-
CLINICAL REPORT
Prediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
- Simon Corrado Serafini
, - David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo , [ ... ],
- Guido Mazzinari
03-19-2025
Abstract
CLINICAL REPORTPrediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
Critical Care Science. 2025;37:e20250270
03-19-2025DOI 10.62675/2965-2774.20250270
- Simon Corrado Serafini ,
- David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo ,
- Tai Pham ,
- Eya Sahraoui ,
- Giacomo Bellani ,
- John G. Laffey ,
- Marcus J. Schultz ,
- Guido Mazzinari
Views110ABSTRACT
Introduction:
In patients with acute respiratory distress syndrome (ARDS), mortality risk is typically assessed using the arterial partial pressure of oxygen (PaO2) divided by the fraction of inspired oxygen (FiO2), known as the PaO2/FiO2 ratio. Recently, the SpO2/FiO2 ratio, which uses peripheral oxygen saturation (SpO2) instead of PaO2, has been suggested as a reasonable alternative when there is little access to arterial blood gas analyses. Additionally, equations that predict PaO2 from SpO2 values could offer another viable method for assessment.
Aim:
To evaluate the accuracy of methods for predicting PaO2 from SpO2 values and compare risk stratification based on measured versus predicted PaO2/FiO2 ratios using a large database that harmonizes the individual data of patients included in four observational studies.
Methods and analysis:
The individual data from four observational studies (‘Epidemiology of Respiratory Insufficiency in Critical Care study’ [ERICC], ‘Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure’ [LUNG SAFE], ‘PRactice of VENTilation in critically ill patients without ARDS’ [PRoVENT], and ‘PRactice of VENTilation in critically ill patients in Middle–income Countries’ [PRoVENT–iMiC]) were harmonized and pooled into a database named ‘PRoPERLy II’. The primary endpoint of this planned analysis will be the accuracy of currently available methods to predict PaO2 from SpO2 values. The secondary endpoint will be the accuracy of classification based on SpO2/FiO2 ratio and the predicted PaO2/FiO2 ratio.
Dissemination:
Our planned analysis addresses a clinically important research question by comparing different equations for predicting PaO2 from SpO2 values.
Keywords:critical carecritical illnessOxygenOxygen saturationPartial pressureRespiration,artificialRespiratory distress syndromeRespiratory insufficiencyRisk assessmentSee moreViews110
Abstract
CLINICAL REPORTPrediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
Critical Care Science. 2025;37:e20250270
03-19-2025DOI 10.62675/2965-2774.20250270
- Simon Corrado Serafini ,
- David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo ,
- Tai Pham ,
- Eya Sahraoui ,
- Giacomo Bellani ,
- John G. Laffey ,
- Marcus J. Schultz ,
- Guido Mazzinari
Views110ABSTRACT
Introduction:
In patients with acute respiratory distress syndrome (ARDS), mortality risk is typically assessed using the arterial partial pressure of oxygen (PaO2) divided by the fraction of inspired oxygen (FiO2), known as the PaO2/FiO2 ratio. Recently, the SpO2/FiO2 ratio, which uses peripheral oxygen saturation (SpO2) instead of PaO2, has been suggested as a reasonable alternative when there is little access to arterial blood gas analyses. Additionally, equations that predict PaO2 from SpO2 values could offer another viable method for assessment.
Aim:
To evaluate the accuracy of methods for predicting PaO2 from SpO2 values and compare risk stratification based on measured versus predicted PaO2/FiO2 ratios using a large database that harmonizes the individual data of patients included in four observational studies.
Methods and analysis:
The individual data from four observational studies (‘Epidemiology of Respiratory Insufficiency in Critical Care study’ [ERICC], ‘Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure’ [LUNG SAFE], ‘PRactice of VENTilation in critically ill patients without ARDS’ [PRoVENT], and ‘PRactice of VENTilation in critically ill patients in Middle–income Countries’ [PRoVENT–iMiC]) were harmonized and pooled into a database named ‘PRoPERLy II’. The primary endpoint of this planned analysis will be the accuracy of currently available methods to predict PaO2 from SpO2 values. The secondary endpoint will be the accuracy of classification based on SpO2/FiO2 ratio and the predicted PaO2/FiO2 ratio.
Dissemination:
Our planned analysis addresses a clinically important research question by comparing different equations for predicting PaO2 from SpO2 values.
Keywords:critical carecritical illnessOxygenOxygen saturationPartial pressureRespiration,artificialRespiratory distress syndromeRespiratory insufficiencyRisk assessmentSee more
- Simon Corrado Serafini
-
ORIGINAL ARTICLE
Lycopene supplementation reduces inflammatory, histopathological and DNA damage in an acute lung injury rabbit model
- José Roberto Fioretto ,
- Susiane Oliveira Klefens ,
- Mário Ferreira Carpi ,
- Marcos Aurélio Moraes ,
- Rossano César Bonatto , [ ... ],
- Carlos Fernando Ronchi
12-18-2024
Abstract
ORIGINAL ARTICLELycopene supplementation reduces inflammatory, histopathological and DNA damage in an acute lung injury rabbit model
Critical Care Science. 2024;37:e20250250
12-18-2024DOI 10.62675/2965-2774.20250250
- José Roberto Fioretto ,
- Susiane Oliveira Klefens ,
- Mário Ferreira Carpi ,
- Marcos Aurélio Moraes ,
- Rossano César Bonatto ,
- Ana Lúcia Anjos Ferreira ,
- Camila Renata Corrêa ,
- Cilmery Suemi Kurokawa ,
- Carlos Fernando Ronchi
Views211ABSTRACT
Objective
To investigate the effects of lycopene supplementation on inflammation, lung histopathology and systemic DNA damage in an experimentally induced lung injury model, ventilated by conventional mechanical ventilation and high-frequency oscillatory ventilation, compared with a control group.
Methods
Fifty-five rabbits sampled by convenience were supplemented with 10mg/kg lycopene for 21 days prior to the experiment. Lung injury was induced by tracheal infusion of warm saline. The rabbits were randomly assigned to the control group and subjected to protective conventional mechanical ventilation (n = 5) without supplementation or the experimental group that was subjected to acute lung injury and provided conventional mechanical ventilation and high-frequency oscillatory ventilation with and without lycopene supplementation (n = 10 rabbits in each group). Lung oxidative stress and the inflammatory response were assessed based on the number of polymorphonuclear leukocytes in bronchoalveolar lavage fluid, DNA damage and pulmonary histological damage.
Results
A significant worsening of oxygenation and a decrease in static lung compliance was noted in all groups after pulmonary injury induction (partial pressure of oxygen before 451.86 ± 68.54 and after 71 ± 19.27, p < 0.05). After 4 hours, the high-frequency oscillatory ventilation groups with and without lycopene supplementation as well as the group receiving protective conventional mechanical ventilation with lycopene supplementation showed significant oxygenation improvement compared with the protective conventional mechanical ventilation group without supplementation (partial pressure of oxygen of the group with mechanical ventilation without lycopene of 102 ± 42, of the group that received conventional protective mechanical ventilation with lycopene supplementation of 362 ± 38, of the high-frequency group without lycopene supplementation of 420 ± 28 and of the high-frequency group with lycopene supplementation of 422 ± 25; p < 0.05). Compared with rabbits not receiving supplementation, those in the groups that received protective conventional mechanical ventilation with lycopene supplementation and high-frequency oscillatory ventilation with lycopene supplementation had significantly less inflammation as well as less histological injury (p < 0.05). Compared with rabbits subjected to protective conventional mechanical ventilation, significantly lower DNA damage was observed in rabbits supplemented with lycopene (p < 0.05).
Conclusion
Lycopene supplementation reduces inflammatory and histopathological lung injuries, regardless of the associated ventilatory mode. In addition, lycopene improved oxygenation and reduced DNA damage when protective conventional mechanical ventilation was used.
Keywords:CarotenoidsDNA damageinflammationlung injuryRespiration, artificialRespiratory distress syndromeSee moreViews211Abstract
ORIGINAL ARTICLELycopene supplementation reduces inflammatory, histopathological and DNA damage in an acute lung injury rabbit model
Critical Care Science. 2024;37:e20250250
12-18-2024DOI 10.62675/2965-2774.20250250
- José Roberto Fioretto ,
- Susiane Oliveira Klefens ,
- Mário Ferreira Carpi ,
- Marcos Aurélio Moraes ,
- Rossano César Bonatto ,
- Ana Lúcia Anjos Ferreira ,
- Camila Renata Corrêa ,
- Cilmery Suemi Kurokawa ,
- Carlos Fernando Ronchi
Views211ABSTRACT
Objective
To investigate the effects of lycopene supplementation on inflammation, lung histopathology and systemic DNA damage in an experimentally induced lung injury model, ventilated by conventional mechanical ventilation and high-frequency oscillatory ventilation, compared with a control group.
Methods
Fifty-five rabbits sampled by convenience were supplemented with 10mg/kg lycopene for 21 days prior to the experiment. Lung injury was induced by tracheal infusion of warm saline. The rabbits were randomly assigned to the control group and subjected to protective conventional mechanical ventilation (n = 5) without supplementation or the experimental group that was subjected to acute lung injury and provided conventional mechanical ventilation and high-frequency oscillatory ventilation with and without lycopene supplementation (n = 10 rabbits in each group). Lung oxidative stress and the inflammatory response were assessed based on the number of polymorphonuclear leukocytes in bronchoalveolar lavage fluid, DNA damage and pulmonary histological damage.
Results
A significant worsening of oxygenation and a decrease in static lung compliance was noted in all groups after pulmonary injury induction (partial pressure of oxygen before 451.86 ± 68.54 and after 71 ± 19.27, p < 0.05). After 4 hours, the high-frequency oscillatory ventilation groups with and without lycopene supplementation as well as the group receiving protective conventional mechanical ventilation with lycopene supplementation showed significant oxygenation improvement compared with the protective conventional mechanical ventilation group without supplementation (partial pressure of oxygen of the group with mechanical ventilation without lycopene of 102 ± 42, of the group that received conventional protective mechanical ventilation with lycopene supplementation of 362 ± 38, of the high-frequency group without lycopene supplementation of 420 ± 28 and of the high-frequency group with lycopene supplementation of 422 ± 25; p < 0.05). Compared with rabbits not receiving supplementation, those in the groups that received protective conventional mechanical ventilation with lycopene supplementation and high-frequency oscillatory ventilation with lycopene supplementation had significantly less inflammation as well as less histological injury (p < 0.05). Compared with rabbits subjected to protective conventional mechanical ventilation, significantly lower DNA damage was observed in rabbits supplemented with lycopene (p < 0.05).
Conclusion
Lycopene supplementation reduces inflammatory and histopathological lung injuries, regardless of the associated ventilatory mode. In addition, lycopene improved oxygenation and reduced DNA damage when protective conventional mechanical ventilation was used.
Keywords:CarotenoidsDNA damageinflammationlung injuryRespiration, artificialRespiratory distress syndromeSee more
- José Roberto Fioretto
-
CLINICAL REPORT
Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza, [ ... ],
- Regis Goulart Rosa
06-04-2024
Abstract
CLINICAL REPORTImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
06-04-2024DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views88ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See moreViews88Abstract
CLINICAL REPORTImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
06-04-2024DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views88ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See more
- Fernando Luís Scolari
-
CLINICAL REPORT
Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
- ,
- Israel Silva Maia ,
- Fernando Azevedo Medrado Jr ,
- Lucas Tramujas ,
- Bruno Martins Tomazini , [ ... ],
- Fernando Godinho Zampieri
04-30-2024
Abstract
CLINICAL REPORTProspective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
Critical Care Science. 2024;36:e20240210en
04-30-2024DOI 10.62675/2965-2774.20240210-en
- ,
- Israel Silva Maia ,
- Fernando Azevedo Medrado Jr ,
- Lucas Tramujas ,
- Bruno Martins Tomazini ,
- Júlia Souza Oliveira,
- Erica Regina Ribeiro Sady ,
- Letícia Galvão Barbante,
- Marina Lazzari Nicola ,
- Rodrigo Magalhães Gurgel,
- Lucas Petri Damiani ,
- Karina Leal Negrelli,
- Tamiris Abait Miranda,
- Eliana Santucci ,
- Nanci Valeis ,
- Ligia Nasi Laranjeira,
- Glauco Adrieno Westphal ,
- Ruthy Perotto Fernandes,
- Cássio Luis Zandonai ,
- Mariangela Pimentel Pincelli ,
- Rodrigo Cruvinel Figueiredo,
- Cíntia Loss Sartori Bustamante,
- Luiz Fernando Norbin,
- Emerson Boschi ,
- Rafael Lessa,
- Marcelo Pereira Romano ,
- Mieko Cláudia Miura ,
- Meton Soares de Alencar Filho ,
- Vicente Cés de Souza Dantas ,
- Priscilla Alves Barreto,
- Mauro Esteves Hernandes ,
- Cintia Magalhães Carvalho Grion ,
- Alexandre Sanches Laranjeira,
- Ana Luiza Mezzaroba ,
- Marina Bahl ,
- Ana Carolina Starke ,
- Rodrigo Santos Biondi ,
- Felipe Dal-Pizzol ,
- Eliana Bernadete Caser,
- Marlus Muri Thompson,
- Andrea Allegrini Padial,
- Viviane Cordeiro Veiga ,
- Rodrigo Thot Leite,
- Gustavo Araújo,
- Mário Guimarães,
- Priscilla de Aquino Martins ,
- Fábio Holanda Lacerda ,
- Conrado Roberto Hoffmann Filho ,
- Livia Melro ,
- Eduardo Pacheco,
- Gustavo Adolfo Ospina-Táscon ,
- Juliana Carvalho Ferreira ,
- Fabricio Jocundo Calado Freires ,
- Flávia Ribeiro Machado ,
- Alexandre Biasi Cavalcanti ,
- Fernando Godinho Zampieri
Views132ABSTRACT
Background:
Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.
Objective:
To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.
Methods:
The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance.
Outcomes:
The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide.
Conclusion:
STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.
Keywords:Extracorporeal membrane oxygenationpneumoniaPositive-pressure respirationRespiration, artificialRespiratory distress syndromeVentilator-induced lung injurySee moreViews132Abstract
CLINICAL REPORTProspective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
Critical Care Science. 2024;36:e20240210en
04-30-2024DOI 10.62675/2965-2774.20240210-en
- ,
- Israel Silva Maia ,
- Fernando Azevedo Medrado Jr ,
- Lucas Tramujas ,
- Bruno Martins Tomazini ,
- Júlia Souza Oliveira,
- Erica Regina Ribeiro Sady ,
- Letícia Galvão Barbante,
- Marina Lazzari Nicola ,
- Rodrigo Magalhães Gurgel,
- Lucas Petri Damiani ,
- Karina Leal Negrelli,
- Tamiris Abait Miranda,
- Eliana Santucci ,
- Nanci Valeis ,
- Ligia Nasi Laranjeira,
- Glauco Adrieno Westphal ,
- Ruthy Perotto Fernandes,
- Cássio Luis Zandonai ,
- Mariangela Pimentel Pincelli ,
- Rodrigo Cruvinel Figueiredo,
- Cíntia Loss Sartori Bustamante,
- Luiz Fernando Norbin,
- Emerson Boschi ,
- Rafael Lessa,
- Marcelo Pereira Romano ,
- Mieko Cláudia Miura ,
- Meton Soares de Alencar Filho ,
- Vicente Cés de Souza Dantas ,
- Priscilla Alves Barreto,
- Mauro Esteves Hernandes ,
- Cintia Magalhães Carvalho Grion ,
- Alexandre Sanches Laranjeira,
- Ana Luiza Mezzaroba ,
- Marina Bahl ,
- Ana Carolina Starke ,
- Rodrigo Santos Biondi ,
- Felipe Dal-Pizzol ,
- Eliana Bernadete Caser,
- Marlus Muri Thompson,
- Andrea Allegrini Padial,
- Viviane Cordeiro Veiga ,
- Rodrigo Thot Leite,
- Gustavo Araújo,
- Mário Guimarães,
- Priscilla de Aquino Martins ,
- Fábio Holanda Lacerda ,
- Conrado Roberto Hoffmann Filho ,
- Livia Melro ,
- Eduardo Pacheco,
- Gustavo Adolfo Ospina-Táscon ,
- Juliana Carvalho Ferreira ,
- Fabricio Jocundo Calado Freires ,
- Flávia Ribeiro Machado ,
- Alexandre Biasi Cavalcanti ,
- Fernando Godinho Zampieri
Views132ABSTRACT
Background:
Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.
Objective:
To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.
Methods:
The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance.
Outcomes:
The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide.
Conclusion:
STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.
Keywords:Extracorporeal membrane oxygenationpneumoniaPositive-pressure respirationRespiration, artificialRespiratory distress syndromeVentilator-induced lung injurySee more
-
ORIGINAL ARTICLE
Factors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2
Critical Care Science. 2023;35(2):156-162
08-07-2023
Abstract
ORIGINAL ARTICLEFactors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2
Critical Care Science. 2023;35(2):156-162
08-07-2023DOI 10.5935/2965-2774.20230343-en
Views50ABSTRACT
Objective:
To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia.
Methods:
Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a ‘response’. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables.
Results:
A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 - 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 - 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 - 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 - 2.85) compared with a ground-glass pattern.
Conclusion:
This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.
Keywords:artificialCoronavirus infectionsCOVID-19Hypoxiaintratrachealintubationprone positionRespirationRespiratory distress syndromeSARS-CoV-2See moreViews50Abstract
ORIGINAL ARTICLEFactors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2
Critical Care Science. 2023;35(2):156-162
08-07-2023DOI 10.5935/2965-2774.20230343-en
Views50ABSTRACT
Objective:
To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia.
Methods:
Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a ‘response’. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables.
Results:
A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 - 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 - 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 - 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 - 2.85) compared with a ground-glass pattern.
Conclusion:
This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.
Keywords:artificialCoronavirus infectionsCOVID-19Hypoxiaintratrachealintubationprone positionRespirationRespiratory distress syndromeSARS-CoV-2See more
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ORIGINAL ARTICLE
Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
- João Paulo Arruda de Oliveira ,
- Andreia Cristina Travassos Costa ,
- Agnaldo José Lopes ,
- Arthur de Sá Ferreira ,
- Luis Felipe da Fonseca Reis
06-05-2023
Abstract
ORIGINAL ARTICLEFactors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
Critical Care Science. 2023;35(1):19-30
06-05-2023DOI 10.5935/2965-2774.20230203-en
- João Paulo Arruda de Oliveira ,
- Andreia Cristina Travassos Costa ,
- Agnaldo José Lopes ,
- Arthur de Sá Ferreira ,
- Luis Felipe da Fonseca Reis
Views48ABSTRACT
Objectives:
To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19.
Methods:
This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs.
Results:
Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days.
Conclusion:
Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.
Keywords:artificialCoronavirus infectionsCOVID-19mortalityRespirationRespiratory distress syndromerespiratory mechanicsSARS-CoV-2See moreViews48Abstract
ORIGINAL ARTICLEFactors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
Critical Care Science. 2023;35(1):19-30
06-05-2023DOI 10.5935/2965-2774.20230203-en
- João Paulo Arruda de Oliveira ,
- Andreia Cristina Travassos Costa ,
- Agnaldo José Lopes ,
- Arthur de Sá Ferreira ,
- Luis Felipe da Fonseca Reis
Views48ABSTRACT
Objectives:
To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19.
Methods:
This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs.
Results:
Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days.
Conclusion:
Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.
Keywords:artificialCoronavirus infectionsCOVID-19mortalityRespirationRespiratory distress syndromerespiratory mechanicsSARS-CoV-2See more
- João Paulo Arruda de Oliveira
-
Case Report
Long-term extracorporeal membrane oxygenation – from SARS-CoV-2 infection to lung transplantation
Revista Brasileira de Terapia Intensiva. 2022;34(4):519-523
03-03-2022
Abstract
Case ReportLong-term extracorporeal membrane oxygenation – from SARS-CoV-2 infection to lung transplantation
Revista Brasileira de Terapia Intensiva. 2022;34(4):519-523
03-03-2022DOI 10.5935/0103-507X.20220314-en
Views51ABSTRACT
A healthy 55-year-old woman unvaccinated for SARS-CoV-2 was admitted to the hospital with a SARS-CoV-2 infection with rapid clinical deterioration. On the 17th day of disease, she was intubated, and on the 24th day, the patient was referred and admitted to our extracorporeal membrane oxygenation center. Extracorporeal membrane oxygenation support was initially used to enable lung recovery and allow the patient to rehabilitate and improve her physical condition. Despite an adequate physical condition, the lung function was not adequate to discontinue extracorporeal membrane oxygenation, and the patient was considered for lung transplantation. The intensive rehabilitation program was implemented to improve and maintain the physical status throughout all phases. The extracorporeal membrane oxygenation run had several complications that hindered successful rehabilitation: right ventricular failure that required venoarterial-venous extracorporeal membrane oxygenation for 10 days; six nosocomial infections, four with progression to septic shock; and knee hemarthrosis. To reduce the risk of infection, invasive devices (i.e., invasive mechanical ventilation, central venous catheter, and vesical catheter) were removed whenever possible, keeping only those essential for monitoring and care. After 162 days of extracorporeal membrane oxygenation support without other organ dysfunction, bilateral lobar lung transplantation was performed. Physical and respiratory rehabilitation were continued to promote independence in daily life activities. Four months after surgery, the patient was discharged.
Keywords:Coronavirus infectionCOVID-19Extracorporeal membrane oxygenationLung transplantationRespiratory distress syndromeSARS-CoV-2See moreViews51Abstract
Case ReportLong-term extracorporeal membrane oxygenation – from SARS-CoV-2 infection to lung transplantation
Revista Brasileira de Terapia Intensiva. 2022;34(4):519-523
03-03-2022DOI 10.5935/0103-507X.20220314-en
Views51ABSTRACT
A healthy 55-year-old woman unvaccinated for SARS-CoV-2 was admitted to the hospital with a SARS-CoV-2 infection with rapid clinical deterioration. On the 17th day of disease, she was intubated, and on the 24th day, the patient was referred and admitted to our extracorporeal membrane oxygenation center. Extracorporeal membrane oxygenation support was initially used to enable lung recovery and allow the patient to rehabilitate and improve her physical condition. Despite an adequate physical condition, the lung function was not adequate to discontinue extracorporeal membrane oxygenation, and the patient was considered for lung transplantation. The intensive rehabilitation program was implemented to improve and maintain the physical status throughout all phases. The extracorporeal membrane oxygenation run had several complications that hindered successful rehabilitation: right ventricular failure that required venoarterial-venous extracorporeal membrane oxygenation for 10 days; six nosocomial infections, four with progression to septic shock; and knee hemarthrosis. To reduce the risk of infection, invasive devices (i.e., invasive mechanical ventilation, central venous catheter, and vesical catheter) were removed whenever possible, keeping only those essential for monitoring and care. After 162 days of extracorporeal membrane oxygenation support without other organ dysfunction, bilateral lobar lung transplantation was performed. Physical and respiratory rehabilitation were continued to promote independence in daily life activities. Four months after surgery, the patient was discharged.
Keywords:Coronavirus infectionCOVID-19Extracorporeal membrane oxygenationLung transplantationRespiratory distress syndromeSARS-CoV-2See more
-
ORIGINAL ARTICLE
Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials
- Bruno Martins Tomazini ,
- Eduardo Leite Vieira Costa ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Fernando Godinho Zampieri ,
- Carlos Roberto Ribeiro de Carvalho , [ ... ],
- Luciano César Pontes de Azevedo
11-04-2022
Abstract
ORIGINAL ARTICLEClinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials
Revista Brasileira de Terapia Intensiva. 2022;34(3):335-341
11-04-2022DOI 10.5935/0103-507X.20220040-en
- Bruno Martins Tomazini ,
- Eduardo Leite Vieira Costa ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Fernando Godinho Zampieri ,
- Carlos Roberto Ribeiro de Carvalho ,
- Eliana Bernardete Caser,
- Vicente Cés de Souza-Dantas ,
- Emerson Boschi ,
- Renata Rego Lins Fumis ,
- Meton Soares de Alencar Filho ,
- Israel Silva Maia ,
- Wilson de Oliveira Filho ,
- Viviane Cordeiro Veiga ,
- Alvaro Avezum ,
- Renato Delascio Lopes ,
- Flávia Ribeiro Machado ,
- Otávio Berwanger ,
- Regis Goulart Rosa ,
- Alexandre Biasi Cavalcanti ,
- Luciano César Pontes de Azevedo
Views46ABSTRACT
Objective:
To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.
Methods:
We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.
Results:
A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46).
Conclusion:
This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
Keywords:Coronavirus infectionsCOVID-19critical careCritical care outcomesRespiratory distress syndromerespiratory mechanicsSee moreViews46Abstract
ORIGINAL ARTICLEClinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials
Revista Brasileira de Terapia Intensiva. 2022;34(3):335-341
11-04-2022DOI 10.5935/0103-507X.20220040-en
- Bruno Martins Tomazini ,
- Eduardo Leite Vieira Costa ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Fernando Godinho Zampieri ,
- Carlos Roberto Ribeiro de Carvalho ,
- Eliana Bernardete Caser,
- Vicente Cés de Souza-Dantas ,
- Emerson Boschi ,
- Renata Rego Lins Fumis ,
- Meton Soares de Alencar Filho ,
- Israel Silva Maia ,
- Wilson de Oliveira Filho ,
- Viviane Cordeiro Veiga ,
- Alvaro Avezum ,
- Renato Delascio Lopes ,
- Flávia Ribeiro Machado ,
- Otávio Berwanger ,
- Regis Goulart Rosa ,
- Alexandre Biasi Cavalcanti ,
- Luciano César Pontes de Azevedo
Views46ABSTRACT
Objective:
To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.
Methods:
We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.
Results:
A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46).
Conclusion:
This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
Keywords:Coronavirus infectionsCOVID-19critical careCritical care outcomesRespiratory distress syndromerespiratory mechanicsSee more
- Bruno Martins Tomazini
Respiratory distress syndrome Archives - Critical Care Science (CCS)
