Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

Vetrugno, Luigi; Brussa, Alessandro; Guadagnin, Giovanni Maria; Orso, Daniele; Lorenzo, Francesco De; Cammarota, Gianmaria; Santangelo, Erminio; Bove, Tiziana

doi:10.1186/s13089-020-00160-z

Cited by 5 publications

(9 citation statements)

References 60 publications

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“…14 LU allows for the clinical progress of patients admitted to the intensive care unit (ICU) to be monitored (eg, by ultrasound profiling and the LU score) and can predict the probability of successful extubation (the possibility of heart and diaphragm involvement and their ultrasound evaluation are discussed below). 18,38,39 The LU strategy also may allow for the transfer of a patient from the ICU to departments with a lower level of patient care intensity.…”

Section: Roles Of Lu In Covid-19-positive Patients Within the Intensive Care Unitmentioning

confidence: 99%

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Guarracino

Vetrugno

Forfori

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.

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Section: Roles Of Lu In Covid-19-positive Patients Within the Intensive Care Unitmentioning

confidence: 99%

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Guarracino

Vetrugno

Forfori

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Combining LUS with cardiac and diaphragmatic ultrasound assessment has the potential to improve weaning failure prediction, providing insights into the origin of reduced pulmonary aeration [ 113 , 114 ]. A modified LUS assessment and diaphragmatic thickening assessment were associated with high predictive accuracy of successful extubation, with an AUC of 0.78 and 0.76, respectively, which increased up to 0.83 when considering both assessments together [ 112 ]; however, the relationship between LUS and diaphragm thickening during an SBT seems to vary according to the degree of pulmonary aeration [ 115 ], as well as to the considered subpopulation [ 116 ].…”

Section: Resultsmentioning

confidence: 99%

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Vetrugno

Mojoli

Cortegiani

et al. 2021

J Anesth Analg Crit Care

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Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

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“…Intra-abdominal conditions and acute kidney injury (AKI) have shown to worsen outcomes while liberating patients from MV. 22,39 Intra-abdominal hypertension, pneumoperitoneum, hemoperitoneum, abdominal trauma, pancreatitis, end-stage liver disease, liver transplantation can lead to ARDS. 22 As the pressure-volume curve shifts to the right since the compliance decreases from the upward deflection of the diaphragm's initial position; the respiratory workload increases and there is an increase in inspiratory pressures required to ventilate.…”

Section: Pathophysiology Of Weaning Failurementioning

confidence: 99%

“…22,39 Intra-abdominal hypertension, pneumoperitoneum, hemoperitoneum, abdominal trauma, pancreatitis, end-stage liver disease, liver transplantation can lead to ARDS. 22 As the pressure-volume curve shifts to the right since the compliance decreases from the upward deflection of the diaphragm's initial position; the respiratory workload increases and there is an increase in inspiratory pressures required to ventilate. 22 Furthermore, in comparison to patients without AKI, patients with AKI are less likely to wean and are prone to difficult liberation.…”

Section: Pathophysiology Of Weaning Failurementioning

confidence: 99%

“…22 As the pressure-volume curve shifts to the right since the compliance decreases from the upward deflection of the diaphragm's initial position; the respiratory workload increases and there is an increase in inspiratory pressures required to ventilate. 22 Furthermore, in comparison to patients without AKI, patients with AKI are less likely to wean and are prone to difficult liberation. 39 They are also more likely to have longer duration of MV in ICU and increased LOS in the ICU.…”

Section: Pathophysiology Of Weaning Failurementioning

confidence: 99%

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To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning

Akella

Voigt

Chawla

2022

J Intensive Care Med

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Since the inception of critical care medicine and artificial ventilation, literature and research on weaning has transformed daily patient care in intensive care units (ICU). As our knowledge of mechanical ventilation (MV) improved, so did the need to study patient-ventilator interactions and weaning predictors. Randomized trials have evaluated the use of protocol-based weaning (vs. usual care) to study the duration of MV in ICUs, different techniques to conduct spontaneous breathing trials (SBT), and strategies to eventually extubate a patient whose initial SBT failed. Despite considerable milestones in the management of multiple diseases contributing to reversible respiratory failure, in the application of early rehabilitative interventions to preserve muscle integrity, and in ventilator technology that mitigates against ventilator injury and dyssynchrony, major barriers to successful liberation from MV persist. This review provides a broad encompassing view of weaning classification, causes of weaning failure, and evidence behind weaning predictors and weaning modes.

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Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

Cited by 5 publications

References 60 publications

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning

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