Patients will be resuscitated according to the PERSEUS protocol

Patients will be resuscitated according to current Advanced Life Support guidelines

Cardiac Arrest

Cardiopulmonary Arrest With Successful Resuscitation

Resuscitation based on patient physiology

PERSEUS CPR

Resuscitation based on current guidelines

Standard CPR

University Hospital of Larisa, Department of Anesthesiology

PERSEUS-PS Randomized Controlled Trial

Assessment of the Efficacy of Personalized Physiology-guided Resuscitation in Patients With Cardiac Arrest: The PERSEUS Pilot Randomized Trial

Days hospitalized in the intensive care unit

How many days the patient will be mechanically ventilated

Dead or alive at hospital discharge with favorable neurological outcome (CPC 1 or 2)

Dead or alive at 1 month after hospital discharge with favorable neurological outcome (CPC 1 or 2)

Dead or alive at 3 months after hospital discharge with favorable neurological outcome (CPC 1 or 2)

PD may be shared with other researchers upon reasonable request

Athanasios Chalkias, MD, PhD

Assistant Professor of Anesthesiology

University of Thessaly

COVID-19

4:1 ratio enteral ketogenic formula within 48 hours of intubation

Ketogenic diet

standard of care

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12-March 16, 2020

Keto-diet for Intubated Critical Care COVID-19

Keto-diet for Intubated Critical Care COVID-19 (KICC-COVID19)

PaCO2 is the partial pressure of carbon dioxide Units: millimeters of mercury

Minute ventilation is the product of respiratory rate and tidal volume. Units: Liter per minute

Respiratory system compliance measures the extent to which the lungs will expand.
In a ventilated patient, compliance can be measured by dividing the delivered tidal volume by the [plateau pressure minus the total peep]. Units: liter/centimeter of water

Driving pressure is a measure of the strain applied to the respiratory system and the risk of ventilator-induced lung injuries Driving pressure = Plateau pressure - Total Positive end-expiratory pressure (PEEP) Units: centimeter of water

Ventilator synchrony is the match between the patient's neural inspiratory time and the ventilator insufflation time

Mean arterial pressure is the average pressure in a patient's arteries during one cardiac cycle. Mean arterial pressure = diastolic blood pressure +[1/3(systolic blood pressure - diastolic blood pressure)] Units: millimeter of mercury

FiO2: Fraction of Inspired Oxygen Percentage of oxygen in the air mixture that is delivered to the patient.
Units: %

PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure (PaO2) to fractional inspired oxygen.
Units: millimeter of mercury

pH measures hydrogen ion activity. It is a conventional part of every arterial blood gas determination pH: no units.

Bicarbonate is a conventional part of every arterial blood gas determination Units: milliequivalents/Liter

Red blood cell count measure anemia or hypoglycemia. Units: cells per liter

White blood cell count evaluates leukopenia or leukocytosis. Units: cells/liter

White cell differential shows the amount of neutrophils, lymphocytes, basophils, eosinophils and may give some clue of the type of infection. Units: %

Hemoglobin is an indirect way to measure red blood cells. Units: gram/deciliter

Hematocrit measures the volume percentage of red blood cells in blood. Units: %

Mean cell volume is a measure of the average volume of a red blood corpuscle. Units: femtoliters

Mean cell hemoglobin is the average mass of hemoglobin per red blood cell in a sample of blood. Units: picograms

Mean cell hemoglobin concentration is the average concentration of hemoglobin in a given volume of blood. Units: %

Platelet count measures the number of platelets in the blood and determines thrombocytopenia or thrombocytosis. Units: platelets/liter

Red cell distribution width is a measure of the range of variation of red blood cell volume. Units: no units

Liver function test Units: gram/deciliter

Liver function test Units: international units/liter

Liver function test Units: international units/liters

Kidney function test Units: milligram/deciliter

Kidney function test Units: millimole/liter

Kidney function test Units: gram/deciliter

If the patient needs mechanical ventilation for a second time, this information will be collected.

Time from intensive care unit admission until death or transfer to hospital bed.

Time from hospital admission to discharge from the hospital. This information will be collected.

Once the patient feels better and can leave the hospital, he/she will be discharged. The place of discharge (e.g. home, rehab facility, nursing home, etc), time and date will be collected.

Heart rate: is the number of times a person's heart beats per minute

Glucose: sugar in blood. Units: millimole/liter

Glucagon: hormone release by pancreas that increase concentration of glucose in blood. Units: nanogram/liter

Free fatty acids are fatty acids that are produced from triglycerides and are measure in blood.

Hormone that regulates glucose. Units: insulin units/liter

Leptin helps regulate and alter long-term food intake and energy expenditure. Units: nanogram/deciliter

C-reactive protein is a protein made by the liver that measures inflammation (e.g. pancreatitis). Units: microgram/milliliter

Cytokines are signaling molecules that measure inflammation.

Ferritin stores iron inside of cells. Units: nanogram/milliliter

Johns Hopkins University

This is a single-center, open-label, clinical trial designed to determine whether a ketogenic diet improves gas exchange and reduces ventilator requirements in patients with coronavirus disease intubated for respiratory failure. The study team will prospectively enroll 15 intubated patients with COVID-19 infection and administer a 4:1 ratio enteral ketogenic formula within 48 hours of intubation. This study will compare outcomes to a retrospective cohort of intubated patients with COVID-19 who did not receive ketogenic diet. As other clinical trials begin, co-administration of other therapies as well as standard care treatments will be recorded. In addition, the study will compare clinical outcomes with patients receiving exclusively standard clinical care.

Acute Cardiogenic Pulmonary Edema

Hypercapnic Respiratory Failure

HFNT will be administered through a heated humidifier (Airvo 2, Fisher and Paykel healthcare) and applied through large bore binasal prongs.
Initial gas flow rate will be set at of 60 l/min and adjusted to 40-50 l/min based on patient's tolerance. FiO2 will be adjusted to maintain an SpO2 ≥ 92%. Initial temperature will be set at 37° and reduced according to patient's tolerance

High flow nasal therapy (HFNT) : Optiflow™

NIV will be delivered through a face mask connected to a dedicated ventilator with pressure support applied in a noninvasive ventilation mode (Monnal T75, Airliquide Medical Systems, Antony, France).
The Pressure-support level will be adjusted to obtain an expired tidal volume of 6-8 ml/kg of predicted body weight and a respiratory rate of 25-30 b/min. PEEP (range 5-10 cm of water) and FiO2 will be adjusted to maintain an SpO2 ≥92% and to patient's comfort.

Non invasive ventilation (niv)

Uhmontpellier

High Flow Nasal Cannula Therapy for Early Management of Acute Hypercapnic Cardiogenic Pulmonary Edema in the Emergency Department

High-flow Nasal Therapy for Early Management of Hypercapnic Respiratory Failure Due to Acute Cardiogenic Pulmonary Edema in the ED: a Prospective Observational Study

PaCO2 will be measured from standard laboratory arterial blood gas analysis performed at the end of the first 1-hour-treatment session

blood gas (PaO2, pH, SaO2) measured from standard laboratory arterial blood gas analysis at the end of each 1h-ventilatory support session and throughout ventilatory support

Respiratory rate, measured over 1-min as part of standard clinical assessment after each 1h ventilatory support session and throughout ventilatory support

signs of increased work of breathing assessed based on patient's use of accessory respiratory muscles and paradoxical abdominal movement and measured using 5-point likert scales ranging from 1 to 5. Signs of increased work of berthing will be assessed at the end of each 1h ventilatory support sessions throughout ventilatory support

Dyspnea recorded by the patient using a Modified Borg scale ranging from 0 to 10.
Dyspnea will be measured at the end of each 1h ventilatory support sessions and throughout ventilatory support

Comfort recorded by the patient using a visual analog scale from 0 to 10. Comfort will be assessed at the end of each 1h ventilatory support sessions and throughout ventilatory support

Proportion of patients with a normalized PaCO2 (PaCO2 equal or lower than 45 mmHg),

University Hospital, Montpellier

Fisher and Paykel Healthcare

Injection Tramadol 100mg diluted in 10 cc syringe (10mg/ml) to be given as 1mg/kg or (1ml/10kg) via intravenous route, once, at the time of dura closure

0.9% Normal saline in 10 cc syringe,1ml/10kg via intravenous route, once at the time of dura closure

Brain Neoplasm

Injection Tramadol

placebo

Aga Khan University

Single Dose Tramadol Effect on Extubation Response and Quality of Emergence Post-supratentorial Intracranial Surgery

Effect of Single Dose of Tramadol on Extubation Response and Quality of Emergence(Cough and Nausea Vomiting) Following Supratentorial Intracranial Surgery

Blood pressure will be recorded at 1 minute before giving the reversal (glycopyrolate and neostigmine) and then 1,2,5,10,20,30 minutes ,1,2,4 and 6 hours after extubation. If values of blood pressure rise more than 20% from baseline values injection Metoprolol 1mg (beta blocker) bolus will be used and titrated according to response. The study will end at 6 hours post extubation.

Heart rate will be recorded at 1 minute before giving the reversal (glycopyrolate and neostigmine) and then 1,2,5,10,20,30 minutes ,1,2,4 and 6 hours after extubation. If haemodynamic values of heart rate rise more than 20% from baseline values injection Metoprolol 1mg (beta blocker) bolus will be used and titrated according to response. The study will end at 6 hours post extubation.

Cough will be described on following scale 5 = No coughing or straining, 4 = Very smooth minimal coughing, 3 = Moderate coughing, 2 = Marked coughing or straining,
1 = Poor extubation
Cough will be recorded on the above mentioned scale by resident/consultant at following time intervals of emergence
At resumption of spontaneous breathing,
Ability to respond to verbal commands
At cuff deflation
At extubation
2 minutes after extubation. It will be noted if it occurs during emergence at the above mentioned time intervals. Absence of it will be considered as smooth emergence.

If there is any episode of bronchospasm or laryngospasm, it will be noted if it occured during emergence and for 6 hours post operatively. Absence of it will be considered as smooth emergence

If there is any episode of desaturation (oxygen saturation <92%), it will be noted if it occurs during emergence and for 6 hours post operatively. Absence of it will be considered as smooth emergence.

If there is any episode of sedation it will be noted if it occurs during emergence and for 6 hours post operatively. Absence of it will be considered as smooth emergence.
sedation score will be used as 0= no sedation, 1= mildly sedated (eye opening on verbal commands), 2= moderately sedated ( awakens on giving pain), 3= deeply sedated ( not waking up even on pain)

Post operative nausea vomiting will be recorded at 2, 4 and 6 hours postoperatively. If there is any episode of PONV it will be noted. Absence of it will be considered as smooth emergence

Convulsions will be recorded at 2, 4 and 6 hours postoperatively.If there is any episode of convulsion, it will be noted. Absence of it will be considered as smooth emergence.

Post operative GCS will be recorded at 2, 4 and 6 hours postoperatively.If there is any deterioration in GCS, it will be noted. Full GCS will be considered as smooth emergence.

It will be recorded at 2, 4 and 6 hours postoperatively. If there is any need of analgesic, it will be noted and will be considered as one of the determinants of poor quality of emergence.

Asma Abdus Salam

Senior Instructor

Pulmonary Disease

Postoperative Respiratory Complications

Malignant Neoplasm of Stomach

Liver Diseases

Pancreatic Diseases

Universitätsmedizin Mainz, Klinik für Anästhesiologie (University Hospital of Johannes Gutenberg-University Mainz, Department of Anesthesiology)

Screening of Postoperative Pulmonary Complications by Electrical Impedance Tomography

Screening of Postoperative Pulmonary Complications by Electrical Impedance Tomography in Intensive Care Patients Undergoing Epigastric Surgery

Comparison of the changed regional ventilation partition to the occurence of postoperative pulmonary complications => calculation of sensitivity and specifity of the primary outcome measure to predict PPC. Statistical analysis: receiver operating characteristic (ROC curve).

Sensitivity and specifiy for appearance of PPC (Postoperative Pulmonary Complications) within Postoperative Day 1-7.
Statistical analysis: Sensitivity, Specificity, ROC-curve

Correlation of pre-existing pathologic pulmonary conditions with specific postoperative changes in regional distribution of lung ventilation and perfusion assessed by EIT Statistical analysis: Sensitivity, Specificity, ROC-curve

Appearance of all different forms of PPC within Postoperative Day 1-7 and relation to postoperative EIT-measure (ROI analysis in 8 pulmonary ROIs).
Statistical analysis: Sensitivity, Specificity, ROC-curve

Sensitivity and specifity of postoperative EIT-measure for mortality. Statistical analysis: Sensitivity, Specificity, ROC-curve

Sensitivity and specifity of postoperative EIT-measure for time of intensive care therapy.
Statistical analysis: Sensitivity, Specificity, ROC-curve

Sensitivity and specifity of postoperative EIT-measure for Ventilator-obligatory-free days.
Statistical analysis: Sensitivity, Specificity, ROC-curve

hypercapnia/edema

PERSEUS-PS Randomized Controlled Trial

Keto-diet for Intubated Critical Care COVID-19

High Flow Nasal Cannula Therapy for Early Management of Acute Hypercapnic Cardiogenic Pulmonary Edema in the Emergency Department

Single Dose Tramadol Effect on Extubation Response and Quality of Emergence Post-supratentorial Intracranial Surgery

Screening of Postoperative Pulmonary Complications by Electrical Impedance Tomography

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