Daily Ards Research Analysis

BackgroundLiberation from sedation may be beneficial for patients with acute respiratory distress syndrome supported by veno-venous (VV) extracorporeal membrane oxygenation (ECMO). Currently, there is limited evidence to support this approach. Therefore, this study aimed to compare the 90-day patient mortality of different sedation strategies in COVID-19 patients supported with VV ECMO.MethodsRetrospective, observational sub-study of the COVID-19 Critical Care Consortium database including COVID-19 patients supported with VV ECMO. Two cohorts were compared: high sedation patients who received neuromuscular blocking agents (NMBAs) throughout ECMO and low sedation patients who did not receive NMBA consistently. Patients' level of sedation during ECMO was also considered. The primary outcome was 90-day in-hospital mortality and was assessed using cause-specific Cox proportional hazard models.Results224 low and 104 high sedation patients were included. Pre-ECMO respiratory condition prior was similar between groups, except for the ratio of partial pressure of oxygen to inspired fraction of oxygen, which was lower in the high sedation group at 93 [61-130] than the low sedation group at 106 [69-140]. No difference was observed in disease severity scores between cohorts. Low sedation patients had longer ECMO runs, more circuit changes, but lower infectious and hemorrhagic complications. Higher sedation was associated with a hazard ratio for death of 3.23 (95% CI 2.16-4.83) compared to low sedation.ConclusionsReduced sedation in COVID-19 ECMO patients is feasible and may be associated with improved survival and reduced complications compared to continuous paralysis, albeit with longer ECMO runs.

Dyspnea is a prominent symptom in patients with long COVID due to its high prevalence and significant clinical impact. However, the influence of commonly used medications in critically ill patients on long-term dyspnea remains unclear. This study aimed to identify risk factors and assess the impacts associated with moderate to severe dyspnea in COVID-19 survivors. This study evaluated patients admitted to a university hospital between April 2020 and April 2021. Data were collected on clinical preconditions, hospital and ICU stays, and the use of corticosteroids, neuroleptics, neuromuscular blockers, midazolam, fentanyl, and noradrenaline. Post-discharge evaluations were conducted at 1 and 12 months, assessing dyspnea, frailty, quality of life, functional capacity, anxiety, and depression. Descriptive statistics, including frequencies and percentages, were used, and logistic regression analysis was performed to identify factors associated with moderate to severe dyspnea at 1 and 12 months post-discharge. Statistical significance was defined as P < 0.05. A total of 100 patients were prospectively included in the study; all underwent the 1-month evaluation, and 63 completed the 12-month evaluation. Limiting dyspnea, defined as an mMRC score > 1, was observed in 56.6% of patients at 1 month and 33.9% at 12 months post-discharge. Independent factors associated with limiting dyspnea at 1 month included the total dose of neuroleptics administered during hospitalization and the presence of pre-existing comorbidities. The use of corticosteroids, neuromuscular blockers, midazolam, fentanyl, and noradrenaline showed no significant association with limiting dyspnea. Dyspnea at 1 month post-discharge was an independent risk factor for the persistence of limiting dyspnea at 12 months. Patients with limiting dyspnea at 12 months exhibited higher levels of depression, anxiety, and frailty, alongside reduced quality of life and functionality. Patients with severe COVID-19 exhibit a high prevalence of limiting dyspnea in the long term. The total dose of neuroleptics administered during hospitalization and the presence of comorbidities were independently associated with limiting dyspnea after discharge. At 12 months post-discharge, individuals with persistent limiting dyspnea frequently demonstrated additional physical and mental health impairments, underscoring the need for comprehensive evaluation and management to mitigate the burden of long-term disabilities.

BACKGROUND/OBJECTIVES: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. METHODS: We retrospectively reviewed our center's experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. RESULTS: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. CONCLUSIONS: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings.