Background
This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure.
Methods
We performed a ...comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods.
Results
We included 9 RCTs (
n
= 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk RR 0.94, 95% confidence interval CI 0.67–1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74–0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51–0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference MD 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference SMD 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use.
Conclusion
In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
Invasive mechanical ventilation in onco-hematology patients has become relatively routine, and is now part and parcel of their care pathway. Nevertheless, specific complications and subsequent ...therapeutic possibilities require discussion. To a greater extent than with regard to other patient populations, cooperation between specialist and ICU physician is mandatory, the objective being to more comprehensively assess a therapeutic project before or during the period of invasive mechanical ventilation. After an overview of recent results concerning ventilated patients in intensive care, this review aims to describe the specific complications and factors associated with mortality in this population.
Physiotherapy leads to improvements in critically ill patients who receive mechanical ventilation. However, cancer patients have not been included in previous studies on this subject. This study ...explored the feasibility and safety of physiotherapy in the intensive care unit for patients with malignancy.
Observational prospective single-centre study, comparing cancer and control patients.
All consecutive patients admitted to the intensive care unit who needed invasive mechanical ventilation for more than 2 days with no contraindication to physiotherapy were included in the study.
The main outcome was the proportion of physiotherapy sessions at the prescribed level in each group.
A total of 60 patients were included within 1 year. A total of 576 days were screened for physiotherapy sessions and 367 physiotherapy-days were analysed (137 days for control patients and 230 days for cancer patients). The ratio of physiotherapy sessions performed/prescribed did not differ between groups: 0.78 (0.47-1) in the control group vs 0.69 (0.6-1) in the cancer group (odds ratio 1.18 (IC95% 0.74-1.89); p = 0.23). A sensitivity analysis including patient effect as random variable confirmed those results (odds ratio 1.16 (0.56-2.38), p = 0.69). Adverse events occurred with the same frequency in cancer patients and non-cancer patients.
Physiotherapy in cancer patients who require intubation is feasible and safe. However, only two-thirds of prescribed physiotherapy sessions were performed. Studies are warranted to explore the barriers to physiotherapy in the intensive care unit setting.
•SPH modelling for three different sets of common solid mechanical tests – uniaxial, biaxial and triaxial loading.•A new numerical treatment is introduced to deal with these boundary conditions.•The ...numerical method is robust to large strain (30%).•The sample deforms in shape which is readily and accurately captured by SPH.•Both elastic and more complex (elasto-plastic) materials are considered.
Smoothed Particle Hydrodynamics (SPH) is a numerical method that does not use a mesh or grid when solving a set of partial differential equations. This makes it particularly useful in application to solid mechanics problems where the sample undergoes large deformation. Whereas mesh-based methods have difficulty when the sample becomes severely distorted, SPH naturally deals with this important engineering scenario. We implement the SPH method for compressional deformation of solid samples and focus on uniaxial, biaxial and triaxial loading. We develop numerical procedures that naturally deal with these three different sets of boundary conditions and apply it to both small and larger strains in elastic and more complex materials. The method is shown to be robust up to large strains of 30%. Under uniaxial loading, a cylindrical sample tends to deform by bulging while under triaxial loading the cylindrical sample will remain cylindrical, but the diameter of the sample increases accordingly.
•Complete SPH solution for a kneading element in the extrusion process with no simplifying assumptions.•Excellent agreement with FEM solutions for the modelling of single kneading element in ...barrel.•Up to 34 million SPH particles used.•Twin kneading elements SPH results also given.•Method can be extended to include correct heat transfer and shear rates within extruder.
The Smoothed Particle Hydrodynamics (SPH) method is used to determine the flow through a model screw extruder at low Reynolds number with an emphasis on resolving the flow in narrow gaps, which are known to produce high shear rates and generate large temperatures. Firstly we demonstrate the validity of the SPH methodology by comparison on simple flows with known analytic solutions. We find excellent agreement and this also allows us to estimate the SPH particle size that is required to obtain accurate solutions for these and more complex flows. SPH simulations on a model single screw extruder with a kneading element are then compared with FEM solutions. Once again excellent agreement is achieved. Finally we demonstrate the SPH method on a model twin screw extruder, which is shown to be robust and qualitatively valid. In general these results show that SPH will be an important computational tool to investigate flows in similar devices.
Cold spray is a manufacturing process that has proved to be a valuable technique for producing high strength metallic coatings. It has been extensively studied in recent years, both experimentally ...and computationally. Among the various modelling investigations in the literature, a large number have considered the problem of a single particle impacting a substrate by means of a continuum technique, most commonly the finite element method. These models that have been used previously are generally based on two inadequate assumptions, namely 1) both particle and substrate are assumed to initially be at room temperature, and 2) the experimentally observed increase in strain rate sensitivity of the flow stress at high strain rates is ignored. To investigate the combined effect of temperature and strain rates, a three-dimensional model of a single particle impact with a metallic substrate has been developed using smoothed particle hydrodynamics. This meshless method is ideally suited to the simulation of cold spray as very large material deformations can be readily accommodated, whereas this is often a significant difficulty in mesh based techniques. A Cu-on-Cu impact was considered and quantitative comparisons with experimental cross-sections were conducted. It was found that predictions within 5% of the experimental data could be achieved only when both the softening effect due to the initial thermal field and the hardening effect due to the very high strain rates were included in the model. In contrast ignoring these effects led to results that had as much as 50% variation compared to experiments. The model described in this paper is a robust tool that will enable quantitative predictions of cold spray impacts and help further optimise the process.
•Smoothed particle hydrodynamics is a very effective modelling method for particle impacts.•Particle and substrate cannot be assumed at room temperature in cold spray models.•Hardening due to very high strain rates must be included in these models.
Purpose
The prognosis of critically ill cancer patients has improved recently. Controversies remain as regard to the specific prognosis impact of neutropenia in critically ill cancer patients. The ...primary objective of this study was to assess hospital outcome of critically ill neutropenic cancer patients admitted into the ICU. The secondary objective was to assess risk factors for unfavorable outcome in this population of patients and specific impact of neutropenia.
Methods
We performed a post hoc analysis of a prospectively collected database. The study was carried out in 17 university or university-affiliated centers in France and Belgium. Neutropenia was defined as a neutrophil count lower than 500/mm
3
.
Results
Among the 1,011 patients admitted into the ICU during the study period 289 were neutropenic at the time of admission. Overall, 131 patients died during their hospital stay (hospital mortality 45.3 %). Four variables were associated with a poor outcome, namely allogeneic transplantation (OR 3.83; 95 % CI 1.75–8.35), need for mechanical ventilation (MV) (OR 6.57; 95 % CI 3.51–12.32), microbiological documentation (OR 2.33; CI 1.27–4.26), and need for renal replacement therapy (OR 2.77; 95 % CI 1.34–5.74). Two variables were associated with hospital survival, namely age younger than 70 (OR 0.22; 95 % CI 0.1–0.52) and neutropenic enterocolitis (OR 0.37; 95 % CI 0.15–0.9). A case–control analysis was also performed with patients of the initial database; after adjustment, neutropenia was not associated with hospital mortality (OR 1.27; 95 % CI 0.86–1.89).
Conclusion
Hospital survival was closely associated with younger age and neutropenic enterocolitis. Conversely, need for conventional MV, for renal replacement therapy, and allogeneic hematopoietic stem cell transplantation (HSCT) were associated with poor outcome.
Abstract Background Scleromyxedema (SM) is a rare skin disorder related to monoclonal gammopathy. High dose intravenous immunoglobulins (HDIVIg) are usually used as a frontline therapy with initial ...efficacy. However, some patients evolve with relapse, refractory state or severe extra‐cutaneous complications such as dermato‐neuro syndrome (DNS) or cardiac involvement. The objective of the study is to evaluate the use of anti‐plasma cell treatment in these patients in order to obtain a deep and durable dermatological and haematological response. Methods We report here eight patients treated with HDIVIg together with anti‐plasma cell therapy including: lenalidomide and dexamethasone ( n = 5); bortezomib, cyclophosphamide and dexamethasone ( n = 1); daratumumab, lenalidomide and dexamethasone ( n = 2). Results Combination of HDIVIg with a treatment targeting the monoclonal component led to a high level of haematological remission and drastically improved skin response with an acceptable safety profile in all patients. Moreover, HDIVIg was reduced and stopped in 4 of the 7 patients who achieved complete remission. Conclusions The association of lenalidomide and dexamethasone with HDIVIg could improve the treatment of relapsed or severe SM.
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