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Update on Ventilation and Airway Management in the ICU
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Update on Ventilation and Airway Management in the ICU

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 5331

Special Issue Editors

Prof. Dr. Tamas Szakmany

E-Mail Website
Guest Editor
Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
Interests: ARDS; sepsis; epidemiology; haemodynamic monitoring; biomarkers
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Radmilo J. Janković

E-Mail Website
Guest Editor
Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, Nis 18000, Serbia
Interests: airway management; perioperative period; anaesthetic; critical care; emergency medicine; sepsis

Special Issue Information

Dear Colleagues,

Airway management and mechanical ventilation are continuously evolving problems in the ICU. The ongoing COVID-19 pandemic has changed clinical practice and perception of these tenets of critical care practice. There is an ongoing need to understand how we can provide better care to critically ill patients who need mechanical ventilation. The safety of airway management and the potential side effects of mechanical ventilation are now at the forefront of many clinicians’ decision-making process. Better understanding the haemodynamic effects of airway management manoeuvres, the impact of procedural and pharmacological interventions during mechanical ventilation, the risk factors, and the distinct subgroups of patients is necessary to improve practice. This Special Issue welcomes a broad range of articles, both from the bench and at the bedside, which would help to elucidate these questions for the wide readership of the Journal of Clinical Medicine.

Prof. Dr. Tamas Szakmany
Prof. Dr. Radmilo J. Janković
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mechanical ventilation
  • airway management
  • ARDS
  • bronchoscopy
  • VAP
  • haemodynamics

Published Papers (2 papers)

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13 pages, 514 KiB  
Article
Awake Tracheal Intubation Is Associated with Fewer Adverse Events in Critical Care Patients than Anaesthetised Tracheal Intubation
by Marc Kriege, Rene Rissel, Hazem El Beyrouti and Eric Hotz
J. Clin. Med. 2023, 12(18), 6060; https://doi.org/10.3390/jcm12186060 - 19 Sep 2023
Cited by 2 | Viewed by 1604
Abstract
Background: Tracheal intubation in critical care is a high-risk procedure requiring significant expertise and airway strategy modification. We hypothesise that awake tracheal intubation is associated with a lower incidence of severe adverse events compared to standard tracheal intubation in critical care patients. Methods: [...] Read more.
Background: Tracheal intubation in critical care is a high-risk procedure requiring significant expertise and airway strategy modification. We hypothesise that awake tracheal intubation is associated with a lower incidence of severe adverse events compared to standard tracheal intubation in critical care patients. Methods: Records were acquired for all tracheal intubations performed from 2020 to 2022 for critical care patients at a tertiary hospital. Each awake tracheal intubation case, using a videolaryngoscope with a hyperangulated blade (McGrath® MAC X-Blade), was propensity matched with two controls (1:2 ratio; standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL) undergoing general anaesthesia). The primary endpoint was the incidence of adverse events, defined as a mean arterial pressure of <55 mmHg (hypotension), SpO2 < 80% (desaturation) after sufficient preoxygenation, or peri-interventional cardiac arrest. Results: Of the 135 tracheal intubations included for analysis, 45 involved the use of an awake tracheal intubation. At least one adverse event occurred after tracheal intubation in 36/135 (27%) of patients, including awake 1/45 (2.2%; 1/1 hypotension), VL 10/45 (22%; 6/10 hypotension and 4/10 desaturation), and DL 25/45 (47%; 10/25 hypotension, 12/25 desaturation, and 3/25 cardiac arrest; p < 0.0001). Conclusions: In this retrospective observational study of intubation practices in critical care patients, awake tracheal intubation was associated with a lower incidence of severe adverse events than anaesthetised tracheal intubation. Full article
(This article belongs to the Special Issue Update on Ventilation and Airway Management in the ICU)
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12 pages, 1359 KiB  
Systematic Review
Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials
by Huzaifa Ahmad Cheema, Amna Siddiqui, Sidhant Ochani, Alishba Adnan, Mahnoor Sukaina, Ramsha Haider, Abia Shahid, Mohammad Ebad Ur Rehman, Rehmat Ullah Awan, Harpreet Singh, Natalie Duric, Brigitta Fazzini, Antoni Torres and Tamas Szakmany
J. Clin. Med. 2023, 12(3), 926; https://doi.org/10.3390/jcm12030926 - 25 Jan 2023
Cited by 6 | Viewed by 3357
Abstract
Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify [...] Read more.
Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74–0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77–1.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment. Full article
(This article belongs to the Special Issue Update on Ventilation and Airway Management in the ICU)
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