Next :: Claude Guerin. Covid v non covid and NIV. #LIVES2022#ventilation#NIV@ESICM summarising risk factors for NIV failure - old age, multi organ failure etc. then diving straight into “Happy Hypoxemia”.
Re-visiting H and L phenotypes. Silent or happy hypoxemia. So best to proceed by undertaking in depth literature search
But the evidence tends to suggest covid has higher mortality and is also v heterogeneous.
Contrasting with another classic lung safe study. Left graph non covid and right is covid. NIV group annotated. In comparison mortality is comparable at 40% and higher than with invasive.
Let’s look at “intubation”. NIV is tested here with high flow. No effect of NIV versus hfnc n covid and non covid to prevent intubation. NOTE. Significant heterogeneity. BUT. NIV better than SOR to prevent intubation
Just to note on mortality here .
But the new evidence not included in the meta analysis is HELMET NIV. In summary : rate of intubation is v similar between cov and non cov. NIC both cov or non covid prevented intubation without significant effect in mortality. So effectively :: NIV is NIV whatever the aetiology
I'm following the session earlier by Prof Xavier Monnet: 'Venous RETURN' & its monitoring.
Venous return
👉 is NOT cardiac preload
👉 is a flow
👉 measured in litres / min.
should be renamed to reflect that ideally.
Of course VR is linked to cardiac preload.
@ESICM #LIVES2023
1st FACT: VR = Cardiac Output AT equilibrium. LV can only eject what it gets frm R side.
Like any flow, VR determined by Delta P & resistance.
Now what is Delta P here? it's difference betn
👉 Mean Systemic Pressure (upstream)
👉 Right Atrial P(downstream)
@ESICM #LIVES2023
Now, MSP is not 'REAL' : is hypothetical.
by defn - it must be higher than RA to generate VR/flow.
👉not accurate but can visualise as space betn capillary & vein
👉 when heart stops, arterial pressure drops & CVP rises to equilibrate at Mean circulatory P
@ESICM #LIVES2023
But what #kind of #registries ? - Patient, Specialty, Device ? e.g., Abiomed Imeplla registry data. Regulatory process is different - FDA normally requires RCT. Abiomed registry data was compelling , resulting in +++ impella uptake in USA. #UKECPR23