Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF)

Quintard, Hervé; L’Her, Erwan; Pottecher, Julien; Adnet, Frédéric; Constantin, Jean-Michel; Jong, Audrey De; Diemunsch, Pierre; Fesseau, Rose; Freynet, Anne; Girault, Christophe; Guitton, Christophe; Hamonic, Yann; Maury, Éric; Mekontso-Dessap, Armand; Michel, Fabrice; Nolent, Paul; Parratte, Sébastien; Prat, Gwénaël; Roquilly, Antoine; Tazarourte, Karim; Terzi, Nicolas; Thille, Arnaud W.; Alves, Mikael; Gayat, Étienne; Donetti, L.

doi:10.1186/s13613-019-0483-1

Cited by 96 publications

(64 citation statements)

References 16 publications

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“…At the end of surgery, all patients were sedated and the lungs were mechanically ventilated until haemodynamic stability and normothermia were obtained and blood loss was considered acceptable (less than 1 ml kg − 1 h − 1 ). Tracheal extubation was done according to the French guidelines [19]. Patients were managed by a team of physicians trained in postoperative cardiac surgical care which included a cardiologist.…”

Section: Methodsmentioning

confidence: 99%

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

et al. 2019

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Background No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. Methods After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). Results One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p = 0.037). Conclusion The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. Trial registration This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.

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Section: Methodsmentioning

confidence: 99%

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

et al. 2019

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“…In the intensive care unit (ICU), spontaneous breathing trials (SBTs) are used to assess the patient’s readiness for liberation from the ventilator [ 2 ], and extubation is deemed successful if mechanical assistance is not needed for 48 hours after removal of the endotracheal tube [ 3 ]. Extubation is the culmination of the weaning process, and the decision to extubate is usually based on objective parameters demonstrating the patient’s ability to maintain respiratory needs without the aid of a respiratory prosthesis and a mechanical ventilator [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several parameters have been used to predict the patient’s fitness for weaning from mechanical ventilation and extubation [ 4 ]. However, no single parameter can reflect the status of different organs and systems; respiratory parameters alone will not suffice because the factors determining success of weaning are complex and diverse, and vary from patient to patient [ 3 ]. Different multifactor scores and indices have been created for this purpose [ 10 – 12 ], but none of them can differentiate prediction of weaning success (success in SBT) from extubation success (removal of the endotracheal tube and absence of mechanical assistance for 48 hours); such differentiation is essential, given the differences in the pathophysiology of weaning failure versus extubation failure [ 1 ], and the clinical implications, since patient who failed the weaning, back to the IMV, rest for at least 24 hours, and then, can be submitted to another SBT, while extubation failure decisively impact the patients’ prognosis [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of extubation outcome in mechanically ventilated patients: Development and validation of the Extubation Predictive Score (ExPreS)

Baptistella

Mantelli

Matte³

et al. 2021

PLoS ONE

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Despite the best efforts of intensive care units (ICUs) professionals, the extubation failure rates in mechanically ventilated patients remain in the range of 5%–30%. Extubation failure is associated with increased risk of death and longer ICU stay. This study aimed to identify respiratory and non-respiratory parameters predictive of extubation outcome, and to use these predictors to develop and validate an “Extubation Predictive Score (ExPreS)” that could be used to predict likelihood of extubation success in patients receiving invasive mechanical ventilation (IMV). Derivation cohort was composed by patients aged ≥18 years admitted to the ICU and receiving IMV through an endotracheal tube for >24 hours. The weaning process followed the established ICU protocol. Clinical signs and ventilator parameters of patients were recorded during IMV, in the end phase of weaning in pressure support ventilation (PSV) mode, with inspiratory pressure of 7 cm H2O over the PEEP (positive end expiratory pressure). Patients who tolerated this ventilation were submitted to spontaneous breathing trial (SBT) with T-tube for 30 minutes. Those who passed the SBT and a subsequent cuff-leak test were extubated. The primary outcome of this study was extubation success at 48 hours. Parameters that showed statistically significant association with extubation outcome were further investigated using the receiver operating characteristics (ROC) analysis to assess their predictive value. The area under the curve (AUC) values were used to select parameters for inclusion in the ExPreS. Univariable logistic regression analysis and ROC analysis were performed to evaluate the performance of ExPreS. Patients’ inclusion and statistical analyses for the prospective validation cohort followed the same criteria used for the derivation cohort and the decision to extubate was based on the ExPreS result. In the derivation cohort, a total of 110 patients were extubated: extubation succeeded in 101 (91.8%) patients and failed in 9 (8.2%) patients. Rapid shallow-breathing index (RSBI) in SBT, dynamic lung compliance, duration of IMV, muscle strength, estimated GCS, hematocrit, and serum creatinine were significantly associated with extubation outcome. These parameters, along with another parameter—presence of neurologic comorbidity—were used to create the ExPreS. The AUC value for the ExPreS was 0.875, which was higher than the AUCs of the individual parameters. The total ExPreS can range from 0 to 100. ExPreS ≥59 points indicated high probability of success (OR = 23.07), while ExPreS ≤44 points indicated low probability of success (OR = 0.82). In the prospective validation cohort, 83 patients were extubated: extubation succeeded in 81 (97.6%) patients and failed in 2 (2.4%) patients. The AUC value for the ExPreS in this cohort was 0.971. The multiparameter score that we propose, ExPreS, shows good accuracy to predict extubation outcome in patients receiving IMV in the ICU. In the prospective validation, the use of ExPreS decreased the extubation failure rate from 8.2% to 2.4%, even in a cohort of more severe patients.

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“…Una de ellas, es la protección del personal que reduzca la exposición viral. En la actualidad, existe un amplio asesoramiento que se actualiza periódicamente sobre la prevención y el control de infecciones relacionadas con COVID- 19.…”

Section: ) Infección Por Virus Sars-cov-2unclassified

Manejo de la vía aérea en el perioperatorio de los pacientes infectados con COVID-19

Carrillo-Esper¹,

Mejía-Gómez²,

Sánchez-Rosendo³

et al. 2020

Revista Mexicana De Anestesiología

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Se estima que el COVID-19 tiene una tasa de letalidad del 2%, la cual es menor que la del síndrome respiratorio agudo grave (SARS, por sus siglas en ingles) (10%) y que la del síndrome respiratorio de oriente medio (MERS, por sus siglas en inglés), pero es significativamente más alta que el virus de la influenza H1N1 (0.026%). No se tiene certeza aún del período de incubación, pero, según los datos de la OMS, es de dos a 10 días en promedio. De allí, las presentaciones típicas serán de cuatro a siete días antes del inicio de los síntomas. Se tiene reportado un caso que sugiere que la transmisión puede ocurrir durante el período INTRODUCCIÓN A finales del mes de diciembre de 2019, se presentó en la ciudad de Wuhan, una provincia de Hubei en China, el brote de una neumonía viral que es consecuencia de un nuevo tipo de coronavirus B, el cual fue denominado como COVID-19 (acrónimo del inglés coronavirus disease); posteriormente, de manera oficial, se declarará al virus como SARS-Cov-2. Este coronavirus, a la fecha, se ha convertido en una pandemia y en una emergencia de salud a nivel mundial según lo declarado por la Organización Mundial de la Salud (1) .

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Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF)

Cited by 96 publications

References 16 publications

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Prediction of extubation outcome in mechanically ventilated patients: Development and validation of the Extubation Predictive Score (ExPreS)

Manejo de la vía aérea en el perioperatorio de los pacientes infectados con COVID-19

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