Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference

Annals of Intensive Care, Journal Year: 2024, Volume and Issue: 14(1)

Published: Sept. 5, 2024

Although largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation Langue Française, SRLF) Emergency Medicine Française Médecine d'Urgence, SFMU) organized a consensus conference on ARF (excluding cardiogenic pulmonary oedema hypercapnic exacerbation chronic obstructive diseases) December 2023.

Language: Английский

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2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

Resuscitation, Journal Year: 2024, Volume and Issue: unknown, P. 110414 - 110414

Published: Nov. 1, 2024

Language: Английский

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Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation

Intensive Care Medicine, Journal Year: 2024, Volume and Issue: 50(9), P. 1470 - 1483

Published: Aug. 20, 2024

Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets also lead to harmful episodes of hypoxaemia. In this registry-embedded, multicentre trial, we randomly assigned adult patients VA-ECMO in an intensive care unit (ICU) either a conservative (target SaO2 92–96%) or liberal strategy 97–100%) through controlled administration via the ventilator and ECMO gas blender. The primary outcome was number ICU-free days day 28. Secondary outcomes included 60, mortality, ventilation duration, ICU hospital lengths stay, functional at 6 months. From September 2019 June 2023, 934 who received were reported EXCEL registry, whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) recruited. We randomised 149 151 strategy. median 28 similar both groups (conservative: 0 [interquartile range (IQR) 0–13.7] versus liberal: [IQR 0–13.7], treatment effect: [95% confidence interval (CI) – 3.1 3.1]). Mortality (59/159 [39.6%] vs 59/151 [39.1%]) 60 (64/149 [43%] 62/151 [41.1%] groups, as all other secondary adverse events. group experienced 44 (29.5%) major protocol deviations compared 2 (1.3%) (P < 0.001). adults ICU, strategy, did not affect

Language: Английский

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Hyperoxemia after reperfusion in cardiac arrest patients: a potential dose–response association with 30-day survival

Critical Care, Journal Year: 2023, Volume and Issue: 27(1)

Published: March 6, 2023

Hyperoxemia may aggravate reperfusion brain injury after cardiac arrest. The aim of this study was to the associations between different levels hyperoxemia in period arrest and 30-day survival.Nationwide observational using data from four compulsory Swedish registries. Adult in- out-of-hospital patients admitted an ICU, requiring mechanical ventilation, January 2010 March 2021, were included. partial oxygen pressure (PaO2) collected a standardized way at ICU admission (± one hour) according simplified acute physiology score 3 reflecting time interval with treatment return spontaneous circulation admission. Subsequently, divided into groups based on registered PaO2 categorized mild (13.4-20 kPa), moderate (20.1-30 kPa) severe (30.1-40 extreme (> 40 normoxemia as 8-13.3 kPa. Hypoxemia defined < 8 Primary outcome survival relative risks (RR) estimated by multivariable modified Poisson regression.In total, 9735 included which 4344 (44.6%) hyperoxemic Among these, 2217 classified mild, 1091 moderate, 507 severe, 529 hyperoxemia. Normoxemia present 4366 (44.8%) 1025 (10.5%) had hypoxemia. Compared group, adjusted RR for whole group 0.87 (95% CI 0.82-0.91). corresponding results subgroups were; 0.91 0.85-0.97), 0.88 0.82-0.95), 0.79 0.7-0.89), 0.68 0.58-0.79). Adjusted hypoxemia compared 0.83 0.74-0.92). Similar seen both in-hospital arrests.In nationwide comprising patients, associated lower survival.

Language: Английский

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Post-Cardiac Arrest Syndrome

Journal of Neurosurgical Anesthesiology, Journal Year: 2023, Volume and Issue: 35(3), P. 260 - 264

Published: May 16, 2023

Post-cardiac arrest syndrome (PCAS) is a multicomponent entity affecting many who survive an initial period of resuscitation following cardiac arrest. This focussed review explores some the strategies for mitigating effects PCAS return spontaneous circulation. We consider current evidence controlled oxygenation, blood-pressure targets, timing coronary reperfusion, and temperature control treatment seizures. Despite several large trials investigating specific to improve outcomes after arrest, questions remain unanswered. Results studies suggest that interventions may benefit subgroups patients, but optimal duration unknown. The role intracranial pressure monitoring has been subject only few studies, its benefits unclear. Research aimed at improving management ongoing.

Language: Английский

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Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: A meta-analysis

Resuscitation, Journal Year: 2023, Volume and Issue: 194, P. 110071 - 110071

Published: Dec. 5, 2023

Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or cardiac arrest (CA). Exposure to hyperoxemia common during VA-ECMO, and its impact on patient's outcome remains unclear.

Language: Английский

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Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest—Device Matters: A Propensity-Score-Based Match Analysis

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(13), P. 4429 - 4429

Published: June 30, 2023

Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices available, but the literature is poor in direct comparison studies. Our aim was to assess whether type of chest compressor could affect probability return spontaneous circulation (ROSC) and 30-day survival Out-of-Hospital Cardiac Arrest (OHCA) patients as compared manual standard CPR.We considered all OHCAs that occurred from 1 January 2015 31 December 2022 seven provinces Lombardy region equipped with three different types compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), Easy Pulse® (Schiller, Switzerland).Two groups, 2146 each (manual CPR), were identified by propensity-score-based random matching. The rates ROSC (15% vs. 23%, p < 0.001) (6% 14%, lower group. After correction confounders, Autopulse® [OR 2.1, 95%CI (1.6-2.8), 0.001] 2.5, (1.7-3.6), significantly increased ROSC, [HR 0.9, (0.8-0.9), = 0.005].Mechanical compressors increase rate especially case prolonged resuscitation. dissimilar, their performances influence patient outcomes. load-distributing-band device only able favorably survival.

Language: Английский

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Combined effects of targeted blood pressure, oxygenation, and duration of device-based fever prevention after out-of-hospital cardiac arrest on 1-year survival: post hoc analysis of a randomized controlled trial

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Jan. 12, 2024

Abstract Background The “Blood Pressure and Oxygenation Targets in Post Resuscitation Care” (BOX) trial investigated whether a low versus high blood pressure target, restrictive liberal oxygenation shorter longer duration of device-based fever prevention comatose patients could improve outcomes. No differences rates discharge from hospital with severe disability or 90-day mortality were found. However, long-term effects potential interaction the interventions are unknown. Accordingly, objective this study is to investigate both individual combined on 1-year rates. Methods BOX was randomized controlled two-center that assigned resuscitated out-of-hospital cardiac arrest following three at admission: A target either 63 mmHg 77 mmHg; An arterial 9–10 kPa 13–14 kPa; Device-based administered as an initial 24 h 36 °C then 12 48 37 °C; totaling 72 temperature control. Randomization occurred parallel simultaneously all interventions. Patients followed for occurrence death causes 1 year. Analyzes performed by Cox proportional models, assessment interactions stated term. Results Analysis included 789 patients. For intervention compared targets, 35% (138 396) 36% (143 393), respectively, hazard ratio (HR) 0.92 (0.73–1.16) p = 0.47. 34% (135 394) 37% (146 395), HR 0.46. total h, (139 393) (142 396), 0.98 (0.78–1.24) 0.89. There no sign between interventions, accordingly, combination randomizations indicated differentiated treatment effects. Conclusions difference after arrest. affected these findings. Trial registration ClinicalTrials.gov NCT03141099, Registered 30 April 2017.

Language: Английский

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Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation

Resuscitation, Journal Year: 2024, Volume and Issue: 201, P. 110196 - 110196

Published: June 27, 2024

Language: Английский

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Post resuscitation oxygen supplementation: Throw it away?

Resuscitation, Journal Year: 2025, Volume and Issue: 207, P. 110485 - 110485

Published: Jan. 5, 2025

Language: Английский

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