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Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19

OBJECTIVES: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of oth...

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Autores principales: Pérez, Joaquin, Accoce, Matías, Dorado, Javier H., Gilgado, Daniela I., Navarro, Emiliano, Cardoso, Gimena P., Telias, Irene, Rodriguez, Pablo O., Brochard, Laurent
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461949/
https://www.ncbi.nlm.nih.gov/pubmed/37644972
http://dx.doi.org/10.1097/CCE.0000000000000968
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author Pérez, Joaquin
Accoce, Matías
Dorado, Javier H.
Gilgado, Daniela I.
Navarro, Emiliano
Cardoso, Gimena P.
Telias, Irene
Rodriguez, Pablo O.
Brochard, Laurent
author_facet Pérez, Joaquin
Accoce, Matías
Dorado, Javier H.
Gilgado, Daniela I.
Navarro, Emiliano
Cardoso, Gimena P.
Telias, Irene
Rodriguez, Pablo O.
Brochard, Laurent
author_sort Pérez, Joaquin
collection PubMed
description OBJECTIVES: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes. DESIGN: Retrospective cohort study. SETTING: Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina). PATIENTS: Subjects with arterial pressure of oxygen (AHRF to Fio(2) [Pao(2)/Fio(2)] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15–4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15–4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05–1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91–0.99]; p = 0.029), Pao(2)/Fio(2) (OR: 0.87; 95% CI [0.78–0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38–0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083). CONCLUSIONS: In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes.
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spelling pubmed-104619492023-08-29 Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19 Pérez, Joaquin Accoce, Matías Dorado, Javier H. Gilgado, Daniela I. Navarro, Emiliano Cardoso, Gimena P. Telias, Irene Rodriguez, Pablo O. Brochard, Laurent Crit Care Explor Observational Study OBJECTIVES: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes. DESIGN: Retrospective cohort study. SETTING: Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina). PATIENTS: Subjects with arterial pressure of oxygen (AHRF to Fio(2) [Pao(2)/Fio(2)] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15–4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15–4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05–1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91–0.99]; p = 0.029), Pao(2)/Fio(2) (OR: 0.87; 95% CI [0.78–0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38–0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083). CONCLUSIONS: In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes. Lippincott Williams & Wilkins 2023-08-25 /pmc/articles/PMC10461949/ /pubmed/37644972 http://dx.doi.org/10.1097/CCE.0000000000000968 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational Study
Pérez, Joaquin
Accoce, Matías
Dorado, Javier H.
Gilgado, Daniela I.
Navarro, Emiliano
Cardoso, Gimena P.
Telias, Irene
Rodriguez, Pablo O.
Brochard, Laurent
Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title_full Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title_fullStr Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title_full_unstemmed Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title_short Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19
title_sort failure of first transition to pressure support ventilation after spontaneous awakening trials in hypoxemic respiratory failure: influence of covid-19
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461949/
https://www.ncbi.nlm.nih.gov/pubmed/37644972
http://dx.doi.org/10.1097/CCE.0000000000000968
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