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Inhaled nitric oxide (NO) is most frequently delivered to mechanically ventilated patients in critical care, but it can also be administered noninvasively. The delivered dose and efficiency of continuous flow NO supplied through a nasal cannula has yet to be established. This study aimed to determine the influence of nasal cannula type, supply flow, and breathing pattern on delivered NO using a realistic adult airway replica and lung simulator.

Simulated breathing patterns were selected to represent rest, sleep, and light exercise, and were varied to investigate the effects of tidal volume and breathing frequency independently. Supplied gas flows targeted tracheal concentrations at rest of 5 or 20 ppm NO and were supplied with 2 L/min O

. Three different cannulas were tested. Tracheal NO concentrations and NO mass flow past the trachea were evaluated.

Cannula type had a minor influence on delivered dose. Tracheal NO concentrations differed significantly based on breathing pattern (

< 0.01); for a target NO concentration of 20 ppm at rest, average inhaled NO concentrations were 23.3 ± 0.5 ppm, 36.5 ± 1.4 ppm, and 17.2 ± 0.3 ppm for the rest, sleep, and light exercise breathing patterns, respectively. For the same test conditions, mass flow of NO past the trachea was less sensitive to breathing pattern 20.3 ± 0.5 mg/h, 19.9 ± 0.8 mg/h, and 24.3 ± 0.4 mg/h for the rest, sleep, and light exercise breathing patterns, respectively. Mass flow and delivery efficiency increased when minute volume increased.

These results indicate that inhaled NO concentration is strongly influenced by breathing pattern, whereas inhaled NO mass flow is not. NO mass flow may therefore be a useful dose metric for continuous flow delivery via nasal cannula.

These results indicate that inhaled NO concentration is strongly influenced by breathing pattern, whereas inhaled NO mass flow is not. NO mass flow may therefore be a useful dose metric for continuous flow delivery via nasal cannula.

Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants.

Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model.

Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similaerform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.

In actuality, it is difficult to obtain an early prognostic stratification for patients with acute respiratory failure treated with noninvasive ventilation (NIV). We tested whether an early evaluation through a predictive scoring system could identify subjects at risk of in-hospital mortality or NIV failure.

This was a retrospective study, which included all the subjects with acute respiratory failure who required NIV admitted to an emergency department-high-dependence observation unit between January 2014 and December 2017. The HACOR (heart rate, acidosis [by using pH], consciousness [by using the Glasgow coma scale], oxygenation [by using [Formula see text]/[Formula see text]], respiratory rate) score was calculated before the NIV initiation (T0) and after 1 h (T1) and 24 h (T24) of treatment. Akt activator The primary outcomes were in-hospital mortality and NIV failure, defined as the need for invasive ventilation.

The study population included 644 subjects, 463 with hypercapnic respiratory failure and an overall in-hospital mortality.

The number of patients requiring prolonged mechanical ventilation (PMV) is predicted to escalate due to an aging population. International studies on prevalence and resource utilization of this patient group exist, but data are lacking from Scandinavian ICUs, where there is a relatively low number of ICU beds in relation to population. The primary aim was to identify prevalence of admissions requiring mechanical ventilation ≥ 7-21 d and PMV > 21 d, and their use of ICU bed days in Sweden. Secondary aims were to describe patient characteristics and outcomes.

We obtained data from the Swedish Intensive Care Registry on admissions age ≥ 18 y mechanically ventilated ≥ 7 d and used open source registry data to calculate the prevalence and use of bed days of admissions ventilated ≥ 7-21 d and PMV > 21 d.

Of the 39,510 ICU admissions to Swedish ICUs in 2017, those mechanically ventilated ≥ 7-21 d accounted for 1,643 (4%) admissions, and those with PMV > 21 d accounted for 307 (0.8%) admissions. Of the 109,457 ICU bed days, 22% were consumed by admissions ventilated ≥ 7-21 d and 10% by those with PMV > 21 d. The ICU mortality of both groups was 21%. Admissions with mechanical ventilation ≥ 7 d had a median age of 65 y and were predominantly male (64%).

Admissions to Swedish ICUs who required mechanical ventilation ≥ 7-21 d and PMV > 21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.

21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.