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. These asynchronies can lead the patient to worst outcomes; because of that is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and in intensive care and improve clinical results.

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 […] ABSTRACT 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 […]

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. We performed a scoping review to highlight the usefulness and limitations of ultrasonography as a tool for detecting weaning failure. The Joanna Briggs Institute recommendations, the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist, and the methodological framework by Arksey and O'Malley were followed. We searched PubMed, Scopus, and Cochrane databases for observational and randomised studies published from inception to August 12, 2024. Inclusion criteria were articles written in English, intensive care unit setting, mechanical ventilation, adults, and those that described a measure for burden of weaning failure using ultrasonography. The search revealed 3573 records. After removal of duplicates, 3117 articles were screened for potential inclusion, of which 89 articles were finally included. These comprised six clinical trials, 80 observational prospective studies, and three retrospective studies. In total, 6841 subjects were included, with a weaning failure rate of 28.2%. The parameters most associated with weaning failure were higher ratio of early diastolic mitral inflow velocity to early diastolic septal mitral annulus velocity, diaphragmatic excursion, diaphragm thickening fraction, diaphragmatic rapid shallow breathing index, ratio between ventilatory frequency, diaphragmatic displacement, excursions, and contraction velocity on coughing. Loss of aeration, pulmonary oedema, and pleural effusion detected with ultrasound were associated with weaning failure and airway obstruction caused by post-extubation laryngeal oedema. Ultrasound represents a valuable tool for optimising the weaning process. It enables precise assessment of lung function and diaphragmatic performance, underscoring the need for its implementation in ICU setting.

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. Intervention group was treated with HFNC, and control group was treated with standard oxygen therapy. Baseline characteristics and clinical evolution were analyzed. Mantel-Haenszel test was used for categorical variables. Paired samples Wilcoxon test was used for quantitative variables. Multivariate analysis was performed using conditional multiple logistic regression. RESULTS: Eighty-four subjects were included. The median time from admission to progression of oxygen therapy to F IO ₂ ≥ 0.5 or HFNC was 1 (interquartile range [IQR] 0–3) d. P aO ₂ /F IO ₂ at the time of oxygen therapy progression showed a median of 150.5 (IQR 100.0–170.0) for the entire sample and was lower in HFNC group compared with control group (median 135 [IQR 96–162] vs median 158 [IQR 132–174], respectively, P = .02). Endotracheal intubation at 28 d was observed in 54.8% HFNC and 73.8% standard oxygen (unadjusted odds ratio 0.38 [95% CI 0.13–1.07], P = .069). In the multivariate analysis, presence of dyspnea at hospital admission, Sequential Organ Failure Assessment score, and P aO ₂ /F IO ₂ at time of progression of oxygen therapy to F IO ₂ ≥ 0.5 was identified as confounding factors for the association between the intervention group and the outcome. Use of HFNC was not an independent predictor of endotracheal intubation frequency after adjusting confounders (odds ratio 0.26 [95% CI 0.04–1.51], P = .13). CONCLUSIONS: In this study, HFNC therapy in subjects with AHRF secondary to COVID-19 was not an independent predictor of endotracheal intubation, compared with standard oxygen therapy, after adjusting for confounders.

To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina. This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting–propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves. A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves). The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.