Noninvasive respiratory supports in ICU.

Background: Noninvasive respiratory supports are routinely applied in critically ill patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation, thereby reducing the risk of related complications, and to facilitate successful weaning from mechanical ventilation after extubation. They are also applied during the intubation procedure for preoxygenation with the aim of enhancing oxygenation and ensuring the safety of the procedure.

Main Body: High-flow nasal oxygen decreases airway dead space, provides a stable concentration of inspired oxygen, generates low level of flow-dependent positive airway pressure, and optimizes comfort.

Physiological comparison of noninvasive ventilation and high-flow nasal oxygen on inspiratory efforts and tidal volumes after extubation: a randomized crossover trial.

Background: Extubation failure leading to reintubation is associated with high mortality. In patients at high-risk of extubation failure, clinical practice guidelines recommend prophylactic non-invasive ventilation (NIV) over high-flow nasal oxygen (HFNO) immediately after extubation. However, the physiological effects supporting the beneficial effect of NIV have been poorly explored.

Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis.

Purpose: Predicting extubation failure remains a clinical challenge. This study aimed to determine diagnostic accuracy of models used at the bed side.

Methods: Post hoc analysis of 2341 patients at all risk included in five multicenter randomized trials.

Noise-sensitivity during sleep in non-sedated mechanically ventilated patients is associated with weaning duration: a polysomnographic study.

Background: Poor sleep is a major concern in intensive care units (ICUs), particularly in mechanically ventilated patients, because it is associated with longer duration of the weaning phase and higher mortality. High noise levels in ICUs are frequently reported by patients as one of the most disturbing sleep-disrupting factors but would be responsible for less than 20% of arousals. This suggests major inter-individual variability in noise sensitivity.

Effect of high-flow nasal cannula oxygen versus standard oxygen on mortality in patients with acute hypoxaemic respiratory failure: protocol for a multicentre, randomised controlled trial (SOHO).

Introduction: First-line oxygenation strategy in patients with acute hypoxaemic respiratory failure consists in standard oxygen or high-flow nasal oxygen therapy. Clinical practice guidelines suggest the use of high-flow nasal oxygen rather than standard oxygen. However, findings remain contradictory with a low level of certainty.

Oxygen therapy and noninvasive respiratory supports in acute hypoxemic respiratory failure: a narrative review.

Background: This narrative review was written by an expert panel to the members of the jury to help in the development of clinical practice guidelines on oxygen therapy.

Results: According to the expert panel, acute hypoxemic respiratory failure was defined as PaO < 60 mm Hg or SpO < 90% on room air, or PaO/FiO ≤ 300 mm Hg. Supplemental oxygen should be administered according to the monitoring of SpO, with the aim at maintaining SpO above 92% and below 98%.

Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure.

Background: Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population.

Methods: This was a secondary analysis of a multicenter, randomized, controlled trial.

Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome: A retrospective, observational cohort study.

Background: Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.

Challenges for a broad international implementation of the current severe community-acquired pneumonia guidelines.

Severe community-acquired pneumonia (sCAP) remains one of the leading causes of admission to the intensive care unit, thus consuming a large share of resources and is associated with high mortality rates worldwide. The evidence generated by clinical studies in the last decade was translated into recommendations according to the first published guidelines focusing on severe community-acquired pneumonia. Despite the advances proposed by the present guidelines, several challenges preclude the prompt implementation of these diagnostic and therapeutic measures.

CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma.

Background: One of the major challenges in managing allergic bronchopulmonary aspergillosis remains consistent and reproducible assessment of response to treatment.

Research Question: What are the most relevant changes in CT scan parameters over time for assessing response to treatment?

Study Design And Methods: In this ancillary study of a randomized clinical trial (NebuLamB), patients with asthma with available CT scan and without exacerbation during a 4-month allergic bronchopulmonary aspergillosis exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT scan parameters were assessed by systematic analyses of CT scan findings at initiation and end of treatment.

Physiologic Effects of Reconnection to the Ventilator for 1 Hour Following a Successful Spontaneous Breathing Trial.

Background: Reconnection to the ventilator for 1 h following a successful spontaneous breathing trial (SBT) may reduce reintubation rates compared with direct extubation. However, the physiologic mechanisms leading to this effect are unclear.

Research Question: Does reconnection to the ventilator for 1 h reverse alveolar derecruitment induced by SBT, and is alveolar derecruitment more pronounced with a T-piece than with pressure-support ventilation (PSV)?

Study Design And Methods: This is an ancillary study of a randomized clinical trial comparing SBT performed with a T-piece or with PSV.

Sex difference in the risk of extubation failure in ICUs.

Background: Little attention has been paid to potential differences in prognosis between mechanically ventilated males and females in intensive care units (ICUs). We hypothesized that a sex gap in the risk of extubation failure in ICUs may exist.

Methods: Post hoc analysis of a large-scale clinical trial including patients at high risk of extubation failure in ICUs, with the aim of assessing the risk of extubation failure according to sex.

A real-time automated sleep scoring algorithm to detect refreshing sleep in conscious ventilated critically ill patients.

Objectives: Due to the noisy environment, a very large number of patients admitted to intensive care units (ICUs) suffer from sleep severe disruption. These sleep alterations have been associated with a prolonged need for assisted ventilation or even with death. Sleep scoring in the critically ill is very challenging and requires sleep experts, limiting relevant studies to a few experienced teams.