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Comparison of haemodynamic effects of noninvasive ventilation delivered via ResQGARD and CPAP boussignac masks

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Gaszyńska E., Roguszka K., Stankiewicz- Rudnicki M., Wieczorek A., Gaszyński T.
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vol. 85
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issue 3
129-132
EN
Noninvasive ventilation (NIV) is a technique of mechanical ventilation which does not require invasive airway management, i.e. intubation or tracheostomy. In emergency medicine Continuous Positive Airway Pressure (CPAP) is used often. A new method of NIV is Impedance Threshold Device (ITD). Breathing through an ITD is utilized to raise blood pressure in hypotensive patients. Aim of the study was to compare haemodynamic effects of NIV ITD and NIV CPAP. Material and methods. This study involved a group of 25 healthy volunteers. NIV was performed using ResQGARD ITD and CPAP Boussignac. Ventilation time was 25 minutes for each mask in each participant. Every three minutes parameters were collected: SpO2, BP and HR. There was a one hour interval in between ventilation with each mask. CPAP pressure was set at a level of 8 cm H2O and the mean inspiratory resistance of the ITD was 7cm H2O. Collected parameters were subjected to ANOVA statistical analysis. Results. Absolute comparison of BP, HR and SpO2 values did not reveal statistically significant differences between the masks. However considering blood pressure levels at entry, ventilation through an ITD significantly raised BP. Ventilation with NIV CPAP did not change significantly BP. Conclusion. Ventilation through an ITD device significantly improve haemodynamic function, whereas CPAP ventilation had no significant effect on it.
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Early or late tracheotomy in patients after multiple organ trauma

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Skrzypiec Ł., Rot P., Fus M., Witkowska A., Możański M., Jurkiewicz D.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 6
23-27
EN
Introduction: Prolonged mechanical ventilation in patients after multiple organ trauma is an indication for a tracheotomy procedure being performed i.a. to ensure proper hygiene of patient’s airways. Recommendations regarding the optimum timing for the procedure remain ambiguous. Procedures performed before post-operative day 10 are beneficial for the further course of the treatment and patient’s health. Aim: The main objective of the study was to analyze the relationship between the timing of tracheotomy and the length of mechanical ventilation in patients with multiple organ trauma. Secondary objectives included the assessment of the relationships between the timing of tracheotomy and the lengths of intensive care unit (ICU) stay and total hospitalization as well as the incidence of pneumonia and mortality. Material and methods: A retrospective analysis was carried out in 543 patients in whom tracheotomy had been performed at the Clinical Intensive Care Unit of the Military Institute of Medicine in years 2015–2019. Patients were divided into two groups: (1) those subjected to early tracheotomy (prior to hospitalization day 10); and (2) those subjected to late tracheotomy (at day 10 or later). Results: Duration of mechanical ventilation was shorter in patients subjected to early tracheotomy (by 20.3 days on average). The ICU stay and overall hospitalization lengths were also significantly shorter (by the average of 39.4 and 43.1 days, respectively). The mortality rate in patients subjected to early tracheotomy was lower (2%) than in those subjected to late tracheotomy (9%). Pneumonic complications were more common in patients subjected to tracheotomy at hospitalization day 10 or later. Conclusions: Tracheotomy performed within up to 10 days of hospitalization significantly shortens the lengths of mechanical ventilation, ICU stay, and total hospitalization while simultaneously reducing the risk of pneumonia. No correlation has been observed between the timing of tracheotomy and patient mortality rates.
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Extrathoracic negative pressure ameliorates lung injury during mechanical ventilation in experimental pigs

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Wessely-Szponder J., Szponder T., Fijalkowska-Nestorowicz A., Bobowiec R., Sobczyńska A., Wessely-Szponder J., Szponder T., Fijalkowska-Nestorowicz A., Bobowiec R., Sobczyńska A.
Polish Journal of Veterinary Sciences
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2018
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vol. 21
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issue 4
4
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Indirect calorimetry versus usual care: a retrospective cohort study

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Saseedharan S., Karanam R., Kadam V., Chiluka A., Mathew E.
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EN
INTRODUCTION: : This is a study evaluating the effect of Indirect calorimetry on the length of stay. The study comprises of the comparison between the use of indirect calorimetry versus usual care in critically ill mechanically ventilated patients with respect to the length of stay in the intensive care unit, and duration of time on ventilator. Patients were divided on basis of their nutrition risk to study the effect of Indirect calorimetry on the length of stay. MATERIAL AND METHODS: This was a retrospective cohort study of 166 mechanical ventilated patients in S .L Raheja Hospital. Data was collected from 83 patients who were mechanically ventilated between January 2019 and November 2019 on whom indirect calorimetry was used to measure energy requirements. This cohort was compared to 83 patients between January 2018 and November 2918 where the energy requirements were calculated with the use of predictive equations. Both groups were matched for age, sex, comorbidities, APACHE score and use of vasopressors. RESULTS: Significant difference in the sicker group of patients was seen in the Length of stay in the intensive care unit. (9.23 ± 8.14 vs. 11.52 ± 5.65, p = 0.0034) Patients at risk for malnutrition demonstrated reduced length of time on ventilation as compared to those not at risk. (10.2 ± 11.01 vs. 13 ± 5.87; p = 0.0042). CONCLUSIONS: The use of indirect calorimetry may be associated with a lower length of ICU stay among ventilated patients in a reasonably sick group of mixed surgical patients.
PL
WSTĘP: Badanie ocenia wpływ kalorymetrii pośredniej na długość hospitalizacji. Badanie polega na porównaniu zastosowania kalorymetrii pośredniej i zwykłej opieki u krytycznie chorych wentylowanych mechanicznie pacjentów pod względem długości pobytu na oddziale intensywnej terapii i czasu pod respiratorem. Pacjentów podzielono na podstawie ryzyka żywieniowego, aby zbadać wpływ kalorymetrii pośredniej na długość pobytu. MATERIAŁ I METODY: Było to retrospektywne badanie kohortowe 166 pacjentów wentylowanych mechanicznie w szpitalu S.L Raheja. Dane zebrano od 83 pacjentów wentylowanych mechanicznie między styczniem 2019 a listopadem 2019, u których zastosowano kalorymetrię pośrednią do pomiaru zapotrzebowania na energię. Kohortę tę porównano z 83 pacjentami w okresie od stycznia 2018 do listopada 2918 roku, u których zapotrzebowanie na energię obliczono za pomocą równań predykcyjnych. Obie grupy dobrano pod względem wieku, płci, chorób współistniejących, wyniku w skali APACHE i stosowania leków wazopresyjnych. WYNIKI: Istotną różnicę w grupie chorych z cięższą chorobą zaobserwowano w długości pobytu na oddziale intensywnej terapii (9,23 ± 8,14 vs. 11,52 ± 5,65, p = 0,0034). Pacjenci zagrożeni niedożywieniem wykazywali krótszy czas wentylacji w porównaniu z osobami bez ryzyka (10,2 ± 11,01 vs. 13 ± 5,87; p = 0,0042). WNIOSKI: Zastosowanie kalorymetrii pośredniej może wiązać się z krótszym czasem pobytu na OIT wśród pacjentów wentylowanych w grupie o umiarkowanym przebiegu chirurgii mieszanej.
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