Anticipated response to prone position assessed with lung ultrasound.

Acute respiratory distress syndrome (ARDS) presents a challenge for clinicians due to its high morbidity and mortality. Prone position (PP) has been used as a therapeutic strategy in ARDS patients, demonstrating benefits in respiratory mechanics and gas exchange. In SARSCoV-2-related ARDS (C-ARDS), 80% of patients require PP to alleviate refractory hypoxemia.

Lung Ultrasound After COVID-19: A Pivotal Moment for Clinical Integration-Navigating Challenges and Seizing Opportunities.

Lung ultrasound (LUS) has emerged as a valuable bedside decision-making tool, particularly since the COVID-19 pandemic, with applications in diagnosing pneumonia, managing fluid, and monitoring interstitial lung diseases (ILDs) and acute respiratory distress syndrome (ARDS), ultimately improving patient outcomes. Its repeatability, environmental safety, and reduced radiation exposure make it ideal for vulnerable populations and resource-limited settings. However, challenges such as inadequate documentation and a lack of standardized reporting formats limit its widespread adoption.

Weaning failure from mechanical ventilation: a scoping review of the utility of ultrasonography in the weaning process.

Background: Weaning failure has been associated with increased hospital stay and higher mortality. Identification of the risk factors that may affect weaning outcome is paramount. Ultrasonography is an excellent tool for pulmonary and diaphragmatic monitoring during mechanical ventilation, allowing real-time evaluation of anatomical structures and function.

Debate on the Role of Eccentric Contraction of the Diaphragm: Is It Always Harmful?

The diaphragm is the primary muscle involved in the ventilatory pump, making it a vital component in mechanical ventilation. Various factors in patients who require mechanical ventilation can lead to the deterioration of the diaphragm, which is associated with increased mortality. This deterioration can arise from either excessive or insufficient support due to improper adjustment of ventilation programming variables.

Effectiveness of bundle of care on tolerance of awake-prone positioning in patients with acute respiratory failure. A multicenter observational study.

Purpose: This study aimed to assess the impact of a bundle of care strategy on the duration of awake prone positioning (AW-PP) and other key clinical outcomes in patients with acute respiratory failure (ARF) who require high-flow nasal oxygen (HFNO).

Methods: In this secondary analysis of a prospective, multicenter cohort study, we included patients admitted with COVID-19-related ARF who required HFNO. The protocol encouraged AW-PP for as long as possible.

Protocolized strategies to encourage early mobilization of critical care patients: challenges and success.

Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families.

Reverse triggering during mechanical ventilation: Diagnosis and clinical implications.

This review addresses the phenomenon of "reverse triggering", an asynchrony that occurs in deeply sedated patients or patients in transition from deep to light sedation. Reverse triggering has been reported to occur in 30-90% of all ventilated patients. The underlying pathophysiological mechanisms remain unclear, but "entrainment" is proposed as one of them.

The Predictive Validity of the Berlin Definition of Acute Respiratory Distress Syndrome for Patients With COVID-19-Related Respiratory Failure Treated With High-Flow Nasal Oxygen: A Multicenter, Prospective Cohort Study.

Objectives: The Berlin definition of acute respiratory distress syndrome (ARDS) was constructed for patients receiving invasive mechanical ventilation (IMV) with consideration given to issues related to reliability, feasibility, and validity. Notwithstanding, patients with acute respiratory failure (ARF) may be treated with high-flow nasal oxygen (HFNO) and may not fall within the scope of the original definition. We aimed to evaluate the predictive validity of the Berlin definition in HFNO-treated patients with COVID-19-related respiratory failure who otherwise met ARDS criteria.

[Advanced monitoring during weaning of invasive mechanical ventilation in single-lung transplantation].

Bilateral lung transplantation is the treatment of end-stage lung diseases. However, sometimes a single lung transplant is performed. The technique is not exempt from complications such as acute hyperinflation of the native lung and changes in the diaphragm, predisposing to atelectasis and respiratory failure that can lead to negative results.

Asynchronies during invasive mechanical ventilation: narrative review and update.

Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors.

Strategies to achieve adherence to prone positioning in awake COVID-19 patients with high-flow nasal oxygen. A case series.

Introduction: The use of high-flow nasal oxygen (HFNO) is a simple method that can reduce intubation in patients with hypoxemic acute respiratory failure (ARF). Early and prolonged prone position has demonstrated benefits on mortality in mechanically ventilated patients and on intubation in awake patients with ARF. However, strategies to achieve adherence to awake prone positioning (APP) have not been previously described.

High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19.

Background: The evidence regarding benefits of high-flow nasal cannula (HFNC) in patients with COVID-19 is controversial. The aim of this study was to evaluate the impact of HFNC in comparison with standard oxygen therapy on the frequency of endotracheal intubation at 28 d in subjects with acute hypoxemic respiratory failure (AHRF) secondary to SARS-CoV-2 infection.

Methods: A retrospective, age- and sex-matched-paired, cohort study was conducted in subjects with moderate-to-severe AHRF.

Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study.

Background: In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP.

[The "B-side" of the prone: axonal injury in patients with SARS-CoV-2].

The prone position for the treatment of hypoxemic acute respiratory failure in patients with severe COVID-19 pneumonia, who are critically ill and mechanically ventilated, is well documented. These cases provide information on the most frequent injury locations, severity, and prevalence in affected peripheral nerves, mostly involving the upper limb, as these injuries are not widely discussed in the literature. Furthermore, it is intended to be a starting point to provide intensive care units with a review of their prone application protocols.

The aftermath of the Fukushima nuclear accident: Measures to contain groundwater contamination.

Several measures are being implemented to control groundwater contamination at the Fukushima Daiichi Nuclear Plant. This paper presents an overview of work undertaken to contain the spread of radionuclides, and to mitigate releases to the ocean via hydrological pathways. As a first response, contaminated water is being held in tanks while awaiting treatment.

Managing Groundwater Radioactive Contamination at the Daiichi Nuclear Plant.

The Great East Japan Earthquake and tsunami of March 2011 severely damaged three reactors at the Fukushima Daiichi nuclear power station, leading to a major release of radiation into the environment. Groundwater flow through these crippled reactors continues to be one of the main causes of contamination and associated transport of radionuclides into the Pacific Ocean. In this context, a number of strategies are being implemented to manage radioactive pollution of the water resources at the nuclear plant site.