaltrials.gov NCT 21/399-E) is a registry-based prospective observational cohort study to evaluate long-term outcomes and recovery 12 months after SARS-CoV-2 infection according to severity. Results 305 COVID-19 survivors were included (moderate: 162, severe: 143). 12 months after SARS-CoV-2 infection, there was resolution of respiratory symptoms (37.9% in severe versus 27.3% in moderate pneumonia; p = 0.089). Exertional dyspnea was present (20% in severe vs 18.4% in moderate, p = 0.810). Abnormalities in chest radiology imaging were detected in severe COVID-19 infection versus moderate infection (29% versus 8.8%; p <0.001). Pulmonary function testing (forced spirometry or diffusion) performed at 12 months of mean follow-up according to protocol detected anomalies in 31.4% of patients with severe COVID-19 courses and in 27.7% of moderate patients. Risk factors associated with diffusion impairment at 12 months were age (OR: 1.05, 95% CI: 1.01-1.10, p = 0.008), FEV1% predicted at follow-up (OR: 0.96, 95% CI: 0.93-0.99, p = 0.017) and dyspnea score at follow-up (OR: 3.16, 95% CI: 1.43-6.97, p = 0.004). CT scans performed at 12 months of mean follow-up showed evidence of fibrosis in almost half of patients with severe COVID-19 courses, who underwent CT according to protocol. Conclusions At 12 months from infection onset, most patients refer to symptoms, particularly muscle weakness and dyspnea, and almost one third of patients with severe COVID-19 pneumonia had impaired pulmonary diffusion and abnormalities in chest radiology imaging. These results emphasize the importance of a systematic follow-up after severe COVID-19, with appropriate management of pulmonary sequelae.

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PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS ) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs . 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.