ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

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Abstract

The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.

Abstract

The #ERSCongress in Madrid had some great sessions on respiratory intensive care. This article highlights the most important sessions. http://bit.ly/2GtT0qL

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Most cited references 115

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Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure.

Tommaso Mauri, Cecilia Turrini, Nilde Eronia … (2017)

High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF).

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Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans.

Samir Jaber, Basil Petrof, Boris Jung … (2011)

Diaphragmatic function is a major determinant of the ability to successfully wean patients from mechanical ventilation (MV). Paradoxically, MV itself results in a rapid loss of diaphragmatic strength in animals. However, very little is known about the time course or mechanistic basis for such a phenomenon in humans. To determine in a prospective fashion the time course for development of diaphragmatic weakness during MV; and the relationship between MV duration and diaphragmatic injury or atrophy, and the status of candidate cellular pathways implicated in these phenomena. Airway occlusion pressure (TwPtr) generated by the diaphragm during phrenic nerve stimulation was measured in short-term (0.5 h; n = 6) and long-term (>5 d; n = 6) MV groups. Diaphragmatic biopsies obtained during thoracic surgery (MV for 2-3 h; n = 10) and from brain-dead organ donors (MV for 24-249 h; n = 15) were analyzed for ultrastructural injury, atrophy, and expression of proteolysis-related proteins (ubiquitin, nuclear factor-κB, and calpains). TwPtr decreased progressively during MV, with a mean reduction of 32 ± 6% after 6 days. Longer periods of MV were associated with significantly greater ultrastructural fiber injury (26.2 ± 4.8 vs. 4.7 ± 0.6% area), decreased cross-sectional area of muscle fibers (1,904 ± 220 vs. 3,100 ± 329 μm²), an increase of ubiquitinated proteins (+19%), higher expression of p65 nuclear factor-κB (+77%), and greater levels of the calcium-activated proteases calpain-1, -2, and -3 (+104%, +432%, and +266%, respectively) in the diaphragm. Diaphragmatic weakness, injury, and atrophy occur rapidly in critically ill patients during MV, and are significantly correlated with the duration of ventilator support.

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Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.

Gonzalo Hernández, Concepción Vaquero, Laura Colinas … (2016)

High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms.

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Author and article information

Journal

Journal ID (nlm-ta): ERJ Open Res

Journal ID (iso-abbrev): ERJ Open Res

Journal ID (publisher-id): ERJOR

Journal ID (hwp): erjor

Title: ERJ Open Research

Publisher: European Respiratory Society

ISSN (Electronic): 2312-0541

Publication date Collection: January 2020

Publication date (Electronic): 09 March 2020

Volume: 6

Issue: 1

Electronic Location Identifier: 00331-2019

Affiliations

[1 ]Respiratory Medicine, Istanbul Gaziosmanpasa Training and Research Hospital, Health Science University, Istanbul, Turkey

[2 ]Respiratory Dept, Gregorio Marañón University Hospital, Spanish Sleep Network, Madrid, Spain

[3 ]Interdepartmental Division of Critical Care, University of Toronto, Unity Health Toronto (St Michael's Hospital) and the Li Ka Shing Knowledge Institute, Toronto, Canada

[4 ]Pulmonology Dept, Hôpitaux Universitaires de Genève, Geneva, Switzerland

[5 ]University Hospitals Bristol NHS Foundation Trust, Adult Therapy Services, Bristol Royal Infirmary, Bristol, UK

[6 ]Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands

[7 ]Rouen University Hospital, Rouen, France

[8 ]Respiratory Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands

[9 ]Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy

[10 ]Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand

[11 ]Nuffield Dept of Medicine, University of Oxford, Oxford, UK

[12 ]Intensive Care, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands

Author notes

Lieuwe D. Bos, Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9 M0-127, Amsterdam 1105AZ, the Netherlands. E-mail: l.d.bos@ 123456amc.uva.nl

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Daniel López-Padilla https://orcid.org/0000-0001-8858-1070

Lieuwe D. Bos https://orcid.org/0000-0003-2911-4549

Article

Publisher ID: 00331-2019

DOI: 10.1183/23120541.00331-2019

PMC ID: 7061203

SO-VID: eeb0bc28-f5f8-4205-9bf6-c055849968a1

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This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

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European Respiratory Society: COVID-19

Most cited references 115

Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure.

Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans.

Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.

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