Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support

Grieco, Domenico Luca; Menga, Luca Salvatore; Eleuteri, Davide; Antonelli, Massimo

doi:10.23736/s0375-9393.19.13418-9

Cited by 193 publications

(172 citation statements)

References 80 publications

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“…Taking into account both the effects of excessive ventilatory assistance on the risk of diaphragm dysfunction and the effects of insufficient ventilatory assistance on the risk of patient self-inflicted lung injury (40), the main objective of diaphragm function monitoring would be to closely tailor the appropriate level of assistance to the patient's needs and comfort. Some strategies designed to protect the lungs and mitigate the effects of diaphragm disuse have been proposed, but they now need to be tested before they can be generalized (41).…”

Section: What Are the Indications For Diaphragm Function Monitoring?mentioning

confidence: 99%

Monitoring diaphragm function in the ICU

Dres

Demoule

2020

Current Opinion in Critical Care

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This article reviews the clinical problem of diaphragm function in critically ill patients and describes recent advances in bedside monitoring of diaphragm function. Recent findings Diaphragm weakness, a consequence of diaphragm dysfunction and atrophy, is a common condition in the intensive care unit and is associated with serious clinical consequences. Bedside diaphragm function monitoring can now be performed by means of two approaches: diaphragm electrical activity and diaphragm ultrasound. The use of ultrasound to assess diaphragm structure (thickness, thickening) and mobility (caudal displacement) appears to be feasible and reproducible, but no large-scale "real-life" study is available. Diaphragm ultrasound can also be used to evaluate diaphragm muscle stiffness by means of shear wave elastography and strain by means of speckle tracking, both of which are correlated with diaphragm function in healthy subjects. Electrical activity of the diaphragm is correlated with diaphragm function during brief airway occlusion, but the repeatability of these measurements exhibits high within-subject variability.

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Section: What Are the Indications For Diaphragm Function Monitoring?mentioning

confidence: 99%

Monitoring diaphragm function in the ICU

Dres

Demoule

2020

Current Opinion in Critical Care

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“…This study started to raise concerns for potential harmful effects associated with FM-NIV, which were further supported by two large observational studies [18,19]. Potential mechanisms of harm attributable to FM-NIV as compared to HFNC include the poor tolerance of the face-mask interface, increased risk of patient-ventilator asynchrony, and the inability to limit tidal volumes leading to high transpulmonary pressures and ventilator-and patient-inflicted lung injury [20][21][22]. As a result, recent guidelines have expressed uncertainty regarding the use of FM-NIV for the treatment of de novo AHRF [7].…”

Section: (Continued From Previous Page)mentioning

confidence: 95%

“…The helmet interface may act to decrease air leaks when compared to the face mask interface. This may permit more effective delivery of higher levels of positive end-expiratory pressure potentially increasing alveolar recruitment and decreasing respiratory drive [2,8,22,27]. Furthermore, patients with AHRF seem to have better tolerance for a helmet interface minimizing the time that the therapy requires interruption-something not uncommon for FM-NIV [25].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis

et al. 2020

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Background: Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network metaanalysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure. Methods: We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology.(Continued on next page)

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“…Esta condição está associada à piora da evolução ventilatória e desenvolvimento de quadros de SDRA. 13 P-SILI resulta de esforços inspiratórios intensos e sustentados que levam a variações na pressão transpulmonar (lung stress), causando insuflação de grandes volumes de ar em um pulmão já inflamado, do aumento da pressão transvascular, favorecendo o desenvolvimento de edema pulmonar de pressão negativa e lesão diafragmática por fadiga. P-SILI é mais provável de acontecer em pacientes que se apresentem com insuficiência respiratória hipoxêmica moderada a grave (relação PO 2 /FiO 2 < 200).…”

Section: Critérios Para Admissão Em Utiunclassified

Manuseio do Paciente com COVID-19 em Unidade de Terapia Intensiva

Filho¹,

Maciel²,

Trindade³

et al. 2020

RCHSI

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A pandemia da COVID-19 trouxe um grande desafio para a equipe de unidade de terapia intensiva. Inicialmente pela grande quantidade de afluxo de pacientes, a falta de suprimentos gerou quadros mais severos de síndromes respiratórias agudas (SARS e outras) e mais longos nas unidades, em seguida os protocolos de não se por em risco a equipe laborativa e a falta de profissional qualificado para determinadas condições geradas pela doença, como a lesão renal aguda (LRA), criou um cenário estressante e desafiador para equipes médicas, para o doente e a família. Além disso, a falta de um conhecimento prévio sobre a doença colocou os médicos em posição de decisões para as quais ainda não havia literatura consubstanciada. Neste artigo tratamos desses desafios e das condutas relacionadas à necessidades geradas pela COVID-19 em UTIs principalmente no que concerne à ventilação mecânica.

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Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support

Cited by 193 publications

References 80 publications

Monitoring diaphragm function in the ICU

Monitoring diaphragm function in the ICU

Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis

Manuseio do Paciente com COVID-19 em Unidade de Terapia Intensiva

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