1
|
Taran S, Angeloni N, Pinto R, Lee S, McCredie VA, Schultz MJ, Robba C, Taccone FS, Adhikari NKJ. Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis. Crit Care Med 2023; 51:401-412. [PMID: 36583622 DOI: 10.1097/ccm.0000000000005769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Extubation failure in brain-injured patients is associated with increased morbidity. Our objective was to systematically review prognostic factors associated with extubation failure in acutely brain-injured adult patients receiving invasive ventilation in an ICU. DATA SOURCES MEDLINE, Embase, and Cochrane Central were searched from inception to January 31, 2022. STUDY SELECTION Two reviewers independently screened citations and selected English-language cohort studies and randomized trials examining the association of prognostic factors with extubation failure. Studies were considered if they included greater than or equal to 80% adult patients with acute brain injury admitted to the ICU and mechanically ventilated for greater than or equal to 24 hours. DATA EXTRACTION Two reviewers extracted data on population, prognostic factors, extubation outcomes, and risk of bias (using the quality in prognostic factors tool). DATA SYNTHESIS In the primary analysis, adjusted odds ratios (aOR) for each prognostic factor were pooled using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The search identified 7,626 citations, of which 21 studies met selection criteria. Moderate-certainty evidence suggested increased risk of extubation failure with older age (aOR, 3.0 for upper vs lower tertile; 95% CI, 1.78-5.07) and longer duration of mechanical ventilation (aOR, 3.47 for upper vs lower tertile; 95% CI, 1.68-7.19). Presence of cough (aOR, 0.40; 95% CI, 0.28-0.57) and intact swallow (aOR, 0.34; 95% CI, 0.21-0.54) probably decreased risk of extubation failure (moderate certainty). Associations of other factors with extubation failure were informed by low or very low certainty evidence. CONCLUSIONS Patient age, duration of mechanical ventilation, and airway reflexes were associated with extubation failure in brain-injured patients with moderate certainty. Future studies are needed to determine the optimal application of these variables in clinical practice.
Collapse
Affiliation(s)
- Shaurya Taran
- Interdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Natalia Angeloni
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shawn Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Chiara Robba
- Department of Surgical Science and Diagnostics, University of Genoa, Genoa, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Hôpital Erasme, Brusssels, Belgium
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
2
|
da Silva AR, Novais MCM, Neto MG, Correia HF. Predictors of extubation failure in neurocritical patients: A systematic review. Aust Crit Care 2023; 36:285-291. [PMID: 35197209 DOI: 10.1016/j.aucc.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify predictors of extubation failure in neurocritical patients. METHODS This was systematic review performed through a bibliographic search of the databases PubMed/Medline, Lilacs, SciELO, and Web of Science, from February 2020 to October 2021. Cohort studies that investigated the predictors of extubation failure were included, defined as the need for reintubation within 48 h after extubation, in adult neurocritical patients. The risk-of-bias assessment was performed using the Newcastle-Ottawa Scale, for cohort studies. RESULTS Eight studies, totaling 18 487 participants, were included. A total of 15 predictors for extubation failure in neurocritical patients have been identified. Of these, four were the most frequent: low score on the Glasgow Coma Scale (motor score ≤5, 8T-10T), female gender, time on mechanical ventilation (≥7 days, ≥ 10 days), and moderate or large secretion volume. CONCLUSIONS In addition to the conventional parameters of weaning and extubation, other factors, such as a low score on the Glasgow Coma Scale, female gender, mechanical ventilation time, and moderate or large secretion volume, must be taken into account to prevent extubation failure in neurocritical patients in clinical practice.
Collapse
Affiliation(s)
- Alanna Ribeiro da Silva
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil.
| | - Michelli Christina Magalhães Novais
- Graduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
| | - Mansueto Gomes Neto
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
| | - Helena França Correia
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
| |
Collapse
|
3
|
Guo J, Ling W. The relationship between the mental health status and social support of the lonely elderly with government participation in the Internet context. Front Public Health 2022; 10:1013069. [PMID: 36388389 PMCID: PMC9650479 DOI: 10.3389/fpubh.2022.1013069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023] Open
Abstract
Objective At present, urban community aging has become a new way to solve aging problem and has made outstanding contributions to alleviate current aging dilemma. However, there are still deficiencies in the services provided by this new method of community-based elderly care for the elderly who are left alone. Therefore, this paper explores the problems of government policies, facilities and services for the elderly who have lost their independence, analyzes the reasons behind them, and proposes countermeasures. Method This paper introduces and compares the government's current services for the elderly who are left alone in the city at the level of community-based elderly care services. From the existing literature, we find that most researchers have studied the single-parent family as an individual, exploring its elderly care dilemma, analyzing the causes and proposing countermeasures. It introduces and summarizes the situation of the elderly left alone in Taiyuan, the government's policies on the elderly left alone and community elderly care, the current community elderly care construction in Taiyuan, and the service models provided by the government. Results/Discussion This paper provides a detailed description and in-depth analysis of the lack of elderly care protection in communities, and analyzes the underlying causes. Activity theory suggests that even though older people are no longer in the same mental state as younger people, they can still enhance their self-worth through active participation in social activities and gain a sense of social identity through social activities. The services provided by social organizations are typical services purchased by the Health and Welfare Commission for the elderly who are left alone, and it is feasible to gradually extend the services to provide more specialized community-based elderly care services for the elderly who are left alone. Therefore, this study takes the use of services provided by social organizations as an example to understand the current situation of services received and used by the elderly who are left alone, and concludes that the services are weakly accessible, and finally proposes suggestions to improve the accessibility of services in three aspects: supply, delivery, and use.
Collapse
Affiliation(s)
- Jun Guo
- Department of Labor and Social Security, School of Philosophy and Public Administration, Henan University, Kaifeng, Henan, China
| | - Wenhao Ling
- Institute of Social Governance Research Center, Henan University, Kaifeng, China,*Correspondence: Wenhao Ling
| |
Collapse
|
4
|
Clinical Indications for Extubation in Coma Patients with Severe Neurological Craniocerebral Injury with Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8012018. [PMID: 36193306 PMCID: PMC9526588 DOI: 10.1155/2022/8012018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Abstract
Computer searches of the PubMed, Cochrane Library, and Embase databases for randomized controlled studies on the effects of intensive nutrition on clinical outcomes in patients with severe craniocerebral injury were conducted from the time of database creation to June 11, 2022, along with manual searches of the relevant literature. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies before the effect sizes were combined using RevMan 5.3 statistical software provided by the Cochrane Collaboration Network, and publication bias was detected using Stata 12.0 software. Meta-analysis showed that total protein levels were higher in the intensive nutrition group than in the regular nutrition group (WMD = 4.96 g/L (1.57-8.34), P < 0.001); IgA levels were significantly higher in the intensive nutrition group than in the regular nutrition group (SMD = 0.79 (0.51-1.07), P < 0.001; SMD = 0.98 (0.58-1.38), P < 0.001); IgG levels were significantly higher in the fortified group than in the regular group (SMD = 0.98 (0.58-1.38), P < 0.001); CD4/CD8 was significantly higher in the fortified patients than in the regular patients with a combined effect size of WMD = 0.33 (0.18-0.48) (P < RR = 0.45 (0.27-0.75), P = 0.002). The results show that effective support of early enteral nutrition can reduce the occurrence of gastrointestinal complications in patients, give them a better adaptation process to the gastrointestinal tract, and ensure the degree of tolerance of their gastric mucosa, thus absorbing more nutrition. Fortification significantly reduced the incidence of gastric retention in patients with craniocerebral injury (RR = 0.19 (0.07-0.49), P < 0.001). In the subgroup analysis of the three groups, it was shown that, depending on the starting time, the total protein level and IgG level were better in the early nutrition at 24 h than in the late nutrition above 24h and that, depending on the starting dose, the total protein level, IgA, IgG, and CD4/CD8 were better in the intervention at doses above 30 mL/h, using the starting dose of 30 mL/h as the cut-off point. In the subgroup analysis based on different nutrition methods (enteral and parenteral nutrition), IgA levels and the incidence of bloating and diarrhea were better than those of parenteral nutrition in the indicators of enteral nutrition.
Collapse
|
5
|
Torrini F, Gendreau S, Morel J, Carteaux G, Thille AW, Antonelli M, Mekontso Dessap A. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:391. [PMID: 34782003 PMCID: PMC8591441 DOI: 10.1186/s13054-021-03802-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022]
Abstract
Background Extubation failure is an important issue in ventilated patients and its risk factors remain a matter of research. We conducted a systematic review and meta-analysis to explore factors associated with extubation failure in ventilated patients who passed a spontaneous breathing trial and underwent planned extubation. This systematic review was registered in PROPERO with the Registration ID CRD42019137003. Methods We searched the PubMed, Web of Science and Cochrane Controlled Register of Trials for studies published from January 1998 to December 2018. We included observational studies involving risk factors associated with extubation failure in adult intensive care unit patients who underwent invasive mechanical ventilation. Two authors independently extracted data and assessed the validity of included studies. Results Sixty-seven studies (involving 26,847 participants) met the inclusion criteria and were included in our meta-analysis. We analyzed 49 variables and, among them, we identified 26 factors significantly associated with extubation failure. Risk factors were distributed into three domains (comorbidities, acute disease severity and characteristics at time of extubation) involving mainly three functions (circulatory, respiratory and neurological). Among these, the physiological respiratory characteristics at time of extubation were the most represented. The individual topic of secretion management was the one with the largest number of variables. By Bayesian multivariable meta-analysis, twelve factors were significantly associated with extubation failure: age, history of cardiac disease, history of respiratory disease, Simplified Acute Physiologic Score II score, pneumonia, duration of mechanical ventilation, heart rate, Rapid Shallow Breathing Index, negative inspiratory force, lower PaO2/FiO2 ratio, lower hemoglobin level and lower Glasgow Coma Scale before extubation, with the latest factor having the strongest association with extubation outcome. Conclusions Numerous factors are associated with extubation failure in critically ill patients who have passed a spontaneous breathing trial. Robust multiparametric clinical scores and/or artificial intelligence algorithms should be tested based on the selected independent variables in order to improve the prediction of extubation outcome in the clinical scenario. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03802-3.
Collapse
Affiliation(s)
- Flavia Torrini
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Ségolène Gendreau
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Johanna Morel
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.,INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France
| | - Arnaud W Thille
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France.,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France. .,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France. .,INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France.
| |
Collapse
|
6
|
Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation. Clin Neurol Neurosurg 2019; 184:105419. [PMID: 31306892 DOI: 10.1016/j.clineuro.2019.105419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Tracheostomy is often indicated in patients with spontaneous subarachnoid hemorrhage (sSAH). Decannulation is a major goal of neurorehabilitation, but cannot be achieved in all patients. The aim of this study was to describe the course of decannulation and to identify associated risk factors in a single-center collective. PATIENTS AND METHODS We retrospectively reviewed 87 sSAH patients with WFNS (World Federation of Neurosurgical Societies) grade III-IV, who received tracheostomy. Decannulation events and the time from tracheostomy to decannulation were recorded in a 200-days follow-up. Variables analyzed were: age, sex, WFNS grade, Fisher grade, the presence of intracerebral or intraventricular hematoma, acute hydrocephalus, aneurysm location, aneurysm obliteration (surgical vs. endovascular), treatment related complications, decompressive craniectomy, symptomatic cerebral vasospasm, vasospasm-related infarction and timing of tracheostomy. Further risk factors analyzed were preexisting chronic lung disease and pneumonia. Functional outcome was assessed by the modified Rankin Scale (mRS). RESULTS The rate of successful decannulation was 84% after a median of 47 days. A higher WFNS grade and pneumonia were associated with both a prolonged time to decannulation (TTD) and decannulation failure (DF). Older age (> 60 years) and necessity for decompressive craniectomy were only associated with prolonged TTD. Outcome analysis revealed that patients with DF show a significantly (p < 0.01) higher rate of unfavorable outcome (mRS 3-6). CONCLUSION Successful decannulation is possible in the majority of sSAH patients and particularly, in all patients with WFNS grade III. WFNS grading, age, the necessity for decompressive craniectomy and pneumonia are significantly associated with the TTD. WFNS grade and pneumonia are significantly associated with DF. The mean cannulation time of sSAH patients is shorter in relation to stroke patients.
Collapse
|