UNASSIGNED: Hypophosphatemia has been reported to impair diaphragmatic function in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the role of dysphosphatemia at admission [plasmatic phosphate concentration at intensive care unit (ICU) admission (T0-Ph)] to the ICU and respiratory outcomes among patients with severe acute COPD exacerbation. We aimed to assess the value of T0-Ph as a predictive factor of invasive mechanical ventilation (MV) during ICU stay.
UNASSIGNED: We retrospectively included consecutive patients admitted to the ICU for a severe acute exacerbation of COPD between May 2015 and December 2018. Logistic multivariate regression analysis was performed to identify association between T0-Ph and the need for invasive MV during the ICU stay.
UNASSIGNED: We included 198 patients of whom 132 (67%) were male. The median age was 70 [interquartile range (IQR), 61-77] years. Nine (4.5%) patients died in the ICU. Median T0-Ph was significantly higher among patients requiring invasive MV as compared to non-intubated patients [1.23 (IQR, 1.07-1.41) and 1.09 (IQR, 0.91-1.27) mmol/L; P=0.005]. By multivariate analysis, pneumonia [odds ratio (OR) =6.42; 95% confidence interval (CI): 2.78-15.96; P<0.0001) and a history of intubation (OR =3.33; 95% CI: 0.97-11.19; P=0.05) were independently associated with the need for invasive MV, whereas T0-Ph was not (OR =1.75; 95% CI: 0.72-4.44; P=0.22).
UNASSIGNED: T0-Ph was significantly higher in patients requiring invasive MV. However, T0-Ph was not associated with the need for invasive MV in multivariate analysis.

UNASSIGNED: Aneurysmal subarachnoid hemorrhage (aSAH) necessitating mechanical ventilation (MV) presents a serious challenge for intensivists. Laboratory blood tests reflect individual physiological and biochemical states, and provide a useful tool for identifying patients with critical condition and stratifying risk levels of death. This study aimed to determine the prognostic role of initial routine laboratory blood tests in these patients.
UNASSIGNED: This retrospective cohort study included 190 aSAH patients requiring MV in the neurosurgical intensive care unit from December 2019 to March 2022. Follow-up evaluation was performed in May 2022 via routine outpatient appointment or telephone interview. The primary outcomes were death occurring within 7 days after discharge (short-term mortality) or reported at time of follow-up (long-term mortality). Clinico-demographic and radiological characteristics, initial routine laboratory blood tests (e.g., metabolic panels and arterial blood gas analysis), and treatment were analyzed and compared in relation to mortality. Multivariable logistic and Cox regression analyses, with adjustment of other clinical predictors, were performed to determine independent laboratory test predictors for short- and long-term mortality, respectively.
UNASSIGNED: The patients had a median age of 62 years, with a median World Federation of Neurosurgical Societies grade (WFNS) score of 5 and a median modified Fisher grade (mFisher) score of 4. The short- and long-term mortality of this cohort were 60.5% and 65.3%, respectively. Compared with survivors, non-survivors had more severe disease upon admission based on neurological status and imaging features and a shorter disease course, and were more likely to receive conservative treatment. Initial ionized calcium was found to be independently associate with both short-term [adjusted odds ratio (OR): 0.92; 95% confidence interval (CI): 0.86 to 0.99; P=0.020] and long-term mortality [adjusted hazard ratio (HR): 0.95; 95% CI: 0.92 to 0.99; P=0.010], after adjusting for potential confounders. Moreover, the admission glucose level was found to be associated only with short-term mortality (adjusted OR: 1.19; 95% CI: 1.06 to 1.34; P=0.004).
UNASSIGNED: Laboratory screening may provide a useful tool for the management of aSAH patients requiring MV in stratifying risk levels for mortality and for better clinical decision-making. Further study is needed to validate the effects of calcium supplementation and glucose-lowering therapy on the outcomes in this disease.

UNASSIGNED: Mechanical ventilation (MV) is an important life-saving method in the intensive care unit (ICU). A lower mechanical power (MP) is associated with a better MV strategy. However, traditional MP calculating methods are complicated, and algebraic formulas seem to be rather practical. The aim of the present study was to compare the accuracy and application of different algebraic formulas calculating MP.
UNASSIGNED: A lung simulator, TestChest, was used to simulate pulmonary compliance variations. Using the TestChest system software, the parameters, including compliance and airway resistance, were set to simulate various acute respiratory distress syndrome (ARDS) lungs. Ventilator was also set to volume- and pressure-controlled modes with various parameter values (respiratory rate, RR, time of inspiration, Tinsp, positive end-expiratory pressure, PEEP) to ventilate the simulated lung of ARDS (with various respiratory system compliance, Crs). For the lung simulator, resistance of airway (Raw) was fixed to 5 cmH2O/L/s. Crs below lower inflation point (LIP) or above upper inflation point (UIP) was set to 10 mL/cmH2O. The reference standard geometric method was calculated offline with a customized software. Three algebraic formulas for volume-controlled and three for pressure-controlled were used to calculate MP.
UNASSIGNED: The performances of the formulas were different, although the derived MP were significantly correlated with that derived from the reference method (R2>0.80, P<0.001). Under volume-controlled ventilation, medians of MP calculated with one equation was significantly lower than that with the reference method (P<0.001). Under pressure-controlled ventilation, median of MP calculated with two equations were significantly higher (P<0.001). The maximum difference was over 70% of the MP value calculated with the reference method.
UNASSIGNED: The algebraic formulas may introduce considerably large bias under the presented lung conditions, especially in moderate to severe ARDS. Cautious is required when selecting adequate algebraic formulas to calculate MP based on the formula\'s premises, ventilation mode, and patients\' status. In clinical practice, the trend rather than the value of MP calculated by formulas should require more attention.

Ventilation mode is one of the most crucial ventilator settings, selected and set by knowledgeable critical care therapists in a critical care unit. The application of a particular ventilation mode must be patient-specific and patient-interactive. The main aim of this study is to provide a detailed outline regarding ventilation mode settings and determine the best machine learning method to create a deployable model for the appropriate selection of ventilation mode on a per breath basis. Per-breath patient data is utilized, preprocessed and finally a data frame is created consisting of five feature columns (inspiratory and expiratory tidal volume, minimum pressure, positive end-expiratory pressure, and previous positive end-expiratory pressure) and one output column (output column consisted of modes to be predicted). The data frame has been split into training and testing datasets with a test size of 30%. Six machine learning algorithms were trained and compared for performance, based on the accuracy, F1 score, sensitivity, and precision. The output shows that the Random-Forest Algorithm was the most precise and accurate in predicting all ventilation modes correctly, out of the all the machine learning algorithms trained. Thus, the Random-Forest machine learning technique can be utilized for predicting optimal ventilation mode setting, if it is properly trained with the help of the most relevant data. Aside from ventilation mode, control parameter settings, alarm settings and other settings may also be adjusted for the mechanical ventilation process utilizing appropriate machine learning, particularly deep learning approaches.

UNASSIGNED: Diaphragmatic pacing can improve diaphragm function, which is beneficial for the prognosis of patients treated with prolonged mechanical ventilation (MV). While most previous studies have focused on the role of implanted diaphragm pacing (IDP), our study is the first to examine the effects of external diaphragmatic pacing (EDP) in mechanically ventilated patients. Specifically, the effect of EDP on diaphragm function, the success rate of weaning, the duration of MV (DMV), and the intensive care unit (ICU) length of stay (ILOS) were assessed.
UNASSIGNED: From September 2019 to December 2020, a total of 51 mechanically ventilated patients in the ICU of the Sun Yat-sen Memorial Hospital, Sun Yat-sen University were enrolled and randomly divided into an EDP group of 27 patients and a control group of 24 patients. The control group received routine treatment, and the EDP group received EDP treatment in addition to routine treatment. The diaphragm excursion (DE), diaphragm thickening fraction (DTF), DMV, ILOS, and average survival time were recorded to evaluate efficacy.
UNASSIGNED: Patients treated with EDP had increased DE [exp(B) =1.86, 95% CI: 1.39 to 2.50, P<0.001] and DTF [exp(B) =1.35, 95% CI: 1.05 to 1.76, P=0.022], shortened weaning time (P=0.026) and prolonged average survival time (P<0.001) compared to patients who did not receive EDP therapy. Especially in cases with difficult weaning, the improvement of DE and DTF in the EDP treatment group was more obvious than that in the control group (P=0.013 and P=0.032). Moreover, the DTF upon attempted spontaneous breathing trial (SBT) was negatively correlated with the fraction of inspired oxygen (FiO2) [r=-0.54; 95% confidence interval (CI): -0.77 to -0.19; P=0.004], the arterial partial pressure of oxygen (PaO2) (r=-0.58; 95% CI: -0.79 to -0.25; P=0.001), the PaO2/FiO2 ratio (r=-0.52; 95% CI: -0.75 to -0.16; P=0.006), and the serum lactate concentration (Lac) (r=-0.39; 95% CI: -0.68 to 0.003; P=0.046).
UNASSIGNED: EDP treatment can effectively reduce the DMV and prolong the average survival time of mechanically ventilated patients.
UNASSIGNED: Chinese Clinical Trial Registry ChiCTR1900024096.

BACKGROUND: Mechanical ventilation (MV) is an important lifesaving method in intensive care unit (ICU). Prolonged MV is associated with ventilator associated pneumonia (VAP) and other complications. However, premature weaning from MV may lead to higher risk of reintubation or mortality. Therefore, timely and safe weaning from MV is important. In addition, identification of the right patient and performing a suitable weaning process is necessary. Although several guidelines about weaning have been reported, compliance with these guidelines is unknown. Therefore, the aim of this study is to explore the variation of weaning in China, associations between initial MV reason and clinical outcomes, and factors associated with weaning strategies using a multicenter cohort.
METHODS: This multicenter retrospective cohort study will be conducted at 17 adult ICUs in China, that included patients who were admitted in this 17 ICUs between October 2020 and February 2021. Patients under 18 years of age and patients without the possibility for weaning will be excluded. The questionnaire information will be registered by a specific clinician in each center who has been evaluated and qualified to carry out the study.
CONCLUSIONS: In a previous observational study of weaning in 17 ICUs in China, weaning practices varies nationally. Therefore, a multicenter retrospective cohort study is necessary to be conducted to explore the present weaning methods used in China.
BACKGROUND: Chinese Clinical Trial Registry (ChiCTR) (No. ChiCTR2100044634).

A meta-analysis was conducted to investigate the effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients.
The PubMed, Embase, and Cochrane medical databases were searched using the keywords \"45°\", \"head-of-bed elevation\", and \"semi-recumbent\". All relevant randomized controlled trials (RCTs) published between 2005 and 2021 were obtained. The Cochrane system for randomized intervention was adopted and the RevMan 5.3.5 software was used to construct forest plots and funnel plots to assess the risk of bias for the included studies.
A total of 128 literatures were initially screened for this meta-analysis, and 7 studies were finally included, with a total of 740 patients. Meta-analysis revealed that the incidence of ventilator-associated pneumonia (VAP) was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position [odds ratio (OR) =0.48; 95% confidence interval (CI): 0.28 to 0.84; Z=2.59; P=0.009]. Furthermore, the incidence of gastric reflux was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =0.50; 95% CI: 0.27 to 0.96; Z=2.09; P=0.04). Meta-analysis demonstrated that the incidence of pressure sores was significantly higher in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =1.88; 95% CI: 1.05 to 3.36; Z=2.11; P=0.03).
The 45° semi-recumbent position can reduce the incidence of VAP and gastric reflux in patients undergoing mechanical ventilation (MV), but it may also increase the risk of pressure sores. Thus, consideration should be made based on a comprehensive understanding of the patient\'s condition and physical state.

BACKGROUND: The hypoxemia condition after mechanical ventilation (MV) weaning is not rare among sepsis patients, so we compared the efficacy in two different intervention groups: high-flow nasal cannula device group and non-invasive positive pressure ventilation (NPPV) group.
METHODS: This is a retrospective cohort study. Participants were patients with sepsis receiving high-flow nasal catheter (HFNC) device or NPPV within 24 hours after weaning from MV. The primary outcome was tracheal re-intubation within 72 hours after extubation. Secondary outcomes included: oxygenation index, complication rate, patient comfort evaluation, HFNC/NPPV treatment time, ICU length of stay (LOS), ICU mortality, and in-hospital 28-day mortality.
RESULTS: A total of 283 patients were included in the study with 167 in the HFNC group and 116 in the NPPV group. The re-intubation rates after extubation in both groups were respectively 4.2% and 5.2% without significant difference. Patients in the HFNC group experienced lower incidence of delirium, reflux aspiration, facial pressure ulcer and other complications, and higher score of patients comfort than that in the NPPV group. There was no significant difference in ICU LOS, ICU mortality and in-hospital 28-day mortality between the two groups.
CONCLUSIONS: HFNC and NPPV have similar efficacy in the sequential treatment of sepsis patients after weaning from MV. Compared with NPPV, those extubated to HFNC had lower rate of complications such as reflux aspiration and facial pressure ulcers. The patients extubation to HFNC is more comfortable (and associated with less delirium) than to NPPV.

BACKGROUND: In recent years, the number of elderly patients receiving mechanical ventilation (MV) in intensive care units (ICUs) has increased. However, the evidence on the outcomes of elderly mechanically ventilated patients is scant in China. Our objective was to evaluate the characteristics and outcomes in elderly patients (≥65 years) receiving MV in the ICU.
METHODS: We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 hours of MV. Patients were divided into three age groups: under 65, 65-79, and ≥80 years. The primary outcome was hospital mortality. We performed univariate and multivariate logistic regression analysis to identify factors associated with hospital mortality.
RESULTS: A total of 853 patients were analysed. Of those, 61.5% were ≥65 years of age, and 26.0% were ≥80 years of age. There were significant differences in the principal reason for MV among the three age groups (P<0.001). Advanced age was significantly associated with total duration of MV, ICU length of stay (LOS), and ICU costs (all P<0.001), but not with hospital LOS and hospital costs (P>0.05). In addition, mortality rates in the ICU, hospital, and at 60 days significantly increased with age (all P<0.001). In the age group of 80 years and older, the mortality rates were 47.7%, 49.5%, and 50.0%, respectively. Multivariate logistic regression analysis had found that age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio, total duration of MV, ICU LOS, and the decision to withhold/withdraw life-sustaining treatments were independent influence factors for mortality rates.
CONCLUSIONS: Mechanically ventilated elderly patients (≥65 years) have a higher ICU and hospital mortality, but the hospital LOS and hospital costs are similar to younger patients. Advanced age should be considered as a significant independent risk factor for hospital mortality of mechanically ventilated ICU patients.

BACKGROUND: Evaluate the accuracy of IWI predicting weaning in patients with mechanical ventilation greater than 72 hours.
METHODS: All patients were divided into two groups, according to FiO2 in the intensive care unit (ICU) with mechanically ventilated for more than 72 hours. Recorded Integrative weaning index (IWI) related indicators in all patients. Evaluate the accuracy of IWI predicting weaning success.
RESULTS: Within these 50 patients, 32 of them were weaning successfully, and 18 of the patients failed. Using IWI >45.70 mL/cmH2O breaths/minute/liter as a threshold of predicting successful weaning, the sensitivity is 0.91, and the specificity is 0.83. The AUC of IWI was 0.91. In the group with FiO2 =0.40, 17 patients were successfully liberated from MV, while 8 patients failed. The sensitivity is 0.8235, and specificity is 0.88 using IWI >50.40 mL/cmH2O breath/minute/liter as a threshold for predicting the outcome of weaning. The AUC of IWI was 0.846±0.117. In the FiO2 =0.35 group, 15 patients were successfully liberated from MV, while 10 patients failed. Using IWI >39.33 mL/cmH2O breaths/minute/liter, as a threshold to predict successful weaning, results in a sensitivity of 0.93 and a specificity of 0.90. The AUC of IWI was 0.953±0.395.
CONCLUSIONS: Results showed IWI has a significantly higher AUC value compared with other traditional weaning indexes. Hence, it can be a significant predictor for weaning outcomes.