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Review Articles
Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis
- Pedro Vitale Mendes,
- Livia Maria Garcia Melro,
- Ho Yeh Li,
- Daniel Joelsons
, - Rogerio Zigaib, [ … ],
- Marcelo Park
Abstract
Review ArticlesExtracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2019;31(4):548-554
DOI 10.5935/0103-507X.20190077
- Pedro Vitale Mendes,
- Livia Maria Garcia Melro,
- Ho Yeh Li,
- Daniel Joelsons ,
- Rogerio Zigaib,
- José Mauro da Fonseca Pestana Ribeiro,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Marcelo Park
Views0ABSTRACT
Objective:
The evidence of improved survival with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome is still uncertain.
Methods:
This systematic review and meta-analysis was registered in the PROSPERO database with the number CRD-42018098618. We performed a structured search of Medline, Lilacs, and ScienceDirect for randomized controlled trials evaluating the use of ECMO associated with (ultra)protective mechanical ventilation for severe acute respiratory failure in adult patients. We used the Cochrane risk of bias tool to evaluate the quality of the evidence. Our primary objective was to evaluate the effect of ECMO on the last reported mortality. Secondary outcomes were treatment failure, hospital length of stay and the need for renal replacement therapy in both groups.
Results:
Two randomized controlled studies were included in the meta-analysis, comprising 429 patients, of whom 214 were supported with ECMO. The most common reason for acute respiratory failure was pneumonia (60% – 65%). Respiratory ECMO support was associated with a reduction in last reported mortality and treatment failure with risk ratios (RR: 0.76; 95%CI 0.61 – 0.95 and RR: 0.68; 95%CI 0.55 – 0.85, respectively). Extracorporeal membrane oxygenation reduced the need for renal replacement therapy, with a RR of 0.88 (95%CI 0.77 – 0.99). Intensive care unit and hospital lengths of stay were longer in ECMO-supported patients, with an additional P50th 14.84 (P25th – P75th: 12.49 – 17.18) and P50th 29.80 (P25th – P75th: 26.04 – 33.56] days, respectively.
Conclusion:
Respiratory ECMO support in severe acute respiratory distress syndrome patients is associated with a reduced mortality rate and a reduced need for renal replacement therapy but a substantial increase in the lengths of stay in the intensive care unit and hospital. Our results may help bedside decision-making regarding ECMO initiation in patients with severe respiratory distress syndrome.
Keywords:Extracorporeal membrane oxygenationIntensive care unitsMeta-analysisRespiratory distress syndrome, adultRespiratory insufficiencySee moreViews0
Abstract
Review ArticlesExtracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2019;31(4):548-554
DOI 10.5935/0103-507X.20190077
- Pedro Vitale Mendes,
- Livia Maria Garcia Melro,
- Ho Yeh Li,
- Daniel Joelsons ,
- Rogerio Zigaib,
- José Mauro da Fonseca Pestana Ribeiro,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Marcelo Park
Views0ABSTRACT
Objective:
The evidence of improved survival with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome is still uncertain.
Methods:
This systematic review and meta-analysis was registered in the PROSPERO database with the number CRD-42018098618. We performed a structured search of Medline, Lilacs, and ScienceDirect for randomized controlled trials evaluating the use of ECMO associated with (ultra)protective mechanical ventilation for severe acute respiratory failure in adult patients. We used the Cochrane risk of bias tool to evaluate the quality of the evidence. Our primary objective was to evaluate the effect of ECMO on the last reported mortality. Secondary outcomes were treatment failure, hospital length of stay and the need for renal replacement therapy in both groups.
Results:
Two randomized controlled studies were included in the meta-analysis, comprising 429 patients, of whom 214 were supported with ECMO. The most common reason for acute respiratory failure was pneumonia (60% – 65%). Respiratory ECMO support was associated with a reduction in last reported mortality and treatment failure with risk ratios (RR: 0.76; 95%CI 0.61 – 0.95 and RR: 0.68; 95%CI 0.55 – 0.85, respectively). Extracorporeal membrane oxygenation reduced the need for renal replacement therapy, with a RR of 0.88 (95%CI 0.77 – 0.99). Intensive care unit and hospital lengths of stay were longer in ECMO-supported patients, with an additional P50th 14.84 (P25th – P75th: 12.49 – 17.18) and P50th 29.80 (P25th – P75th: 26.04 – 33.56] days, respectively.
Conclusion:
Respiratory ECMO support in severe acute respiratory distress syndrome patients is associated with a reduced mortality rate and a reduced need for renal replacement therapy but a substantial increase in the lengths of stay in the intensive care unit and hospital. Our results may help bedside decision-making regarding ECMO initiation in patients with severe respiratory distress syndrome.
Keywords:Extracorporeal membrane oxygenationIntensive care unitsMeta-analysisRespiratory distress syndrome, adultRespiratory insufficiencySee more
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Original Article
Oxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach
Rev Bras Ter Intensiva. 2019;31(2):113-121
Abstract
Original ArticleOxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach
Rev Bras Ter Intensiva. 2019;31(2):113-121
DOI 10.5935/0103-507X.20190018
Views0ABSTRACT
Objective:
To describe (1) the energy transfer from the ventilator to the lungs, (2) the match between venous-venous extracorporeal membrane oxygenation (ECMO) oxygen transfer and patient oxygen consumption (VO2), (3) carbon dioxide removal with ECMO, and (4) the potential effect of systemic venous oxygenation on pulmonary artery pressure.
Methods:
Mathematical modeling approach with hypothetical scenarios using computer simulation.
Results:
The transition from protective ventilation to ultraprotective ventilation in a patient with severe acute respiratory distress syndrome and a static respiratory compliance of 20mL/cm H2O reduced the energy transfer from the ventilator to the lungs from 35.3 to 2.6 joules/minute. A hypothetical patient, hyperdynamic and slightly anemic with VO2 = 200mL/minute, can reach an arterial oxygen saturation of 80%, while maintaining the match between the oxygen transfer by ECMO and the VO2 of the patient. Carbon dioxide is easily removed, and normal PaCO2 is easily reached. Venous blood oxygenation through the ECMO circuit may drive the PO2 stimulus of pulmonary hypoxic vasoconstriction to normal values.
Conclusion:
Ultraprotective ventilation largely reduces the energy transfer from the ventilator to the lungs. Severe hypoxemia on venous-venous-ECMO support may occur despite the matching between the oxygen transfer by ECMO and the VO2 of the patient. The normal range of PaCO2 is easy to reach. Venous-venous-ECMO support potentially relieves hypoxic pulmonary vasoconstriction.
Keywords:acute respiratory distress syndromeExtracorporeal membrane oxygenationIntensive Care UnitMathematical modelmechanical ventilationrespiratory failureSee moreViews0Abstract
Original ArticleOxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach
Rev Bras Ter Intensiva. 2019;31(2):113-121
DOI 10.5935/0103-507X.20190018
Views0ABSTRACT
Objective:
To describe (1) the energy transfer from the ventilator to the lungs, (2) the match between venous-venous extracorporeal membrane oxygenation (ECMO) oxygen transfer and patient oxygen consumption (VO2), (3) carbon dioxide removal with ECMO, and (4) the potential effect of systemic venous oxygenation on pulmonary artery pressure.
Methods:
Mathematical modeling approach with hypothetical scenarios using computer simulation.
Results:
The transition from protective ventilation to ultraprotective ventilation in a patient with severe acute respiratory distress syndrome and a static respiratory compliance of 20mL/cm H2O reduced the energy transfer from the ventilator to the lungs from 35.3 to 2.6 joules/minute. A hypothetical patient, hyperdynamic and slightly anemic with VO2 = 200mL/minute, can reach an arterial oxygen saturation of 80%, while maintaining the match between the oxygen transfer by ECMO and the VO2 of the patient. Carbon dioxide is easily removed, and normal PaCO2 is easily reached. Venous blood oxygenation through the ECMO circuit may drive the PO2 stimulus of pulmonary hypoxic vasoconstriction to normal values.
Conclusion:
Ultraprotective ventilation largely reduces the energy transfer from the ventilator to the lungs. Severe hypoxemia on venous-venous-ECMO support may occur despite the matching between the oxygen transfer by ECMO and the VO2 of the patient. The normal range of PaCO2 is easy to reach. Venous-venous-ECMO support potentially relieves hypoxic pulmonary vasoconstriction.
Keywords:acute respiratory distress syndromeExtracorporeal membrane oxygenationIntensive Care UnitMathematical modelmechanical ventilationrespiratory failureSee more
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Original Article
Characterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil
Rev Bras Ter Intensiva. 2018;30(3):317-326
Abstract
Original ArticleCharacterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil
Rev Bras Ter Intensiva. 2018;30(3):317-326
DOI 10.5935/0103-507X.20180052
Views0ABSTRACT
Objective:
To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support.
Methods:
A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database.
Results:
From 2011 to 2017, 18 patients aged 29 (25 – 31) years with a SAPS 3 of 84 (68 – 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 – 82) km was traveled on each rescue mission during a period of 360 (308 – 431) min. A median of one (0 – 2) nurse, three (2 – 3) physicians, and one (0 – 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis.
Conclusions:
Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
Keywords:artificial respirationCritical illnessExtracorporeal membrane oxygenationIntensive care unitsRespiratory insufficiencyTransportation of patientsSee moreViews0Abstract
Original ArticleCharacterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil
Rev Bras Ter Intensiva. 2018;30(3):317-326
DOI 10.5935/0103-507X.20180052
Views0ABSTRACT
Objective:
To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support.
Methods:
A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database.
Results:
From 2011 to 2017, 18 patients aged 29 (25 – 31) years with a SAPS 3 of 84 (68 – 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 – 82) km was traveled on each rescue mission during a period of 360 (308 – 431) min. A median of one (0 – 2) nurse, three (2 – 3) physicians, and one (0 – 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis.
Conclusions:
Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
Keywords:artificial respirationCritical illnessExtracorporeal membrane oxygenationIntensive care unitsRespiratory insufficiencyTransportation of patientsSee more -
Brief Communication
Intracranial epidural hematoma follow-up using bidimensional ultrasound
Rev Bras Ter Intensiva. 2017;29(2):259-260
Abstract
Brief CommunicationIntracranial epidural hematoma follow-up using bidimensional ultrasound
Rev Bras Ter Intensiva. 2017;29(2):259-260
DOI 10.5935/0103-507X.20170036
Views1Bidimensional encephalic ultrasound can be used to diagnose several types of lesions as epidural hematomas.() To illustrate this use, we present a patient in which an epidural hematoma was monitored through the use of a hemicraniectomy bidimensional ultrasound.A 28-year-old male patient was found unconscious after a fall from a platform. He was promptly given medical […]See moreViews1Abstract
Brief CommunicationIntracranial epidural hematoma follow-up using bidimensional ultrasound
Rev Bras Ter Intensiva. 2017;29(2):259-260
DOI 10.5935/0103-507X.20170036
Views1Bidimensional encephalic ultrasound can be used to diagnose several types of lesions as epidural hematomas.() To illustrate this use, we present a patient in which an epidural hematoma was monitored through the use of a hemicraniectomy bidimensional ultrasound.A 28-year-old male patient was found unconscious after a fall from a platform. He was promptly given medical […]See more
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Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model
Rev Bras Ter Intensiva. 2016;28(1):11-18
Abstract
Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model
Rev Bras Ter Intensiva. 2016;28(1):11-18
DOI 10.5935/0103-507X.20160006
Views0ABSTRACT
Objective:
The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure.
Methods:
The factors associated with oxygen – and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested.
Results:
Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL).
Conclusion:
In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.
Keywords:Extracorporeal membrane oxygenationRespiration, artificialRespiratory distress syndrome, adultSwineSee moreViews0Abstract
Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model
Rev Bras Ter Intensiva. 2016;28(1):11-18
DOI 10.5935/0103-507X.20160006
Views0ABSTRACT
Objective:
The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure.
Methods:
The factors associated with oxygen – and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested.
Results:
Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL).
Conclusion:
In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.
Keywords:Extracorporeal membrane oxygenationRespiration, artificialRespiratory distress syndrome, adultSwineSee more
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Original Article
Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome
Rev Bras Ter Intensiva. 2016;28(1):19-26
Abstract
Original ArticleMetabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome
Rev Bras Ter Intensiva. 2016;28(1):19-26
DOI 10.5935/0103-507X.20160009
Views0ABSTRACT
Objective:
Hypercapnia resulting from protective ventilation in acute respiratory distress syndrome triggers metabolic pH compensation, which is not entirely characterized. We aimed to describe this metabolic compensation.
Methods:
The data were retrieved from a prospective collected database. Variables from patients’ admission and from hypercapnia installation until the third day after installation were gathered. Forty-one patients with acute respiratory distress syndrome were analyzed, including twenty-six with persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15 non-hypercapnic (control group). An acid-base quantitative physicochemical approach was used for the analysis.
Results:
The mean ages in the hypercapnic and control groups were 48 ± 18 years and 44 ± 14 years, respectively. After the induction of hypercapnia, pH markedly decreased and gradually improved in the ensuing 72 hours, consistent with increases in the standard base excess. The metabolic acid-base adaptation occurred because of decreases in the serum lactate and strong ion gap and increases in the inorganic apparent strong ion difference. Furthermore, the elevation in the inorganic apparent strong ion difference occurred due to slight increases in serum sodium, magnesium, potassium and calcium. Serum chloride did not decrease for up to 72 hours after the initiation of hypercapnia.
Conclusion:
In this explanatory study, the results indicate that metabolic acid-base adaptation, which is triggered by acute persistent hypercapnia in patients with acute respiratory distress syndrome, is complex. Furthermore, further rapid increases in the standard base excess of hypercapnic patients involve decreases in serum lactate and unmeasured anions and increases in the inorganic apparent strong ion difference by means of slight increases in serum sodium, magnesium, calcium, and potassium. Serum chloride is not reduced.
Keywords:Acid-base equilibriumAcidosis, respiratoryIntensive care unitsRespiration, artificialRespiratory distress syndrome, adultSee moreViews0Abstract
Original ArticleMetabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome
Rev Bras Ter Intensiva. 2016;28(1):19-26
DOI 10.5935/0103-507X.20160009
Views0ABSTRACT
Objective:
Hypercapnia resulting from protective ventilation in acute respiratory distress syndrome triggers metabolic pH compensation, which is not entirely characterized. We aimed to describe this metabolic compensation.
Methods:
The data were retrieved from a prospective collected database. Variables from patients’ admission and from hypercapnia installation until the third day after installation were gathered. Forty-one patients with acute respiratory distress syndrome were analyzed, including twenty-six with persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15 non-hypercapnic (control group). An acid-base quantitative physicochemical approach was used for the analysis.
Results:
The mean ages in the hypercapnic and control groups were 48 ± 18 years and 44 ± 14 years, respectively. After the induction of hypercapnia, pH markedly decreased and gradually improved in the ensuing 72 hours, consistent with increases in the standard base excess. The metabolic acid-base adaptation occurred because of decreases in the serum lactate and strong ion gap and increases in the inorganic apparent strong ion difference. Furthermore, the elevation in the inorganic apparent strong ion difference occurred due to slight increases in serum sodium, magnesium, potassium and calcium. Serum chloride did not decrease for up to 72 hours after the initiation of hypercapnia.
Conclusion:
In this explanatory study, the results indicate that metabolic acid-base adaptation, which is triggered by acute persistent hypercapnia in patients with acute respiratory distress syndrome, is complex. Furthermore, further rapid increases in the standard base excess of hypercapnic patients involve decreases in serum lactate and unmeasured anions and increases in the inorganic apparent strong ion difference by means of slight increases in serum sodium, magnesium, calcium, and potassium. Serum chloride is not reduced.
Keywords:Acid-base equilibriumAcidosis, respiratoryIntensive care unitsRespiration, artificialRespiratory distress syndrome, adultSee more
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Original Article
Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
Abstract
Original ArticleInsights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
DOI 10.5935/0103-507X.20160026
Views0See moreABSTRACT
Objective:
The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation.
Methods:
Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations.
Results:
In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values.
Conclusions:
Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose – formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible.
Views0Abstract
Original ArticleInsights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
DOI 10.5935/0103-507X.20160026
Views0See moreABSTRACT
Objective:
The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation.
Methods:
Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations.
Results:
In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values.
Conclusions:
Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose – formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible.
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Original Articles
Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2016;28(4):444-451
Abstract
Original ArticlesSedation protocols versus daily sedation interruption: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2016;28(4):444-451
DOI 10.5935/0103-507X.20160078
Views0See moreABSTRACT
Objective:
The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies.
Methods:
We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit.
Results:
Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 – 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 – 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 – -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium.
Conclusion:
Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.
Views0Abstract
Original ArticlesSedation protocols versus daily sedation interruption: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2016;28(4):444-451
DOI 10.5935/0103-507X.20160078
Views0See moreABSTRACT
Objective:
The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies.
Methods:
We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit.
Results:
Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 – 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 – 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 – -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium.
Conclusion:
Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis