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Management of Acute Respiratory Failure
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Management of Acute Respiratory Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (15 June 2021) | Viewed by 26898

Special Issue Editors

Prof. Dr. Nicolas Terzi

E-Mail Website
Guest Editor
CHU Grenoble Alpes, Intensive Care Unit, Grenoble, France
Interests: mechanical ventilation; acute respiratory failure; non-invasive ventilation; COPD; ARDS
Prof. Dr. Claude Guerin

E-Mail Website
Guest Editor
Medecine intensive réanimation, Hospital Édouard Herriot, Lyon, France
Interests: ARDS; ICU; acute respiratory distress; mechanical ventilation; physiology

Special Issue Information

Dear Colleagues,

Respiratory failure is a frequent disease process encountered in the emergency department. There is a significant need for improvement in the care of patients on mechanical ventilation. Moreover, non-invasive ventilation (NIV) is increasingly being used to treat episodes of acute respiratory failure in emergency departments. In recent decades, many studies have tried to better define the indication of NIV in the emergency department. High flow oxygen therapy has been developed firstly in intensive care units (ICU), but there is now also an increase in the use of this technique for cardiopulmonary edema and de novo acutre respiratory failure.

This special issue will describe the rationale and physiological advantages of each technique in various situations of respiratory failure. We will review recent improvements in the management of invasive mechanical ventilation for the most severe patients who receive ventilation in the emergency department.

Prof. Dr. Nicolas Terzi
Prof. Dr. Claude Guerin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • respiratory failure
  • mechanical ventilation
  • non-invasive ventilation (NIV)
  • high flow oxygen therapy
  • intensive care unit (ICU)
  • emergency department

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Published Papers (6 papers)

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Research

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7 pages, 2271 KiB  
Article
The eSpiro Ventilator: An Open-Source Response to a Worldwide Pandemic
by Nicolas Terzi, Fabrice Rastello, Christophe Déhan, Marion Roux, Florian Sigaud, Guillaume Rigault, Cyril Fromentin, Adrien Farrugia and Claude Guérin
J. Clin. Med. 2021, 10(11), 2336; https://doi.org/10.3390/jcm10112336 - 27 May 2021
Cited by 1 | Viewed by 2537
Abstract
Objective: To address the issue of ventilator shortages, our group (eSpiro Network) developed a freely replicable, open-source hardware ventilator. Design: We performed a bench study. Setting: Dedicated research room as part of an ICU affiliated to a university hospital. Subjects: We set the [...] Read more.
Objective: To address the issue of ventilator shortages, our group (eSpiro Network) developed a freely replicable, open-source hardware ventilator. Design: We performed a bench study. Setting: Dedicated research room as part of an ICU affiliated to a university hospital. Subjects: We set the lung model with three conditions of resistance and linear compliance for mimicking different respiratory mechanics of representative intensive care unit (ICU) patients. Interventions: The performance of the device was tested using the ASL5000 lung model. Measurements and Main Results: Twenty-seven conditions were tested. All the measurements fell within the ±10% limits for the tidal volume (VT). The volume error was influenced by the mechanical condition (p = 5.9 × 10−15) and the PEEP level (P = 1.1 × 10−12) but the clinical significance of this finding is likely meaningless (maximum −34 mL in the error). The PEEP error was not influenced by the mechanical condition (p = 0.25). Our experimental results demonstrate that the eSpiro ventilator is reliable to deliver VT and PEEP accurately in various respiratory mechanics conditions. Conclusions: We report a low-cost, easy-to-build ventilator, which is reliable to deliver VT and PEEP in passive invasive mechanical ventilation. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
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8 pages, 236 KiB  
Article
Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps
by Julie Pinczon, Nicolas Terzi, Pascal Usseglio-Polatera, Gaël Gheno, Dominique Savary, Guillaume Debaty and Vincent Peigne
J. Clin. Med. 2021, 10(7), 1359; https://doi.org/10.3390/jcm10071359 - 25 Mar 2021
Cited by 1 | Viewed by 1963
Abstract
Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in [...] Read more.
Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in a prehospital setting, where etiological diagnostics rely mainly on clinical examination. This observational multicenter retrospective study included all the patients treated with NIV by three mobile medical emergency teams in 2015. Prehospital diagnoses and hospital diagnoses were extracted from the medical charts. The appropriateness of NIV was determined by matching the hospital diagnosis to the current guidelines. Among the 14,067 patients screened, 172 (1.2%) were treated with NIV. The more frequent prehospital diagnoses were AcPE (n = 102, 59%), acute respiratory failure of undetermined cause (n = 46, 28%) and aeCOPD (n = 17, 10%). An accurate prehospital diagnosis was more frequent for AcPE (83/88, 94%) than for aeCOPD (14/32, 44%; p < 0.01). Only two of the 25 (8%) pneumonia cases were diagnosed during prehospital management. Prehospital NIV was inappropriate for 32 (21%) patients. Patients with inappropriate NIV had a higher rate of in-hospital intubation than patients with appropriate NIV (38% vs. 8%; p < 0.001). This high frequency of inappropriate NIV could be reduced by an improvement in the prehospital detection of aeCOPD and pneumonia. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
13 pages, 1152 KiB  
Article
Multistate Modeling of COVID-19 Patients Using a Large Multicentric Prospective Cohort of Critically Ill Patients
by Moreno Ursino, Claire Dupuis, Niccolò Buetti, Etienne de Montmollin, Lila Bouadma, Dany Golgran-Toledano, Stéphane Ruckly, Mathilde Neuville, Yves Cohen, Bruno Mourvillier, Bertrand Souweine, Marc Gainnier, Virginie Laurent, Nicolas Terzi, Shidasp Siami, Jean Reignier, Corinne Alberti, Jean-François Timsit and on behalf of the OUTCOMEREA Study Group
J. Clin. Med. 2021, 10(3), 544; https://doi.org/10.3390/jcm10030544 - 2 Feb 2021
Cited by 12 | Viewed by 3808
Abstract
The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We [...] Read more.
The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We analyzed a prospective French database that includes critically ill COVID-19 patients. A six-state multistate model was built and 17 transitions were analyzed either using a non-parametric approach or a Cox proportional hazard model. Corticosteroids and IL-antagonists (tocilizumab and anakinra) effects were evaluated using G-computation. We included 382 patients in the analysis: 243 patients were admitted to the ICU with non-invasive ventilation, 116 with invasive mechanical ventilation, and 23 with extracorporeal membrane oxygenation. The predicted 60-day mortality was 25.9% (95% CI: 21.8%–30.0%), 44.7% (95% CI: 48.8%–50.6%), and 59.2% (95% CI: 49.4%–69.0%) for a patient admitted in these three states, respectively. Corticosteroids decreased the risk of being invasively ventilated (hazard ratio (HR) 0.59, 95% CI: 0.39–0.90) and IL-antagonists increased the probability of being successfully extubated (HR 1.8, 95% CI: 1.02–3.17). Antiviral drugs did not impact any transition. In conclusion, we observed that the day-60 outcome in COVID-19 patients is highly dependent on the first ventilation state upon ICU admission. Moreover, we illustrated that corticosteroid and IL-antagonists may influence the intubation duration. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
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12 pages, 744 KiB  
Article
Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study
by Maja Kopczynska, Ben Sharif, Richard Pugh, Igor Otahal, Peter Havalda, Wojciech Groblewski, Ceri Lynch, David George, Jayne Sutherland, Manish Pandey, Phillippa Jones, Maxene Murdoch, Adam Hatalyak, Rhidian Jones, Robert M. Kacmarek, Jesús Villar, Tamas Szakmany and on behalf of the PANDORA-WALES Investigators
J. Clin. Med. 2020, 9(11), 3521; https://doi.org/10.3390/jcm9113521 - 31 Oct 2020
Cited by 8 | Viewed by 4773
Abstract
Background: We aimed to identify the prevalence of acute hypoxaemic respiratory failure (AHRF) in the intensive care unit (ICU) and its associated mortality. The secondary aim was to describe ventilatory management as well as the use of rescue therapies. Methods: Multi-centre prospective study [...] Read more.
Background: We aimed to identify the prevalence of acute hypoxaemic respiratory failure (AHRF) in the intensive care unit (ICU) and its associated mortality. The secondary aim was to describe ventilatory management as well as the use of rescue therapies. Methods: Multi-centre prospective study in nine hospitals in Wales, UK, over 2-month periods. All patients admitted to an ICU were screened for AHRF and followed-up until discharge from the ICU. Data were collected from patient charts on patient demographics, clinical characteristics, management and outcomes. Results: Out of 2215 critical care admissions, 886 patients received mechanical ventilation. A total of 197 patients met inclusion criteria and were recruited. Seventy (35.5%) were non-survivors. Non-survivors were significantly older, had higher SOFA scores and received more vasopressor support than survivors. Twenty-five (12.7%) patients who fulfilled the Berlin definition of acute respiratory distress syndrome (ARDS) during the ICU stay without impact on overall survival. Rescue therapies were rarely used. Analysis of ventilation showed that median Vt was 7.1 mL/kg PBW (IQR 5.9–9.1) and 21.3% of patients had optimal ventilation during their ICU stay. Conclusions: One in four mechanically ventilated patients have AHRF. Despite advances of care and better, but not optimal, utilisation of low tidal volume ventilation, mortality remains high. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
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13 pages, 2617 KiB  
Article
Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients
by Romain Jouffroy, Romain Kedzierewicz, Clement Derkenne, Kilian Bertho, Marine Scannavino, Benoit Frattini, Frederic Lemoine, Daniel Jost and Bertrand Prunet
J. Clin. Med. 2020, 9(9), 3025; https://doi.org/10.3390/jcm9093025 - 20 Sep 2020
Cited by 6 | Viewed by 3202
Abstract
Background: There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting. Methods: We [...] Read more.
Background: There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting. Methods: We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI). Results: We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12–0.41, p < 10−3) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85–0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; p < 10−3). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57–146.54; p < 10−3). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06–0.45; p < 10−3) and HI <3 (ORa, 51.08; 95% CI: 7.83–645.06; p < 10−3). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95–5.08; p < 10−3). Conclusion: An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
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Review

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13 pages, 1606 KiB  
Review
Patient-Self Inflicted Lung Injury: A Practical Review
by Guillaume Carteaux, Mélodie Parfait, Margot Combet, Anne-Fleur Haudebourg, Samuel Tuffet and Armand Mekontso Dessap
J. Clin. Med. 2021, 10(12), 2738; https://doi.org/10.3390/jcm10122738 - 21 Jun 2021
Cited by 69 | Viewed by 9423
Abstract
Patients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that [...] Read more.
Patients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that a ventilatory strategy to limit the risk of P-SILI can improve the outcome, the concept of P-SILI relies on sound physiological reasoning, an accumulation of clinical observations and some consistent experimental data. In this review, we detail the main pathophysiological mechanisms by which the patient’s respiratory effort could become deleterious: excessive transpulmonary pressure resulting in over-distension; inhomogeneous distribution of transpulmonary pressure variations across the lung leading to cyclic opening/closing of nondependent regions and pendelluft phenomenon; increase in the transvascular pressure favoring the aggravation of pulmonary edema. We also describe potentially harmful patient-ventilator interactions. Finally, we discuss in a practical way how to detect in the clinical setting situations at risk for P-SILI and to what extent this recognition can help personalize the treatment strategy. Full article
(This article belongs to the Special Issue Management of Acute Respiratory Failure)
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