[ { "key": "9RMAUXDV", "version": 17, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/9RMAUXDV", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/9RMAUXDV", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/JXVA3EII", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "9RMAUXDV", "version": 17, "parentItem": "JXVA3EII", "itemType": "attachment", "linkMode": "imported_url", "title": "Accepted Version", "accessDate": "2026-01-22T13:06:46Z", "url": "https://europepmc.org/articles/pmc6320691?pdf=render", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Ouchi et al. - 2018 - Prognosis After Emergency Department Intubation to Inform Shared Decision-Making.pdf", "md5": null, "mtime": null, "tags": [], "relations": {}, "dateAdded": "2026-01-22T13:06:46Z", "dateModified": "2026-01-22T13:06:46Z" } }, { "key": "JXVA3EII", "version": 17, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/JXVA3EII", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/JXVA3EII", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Ouchi et al.", "parsedDate": "2018-07", "numChildren": 2 }, "data": { "key": "JXVA3EII", "version": 17, "itemType": "journalArticle", "title": "Prognosis After Emergency Department Intubation to Inform Shared Decision-Making", "creators": [ { "creatorType": "author", "firstName": "Kei", "lastName": "Ouchi" }, { "creatorType": "author", "firstName": "Guruprasad D.", "lastName": "Jambaulikar" }, { "creatorType": "author", "firstName": "Samuel", "lastName": "Hohmann" }, { "creatorType": "author", "firstName": "Naomi R.", "lastName": "George" }, { "creatorType": "author", "firstName": "Emily L.", "lastName": "Aaronson" }, { "creatorType": "author", "firstName": "Rebecca", "lastName": "Sudore" }, { "creatorType": "author", "firstName": "Mara A.", "lastName": "Schonberg" }, { "creatorType": "author", "firstName": "James A.", "lastName": "Tulsky" }, { "creatorType": "author", "firstName": "Jeremiah D.", "lastName": "Schuur" }, { "creatorType": "author", "firstName": "Daniel J.", "lastName": "Pallin" } ], "abstractNote": "OBJECTIVES: To inform the shared decision-making process between clinicians and older adults and their surrogates regarding emergency intubation.\nDESIGN: Retrospective cohort study.\nSETTING: Multicenter, emergency department (ED)-based cohort.\nPARTICIPANTS: Adults aged 65 and older intubated in the ED from 2008 to 2015 from 262 hospitals across the United States (>95% of U.S. nonprofit academic medical centers).\nMEASUREMENTS: Our primary outcome was age-specific in-hospital mortality. Secondary outcomes were age-specific odds of death after adjusting for race, comorbid conditions, admission diagnosis, hospital disposition, and geographic region.\nRESULTS: We identified 41,463 ED intubation encounters and included 35,036 in the final analysis. Sixty-four percent were in non-Hispanic whites and 54% in women. Overall in-hospital mortality was 33% (95% confidence interval (CI)=34-35%). Twenty-four percent (95% CI=24-25%) of subjects were discharged to home, and 41% (95% CI=40-42%) were discharged to a location other than home. Mortality was 29% (95% CI=28-29%) for individuals aged 65 to 74, 34% (95% CI=33-35%) for those aged 75 to 79, 40% (95% CI=39-41%) for those aged 80 to 84, 43% (95% CI=41-44%) for those aged 85 to 89, and 50% (95% CI=48-51%) for those aged 90 and older.\nCONCLUSION: After emergency intubation, 33% percent of older adults die during the index hospitalization. Only 24% of survivors are discharged to home. Simple, graphic representations of this information, in combination with an experienced clinician's overall clinical assessment, will support shared decision-making regarding unplanned intubation.", "publicationTitle": "Journal of the American Geriatrics Society", "publisher": "", "place": "", "date": "2018-07", "volume": "66", "issue": "7", "section": "", "partNumber": "", "partTitle": "", "pages": "1377-1381", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Am Geriatr Soc", "DOI": "10.1111/jgs.15361", "citationKey": "", "url": "", "accessDate": "", "PMID": "29542117", "PMCID": "PMC6320691", "ISSN": "1532-5415", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Cohort Studies", "type": 1 }, { "tag": "Decision Making", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Hospital Mortality", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Intubation, Intratracheal", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 }, { "tag": "Severity of Illness Index", "type": 1 }, { "tag": "Survival Rate", "type": 1 }, { "tag": "emergency department", "type": 1 }, { "tag": "intubation", "type": 1 }, { "tag": "mortality", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2026-01-22T13:06:44Z", "dateModified": "2026-01-22T13:06:44Z" } }, { "key": "EJHECBBU", "version": 17, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/EJHECBBU", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/EJHECBBU", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/JXVA3EII", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "EJHECBBU", "version": 17, "parentItem": "JXVA3EII", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2026-01-22T13:06:44Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29542117", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2026-01-22T13:06:44Z", "dateModified": "2026-01-22T13:06:44Z" } }, { "key": "SVD7HKPF", "version": 15, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/SVD7HKPF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/SVD7HKPF", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/5P5N84AP", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "SVD7HKPF", "version": 15, "parentItem": "5P5N84AP", "itemType": "attachment", "linkMode": "imported_url", "title": "Full Text PDF", "accessDate": "2026-01-22T12:44:52Z", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12765188/pdf/main.pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Klemisch et al. - 2025 - Management of Mechanical Ventilation in Emergency Medicine A Scoping Review.pdf", "md5": null, "mtime": null, "tags": [], "relations": {}, "dateAdded": "2026-01-22T12:44:52Z", "dateModified": "2026-01-22T12:44:52Z" } }, { "key": "58SM52NL", "version": 14, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/58SM52NL", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/58SM52NL", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/5P5N84AP", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "58SM52NL", "version": 14, "parentItem": "5P5N84AP", "itemType": "attachment", "linkMode": "linked_url", "title": "Catalog Page", "accessDate": "2026-01-22T12:44:46Z", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12765188/", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2026-01-22T12:44:46Z", "dateModified": "2026-01-22T12:44:46Z" } }, { "key": "5P5N84AP", "version": 14, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/5P5N84AP", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/5P5N84AP", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Klemisch et al.", "parsedDate": "2025-12-13", "numChildren": 2 }, "data": { "key": "5P5N84AP", "version": 14, "itemType": "journalArticle", "title": "Management of Mechanical Ventilation in Emergency Medicine: A Scoping Review", "creators": [ { "creatorType": "author", "firstName": "Robert J.", "lastName": "Klemisch" }, { "creatorType": "author", "firstName": "Mitchell S.", "lastName": "Hymowitz" }, { "creatorType": "author", "firstName": "Ryan J.", "lastName": "Alcantara" }, { "creatorType": "author", "firstName": "Brendan F.", "lastName": "Mullan" }, { "creatorType": "author", "firstName": "Margaret L.", "lastName": "Davis" }, { "creatorType": "author", "firstName": "Rachel", "lastName": "Blume" }, { "creatorType": "author", "firstName": "Nicholas J.", "lastName": "Johnson" }, { "creatorType": "author", "firstName": "Brian M.", "lastName": "Fuller" } ], "abstractNote": "Objectives\nInvasive mechanical ventilation is used for approximately 250,000 emergency medicine (EM) patients annually and continues to increase. Despite rising volumes, EM clinicians receive limited training in ventilation management. Much of the existing evidence is derived from other environments, which may not fully apply to the unique conditions of EM. This scoping review broadly categorizes literature on invasive ventilation specific to EM patients and clinicians and identifies knowledge gaps to direct future research.\n\nMethods\nFollowing Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews Checklist guidelines, this review comprehensively mapped the literature on optimizing invasive mechanical ventilation in EM. Studies involving EM patients or clinicians were included. Searches in MEDLINE, EMBASE, and CINAHL identified relevant studies, which were screened and data were extracted by multiple reviewers. Identified studies were analyzed and categorized thematically.\n\nResults\nFrom 4386 articles, 65 studies met inclusion criteria. Studies focused on EM patients (54 studies) and clinicians (11 studies). The following 6 themes emerged: tidal volume management (32 studies); ventilator adjustments (15); sedation and neuromuscular blockade (15); education, knowledge, and assessment (10); bundled care (8); and oxygen/carbon dioxide management (8). Some studies fit multiple themes. The variability of study methods and topics precluded synthesis of data; however, some key results were found in the most studied themes. Specifically, ventilation bundles that include low tidal volume ventilation may be associated with reduced mortality. Sedation practices were highly variable, and achieving lighter sedation in EM patients may be an ideal target for future study. Additionally, EM clinicians lack training and comfort in managing invasive mechanical ventilation. Significant gaps in EM-specific evidence and variable adherence to recommended practices were also identified, highlighting opportunities for improved education and care strategies.\n\nConclusion\nLimited research exists on invasive mechanical ventilation management in EM. Although strategies like tidal volume restriction show promise, evidence specific to the EM setting remains sparse. Further research is required to identify critical interventions to improve outcomes for emergency patients.", "publicationTitle": "Journal of the American College of Emergency Physicians Open", "publisher": "", "place": "", "date": "2025-12-13", "volume": "7", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "100297", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Am Coll Emerg Physicians Open", "DOI": "10.1016/j.acepjo.2025.100297", "citationKey": "", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12765188/", "accessDate": "2026-01-22T12:44:46Z", "PMID": "41492494", "PMCID": "PMC12765188", "ISSN": "2688-1152", "archive": "", "archiveLocation": "", "shortTitle": "Management of Mechanical Ventilation in Emergency Medicine", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2026-01-22T12:44:46Z", "dateModified": "2026-01-22T12:44:46Z" } }, { "key": "RIJRPW2W", "version": 13, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/RIJRPW2W", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/RIJRPW2W", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Shupp et al.", "parsedDate": "2010-12", "numChildren": 1 }, "data": { "key": "RIJRPW2W", "version": 13, "itemType": "journalArticle", "title": "A review of the local pathophysiologic bases of burn wound progression", "creators": [ { "creatorType": "author", "firstName": "Jeffrey W.", "lastName": "Shupp" }, { "creatorType": "author", "firstName": "Teresa J.", "lastName": "Nasabzadeh" }, { "creatorType": "author", "firstName": "Dean S.", "lastName": "Rosenthal" }, { "creatorType": "author", "firstName": "Marion H.", "lastName": "Jordan" }, { "creatorType": "author", "firstName": "Philip", "lastName": "Fidler" }, { "creatorType": "author", "firstName": "James C.", "lastName": "Jeng" } ], "abstractNote": "Burn wound progression refers to the phenomenon of continued tissue necrosis in the zone of stasis after abatement of the initial thermal insult. A multitude of chemical and mechanical factors contribute to the local pathophysiologic process of burn wound progression. Prolonged inflammation results in an accumulation of cytotoxic cytokines and free radicals, along with neutrophil plugging of dermal venules. Increased vascular permeability and augmentations of interstitial hydrostatic pressure lead to edema with vascular congestion. Hypercoagulability with thrombosis further impairs blood flow, while oxidative stress damages endothelial cells and compromises vascular patency. A number of studies have investigated the utility of various agents in modulating these mechanisms of burn wound progression. However, as many of studies have used animal models of burn injury, often with administration of therapy preburn, obscuring the clinical applicability of the results to burn patients is of questionable benefit. An understanding of the complex, interrelated mediators of burn wound progression and their ultimate point of convergence in effecting tissue necrosis—cell apoptosis or oncosis—will allow for the future development of therapeutic interventions.", "publicationTitle": "Journal of Burn Care & Research: Official Publication of the American Burn Association", "publisher": "", "place": "", "date": "2010 Nov-Dec", "volume": "31", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "849-873", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Burn Care Res", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "21105319", "PMCID": "", "ISSN": "1559-0488", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Apoptosis", "type": 1 }, { "tag": "Blood Coagulation Disorders", "type": 1 }, { "tag": "Burns", "type": 1 }, { "tag": "Cytokines", "type": 1 }, { "tag": "Disease Progression", "type": 1 }, { "tag": "Edema", "type": 1 }, { "tag": "Free Radicals", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Inflammation", "type": 1 }, { "tag": "Necrosis", "type": 1 }, { "tag": "Risk Factors", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2015-11-03T13:09:00Z", "dateModified": "2015-11-03T13:09:00Z" } }, { "key": "WFDA8DFJ", "version": 11, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/WFDA8DFJ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/WFDA8DFJ", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/RIJRPW2W", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "WFDA8DFJ", "version": 11, "parentItem": "RIJRPW2W", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-11-03T13:09:00Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21105319", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-11-03T13:09:00Z", "dateModified": "2015-11-03T13:09:00Z" } }, { "key": "US9Q4V6F", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/US9Q4V6F", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/US9Q4V6F", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Mutlu et al.", "parsedDate": "2002-02", "numChildren": 1 }, "data": { "key": "US9Q4V6F", "version": 12, "itemType": "journalArticle", "title": "Severe status asthmaticus: management with permissive hypercapnia and inhalation anesthesia", "creators": [ { "creatorType": "author", "firstName": "Gökhan M.", "lastName": "Mutlu" }, { "creatorType": "author", "firstName": "Phillip", "lastName": "Factor" }, { "creatorType": "author", "firstName": "David E.", "lastName": "Schwartz" }, { "creatorType": "author", "firstName": "Jacob I.", "lastName": "Sznajder" } ], "abstractNote": "OBJECTIVE: To describe the difficulties that can be encountered during mechanical ventilation of severe status asthmaticus and to discuss the safety of permissive hypercapnia as a ventilatory strategy and the role and limitations of inhalation anesthesia in the treatment of refractory cases.\nDESIGN: Case series and review of literature.\nSETTING: Intensive care unit of a tertiary care hospital.\nPATIENTS: Two patients with severe status asthmaticus.\nINTERVENTIONS: Administration of inhalational anesthetics.\nMEASUREMENTS AND MAIN RESULTS: Both patients had respiratory failure secondary to status asthmaticus requiring mechanical ventilation and permissive hypercapnia. They also received inhalational anesthetics because of refractory bronchoconstriction. Levels of PaCO(2) in each case were among the highest and most prolonged elevations (>150 mm Hg for several hours) reported to date. In one case, life-threatening difficulties with ventilation were encountered related to the use of an anesthesia ventilator. Although they had complications related to the severity of their illnesses, both were treated to recovery.\nCONCLUSIONS: Mechanical ventilation in severe status asthmaticus can be challenging. Permissive hypercapnia is a relatively safe strategy in the ventilatory management of asthma. High levels of hypercapnia and associated severe acidosis are well tolerated in the absence of contraindications (i.e., preexisting intracranial hypertension). Inhalation anesthesia may be useful in the treatment of refractory cases of asthma but should be used carefully because it may be hazardous owing to poor flow capabilities of most anesthesia ventilators.", "publicationTitle": "Critical Care Medicine", "publisher": "", "place": "", "date": "Feb 2002", "volume": "30", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "477-480", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Crit. Care Med.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "11889333", "PMCID": "", "ISSN": "0090-3493", "archive": "", "archiveLocation": "", "shortTitle": "Severe status asthmaticus", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Anesthesia, Inhalation", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Hypercapnia", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 }, { "tag": "Status Asthmaticus", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T14:00:28Z", "dateModified": "2014-08-31T14:00:28Z" } }, { "key": "K4XFWDU9", "version": 10, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/K4XFWDU9", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/K4XFWDU9", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/US9Q4V6F", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "K4XFWDU9", "version": 10, "parentItem": "US9Q4V6F", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T14:00:28Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/11889333", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T14:00:28Z", "dateModified": "2014-08-31T14:00:28Z" } }, { "key": "CCNMCATD", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/CCNMCATD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/CCNMCATD", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Armaganidis et al.", "parsedDate": "2000-12", "numChildren": 1 }, "data": { "key": "CCNMCATD", "version": 12, "itemType": "journalArticle", "title": "Intrinsic positive end-expiratory pressure in mechanically ventilated patients with and without tidal expiratory flow limitation", "creators": [ { "creatorType": "author", "firstName": "A.", "lastName": "Armaganidis" }, { "creatorType": "author", "firstName": "K.", "lastName": "Stavrakaki-Kallergi" }, { "creatorType": "author", "firstName": "A.", "lastName": "Koutsoukou" }, { "creatorType": "author", "firstName": "A.", "lastName": "Lymberis" }, { "creatorType": "author", "firstName": "J.", "lastName": "Milic-Emili" }, { "creatorType": "author", "firstName": "C.", "lastName": "Roussos" } ], "abstractNote": "OBJECTIVE: To assess static intrinsic positive end-expiratory pressure (PEEPi,st) and expiratory flow limitation (FL) in 32 consecutive mechanically ventilated patients with acute respiratory failure (ARF), using a commercial ventilator with an incorporated device that allows the application of a negative expiratory pressure (NEP).\nDESIGN: Prospective clinical study.\nSETTING: Multidisciplinary intensive care unit of a university hospital.\nPATIENTS: Thirty-two consecutive ventilated patients with ARF of various etiologies.\nINTERVENTIONS: Evaluation of respiratory mechanics, PEEPi,st, and FL from pressure, flow, and volume traces provided by the ventilator.\nMEASUREMENTS: Peak airway pressure, PEEPi,st, dynamic elastance, and interrupter resistance were measured in relaxed patients in a supine position. Comparison of tidal flow-volume curves before and during the application of an NEP of 5 cm H2O was used to assess tidal expiratory FL.\nRESULTS: Twelve of 32 patients studied exhibited tidal expiratory FL, which was detected by the absence of increase in expiratory flow despite application of an NEP over the entire or part of the baseline expiratory flow-volume curve. All patients exhibited PEEPi,st, which amounted to 1.2 +/- 0.9 cm H2O (mean +/- SD) in the 20 non-FL patients and 7.1 +/- 2.8 cm H2O in the 12 FL patients (p < 0.00001). The majority of patients with ARF resulting from underlying lung disease (11 of 13) had FL and a PEEPi,st > 4 cm H2O, whereas in patients with ARF of extrapulmonary origin, PEEPi,st was always < 4 cm H2O and only one grossly obese patient exhibited FL. Based on multiple regression analysis, in non-FL patients, PEEPi,st correlated significantly only with minute ventilation, whereas in FL patients PEEPi,st correlated significantly with peak airway pressure.\nCONCLUSIONS: Because all the patients exhibited PEEPi,st and 12 of 32 patients (38%) also had FL, the authors conclude that the assessment of these variables at the bedside could provide useful information concerning respiratory mechanics in mechanically ventilated patients.", "publicationTitle": "Critical Care Medicine", "publisher": "", "place": "", "date": "Dec 2000", "volume": "28", "issue": "12", "section": "", "partNumber": "", "partTitle": "", "pages": "3837-3842", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Crit. Care Med.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "11153623", "PMCID": "", "ISSN": "0090-3493", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Adolescent", "type": 1 }, { "tag": "Adult", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Airway Resistance", "type": 1 }, { "tag": "Blood Gas Analysis", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Forced Expiratory Flow Rates", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Positive-Pressure Respiration, Intrinsic", "type": 1 }, { "tag": "Prospective Studies", "type": 1 }, { "tag": "Regression Analysis", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 }, { "tag": "Respiratory Distress Syndrome, Adult", "type": 1 }, { "tag": "Respiratory Mechanics", "type": 1 }, { "tag": "Tidal Volume", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:59:28Z", "dateModified": "2014-08-31T13:59:28Z" } }, { "key": "IB96GQAX", "version": 9, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/IB96GQAX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/IB96GQAX", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/CCNMCATD", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "IB96GQAX", "version": 9, "parentItem": "CCNMCATD", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:59:28Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/11153623", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:59:28Z", "dateModified": "2014-08-31T13:59:28Z" } }, { "key": "BMCGZ7SM", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/BMCGZ7SM", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/BMCGZ7SM", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Leatherman et al.", "parsedDate": "2004-07", "numChildren": 1 }, "data": { "key": "BMCGZ7SM", "version": 12, "itemType": "journalArticle", "title": "Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma", "creators": [ { "creatorType": "author", "firstName": "James W.", "lastName": "Leatherman" }, { "creatorType": "author", "firstName": "Charles", "lastName": "McArthur" }, { "creatorType": "author", "firstName": "Robert S.", "lastName": "Shapiro" } ], "abstractNote": "OBJECTIVE: To assess the effect of a decrease in respiratory rate on dynamic hyperinflation, as determined by changes in plateau airway pressure, in patients with status asthmaticus whose baseline minute ventilation approximated 10 L/min.\nDESIGN: Observational descriptive study.\nSETTING: Medical intensive care unit.\nPATIENTS: Twelve patients with severe asthma mechanically ventilated in the assist control mode with a tidal volume of 613 +/- 100 mL and an inspiratory flow rate of 79 +/- 4 L/min.\nINTERVENTIONS: A decrease in respiratory rate from 18 to 12 and 6 breaths/min.\nMEASUREMENTS AND MAIN RESULTS: Plateau airway pressure decreased by approximately 2 cm H2O (25.4 +/- 2.8 vs. 23.3 +/- 2.6 cm H2O, p <.01) when respiratory rate was decreased from 18 to 12 breaths/min (increase in expiratory time 1.7 secs) and by a similar amount (23.3 +/- 2.6 vs. 21.3 +/- 2.9 cm H2O, p <.01) when respiratory rate was decreased from 12 to 6 breaths/min (increase in expiratory time 5 secs). Peak airway pressure was similar at the three respiratory rates (66.8 +/- 8.7 vs. 66.4 +/- 9.5 vs. 67.8 +/- 11.1 cm H2O at 18, 12, and 6 breaths/min, respectively). End-expiratory flow rates (n = 7) were 61.4 +/- 12.6, 38.6 +/- 4.5, and 23.1 +/- 5.8 mL/sec at respiratory rates of 18, 12, and 6 breaths/min, respectively.\nCONCLUSIONS: Prolongation of expiratory time decreases dynamic hyperinflation in patients with status asthmaticus, as evidenced by a reduction in plateau airway pressure, but the magnitude of this effect is relatively modest when baseline minute ventilation is < or = 10 L/min, because of the low end-expiratory flow rates. Since flow progressively decreases throughout expiration, the reduction in dynamic hyperinflation resulting from a given prolongation of expiratory time will depend on the baseline respiratory rate (i.e., less reduction in dynamic hyperinflation at a lower respiratory rate). Changes in peak airway pressure may not always reflect the changes in dynamic hyperinflation that result from prolongation of expiratory time.", "publicationTitle": "Critical Care Medicine", "publisher": "", "place": "", "date": "Jul 2004", "volume": "32", "issue": "7", "section": "", "partNumber": "", "partTitle": "", "pages": "1542-1545", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Crit. Care Med.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "15241099", "PMCID": "", "ISSN": "0090-3493", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Critical Care", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Respiration", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 }, { "tag": "Status Asthmaticus", "type": 1 }, { "tag": "Time Factors", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:58:57Z", "dateModified": "2014-08-31T13:58:57Z" } }, { "key": "JPQ7DTQV", "version": 8, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/JPQ7DTQV", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/JPQ7DTQV", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/BMCGZ7SM", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "JPQ7DTQV", "version": 8, "parentItem": "BMCGZ7SM", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:58:57Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/15241099", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:58:57Z", "dateModified": "2014-08-31T13:58:57Z" } }, { "key": "EGE3GZU2", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/EGE3GZU2", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/EGE3GZU2", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Sydow", "parsedDate": "2003-05", "numChildren": 1 }, "data": { "key": "EGE3GZU2", "version": 12, "itemType": "journalArticle", "title": "Ventilating the patient with severe asthma: nonconventional therapy", "creators": [ { "creatorType": "author", "firstName": "M.", "lastName": "Sydow" } ], "abstractNote": "Conventional pharmacotherapy of severe asthma and status asthmaticus includes beta2-sympathomimetics, theophylline, corticosteroids and occasionally topical anticholinergics (ipratropium bromide). Since hypoxemia is the most severe phenomenon in status asthmaticus the administration of oxygen is mandatory. However, if the bronchodilating therapy fails and hypoxemia continues, usually respiratory failure develops due to progressive respiratory muscle failure. An increasing PaCO(2) and respiratory acidosis are indications for mechanical ventilatory support to unload the failing respiratory pump. Nowadays, there is increasing consensus that ventilatory support should be administered primarily as non-invasive ventilation (NIV) via a face mask1. However, in a significant number of patients with severe asthma NIV is either contraindicated or insufficient. In this case usually the patient must be endotracheally intubated and mechanically ventilated \"invasively\". Intubation and ventilation of patients with severe asthma or status asthmaticus is associated with a high incidence of complications compared to patients ventilated for other causes of respiratory failure2,3. Therefore the risks of invasive mechanical ventilation have to be weighted carefully to ongoing conservative therapy and NIV. Cardiopulmonary arrest and severe hypoxemia in spite of O2 supplement and NIV are absolute criteria for intubation and ventilation. Mostly deterioration in mental status and exhaustion are the clinical findings leading to mechanical ventilation. Decision is guided rather by the course of the deterioration (how fast the patient's condition is worsening) than by pathological values alone. An increased PaCO(2) with moderate respiratory acidosis alone is not per se an indication for mechanical ventilation. However, a continuously rising PaCO(2) or the development of a severe metabolic acidosis after 1 hour of NIV is a strong argument for invasive mechanical ventilation. Other criteria are evidence of cardiac failure with fall in pulse volume and dysrhythmias, pneumomediastinum or pneumothorax (which has to be drained before mechanical ventilation!).", "publicationTitle": "Minerva Anestesiologica", "publisher": "", "place": "", "date": "May 2003", "volume": "69", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "333-337", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Minerva Anestesiol", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "12768162", "PMCID": "", "ISSN": "0375-9393", "archive": "", "archiveLocation": "", "shortTitle": "Ventilating the patient with severe asthma", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Anesthetics, Inhalation", "type": 1 }, { "tag": "Asthma", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Intubation, Intratracheal", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:58:01Z", "dateModified": "2014-08-31T13:58:01Z" } }, { "key": "GTA7KT2Q", "version": 7, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/GTA7KT2Q", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/GTA7KT2Q", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/EGE3GZU2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "GTA7KT2Q", "version": 7, "parentItem": "EGE3GZU2", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:58:01Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/12768162", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:58:01Z", "dateModified": "2014-08-31T13:58:01Z" } }, { "key": "HJ2UD3QP", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/HJ2UD3QP", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/HJ2UD3QP", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Brenner et al.", "parsedDate": "2009-08", "numChildren": 1 }, "data": { "key": "HJ2UD3QP", "version": 12, "itemType": "journalArticle", "title": "Intubation and mechanical ventilation of the asthmatic patient in respiratory failure", "creators": [ { "creatorType": "author", "firstName": "Barry", "lastName": "Brenner" }, { "creatorType": "author", "firstName": "Thomas", "lastName": "Corbridge" }, { "creatorType": "author", "firstName": "Antoine", "lastName": "Kazzi" } ], "abstractNote": "", "publicationTitle": "The Journal of Emergency Medicine", "publisher": "", "place": "", "date": "Aug 2009", "volume": "37", "issue": "2 Suppl", "section": "", "partNumber": "", "partTitle": "", "pages": "S23-34", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Emerg Med", "DOI": "10.1016/j.jemermed.2009.06.108", "citationKey": "", "url": "", "accessDate": "", "PMID": "19683662", "PMCID": "", "ISSN": "0736-4679", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Administration, Inhalation", "type": 1 }, { "tag": "Asthma", "type": 1 }, { "tag": "Bronchodilator Agents", "type": 1 }, { "tag": "Clinical Protocols", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Intubation, Intratracheal", "type": 1 }, { "tag": "Nebulizers and Vaporizers", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 }, { "tag": "Respiratory Insufficiency", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:56:20Z", "dateModified": "2014-08-31T13:56:20Z" } }, { "key": "X7IXNITK", "version": 6, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/X7IXNITK", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/X7IXNITK", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/HJ2UD3QP", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "X7IXNITK", "version": 6, "parentItem": "HJ2UD3QP", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:56:20Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/19683662", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:56:20Z", "dateModified": "2014-08-31T13:56:20Z" } }, { "key": "6BZMEEM2", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/6BZMEEM2", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/6BZMEEM2", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Tabak et al.", "parsedDate": "2009-09-28", "numChildren": 1 }, "data": { "key": "6BZMEEM2", "version": 12, "itemType": "journalArticle", "title": "Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: development and validation of a simple risk score", "creators": [ { "creatorType": "author", "firstName": "Ying P.", "lastName": "Tabak" }, { "creatorType": "author", "firstName": "Xiaowu", "lastName": "Sun" }, { "creatorType": "author", "firstName": "Richard S.", "lastName": "Johannes" }, { "creatorType": "author", "firstName": "Vikas", "lastName": "Gupta" }, { "creatorType": "author", "firstName": "Andrew F.", "lastName": "Shorr" } ], "abstractNote": "BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) often require hospitalization, may necessitate mechanical ventilation, and can be fatal. We sought to develop a simple risk score to determine its severity.\nMETHODS: We analyzed 88,074 subjects admitted with an AECOPD between 2004 and 2006. We used recursive partition to create risk classifications for in-hospital mortality. Need for mechanical ventilation served as a secondary end point. We internally validated the model via 1000 bootstrapping on half of patients and externally validated it on the remaining patients. We assessed predictive ability using the area under the receiver operating curve (AUROC).\nRESULTS: The in-hospital mortality rate was 2%. Three variables had high discrimination of outcomes: serum urea nitrogen level greater than 25 mg/dL (to convert to millimoles per liter, multiply by 0.357); acute mental status change, and pulse greater than 109/min. For those without any of the 3 factors, age 65 years or younger further differentiated the lowest-risk group. In those with all 3 factors, the mortality rates were 13.1% (131 in 1000) and 14.6% (146 in 1000) in the derivation and validation cohorts, respectively, compared with 0.3% (3 in 1000) in both cohorts among patients without any of the 3 factors and age 65 years or younger (P < .001). The AUROC for mortality in the 2 cohorts were 0.72 (95% confidence interval [CI], 0.70-0.74) and 0.71 (95% CI, 0.70-0.73), respectively. For mechanical ventilation, the AUROCs were 0.77 (95% CI, 0.75-0.79) for both cohorts.\nCONCLUSIONS: A simple risk class based on clinical variables easily obtained at presentation predicts mortality and need for mechanical ventilation. It may facilitate the triage and care of patients with AECOPD.", "publicationTitle": "Archives of Internal Medicine", "publisher": "", "place": "", "date": "Sep 28, 2009", "volume": "169", "issue": "17", "section": "", "partNumber": "", "partTitle": "", "pages": "1595-1602", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Arch. Intern. Med.", "DOI": "10.1001/archinternmed.2009.270", "citationKey": "", "url": "", "accessDate": "", "PMID": "19786679", "PMCID": "", "ISSN": "1538-3679", "archive": "", "archiveLocation": "", "shortTitle": "Mortality and need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Age Factors", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Blood Urea Nitrogen", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Heart Rate", "type": 1 }, { "tag": "Hospital Mortality", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Predictive Value of Tests", "type": 1 }, { "tag": "Pulmonary Disease, Chronic Obstructive", "type": 1 }, { "tag": "Reproducibility of Results", "type": 1 }, { "tag": "Respiration, Artificial", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 }, { "tag": "Risk Assessment", "type": 1 }, { "tag": "Severity of Illness Index", "type": 1 }, { "tag": "Ventilators, Mechanical", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:51:17Z", "dateModified": "2014-08-31T13:51:17Z" } }, { "key": "XAGJ6WJE", "version": 5, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/XAGJ6WJE", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/XAGJ6WJE", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/6BZMEEM2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "XAGJ6WJE", "version": 5, "parentItem": "6BZMEEM2", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:51:17Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/19786679", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:51:17Z", "dateModified": "2014-08-31T13:51:17Z" } }, { "key": "CDC59P8W", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/CDC59P8W", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/CDC59P8W", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Ramsay and Hart", "parsedDate": "2013-11", "numChildren": 1 }, "data": { "key": "CDC59P8W", "version": 12, "itemType": "journalArticle", "title": "Current opinions on non-invasive ventilation as a treatment for chronic obstructive pulmonary disease", "creators": [ { "creatorType": "author", "firstName": "Michelle", "lastName": "Ramsay" }, { "creatorType": "author", "firstName": "Nicholas", "lastName": "Hart" } ], "abstractNote": "PURPOSE OF REVIEW: This review examines the current reports, the evidence and the issues surrounding the use of non-invasive ventilation (NIV) for the treatment of chronic obstructive pulmonary disease (COPD) in both the acute and domiciliary setting.\nRECENT FINDINGS: With the increasing use of NIV, more recent studies have focused on investigating the outcomes of our current practice. Although overall morbidity and mortality outcomes in the acute setting have improved, patients who initially stabilize but then deteriorate during an acute exacerbation of COPD have a poor prognosis. The focus must be on phenotyping this high-risk group to investigate other potential rescue treatments, including extracorporeal carbon dioxide removal. Indeed, phenotyping appears to favour the obese COPD patient, which may have a protective role in reducing the risk of NIV failure and recurrent hospital admissions. Randomized controlled trial evidence to support the use of NIV in a domiciliary setting as a treatment for COPD is awaited, and until the data from a number of ongoing clinical trials are available, the wide variation in global practice will continue. Increased understanding of patient ventilator asynchrony has improved domiciliary NIV set up, which is expected to enhance the tolerability of NIV, promoting patient adherence.\nSUMMARY: NIV is the established standard of care to treat acute hypercapnic exacerbations of COPD postoptimal medical management. NIV as a long-term treatment for COPD remains controversial based on the evidence from the published randomized controlled trials. With increasing experience of NIV therapy, patient outcomes are improving; however, further work is still required to better characterize and target the patients who will most benefit from NIV.", "publicationTitle": "Current Opinion in Pulmonary Medicine", "publisher": "", "place": "", "date": "Nov 2013", "volume": "19", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "626-630", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Curr Opin Pulm Med", "DOI": "10.1097/MCP.0b013e3283659e4c", "citationKey": "", "url": "", "accessDate": "", "PMID": "24060980", "PMCID": "", "ISSN": "1531-6971", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Acute Disease", "type": 1 }, { "tag": "Ambulatory Care", "type": 1 }, { "tag": "Disease Progression", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Home Care Services", "type": 1 }, { "tag": "Hospitalization", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Noninvasive Ventilation", "type": 1 }, { "tag": "Patient Compliance", "type": 1 }, { "tag": "Patient Education as Topic", "type": 1 }, { "tag": "Patient Selection", "type": 1 }, { "tag": "Phenotype", "type": 1 }, { "tag": "Prognosis", "type": 1 }, { "tag": "Pulmonary Disease, Chronic Obstructive", "type": 1 }, { "tag": "Randomized Controlled Trials as Topic", "type": 1 }, { "tag": "Respiratory Insufficiency", "type": 1 }, { "tag": "Treatment Outcome", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:49:41Z", "dateModified": "2014-08-31T13:49:41Z" } }, { "key": "C8NJ2JA4", "version": 4, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/C8NJ2JA4", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/C8NJ2JA4", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/CDC59P8W", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "C8NJ2JA4", "version": 4, "parentItem": "CDC59P8W", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:49:41Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/24060980", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:49:41Z", "dateModified": "2014-08-31T13:49:41Z" } }, { "key": "XSEEWCXU", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/XSEEWCXU", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/XSEEWCXU", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Carson et al.", "parsedDate": "2014-01", "numChildren": 1 }, "data": { "key": "XSEEWCXU", "version": 12, "itemType": "journalArticle", "title": "Noninvasive ventilation in acute severe asthma: current evidence and future perspectives", "creators": [ { "creatorType": "author", "firstName": "Kristin V.", "lastName": "Carson" }, { "creatorType": "author", "firstName": "Zafar A.", "lastName": "Usmani" }, { "creatorType": "author", "firstName": "Brian J.", "lastName": "Smith" } ], "abstractNote": "PURPOSE OF REVIEW: The use of noninvasive positive pressure ventilation (NPPV) is often employed for the management of acute respiratory failure as an alternative to endotracheal intubation and mechanical ventilation. However, evidence to support the application of NPPV use in patients with acute severe asthma is less known.\nRECENT FINDINGS: A paucity of evidence is available to support the use of NPPV as part of clinical care in patients with acute severe asthma. A number of small studies in adult and paediatric populations suggest that NPPV may have a beneficial role through improving respiratory rate and reducing the need for more invasive alternatives. Overall NPPV use appeared to be well tolerated with few reports of adverse events.\nSUMMARY: Available evidence is limited by a small number of published trials and lack of methodological rigour in existing study design. There is a need for well conducted clinical studies to establish accurate treatment efficacy, safety and cost-effectiveness, in both the adult and paediatric setting.", "publicationTitle": "Current Opinion in Pulmonary Medicine", "publisher": "", "place": "", "date": "Jan 2014", "volume": "20", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "118-123", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Curr Opin Pulm Med", "DOI": "10.1097/MCP.0000000000000015", "citationKey": "", "url": "", "accessDate": "", "PMID": "24285183", "PMCID": "", "ISSN": "1531-6971", "archive": "", "archiveLocation": "", "shortTitle": "Noninvasive ventilation in acute severe asthma", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Acute Disease", "type": 1 }, { "tag": "Asthma", "type": 1 }, { "tag": "Cost-Benefit Analysis", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Positive-Pressure Respiration", "type": 1 }, { "tag": "Respiratory Insufficiency", "type": 1 }, { "tag": "Severity of Illness Index", "type": 1 }, { "tag": "Treatment Outcome", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:46:18Z", "dateModified": "2014-08-31T13:46:18Z" } }, { "key": "CJN5SV9N", "version": 3, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/CJN5SV9N", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/CJN5SV9N", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/282559/items/XSEEWCXU", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "CJN5SV9N", "version": 3, "parentItem": "XSEEWCXU", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-08-31T13:46:18Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/24285183", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2014-08-31T13:46:18Z", "dateModified": "2014-08-31T13:46:18Z" } }, { "key": "C4P2UCBN", "version": 12, "library": { "type": "group", "id": 282559, "name": "Ventilator_asthma_copd", "links": { "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/282559/items/C4P2UCBN", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ventilator_asthma_copd/items/C4P2UCBN", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Soroksky et al.", "parsedDate": "2010-03", "numChildren": 1 }, "data": { "key": "C4P2UCBN", "version": 12, "itemType": "journalArticle", "title": "Noninvasive positive pressure ventilation in acute asthmatic attack", "creators": [ { "creatorType": "author", "firstName": "A.", "lastName": "Soroksky" }, { "creatorType": "author", "firstName": "E.", "lastName": "Klinowski" }, { "creatorType": "author", "firstName": "E.", "lastName": "Ilgyev" }, { "creatorType": "author", "firstName": "A.", "lastName": "Mizrachi" }, { "creatorType": "author", "firstName": "A.", "lastName": "Miller" }, { "creatorType": "author", "firstName": "T. M.", "lastName": "Ben Yehuda" }, { "creatorType": "author", "firstName": "I.", "lastName": "Shpirer" }, { "creatorType": "author", "firstName": "Y.", "lastName": "Leonov" } ], "abstractNote": "Asthma is characterised by reversible airway obstruction. In most patients, control of disease activity is easily achieved. However, in a small minority, asthma may be fatal. Between the two extremes lie patients with severe asthmatic attacks, refractory to standard treatment. These patients are at an increased risk of recurrent severe attacks, with respiratory failure, and mechanical ventilation. Invasive mechanical ventilation of the asthmatic patient is associated with a higher risk of complications and, therefore, is a measure of last resort. Noninvasive positive pressure ventilation (NPPV) is another treatment modality that may be beneficial in patients with severe asthmatic attack who are at an increased risk of developing respiratory failure. These patients have the potential to benefit from early respiratory support in the form of NPPV. However, reports of NPPV in asthmatic patients are scarce, and its usage in asthmatic attacks is, therefore, still controversial. Only a few reports of NPPV in asthma have been published over the last decade. These studies mostly involve small numbers of patients and those who have problematic methodology. In this article we review the available evidence for NPPV in asthma and try to formulate our recommendations for NPPV application in asthma based on the available evidence and reports.", "publicationTitle": "European Respiratory Review: An Official Journal of the European Respiratory Society", "publisher": "", "place": "", "date": "Mar 2010", "volume": "19", "issue": "115", "section": "", "partNumber": "", "partTitle": "", "pages": "39-45", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Eur Respir Rev", "DOI": "10.1183/09059180.00006109", "citationKey": "", "url": "", "accessDate": "", "PMID": "20956164", "PMCID": "", "ISSN": "1600-0617", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Acute Disease", "type": 1 }, { "tag": "Asthma", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Positive-Pressure Respiration", "type": 1 }, { "tag": "Respiratory Insufficiency", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2014-08-31T13:46:04Z", "dateModified": "2014-08-31T13:46:04Z" } } ]