Jaarlijks worden ongeveer 80.000 patiënten behandeld op de ruim 80 intensive care-afdelingen in Nederland.Op een intensive careafdeling worden vitale functies bewaakt en meestal zelfs overgenomen. Bij de meeste patiënten is voor kortere of langere tijd kunstmatige beademing noodzakelijk. Kunstmatige beademing is effectief en soms zelfs levens reddend maar is in het geheel niet zonder risico’s. Lector Critical Care Frederique Paulus gaat in haar rede in op de uitdagingen die de interprofessionele teams op de Intensive Care hebben ten aanzien van de luchtweg- en beademingszorg. Zij zal proberen te schetsen wat ‘Wij gaan goed voor u zorgen’ op een Intensive Care betekent. Het bijzonder lectoraat CriticalCare is ingesteld in samenwerking methet Amsterdam UMC locatie AMC.
In patients with extensive burns several causes may underliehypoxic respiratory failure and bilateral infiltrates on the chestX-ray in the first week afterburn: cardiogenic pulmonaryedema as a result of congestive heart failure, pneumonia and/or adult respiratory distress syndrome (ARDS). In particular, itis a challenge to differentiate between ARDS and cardiogenicpulmonary edema in these patients because on the one handthe incidence of ARDS in burn shock appears higher thananticipated, whereas on the other hand there is an increasedrisk for cardiogenic pulmonary edema to develop as intensivefluid resuscitation is mandatory, while myocardial function isdepressed as noted by Baxter et al.[1]. Since these twodiagnoses have very different treatment options, it is impor-tant to be able to differentiate between them as soon as
BACKGROUND: Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak.METHODS: PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at ClinicalTrials.gov (NCT04346342).FINDINGS: Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7-7·1), PEEP was 14·0 cm H2O (IQR 11·0-15·0), and driving pressure was 14·0 cm H2O (11·2-16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0-39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0-15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation.INTERPRETATION: In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19.FUNDING: Amsterdam University Medical Centers, location Academic Medical Center.
