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Original Articles
- Neurology
- Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial
- Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow
- Acute Crit Care. 2022;37(3):295-302. Published online June 27, 2022
- DOI: https://doi.org/10.4266/acc.2021.01767
- 4,366 View
- 308 Download
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Abstract
PDF
Supplementary Material - Background
To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.
Methods
In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).
Results
A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.
Conclusions
In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.
- Pulmonary
- Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
- John S. Zorbas, Kwok M. Ho, Edward Litton, Bradley Wibrow, Edward Fysh, Matthew H. Anstey
- Acute Crit Care. 2021;36(2):143-150. Published online May 4, 2021
- DOI: https://doi.org/10.4266/acc.2021.00017
- 9,509 View
- 516 Download
- 6 Web of Science
- 8 Crossref
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Abstract
PDF
- Background
Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation.
Methods
A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated.
Results
Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03–0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation.
Conclusions
Based on the findings of this study, we urge caution with the use of APRV in COVID-19. -
Citations
Citations to this article as recorded by
- Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome—A Multicenter Propensity Score–Matched Analysis
Jan-Hendrik Naendrup, Jonathan Steinke, Jorge Garcia Borrega, Sandra Emily Stoll, Per Ole Michelsen, Yannick Assion, Alexander Shimabukuro-Vornhagen, Dennis Alexander Eichenauer, Matthias Kochanek, Boris Böll
Journal of Intensive Care Medicine.2024; 39(1): 84. CrossRef - Acute Respiratory Failure From Early Pandemic COVID-19
Julia M. Fisher, Vignesh Subbian, Patrick Essay, Sarah Pungitore, Edward J. Bedrick, Jarrod M. Mosier
CHEST Critical Care.2024; 2(1): 100030. CrossRef - Airway Pressure Release Ventilation for Acute Respiratory Failure Due to Coronavirus Disease 2019: A Systematic Review and Meta-Analysis
Ashraf Roshdy, Ahmad Samy Elsayed, Ahmad Sabry Saleh
Journal of Intensive Care Medicine.2023; 38(2): 160. CrossRef - Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019
Guy A. Richards, Oliver Smith
Seminars in Respiratory and Critical Care Medicine.2023; 44(01): 091. CrossRef - Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?
Jiangli Cheng, Aijia Ma, Meiling Dong, Yongfang Zhou, Bo Wang, Yang Xue, Peng Wang, Jing Yang, Yan Kang
Journal of Intensive Medicine.2022; 2(4): 241. CrossRef - Early spontaneous breathing for acute respiratory distress syndrome in individuals with COVID-19
Friedrich Hohmann, Lisa Wedekind, Felicitas Grundeis, Steffen Dickel, Johannes Frank, Martin Golinski, Mirko Griesel, Clemens Grimm, Cindy Herchenhahn, Andre Kramer, Maria-Inti Metzendorf, Onnen Moerer, Nancy Olbrich, Volker Thieme, Astrid Vieler, Falk Fi
Cochrane Database of Systematic Reviews.2022;[Epub] CrossRef - Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis
Mallikarjuna Ponnapa Reddy, Ashwin Subramaniam, Clara Chua, Ryan Ruiyang Ling, Christopher Anstey, Kollengode Ramanathan, Arthur S Slutsky, Kiran Shekar
The Lancet Respiratory Medicine.2022; 10(12): 1178. CrossRef - Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef
- Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome—A Multicenter Propensity Score–Matched Analysis
Letter to the Editor
- Pulmonary
- Vitamin C and corticosteroids in viral pneumonia
- Matthew Harry Anstey, Jacky Luu, Erina Myers, Robert N Palmer, Bradley Wibrow, Kwok M Ho
- Acute Crit Care. 2021;36(2):169-171. Published online March 10, 2021
- DOI: https://doi.org/10.4266/acc.2020.01081
- 5,675 View
- 127 Download
- 2 Web of Science
- 1 Crossref
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