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Gilaed A, Shorbaji N, Katzir O, Ankol S, Badarni K, Andrawus E, Roimi M, Katz A, Bar-Lavie Y, Raz A, Epstein D. Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study. Injury 2024; 55:111194. [PMID: 37978015 DOI: 10.1016/j.injury.2023.111194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND A significant proportion of patients with severe chest trauma require mechanical ventilation (MV). Early prediction of the duration of MV may influence clinical decisions. We aimed to determine early risk factors for prolonged MV among adults suffering from severe blunt thoracic trauma. METHODS This retrospective, single-center, cohort study included all patients admitted between January 2014 and December 2020 due to severe blunt chest trauma. The primary outcome was prolonged MV, defined as invasive MV lasting more than 14 days. Multivariable logistic regression was performed to identify independent risk factors for prolonged MV. RESULTS The final analysis included 378 patients. The median duration of MV was 9.7 (IQR 3.0-18.0) days. 221 (58.5 %) patients required MV for more than 7 days and 143 (37.8 %) for more than 14 days. Male gender (aOR 3.01, 95 % CI 1.63-5.58, p < 0.001), age (aOR 1.40, 95 % CI 1.21-1.63, p < 0.001, for each category above 30 years), presence of severe head trauma (aOR 3.77, 95 % CI 2.23-6.38, p < 0.001), and transfusion of >5 blood units on admission (aOR 2.85, 95 % CI 1.62-5.02, p < 0.001) were independently associated with prolonged MV. The number of fractured ribs and the extent of lung contusions were associated with MV for more than 7 days, but not for 14 days. In the subgroup of 134 patients without concomitant head trauma, age (aOR 1.63, 95 % CI 1.18-2.27, p = 0.004, for each category above 30 years), respiratory comorbidities (aOR 9.70, 95 % CI 1.49-63.01, p = 0.017), worse p/f ratio during the first 24 h (aOR 1.55, 95 % CI 1.15-2.09, p = 0.004), and transfusion of >5 blood units on admission (aOR 5.71 95 % CI 1.84-17.68, p = 0.003) were independently associated with MV for more than 14 days. CONCLUSIONS Several predictors have been identified as independently associated with prolonged MV. Patients who meet these criteria are at high risk for prolonged MV and should be considered for interventions that could potentially shorten MV duration and reduce associated complications. Hemodynamically stable, healthy young patients suffering from severe thoracic trauma but no head injury, including those with extensive lung contusions and rib fractures, have a low risk of prolonged MV.
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Affiliation(s)
- Aran Gilaed
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Nadeem Shorbaji
- Department of Diagnostic Imaging, Rambam Health Care Center, Haifa, Israel
| | - Ori Katzir
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaked Ankol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Karawan Badarni
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Elias Andrawus
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Michael Roimi
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amit Katz
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Yaron Bar-Lavie
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Aeyal Raz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel.
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López-Hernández JC, Vargas-Cañas ES, Galnares-Olalde JA, López-Alderete JA, López-Pizano A, Rivas-Cruz MA, Violante-Villanueva JA, Paredes-Aragón E. Factors Predicting Prolonged Mechanical Ventilation in Guillain-Barré Syndrome. Can J Neurol Sci 2024; 51:98-103. [PMID: 36788667 DOI: 10.1017/cjn.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Up to 30% of patients with Guillain-Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation. METHODS We prospectively analyzed patients with Guillain-Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation. RESULTS Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07-2.25) vs. 3.9 (RIQ1.2-6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0-3.72) vs 1.5 (RIQ0.3-6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1-21.5) p = 0.03, AUC of 0.774, (95%CI 0.66-0.88), p = < 0.001. CONCLUSIONS Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.
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Affiliation(s)
- Juan Carlos López-Hernández
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Mexico
- Neurologic Emergencies Department, Instituto Nacional de Neurología y Neurocirugía, Mexico
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Atchade E, Boughaba A, Dinh AT, Jean-Baptiste S, Tanaka S, Copelovici L, Lortat-Jacob B, Roussel A, Castier Y, Messika J, Mal H, de Tymowski C, Montravers P. Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome. Front Med (Lausanne) 2023; 10:1160621. [PMID: 37228395 PMCID: PMC10203407 DOI: 10.3389/fmed.2023.1160621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Background Risk factors and the incidence of prolonged mechanical ventilation (PMV) after lung transplantation (LT) have been poorly described. The study assessed predictive factors of PMV after LT. Methods This observational, retrospective, monocentric study included all patients who received LT in Bichat Claude Bernard Hospital between January 2016 and December 2020. PMV was defined as a duration of MV > 14 days. Independent risk factors for PMV were studied using multivariate analysis. One-year survival depending on PMV was studied using Kaplan Meier and log-rank tests. A p value <0.05 was defined as significant. Results 224 LT recipients were analysed. 64 (28%) of them received PMV for a median duration of 34 [26-52] days versus 2 [1-3] days without PMV. Independent risk factors for PMV were higher body mass index (BMI) (p = 0.031), diabetes mellitus of the recipient (p = 0.039), ECMO support during surgery (p = 0.029) and intraoperative transfusion >5 red blood cell units (p < 0.001). Increased mortality rates were observed at one-year in recipients who received PMV (44% versus 15%, p < 0.001). Conclusion PMV was associated with increased morbidity and mortality one-year after LT. Preoperative risk factors (BMI and diabetes mellitus) must be considered when selecting and conditioning the recipients.
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Affiliation(s)
- Enora Atchade
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
| | | | - Alexy Tran Dinh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
- INSERM U1148, LVTS, CHU Bichat-Claude Bernard, Paris, France
- Université de Paris, UFR Diderot, Paris, France
| | | | - Sébastien Tanaka
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
- Université De La Réunion, INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, France
| | - Léa Copelovici
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
| | | | - Arnaud Roussel
- APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, Paris, France
| | - Yves Castier
- Université de Paris, UFR Diderot, Paris, France
- APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, Paris, France
- INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Jonathan Messika
- Université de Paris, UFR Diderot, Paris, France
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Hervé Mal
- Université de Paris, UFR Diderot, Paris, France
- INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Christian de Tymowski
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
- INSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
- Université de Paris, UFR Diderot, Paris, France
- INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
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Vali M, Paydar S, Seif M, Sabetian G, Abujaber A, Ghaem H. Prediction prolonged mechanical ventilation in trauma patients of the intensive care unit according to initial medical factors: a machine learning approach. Sci Rep 2023; 13:5925. [PMID: 37045979 PMCID: PMC10097728 DOI: 10.1038/s41598-023-33159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
The goal of this study was to develop a predictive machine learning model to predict the risk of prolonged mechanical ventilation (PMV) in patients admitted to the intensive care unit (ICU), with a focus on laboratory and Arterial Blood Gas (ABG) data. This retrospective cohort study included ICU patients admitted to Rajaei Hospital in Shiraz between 2016 and March 20, 2022. All adult patients requiring mechanical ventilation and seeking ICU admission had their data analyzed. Six models were created in this study using five machine learning models (PMV more than 3, 5, 7, 10, 14, and 23 days). Patients' demographic characteristics, Apache II, laboratory information, ABG, and comorbidity were predictors. This study used Logistic regression (LR), artificial neural networks (ANN), support vector machines (SVM), random forest (RF), and C.5 decision tree (C.5 DT) to predict PMV. The study enrolled 1138 eligible patients, excluding brain-dead patients and those without mechanical ventilation or a tracheostomy. The model PMV > 14 days showed the best performance (Accuracy: 83.63-98.54). The essential ABG variables in our two optimal models (artificial neural network and decision tree) in the PMV > 14 models include FiO2, paCO2, and paO2. This study provides evidence that machine learning methods outperform traditional methods and offer a perspective for achieving a consensus definition of PMV. It also introduces ABG and laboratory information as the two most important variables for predicting PMV. Therefore, there is significant value in deploying such models in clinical practice and making them accessible to clinicians to support their decision-making.
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Affiliation(s)
- Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- Anesthesiology and Critical Care Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Haleh Ghaem
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Wang Z, Zhang L, Huang T, Yang R, Cheng H, Wang H, Yin H, Lyu J. Developing an explainable machine learning model to predict the mechanical ventilation duration of patients with ARDS in intensive care units. Heart Lung 2023; 58:74-81. [PMID: 36423504 PMCID: PMC9678346 DOI: 10.1016/j.hrtlng.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is common in intensive care units with high mortality rate and mechanical ventilation (MV) is the most important related treatment. Early prediction of MV duration has benefit for patients risk stratification and care strategies support. OBJECTIVE To develop an explainable model for predicting mechanical ventilation (MV) duration in patients with ARDS using the machine learning (ML) approach. METHOD The number of 1,148, 1,697, and 29 ARDS patients admitted to intensive care units (ICU) in the MIMIC-IV, eICU-CRD, and AmsterdamUMCdb databases were included in the study. Features at MV initiation from the MIMIC-IV dataset were used to train prediction models based on seven supervised machine learning algorithms. After 5-fold cross-validation for hyperparameters tuning, the hyperparameters- optimized model of different algorithms was tested by external datasets extracted from eICU-CRD and Amsterdamumcdb. Finally, three descriptive machine learning explanation methods were conducted for the model explanation. RESULT The XGBoosting model showed the most stable and accurate performance among two testing datasets (RMSE= 5.57 and 5.46 days in eICU-CRD and AmsterdamUMCdb) and was selected as the optimal model. The model explanation based on SHAP, LIME, and DALEX results showed a consistent result, vasopressor, PH, and SOFA score had the highest effect on MV duration prediction. CONCLUSION ML models with features at MV initiation can accurate predict MV duration in patients with ARDS in ICUs. Among seven algorithms, XGB models showed the best performance (RMSE= 5.57 and 5.46 in two external datasets). LIME, SHAP, and Breakdown methods showed good performance as AXI methods.
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Affiliation(s)
- Zichen Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Department of Public Health, University of California, Irvine, Irvine, California, United State
| | - Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Rui Yang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Statistics, Iowa State University, Ames, Iowa, Unite States
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China.
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Munan M, Hsu Z, Bakal JA, MacIntyre E. Prolonged mechanical ventilation in Alberta: A 10 year historical cohort study. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2023.2165462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Matt Munan
- Covenant Health, Misericordia Community Hospital Intensive Care Unit, Edmonton, AB, Canada
| | - Zoe Hsu
- Provincial Research Data Services – Alberta Health Services, Edmonton, AB, Canada
| | - Jeffrey A. Bakal
- Provincial Research Data Services – Alberta Health Services, Edmonton, AB, Canada
| | - Erika MacIntyre
- Covenant Health, Misericordia Community Hospital Intensive Care Unit, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Cederwall CJ, Rose L, Naredi S, Olausson S, Ringdal M. Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey. Intensive Crit Care Nurs 2023; 74:103309. [PMID: 35965149 DOI: 10.1016/j.iccn.2022.103309] [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: 08/10/2021] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days. RESEARCH METHODOLOGY We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics. RESULTS We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units. CONCLUSION We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
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Affiliation(s)
- Carl-Johan Cederwall
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Lane Fox Respiratory Unit, St Thomas' Hospital, London, UK
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, 413 45 Gothenburg, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
| | - Mona Ringdal
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Anaesthesiology and Critical Care, Kungälvs Hospital, Kungälv, Sweden
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Zhang Z, Tao J, Cai X, Huang L, Liu C, Ren H, Qu D, Gao H, Cheng Y, Zhang F, Yang Z, Xu W, Miao H, Liu P, Liu Y, Lu G, Chen W. Clinical characteristics and outcomes of children with prolonged mechanical ventilation in PICUs in mainland China: A national survey. Pediatr Pulmonol 2023; 58:1401-1410. [PMID: 36705329 DOI: 10.1002/ppul.26332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The number of children on prolonged mechanical ventilation (PMV) in pediatric intensive care units (PICU) has increased markedly, but little is known about the situation in mainland China. We carried out a multicenter retrospective investigation to describe the clinical characteristics and prognosis of Chinese children receiving long-term ventilation in the PICU. METHODS A retrospective study was performed in 11 PICUs. All participating patients with prolonged mechanical ventilation in the study were retrospectively identified and included from cases admitted to PICUs between January 1, 2017 and December 31, 2019. RESULTS A total of 346 children diagnosed with prolonged mechanical ventilation were included in the study. Overall, 240 survived and were discharged from PICU, 55 died in hospital, and 51 withdrew from mechanical ventilation support with 41 died after discharge. Lower airway diseases were the most common underlying causes (41.6%), followed by central nervous system diseases (29.5%), and neuromuscular diseases (13.3%). Most children (327, 94.5%) received invasive mechanical ventilation (IMV) and only 19 (5.5%) children received noninvasive ventilation (NIV). The median time of tracheostomy after ventilation was 21 days (15-35). Children with tracheostomy had lower mortality with longer PICU stay compared with patients without tracheostomy. Children who underwent tracheostomy were more likely to have central nervous system diseases and neuromuscular diseases. CONCLUSION This study showed a steady increase in the number of children receiving prolonged mechanical ventilation during the study period in Chinese PICUs with distinct clinical characteristics and outcomes. A better community-based care for PMV children is needed in mainland China.
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Affiliation(s)
- Zhengzheng Zhang
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jinhao Tao
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaodi Cai
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Li Huang
- Department of Pediatric Intensive Care Unit, National Children's Medical Center for South Central Region, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chengjun Liu
- Department of Pediatric Intensive Care Unit, Western Pediatric Development Union, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Ren
- Department of Pediatric Intensive Care Unit, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong Qu
- Department of Pediatric Intensive Care Unit, Children's hospital, Capital Institute of Pediatrics, Beijing, China
| | - Hengmiao Gao
- Department of Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's hospital, Capital Medical University, Beijing, China
| | - Yibing Cheng
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Furong Zhang
- Department of Pediatric Intensive Care Unit, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zihao Yang
- Department of Pediatric Intensive Care Unit, National Clinical Research Center for Child Health, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Xu
- Department of Pediatric Intensive Care Unit, National Children's (Northeast) Regional Medical Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongjun Miao
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pan Liu
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuxin Liu
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weiming Chen
- Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Abate SM, Basu B, Jemal B, Ahmed S, Mantefardo B, Taye T. Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis. Crit Care 2023; 27:37. [PMID: 36694238 PMCID: PMC9875485 DOI: 10.1186/s13054-023-04316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain. OBJECTIVE The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia. METHODS Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region. RESULTS The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36-58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96-18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = 2.5; 95% CI: 1.24, 5.05) were predictors. CONCLUSION The higher 28-day mortality among ICU patients on mechanical ventilation in our study might be attributed to factors such as delayed patient presentation, lack of resources, insufficient healthcare infrastructure, lack of trained staff, and financial constraints. TRIAL REGISTRATION The protocol was registered retrospectively on ( NCT05303831 ).
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bedru Jemal
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Siraj Ahmed
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bahru Mantefardo
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Tagesse Taye
- Department of Anesthesiology, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
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Liu Q, Luo Q, Li Y, Wu X, Wang H, Huang J, Jia Y, Yuan S, Yan F. A simple-to-use nomogram for predicting prolonged mechanical ventilation for children after Ebstein anomaly corrective surgery: a retrospective cohort study. BMC Anesthesiol 2023; 23:24. [PMID: 36639642 PMCID: PMC9839444 DOI: 10.1186/s12871-022-01942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children. METHODS The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve. RESULTS Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05. CONCLUSIONS We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery.
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Affiliation(s)
- Qiao Liu
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Qipeng Luo
- grid.411642.40000 0004 0605 3760Department of Pain Medicine, Peking University Third Hospital, Beijing, China
| | - Yinan Li
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Xie Wu
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Hongbai Wang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Jiangshan Huang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Yuan Jia
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Su Yuan
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Fuxia Yan
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037 China
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Best A, Harvey C, Minton C. A protocol for exploring patients' and support peoples' experiences after prolonged critical illness. Nurs Crit Care 2023. [PMID: 36626896 DOI: 10.1111/nicc.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Improved survival of critically ill people has increased the number of patients who experience an extended stay in intensive care units (ICU). Evidence suggests the complexities, vulnerabilities, and traumas created by critical illness are substantial for both patients and their support people with a number experiencing devastating impairments across multiple domains of health and function including physical, mental, cognitive, and social health. However, research on survivors predominantly focuses on those who have experienced a relatively short length of stay; only a limited number of studies seek to explore the experiences of survivors and their support people who have had a prolonged stay in intensive care. AIMS AND OBJECTIVES To describe the experiences of survivors of prolonged critical illness (invasively mechanically ventilated in ICU for ≥eight days) and their support people during the first 12 months following hospital discharge in New Zealand. DESIGN This research will be a multi-centre study recruiting from three intensive care units in New Zealand. A narrative inquiry methodology will be used to interview 6-8 former long stay patients and 6-8 support people of a former long stay patient. Each participant will be interviewed at 3-, 6-, 9-, and 12-months following hospital discharge. METHODS Data will be collected via narrative inquiry interviews. Data analysis will combine two theoretical frameworks: the Clandinin and Connelly narrative inquiry three-dimensional space and the Fairclough situation, discourse and context framework. RESULTS The phenomenon of investigation will be experiences after prolonged critical illness explored longitudinally across the first-year post-hospital discharge. RELEVANCE TO CLINICAL PRACTICE This protocol provides a methodological framework for exploring the lived experiences of survivors of prolonged critical illness and their support people. Data analysis will support understanding of the human journey of ICU survivorship and add to the body of knowledge on how to support post-ICU recovery in this population. The barriers and enablers of survivorship at the micro, meso, and macro levels of the health service will also be illuminated.
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Affiliation(s)
- Amy Best
- School of Nursing, Massey University, Wellington, New Zealand.,Intensive Care Unit, Wellington Regional Hospital, Capital Coast Health, Wellington, New Zealand
| | - Clare Harvey
- Deputy Head of School, School of Nursing, Massey University, Wellington, New Zealand
| | - Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
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12
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Gao P, Li C, Wu J, Zhang P, Liu X, Li Y, Ding J, Su Y, Zhu Y, He W, Ning Y, Chen C. Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study. BMC Pulm Med 2023; 23:11. [PMID: 36627599 PMCID: PMC9832679 DOI: 10.1186/s12890-023-02307-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation (PMV), mostly defined as mechanical ventilation > 72 h after lung transplantation with or without tracheostomy, is associated with increased mortality. Nevertheless, the predictive factors of PMV after lung transplant remain unclear. The present study aimed to develop a novel scoring system to identify PMV after lung transplantation. METHODS A total of 141 patients who underwent lung transplantation were investigated in this study. The patients were divided into PMV and non-prolonged ventilation (NPMV) groups. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was then established based on the multivariate analysis, and model performance was further examined regarding its calibration, discrimination, and clinical usefulness. RESULTS Eight factors were finally identified to be significantly associated with PMV by the multivariate analysis and therefore were included as risk factors in the nomogram as follows: the body mass index (BMI, P = 0.036); primary diagnosis as idiopathic pulmonary fibrosis (IPF, P = 0.038); pulmonary hypertension (PAH, P = 0.034); primary graft dysfunction grading (PGD, P = 0.011) at T0; cold ischemia time (CIT P = 0.012); and three ventilation parameters (peak inspiratory pressure [PIP, P < 0.001], dynamic compliance [Cdyn, P = 0.001], and P/F ratio [P = 0.015]) at T0. The nomogram exhibited superior discrimination ability with an area under the curve of 0.895. Furthermore, both calibration curve and decision-curve analysis indicated satisfactory performance. CONCLUSION A novel nomogram to predict individual risk of receiving PMV for patients after lung transplantation was established, which may guide preventative measures for tackling this adverse event.
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Affiliation(s)
- Peigen Gao
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Chongwu Li
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Junqi Wu
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Pei Zhang
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Xiucheng Liu
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Yuping Li
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Junrong Ding
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Yiliang Su
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Yuming Zhu
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Wenxin He
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Ye Ning
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Chang Chen
- grid.24516.340000000123704535Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200443 China ,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
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Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial. J Clin Med 2023; 12:jcm12020546. [PMID: 36675474 PMCID: PMC9866403 DOI: 10.3390/jcm12020546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The efficacy of cytokine adsorption in controlling the early inflammation cascade after open thoracoabdominal aortic (TAAA) repair has not been investigated. The aim of this pilot randomized controlled trial was to assess the feasibility and effect of perioperative hemoadsorption during open TAAA repair. METHODS Patients scheduled for open TAAA repair with the use of cardiopulmonary bypass (CPB) were included. The patients were randomized the day before surgery to either intraoperative hemoadsorption during CPB or standard of care. RESULTS A total of 10 patients were randomly assigned to the intervention group, whereas the control group consisted of 17 patients (mean age of the total cohort, 51.1 ± 11.2 years, 67% male, 3 patients not randomized). The majority of baseline and perioperative characteristics were similar, and no device-related adverse events were reported. A trend to shorter ventilation times in the intervention group was observed (median 88 h vs. 510 h, p = 0.08, Δ422). Severe acute respiratory distress syndrome was significantly less in the intervention patients (p = 0.02). CONCLUSIONS This is the first pilot study showing that the intraoperative use of hemoadsorption in open TAAA repair patients may be feasible and safe, yet larger trials are needed to evaluate whether intraoperative hemoadsorption is associated with improved clinical outcomes.
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Abstract
OBJECTIVES It is well known that polytrauma can lead to acute lung injury. Respiratory failure has been previously observed in combat trauma, but not reported in children, who account for over 11% of bed days at deployed Military Treatment Facilities (MTFs) using significant resources. We seek to identify risk factors associated with prolonged mechanical ventilation (PMV) which is important in resource planning and allocation in austere environments. DESIGN Retrospective review of prospectively collected data within the United States Department of Defense Trauma Registry. SETTING Deployed U.S. MTFs in Iraq and Afghanistan from 2007 to 2016. PATIENTS All pediatric subjects who required at least 1 day of mechanical ventilation, excluding patients who died on day 0. INTERVENTIONS PMV was defined using the Youden index for mortality. A multivariable logistic regression model was then performed to identify factors associated with PMV. MEASUREMENTS AND MAIN RESULTS The Youden index identified greater than or equal to 6 days as the cutoff for PMV. Of the 859 casualties included in the analysis, 154 (17.9%) had PMV. On univariable analysis, age, severe injury to the thorax and skin, 24-hour volume/kg administration of crystalloids, colloids, platelets, plasma, and packed RBCs was associated with PMV. In the multivariable model, odds ratios (95% CI) associated with PMV were crystalloids 1.04 (1.02-1.07), colloids 1.24 (1.04-1.49), platelets 1.03 (1.01-1.05), severe injury to the thorax 2.24 (1.41-3.48), and severe injury to the skin 4.48 (2.72-7.38). Model goodness-of-fit r2 was 0.14. CONCLUSIONS In this analysis of factors associated with PMV in pediatric trauma patients in a combat zone, in addition to severe injury to skin and thorax, we found that administration of crystalloids, colloids, and platelets was independently associated with greater odds of PMV. Our findings will help inform resource planning and suggest potential resuscitation strategies for future studies.
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Caldarelli V, Porcaro F, Filippo PD, Attanasi M, Fainardi V, Gallucci M, Mazza A, Ullmann N, La Grutta S. Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1700. [PMID: 36360427 PMCID: PMC9688784 DOI: 10.3390/children9111700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/09/2023]
Abstract
Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.
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Affiliation(s)
- Valeria Caldarelli
- Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Paola Di Filippo
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
| | - Valentina Fainardi
- Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Angelo Mazza
- Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Stefania La Grutta
- Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy
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Hamed M, Brandecker S, Rana S, Potthoff AL, Eichhorn L, Bode C, Schmeel FC, Radbruch A, Schäfer N, Herrlinger U, Köksal M, Giordano FA, Vatter H, Schneider M, Banat M. Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis. Front Oncol 2022; 12:940790. [PMID: 36387073 PMCID: PMC9647167 DOI: 10.3389/fonc.2022.940790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Patients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS). Methods Between 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality. Results Twenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified “PMV > 24 hrs” (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke’s R2 0.38). Conclusions Our data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Simon Brandecker
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Shaleen Rana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Mohammed Banat,
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Li X, Liu J, Xu Z, Wang Y, Chen L, Bai Y, Xie W, Wu Q. Early identification of delayed extubation following cardiac surgery: Development and validation of a risk prediction model. Front Cardiovasc Med 2022; 9:1002768. [PMID: 36267640 PMCID: PMC9576842 DOI: 10.3389/fcvm.2022.1002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Successful weaning and extubation after cardiac surgery is an important step of postoperative recovery. Delayed extubation is associated with poor prognosis and high mortality, thereby contributing to a substantial economic burden. The aim of this study was to develop and validate a prediction model estimate the risk of delayed extubation after cardiac surgery based on perioperative risk factors. Methods We performed a retrospective cohort study of adult patients undergoing cardiac surgery from 2014 to 2019. Eligible participants were randomly assigned into the development and validation cohorts, with a ratio of 7:3. Variables were selected using least absolute shrinkage and selection operator (LASSO) logistic regression model with 10-fold cross-validation. Multivariable logistic regression was applied to develop a predictive model by introducing the predictors selected from the LASSO regression. Receiver operating characteristic (ROC) curve, calibration plot, decision curve analysis (DCA) and clinical impact curve were used to evaluate the performance of the predictive risk score model. Results Among the 3,919 adults included in our study, 533 patients (13.6%) experienced delayed extubation. The median ventilation time was 68 h in the group with delayed extubation and 21 h in the group without delayed extubation. A predictive scoring system was derived based on 10 identified risk factors based on 10 identified risk factors including age, BMI ≥ 28 kg/m2, EF < 50%, history of cardiac surgery, type of operation, emergency surgery, CPB ≥ 120 min, duration of surgery, IABP and eGFR < 60 mL/min/1.73 m2. According to the scoring system, the patients were classified into three risk intervals: low, medium and high risk. The model performed well in the validation set with AUC of 0.782 and a non-significant p-value of 0.901 in the Hosmer-Lemeshow test. The DCA curve and clinical impact curve showed a good clinical utility of this model. Conclusions We developed and validated a prediction score model to predict the risk of delayed extubation after cardiac surgery, which may help identify high-risk patients to target with potential preventive measures.
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Daza-Arana JE, Lozada-Ramos H, Ávila-Hernández DF, Ordoñez-Mora LT, Sánchez DP. Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia. Vasc Health Risk Manag 2022; 18:767-781. [PMID: 36204193 PMCID: PMC9531618 DOI: 10.2147/vhrm.s367108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft. Patients and Methods This was an analytical retrospective case-control study. Cases were defined as subjects requiring prolonged mechanical ventilation (>48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery. Results A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06-3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: -3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73-7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation <60% (OR 2.00; 95% CI: 1.18-3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06-84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77-4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02-6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91-6.25, p = 0.00). Conclusion This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.
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Affiliation(s)
| | - Heiler Lozada-Ramos
- Medicine Program, Universidad Santiago de Cali, Cali, Colombia
- Doctoral Program in Infectious Diseases, Universidad de Santander – UDES, Bucaramanga, Colombia
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Prolonged mechanical ventilation in patients with severe COVID-19 is associated with serial modified-lung ultrasound scores: A single-centre cohort study. PLoS One 2022; 17:e0271391. [PMID: 35830460 PMCID: PMC9278739 DOI: 10.1371/journal.pone.0271391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Lung ultrasound (LUS), a rapid, bedside, goal-oriented diagnostic test, can be quantitatively assessed, and the scores can be used to evaluate disease progression. However, little data exists on predicting prolonged mechanical ventilation (PMV) and successful extubation using serial LUS scores. We examined the relationship of PMV with successful extubation in patients with severe coronavirus disease (COVID-19) by using two types of serial LUS scores. One LUS score evaluated both the pleura and lung fields, while the other assessed each separately (modified-LUS score). Both LUS scores were determined for 20 consecutive patients with severe COVID-19 at three timepoints: admission (day-1), after 48 h (day-3), and on the seventh follow-up day (day-7). We compared LUS scores with the radiographic assessment of the lung oedema (RALE) scores and laboratory test results, at the three timepoints. The PMV and successful extubation groups showed no significant differences in mortality, but significant differences occurred on day-3 and day-7 both LUS scores, day-7 RALE score, and day-7 PaO2/FiO2 ratio, in the PMV group (p<0.05); and day-3 and day-7 modified-LUS scores, day-7 C-reactive protein levels, and day-7 PaO2/FiO2 ratio, in the successful extubation group (p<0.05). The area under the curves (AUC) of LUS scores on day-3 and day-7, modified-LUS scores on day-3 and day-7,RALE score on day-7, and PaO2/FiO2 ratio on day-7 in the PMV group were 0.98, 0.85, 0.88, 0.98, 0.77, and 0.80, respectively. The AUC of modified-LUS scores on day-3 and day-7, C-reactive protein levels on day-7, and PaO2/FiO2 ratio on day-7 in the successful extubation group were 0.79, 0.90, 0.82, and 0.79, respectively. The modified-LUS score on day 7 was significantly higher than that on day 1 in PMV group (p<0.05). While the LUS score did not exhibit significant differences. The serial modified-LUS score of patients with severe COVID-19 could predict PMV.
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Schauer SG, April MD, Fisher AD, Bynum J, Hill R, Gillespie KR, Chung KK, Borgman MA. An analysis of early volume resuscitation and the association with prolonged mechanical ventilation. Transfusion 2022; 62 Suppl 1:S114-S121. [PMID: 35732473 DOI: 10.1111/trf.16975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have found that intravenous fluid administration within the first 24 h may be associated with prolonged mechanical ventilation (PMV). We examined the association between initial 24 h fluids and PMV in combat casualties. METHODS This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR). We included casualties with at least 24 h on the ventilator and no significant traumatic brain injury. The definition of PMV and associations were constructed using univariable and multivariable logistic regression models. RESULTS We identified 1508 casualties available for analysis for this study - 1275 in the non-PMV cohort (<9 days on ventilator vs. 233 in the PMV cohort (≥9 days on ventilator). Explosives comprised the most common mechanism of injury for both groups (72% vs. 75%) followed by firearms (21% vs. 16%). The composite injury severity score (ISS) was lower in the non-PMV cohort (18 vs. 30, p < .001). There were lower volumes of all resuscitation fluid within the first 24 h in the non-PMV cohort. When adjusting for composite ISS and mechanism of injury in a multivariable logistic regression model with PMV as the outcome, crystalloid volume (unit odds ratio [UOR] 1.07) and colloid volume (UOR 1.03) were both associated with PMV. CONCLUSIONS We found that volume of resuscitation fluids were substantially higher in the PMV cohort. Our findings suggest the need for caution with the routine use of crystalloid and colloid in the first 24 h of resuscitation.
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Affiliation(s)
- Steven G Schauer
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA.,Department of Pediatrics, USUHS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Pediatrics, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Michael D April
- Department of Pediatrics, USUHS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,40th Forward Resuscitation and Surgical Detachment, Fort Carson, Colorado, USA
| | - Andrew D Fisher
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.,Texas Army National Guard, Austin, Texas, USA
| | - James Bynum
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Ronnie Hill
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Kevin R Gillespie
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Kevin K Chung
- Department of Pediatrics, USUHS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Matthew A Borgman
- Department of Pediatrics, USUHS, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Pediatrics, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
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21
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Randhawa MS, Iyer R, Bansal A, Mukund B, Angurana SK, Nallasamy K, Jayashree M, Singhi SC, Singhi P, Baranwal AK, Sankhyan N. Clinical Features Associated With Need for Mechanical Ventilation in Children With Guillain-Barré Syndrome: Retrospective Cohort From India. Pediatr Crit Care Med 2022; 23:378-382. [PMID: 35220343 DOI: 10.1097/pcc.0000000000002930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS). DESIGN Retrospective cohort study, 2010-2019. SETTING PICU. PATIENTS All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU. INTERVENTION Retrospective chart and data review. MEASUREMENTS AND MAIN RESULTS Out of 189 children identified with a diagnosis of GBS, 130 were boys (69%). The median (interquartile range [IQR]) age was 6 years (3-9 yr). At admission, the Hughes disability score was 5 (4-5), and cranial nerve palsies were present in 81 children (42%). Autonomic instability subsequently occurred in a total of 97 children (51%). In the 159 children with nerve conduction studies, the axonal variant of GBS (102/159; 64%) predominated, followed by the demyelinating variant (38/189; 24%). All children received IV immunoglobulins as first-line therapy at the time of admission. The median (IQR) length of PICU stay was 12 days (3-30.5 d). Ninety-nine children (52%) underwent invasive MV, and median duration of MV was 25 days (19-37 d). At admission, upper limb power less than or equal to 3 (p = 0.037; odds ratio (OR), 3.5 [1.1-11.5]), lower limb power less than or equal to 2 (p = 0.008; OR, 3.5 [1.4-8.9]), and cranial nerve palsy (p = 0.001; OR, 3.2 [1.6-6.1]) were associated with subsequent need for MV. Prolonged (> 21 d) MV was associated with more severe examination findings at admission: upper limb power less than or equal to 2 (p < 0.0001; OR, 4.2 [2.5-6.9]) and lower limb power less than or equal to 1 (p < 0.0001; OR, 4.5 [2.6-7.9]). CONCLUSIONS In children with GBS, referred to our center in North India, severe neuromuscular weakness at admission was associated with the need for MV. Furthermore, greater severity of this examination was associated with need for prolonged (> 21 d) MV. Identification of these signs may help in prioritizing critical care needs and early PICU transfer.
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Affiliation(s)
- Manjinder Singh Randhawa
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajalakshmi Iyer
- Pediatric Intensive Care Unit, Birmingham Children's Hospital and Charity, Birmingham, United Kingdom
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bal Mukund
- Pediatrics and Intensive Care, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit C Singhi
- Department of Pediatrics, Medanta Medicity, Gurugram, India
| | | | - Arun Kumar Baranwal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med 2022; 11:jcm11092451. [PMID: 35566577 PMCID: PMC9103623 DOI: 10.3390/jcm11092451] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.
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23
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Xie Q, Li C, Zhong Y, Luo C, Guo R, Liu Y, Zheng J, Ge Y, Sun L, Zhu J. Blood Transfusion Predicts Prolonged Mechanical Ventilation in Acute Stanford Type A Aortic Dissection Undergoing Total Aortic Arch Replacement. Front Cardiovasc Med 2022; 9:832396. [PMID: 35498041 PMCID: PMC9053570 DOI: 10.3389/fcvm.2022.832396] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR).MethodsThe clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h).ResultsThe mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4–574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio (ORPMV≥24) = 1.045, p = 0.005; ORPMV≥48 = 1.060, p = 0.002; ORPMV≥72 = 1.051, p = 0.011]. pRBC transfusion (ORPMV≥24 = 1.156, p = 0.001; ORPMV≥48 = 1.156, p < 0.001; ORPMV≥72 = 1.135, p ≤ 0.001) and PC transfusion (ORPMV≥24 = 1.366, p = 0.029; ORPMV≥48 = 1.226, p = 0.030; ORPMV≥72 = 1.229, p = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [ORPMV≥48 = 0.999, 95% confidence interval (CI) 0.998–1.000, p = 0.039; ORPMV≥72 = 0.999, 95% CI: 0.998–1.000, p = 0.025].ConclusionsIn patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.
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Melamed R, Paz F, Jepsen S, Smith C, Saavedra R, Mulder M, Masood A, Huelster J, Kirkland L, Guenther A, Boland L. Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study. Ther Adv Respir Dis 2022; 16:17534666221086415. [PMID: 35311403 PMCID: PMC8935584 DOI: 10.1177/17534666221086415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients. Methods: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as > 17 days of MV. Results: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO2/FiO2 ratio, higher PCO2, and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO2/FiO2 ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance. Conclusion: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO2/FiO2 ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.
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Affiliation(s)
- Roman Melamed
- Abbott Northwestern Hospital, Minneapolis, MN 55407-3799, USA
| | | | - Stacy Jepsen
- Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | - Adnan Masood
- Abbott Northwestern Hospital, Minneapolis, MN, USA
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25
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Chang HY, Hsiao HC, Chang HL. Impact of Inspiratory Muscle Training on Weaning Parameters in Prolonged Ventilator-Dependent Patients: A Preliminary Study. SAGE Open Nurs 2022; 8:23779608221111717. [PMID: 35837244 PMCID: PMC9274399 DOI: 10.1177/23779608221111717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Patients require prolonged mechanical ventilation to overcome respiratory
failure in the chronic respiratory care ward; however, how to facilitate
ventilator weaning using a nurse-led strategy is limited. Objectives This study aimed to examine the impact of adjusting ventilator trigger
sensitivity as inspiratory muscle training on weaning parameters in patients
with prolonged ventilator dependence. Methods Multiple pre-test–post-test with a non-equivalent control group design was
conducted at a chronic respiratory care ward in southern Taiwan. A
convenience sampling method was used to recruit patients who received
prolonged mechanical ventilation for more than 21 days into control
(n = 20) and intervention groups
(n = 22). Adjustment of ventilator trigger sensitivity
started from 10% of the initial maximum inspiratory pressure and increased
to 40% after a training period of six weeks. The weaning parameters were
collected for pre-test and multiple post-tests, and statistical analysis of
treatment effects was performed using the generalized estimating
equation. Results Magnitude of weaning parameters was significantly higher in the intervention
group after the six-week training, including maximum inspiratory pressure,
rapid shallow breathing index, tidal volume, and ratio of
arterial-to-inspired oxygen. Conclusion Adjustment of ventilator trigger sensitivity as inspiratory muscle training
can help prolonged ventilator-dependent patients improve their respiratory
muscle strength, breathing patterns, and oxygenation.
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Affiliation(s)
- Hsiao-Yun Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan
| | - Hsiang-Chun Hsiao
- Department of Nursing, Jhong-Jheng Spine & Orthopedics Hospital, Kaohsiung
| | - Hwai-Luh Chang
- Department of Medicine, Tao-Yuan General Hospital, Taoyuan
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26
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Na SJ, Ko RE, Nam J, Ko MG, Jeon K. Factors associated with prolonged weaning from mechanical ventilation in medical patients. Ther Adv Respir Dis 2022; 16:17534666221117005. [PMID: 35943272 PMCID: PMC9373110 DOI: 10.1177/17534666221117005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients who need prolonged mechanical ventilation (MV) have high resource utilization and relatively poor outcomes. The pathophysiologic mechanisms leading to weaning failure in this group may be complex and multifactorial. The aim of this study was to investigate the factors associated with prolonged weaning based on the Weaning Outcome according to a New Definition (WIND) classification. METHODS This is a prospective observational study with consecutive adult patients receiving MV for at least two calendar days in medical intensive care units from 1 November 2017 to 30 September 2020. Eligible patients were divided in a non-prolonged weaning group, including short and difficult weaning, and in a prolonged weaning group according to the WIND classification. The risk factors at the time of first separation attempt associated with prolonged weaning were analyzed using a multivariable logistic regression model. RESULTS Of the total 915 eligible patients, 172 (18.8%) patients were classified as prolonged weaning. A higher proportion of the prolonged weaning group had previous histories of endotracheal intubation, chronic lung disease, and hematologic malignancies. When compared with the non-prolonged weaning group, the median duration of MV before the first spontaneous breathing trial (SBT) was longer and the proportion of tracheostomized patients was higher in prolonged weaning group. In addition, the prolonged weaning group used higher peak inspiratory pressures and yielded lower PaO2/FiO2 ratios at the day of the first SBT compared with the non-prolonged weaning group. In multivariate analyses, the duration of MV before first SBT (adjusted odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.06-1.22, p < 0.001), tracheostomy state (adjusted OR = 1.95, 95% CI = 1.04-3.63, p = 0.036), PaO2/FiO2 ratio (adjusted OR = 1.00, 95% CI = 0.99-1.00, p = 0.023), and need for renal replacement therapy (adjusted OR = 2.68, 95% CI = 1.16-6.19, p = 0.021) were independently associated with prolonged weaning. After the exclusion of patients who underwent tracheostomy before the SBTs, similar results were obtained. CONCLUSION Longer duration of MV before the first SBT, tracheostomy status, poor oxygenation, and need for renal replacement therapy at the time of first SBT can predict prolonged weaning. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05134467.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jimyoung Nam
- Intensive Care Unit Nursing Department, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myeong Gyun Ko
- Intensive Care Unit Nursing Department, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Minton C, Batten L, Best A. The long-term ICU patient: Which definition? J Clin Nurs 2021; 32:2933-2940. [PMID: 34723410 DOI: 10.1111/jocn.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To offer a review of the differing terminologies used by clinicians and researchers to describe the long-term intensive care unit (ICU) patient and the underlying propositions that align with this terminology. BACKGROUND Ongoing medical and technological advances in emergency and intensive care have resulted in improved survival of critically ill patients in recent decades. In addition, these advancements have also resulted in improved survival of complex critically ill patients who progress to a trajectory of prolonged critical illness, having protracted stays in the ICU. There is great variability in terminology used to define the long-term ICU patient. This lack of a common definition for long-term ICU patients is problematic, increasing their vulnerability and risk of care not being centred about their unique needs. DESIGN In this discursive article, we explore the terminology used to define the long-term ICU patient. An initial broad search of the literature across four electronic databases was conducted to identify common terminology used to define the long-term ICU patient. From here, seven definitions were identified and chosen for inclusion in the review as they meet inclusion criteria and clearly described a group of patients who have an extended ICU stay. The seven selected terms are as follows: prolonged mechanical ventilation; failure to wean; insertion of tracheostomy; chronically critically ill; persistent critical illness; persistent inflammatory-immunosuppressive and catabolic syndrome; and frailty. Following this a focused review of the literature with the selected terms was conducted to explore in greater detail the terminology. DISCUSSION The lack of clear definition for this patient group can potentiate their care needs being unmet. Acknowledgement of the need to clearly define this patient group is the first step to improve outcomes. Nursing is well positioned to recognise the different terminologies use to describe this group of patients and implement care to suit their unique clinical characteristics. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Recognition and standardisation of these terms are an important priority to pave the way to improve care pathways and outcomes for this group of patients and their family.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- College of Health, Massey University, Palmerston North, New Zealand
| | - Amy Best
- School of Nursing, Massey University, Wellington, New Zealand
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Abstract
Supplemental Digital Content is available in the text. Cardiopulmonary bypass triggers systemic inflammation, resulting in lung injury, and frequently leads to prolonged mechanical ventilation. Biomarkers of systemic inflammation are required to predict the risk of such complications. We hypothesize that specific serum proteins can be used as biomarkers to predict the severity of lung injury following cardiac surgery.
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29
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Tracheostomy Decision-making Communication among Patients Receiving Prolonged Mechanical Ventilation. Ann Am Thorac Soc 2021; 18:848-856. [PMID: 33351720 DOI: 10.1513/annalsats.202009-1217oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Patients receiving prolonged mechanical ventilation experience high morbidity and mortality, poor quality of life, and significant caregiving and financial burden. It is unclear what is discussed with patients and families during the tracheostomy decision-making process.Objectives: The aim of this study was to identify themes of communication related to tracheostomy decision-making in patients receiving prolonged mechanical ventilation and to explore patient and clinical factors associated with more discussion of these themes.Methods: We conducted a mixed-methods study involving adult patients in medical or cardiac intensive care units who received continuous mechanical ventilation for ≥7 days and were considered for tracheostomy placement during the same admission. We performed a consensus-driven review of documented family meeting conversations to identify characteristics and themes related to tracheostomy decision-making. A multivariate analysis was performed to investigate patient and clinical factors associated with the discussion of one or more of the identified themes.Results: Of the 241 patients included, 191 (79.2%) had at least one documented conversation regarding tracheostomy decision-making, and 148 (61.4%) required further discussions before reaching a decision. We identified the following four themes related to tracheostomy decision-making: patient's previously expressed preferences, patient's baseline condition and functional status, long-term complications, and long-term prognosis. Of the documented conversations, 45.3% addressed none of the identified themes. Patients who did not undergo tracheostomy placement were more likely to have documented discussion of one or more themes compared with those who did (74.6% vs. 41.6%). In multivariate analysis, age ≥75, female sex, significant preadmission functional dependence, home oxygen requirement, and involvement of palliative care were associated with more documented discussion of one or more themes.Conclusions: Our findings suggest inadequate information exchange regarding patient preferences and long-term prognosis during tracheostomy decision-making, especially among patients who went on to pursue tracheostomy. There is a critical need to promote effective shared decision-making to better align tracheostomy intervention with patient values and to prevent unwanted health states at the end of life.
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Hernández-Socorro CR, Saavedra P, López-Fernández JC, Lübbe-Vazquez F, Ruiz-Santana S. Novel High-Quality Sonographic Methods to Diagnose Muscle Wasting in Long-Stay Critically Ill Patients: Shear Wave Elastography, Superb Microvascular Imaging and Contrast-Enhanced Ultrasound. Nutrients 2021; 13:nu13072224. [PMID: 34209526 PMCID: PMC8308272 DOI: 10.3390/nu13072224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/05/2023] Open
Abstract
Novel ultrasound (US) methods are required to assess qualitative changes in the quadriceps rectus femoris (QRF) muscle when evaluating mechanically ventilated, long-stay ICU patients with suspected neuromuscular acquired weakness (ICUAW). Our aim was to analyze novel US muscle assessment methods in these patients versus healthy controls by carrying out a prospective observational study. Shear wave elastography (SWE) showed, with a receiver operating characteristic (ROC) curve of 0.972 (95% confidence interval (CI) = 0.916–1.000), that patients increased muscle stiffness associated with muscle fibrosis when diagnosed with ICUAW. We also performed, for the first time, superb microvascular imaging (SMI), which is an innovative US technique designed for imaging microvascularization unseen with color Doppler US, and observed that 53.8% of cases had significantly lower QRF muscle microvascular angiogenic activity than controls (p < 0.001). Finally, we used contrast-enhanced ultrasound (CEUS) to analyze maximum and minimum QRF muscle perfusion and obtained a ROC curve of 0.8, but when used as markers for SMI, their diagnostic capacity increased to 0.988 (CI = 0.965–1) and 0.932 (CI = 0.858–1), respectively. These findings show, for the first time, that these novel sonographic muscle methods should be used for their diagnostic capacity when assessing sarcopenic processes associated with this group of critically ill patients.
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Affiliation(s)
- Carmen Rosa Hernández-Socorro
- Department of Radiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.:+34-928-310570
| | - Pedro Saavedra
- Department of Mathematics, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain;
| | - Juan Carlos López-Fernández
- Department of Neurology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Federico Lübbe-Vazquez
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Sergio Ruiz-Santana
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
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Schuss P, Schäfer N, Bode C, Borger V, Eichhorn L, Giordano FA, Güresir E, Heimann M, Ko YD, Landsberg J, Lehmann F, Potthoff AL, Radbruch A, Schaub C, Schwab KS, Weller J, Vatter H, Herrlinger U, Schneider M. The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases. Front Oncol 2021; 11:658949. [PMID: 33816316 PMCID: PMC8013703 DOI: 10.3389/fonc.2021.658949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Surgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases. Methods 360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed. Results 14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001). Conclusions The present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.
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Affiliation(s)
- Patrick Schuss
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Yon-Dschun Ko
- Department of Oncology and Hematology, Center of Integrated Oncology (CIO) Bonn, Johanniter Hospital Bonn, Bonn, Germany
| | - Jennifer Landsberg
- Department of Dermatology and Allergy, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Katjana S Schwab
- Department of Internal Medicine III, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, Center of Integrated Oncology (CIO) Bonn, University Hospital Bonn, Bonn, Germany
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Fauroux B, Cutrera R. Editorial: Pediatric Long-Term Non-invasive Ventilation. Front Pediatr 2021; 9:654578. [PMID: 33692978 PMCID: PMC7937638 DOI: 10.3389/fped.2021.654578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Fauroux
- Pediatric Non-invasive Ventilation and Sleep Unit, Paris University EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Necker University Hospital, Paris, France
| | - Renato Cutrera
- Respiratory Unit and Pediatric Sleep & Long Term Ventilation Unit, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy
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Mori H, Yamasaki K, Itoh T, Saishoji Y, Torisu Y, Mori T, Izumi Y. Predictors of prolonged mechanical ventilation identified at an emergency visit for elderly people: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23472. [PMID: 33285748 PMCID: PMC7717806 DOI: 10.1097/md.0000000000023472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the factors that are associated with prolonged mechanical ventilation in elderly patients.Retrospective cohort studySingle tertiary hospital in JapanWe retrospectively identified 228 patients aged 75 years or older who were admitted to a single tertiary care center in Japan between January 1, 2014 and December 31, 2017 because of endogenous diseases and underwent mechanical ventilation.The primary outcome was extubation difficulty, which was defined as the need for mechanical ventilation for more than 14 days after intubation, reintubation within 72 hours after extubation, tracheotomy or extubation, or death within 14 days after intubation.A multivariate analysis showed that age (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.66-1.38; P = .80), gender (OR = 0.56; 95%CI = 0.27-1.17; P = .13), body mass index (BMI) (OR = 1.05; 95%CI = 0.98-1.14; P = .16), smoking history (OR = 0.64; 95%CI = 0.29-1.41; P = .27), Activities of daily living (ADL) (OR = 0.95; 95%CI = 0.49-1.83; P = .87), and modified acute physiology and chronic health evaluation (APACHE) II score (OR = 1.02; 95%CI = 0.95-1.09; P = .61) were not statistically significantly different. However, there were statistically significant differences in extubation difficulty between patients with diabetes mellitus (OR = 2.3; 95%CI = 1.01-5.12; P = .04) and those with cardiovascular disease diagnosis on admission (OR = 0.31; 95%CI = 0.1-0.97; P = .04).Diabetes mellitus and cardiovascular disease diagnosis on admission were factors that were associated with prolonged mechanical ventilation in the elderly. The results of this study may help to support shared decision making with patients or surrogate decision makers at the start of intensive care in the elderly.
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Affiliation(s)
| | | | - Takehiro Itoh
- Nursing Department, National Hospital Organization, Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, Japan
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The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One 2020; 15:e0242378. [PMID: 33196655 PMCID: PMC7668609 DOI: 10.1371/journal.pone.0242378] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022] Open
Abstract
Background In clinical practice, a dichotomous approach to delirium identification may no longer be relevant when existing delirium screening tools measure a range of scores. The objective of this study was to compare the Confusion Assessment Method for the Intensive Care Unit 7-item (CAM-ICU-7) and the Intensive Care Delirium Screening Checklist (ICDSC) as measures of the spectrum of delirium severity in critically ill adult patients. Methods In this cross-sectional study, 218 patients underwent 641 paired assessments by bedside nurses (ICDSC, as per usual care) and trained research assistants (CAM-ICU-7). Correlation between the CAM-ICU-7 and ICDSC scores was evaluated. Logistic regression was used to explore associations between CAM-ICU-7 or ICDSC score and length of ICU stay and mechanical ventilation (receipt, ≥96 hours). Results Delirium prevalence evaluated by the CAM-ICU-7 and ICDSC were 46.3% (95% CI:39.7–53.0) and 34.4% (95% CI:28.3–41.0). Prevalence of less than clinical threshold symptoms of delirium evaluated by the CAM-ICU-7 (score: 1–2) and ICDSC (score: 1–3) were 30.3% (95%CI:24.5–36.7) and 50.9% (95%CI:44.3–57.6). The CAM-ICU-7 and ICDSC had significant positive correlation (0.58, p<0.001). Agreement between the tools as measures of delirium was moderate (kappa = 0.51) and as measures of less than clinical threshold symptoms of delirium was fair (kappa = 0.21). Less than clinical threshold symptoms of delirium identified by the ICDSC, not CAM-ICU-7, were associated with prolonged length of ICU stay (≥7 days) in patients <65 years of age [Odds Ratio (OR) 9.2, 95% CI:2.5–34.0] and mechanical ventilation (receipt: OR 2.8, 95% CI:1.3–6.4; ≥96 hours: OR 6.6, 95% CI:1.9–22.9), when compared to patients with no delirium. Conclusions The CAM-ICU-7 and ICDSC are measures of the spectrum of delirium severity that are closely correlated. Less than clinical threshold symptoms of delirium measure by the ICDSC is a better predictor of outcomes, when compared with the CAM-ICU-7.
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Praud JP. Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications. Front Pediatr 2020; 8:584334. [PMID: 33224908 PMCID: PMC7674588 DOI: 10.3389/fped.2020.584334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 01/15/2023] Open
Abstract
This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
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Affiliation(s)
- Jean-Paul Praud
- Division of Pediatric Pulmonology, University of Sherbrooke, Sherbrooke, QC, Canada
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Duke GJ, Moran JL, Santamaria JD, Roodenburg O. Safety of the endotracheal tube for prolonged mechanical ventilation. J Crit Care 2020; 61:144-151. [PMID: 33161243 DOI: 10.1016/j.jcrc.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE The endotracheal tube (ETT) is the most common route for invasive mechanical ventilation (MV) yet controversy attends its long-term safety. OBJECTIVE Assess the safety of ETT compared with tracheostomy tube (TT) for MV support in the intensive care unit (ICU). METHODS Retrospective analysis of five year national dataset of 128,977 adults (age > 15-years) admitted for MV therapy with tracheostomy tube (TT; n = 4772) or without (ETT; n = 124,204), excluding those with neurological diagnoses or likely to require a surgical airway (n = 27,466), in 93 public health service ICUs across Australia, between July 2013-June 2018. MEASUREMENTS Hospital survival (including liberation from MV) for ETT Group compared with TT Group using a probit regression model adjusted for confounding using fixed, endogenous and non-random treatment assignment covariates, and their interactions; analysed and plotted as marginal effects by duration of MV. RESULTS Median duration of MV was 2 (IQR =1-4) days, predominantly via ETT (124,205; 96.3%), and 21,620 (16.7%) died. Temporal trend for ETT increased (OR = 1.06 per year, 95%CI =1.03-1.10) compared to TT, even for prolonged (>3 weeks) MV (38.1%). Higher risk-adjusted mortality was associated with longer duration of MV and after 9 days of MV with retention of ETT compared with TT - average (mortality) treatment effect 12.6% (95%CI =10.7-14.5). The latter was not significant after 30 days of MV. CONCLUSIONS The safety of ETT compared with TT beyond short-term MV (≤9-days) is uncertain and requires prospective evaluation with additional data.
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Affiliation(s)
- Graeme J Duke
- Department of Intensive Care Medicine, Eastern Health, Box Hill, Australia; Monash University, Clayton, Australia.
| | - John L Moran
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, Australia
| | - John D Santamaria
- Department of Critical Care Medicine, St Vincent's Hospital (Melbourne), Fitzroy, Australia
| | - Owen Roodenburg
- Department of Intensive Care Medicine, Eastern Health, Box Hill, Australia; Monash University, Clayton, Australia
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Schwarz S, Benazzo A, Dunkler D, Muckenhuber M, Sorbo LD, Di Nardo M, Sinn K, Moser B, Matilla JR, Lang G, Taghavi S, Vamos FR, Jaksch P, Cypel M, Keshavjee S, Klepetko W, Hoetzenecker K. Ventilation parameters and early graft function in double lung transplantation. J Heart Lung Transplant 2020; 40:4-11. [PMID: 33144029 DOI: 10.1016/j.healun.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Currently, the primary graft dysfunction (PGD) score is used to measure allograft function in the early post-lung transplant period. Although PGD grades at later time points (T48 hours and T72 hours) are useful to predict mid- and long-term outcomes, their predictive value is less relevant within the first 24 hours after transplantation. This study aimed to evaluate the capability of PGD grades to predict prolonged mechanical ventilation (MV) and compare it with a model derived from ventilation parameters measured on arrival at the intensive care unit (ICU). METHODS A retrospective single-center analysis of 422 double lung transplantations (LTxs) was performed. PGD was assessed 2 hours after arrival at ICU, and grades were associated with length of MV (LMV). In addition, peak inspiratory pressure (PIP), ratio of the arterial partial pressure of oxygen to fraction of inspired oxygen (P/F ratio), and dynamic compliance (cDyn) were collected, and a logistic regression model was created. The predictive capability for prolonged MV was calculated for both (the PGD score and the model). In a second step, the created model was externally validated using a prospective, international multicenter cohort including 102 patients from the lung transplant centers of Vienna, Toronto, and Budapest. RESULTS In the retrospective cohort, a high percentage of extubated patients was reported at 24 hours (35.1%), 48 hours (68.0%), and 72 hours (80.3%) after transplantation. At T0 (time point defined as 2 hours after arrival at the ICU), patients with PGD grade 0 had a shorter LMV with a median of 26 hours (interquartile range [IQR]: 16-47 hours) than those with PGD grade 1 (median: 42 hours, IQR: 27-50 hours), PGD grade 2 (median: 37.5 hours, IQR: 15.5-78.5 hours), and PGD grade 3 (median: 46 hours, IQR: 27-86 hours). However, IQRs largely overlapped for all grades, and the value of PGD to predict prolonged MV was poor. A total of 3 ventilation parameters (PIP, cDyn, and P/F ratio), determined at T0, were chosen on the basis of clinical reasoning. A logistic regression model including these parameters predicted prolonged MV (>72 hours) with an optimism-corrected area under the curve (AUC) of 0.727. In the prospective validation cohort, the model proved to be stable and achieved an AUC of 0.679. CONCLUSIONS The prediction model reported in this study combines 3 easily obtainable variables. It can be employed immediately after LTx to quantify the risk of prolonged MV, an important early outcome parameter.
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Affiliation(s)
- Stefan Schwarz
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Alberto Benazzo
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Dunkler
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Moritz Muckenhuber
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Lorenzo Del Sorbo
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Matteo Di Nardo
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Katharina Sinn
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - José Ramon Matilla
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gyoergy Lang
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Ferenc Renyi Vamos
- Department of Thoracic Surgery, Semmelweis University-National Institute of Oncology, Budapest, Hungary
| | - Peter Jaksch
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach. PLoS One 2020; 15:e0235231. [PMID: 32639971 PMCID: PMC7343348 DOI: 10.1371/journal.pone.0235231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES We aimed to build a machine learning predictive model to predict the risk of prolonged mechanical ventilation (PMV) for patients with Traumatic Brain Injury (TBI). METHODS This study included TBI patients who were hospitalized in a level 1 trauma center between January 2014 and February 2019. Data were analyzed for all adult patients who received mechanical ventilation following TBI with abbreviated injury severity (AIS) score for the head region of ≥ 3. This study designed three sets of machine learning models: set A defined PMV to be greater than 7 days, set B (PMV > 10 days) and set C (PMV >14 days) to determine the optimal model for deployment. Patients' demographics, injury characteristics and CT findings were used as predictors. Logistic regression (LR), Artificial neural networks (ANN) Support vector machines (SVM), Random Forest (RF) and C.5 Decision Tree (C.5 DT) were used to predict the PMV. RESULTS The number of eligible patients that were included in the study were 674, 643 and 622 patients in sets A, B and C respectively. In set A, LR achieved the optimal performance with accuracy 0.75 and Area under the curve (AUC) 0.83. SVM achieved the optimal performance among other models in sets B with accuracy/AUC of 0.79/0.84 respectively. ANNs achieved the optimal performance in set C with accuracy/AUC of 0.76/0.72 respectively. Machine learning models in set B demonstrated more stable performance with higher prediction success and discrimination power. CONCLUSION This study not only provides evidence that machine learning methods outperform the traditional multivariate analytical methods, but also provides a perspective to reach a consensual definition of PMV.
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Stone M, Ing RJ, Schwartz L. Risk Stratification for Prolonged Mechanical Ventilation After Cardiac Surgery in Children. J Cardiothorac Vasc Anesth 2020; 34:949-950. [PMID: 31937480 DOI: 10.1053/j.jvca.2019.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Stone
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO; University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Richard J Ing
- University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO; Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Lawrence Schwartz
- University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO; Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
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Barnes M, Feit C, Grant TA, Brisbois EJ. Antimicrobial polymer modifications to reduce microbial bioburden on endotracheal tubes and ventilator associated pneumonia. Acta Biomater 2019; 91:220-234. [PMID: 31022549 DOI: 10.1016/j.actbio.2019.04.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/26/2022]
Abstract
Hospital associated infections (HAIs), infections acquired by patients during care in a hospital, remain a prevalent issue in the healthcare field. These infections often occur with the use of indwelling medical devices, such as endotracheal tubes (ETTs), that can result in ventilator-associated pneumonia (VAP). When examining the various routes of infection, VAP is associated with the highest incidence, rate of morbidity, and economic burden. Although ETTs are essential for the survival of patients requiring mechanical ventilation, their use comes with complications. The presence of an ETT in the airway impairs physiological host defense mechanisms for clearance of pathogens and provides a platform for oropharynx microorganism transport to the sterile tracheobronchial network. Antibiotics are administered to treat lower respiratory infections; however, they are not always effective and consequently can result in increased antibiotic resistance. Prophylactic approaches by altering the surface of ETTs to prevent the establishment and growth of bacteria have exhibited promising results. In addition, passive surface modifications that prevent bacterial establishment and growth, or active coatings that possess a bactericidal effect have also proven effective. In this review we aim to highlight the importance of preventing biofilm establishment on indwelling medical devices, focusing on ETTs. We will investigate successful antimicrobial modifications to ETTs and the future avenues that will ultimately decrease HAIs and improve patient care. STATEMENT OF SIGNIFICANCE: Infections that occur with indwelling medicals devices remain a constant concern in the medical field and can result in hospital-acquired infections. Specifically, ventilator associated pneumonia (VAP) occurs with the use of an endotracheal tube (ETT). Infections often require use of antibiotics and can result in patient mortality. Our review includes a summary of the recent collective work of antimicrobial ETT modifications and potential avenues for further investigations in an effort to reduce VAP associated with ETTs. Polymer modifications with antibacterial nature have been developed and tested; however, a focus on ETTs is lacking and clinical availability of new antimicrobial ETT devices is limited. Our collective work shows the successful and prospective applications to the surfaces of ETTs that can support researchers and physicians to create safer medical devices.
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Dvorak J, Ridder D, Martin B, Ton-That H, Baldea A, Gonzalez RP. Is Tracheostomy Insertion an Indication for Gastrostomy Insertion? Am Surg 2019. [DOI: 10.1177/000313481908500530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy versus those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy. Patients who also underwent open gastrostomy or percutaneous endoscopic gastrostomy during the same hospitalization were identified. Data collected included patient demographics, hospital LOS, ICU LOS, and timing of tracheostomy and gastrostomy. Three hundred one trauma and ACS patients who underwent tracheostomy were identified. Seventy- three per cent of tracheostomy patients underwent gastrostomy during the same admission. Of patients who had both tubes inserted, 79 per cent (175) underwent gastrostomy with tracheostomy as the concomitant procedure, whereas 21 per cent received gastrostomy as a delayed procedure. Median hospital LOS for patients who underwent concomitant procedures was 25 days versus 22 days for those who had delayed or no gastrostomy ( P = 0.24). Eighty-four per cent of patients who had tracheostomy for prolonged or anticipated prolonged mechanical ventilation were receiving tube feeds at discharge, and 78 per cent had not been advanced to an oral diet at discharge. Most trauma/ACS patients who undergo tracheostomy also undergo gastrostomy during their hospitalization. Concomitant gastrostomy is not associated with a decrease in hospital LOS; however, most patients who undergo tracheostomy for prolonged mechanical ventilation are discharged receiving enteral nutrition. These patients may benefit from concomitant ICU gastrostomy as a way to improve efficiency and cost-saving.
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Affiliation(s)
- Justin Dvorak
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - David Ridder
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Brendan Martin
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Hieu Ton-That
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Anthony Baldea
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Richard P. Gonzalez
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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Treatment Outcomes of Stenotrophomonas maltophilia Bacteremia in Critically Ill Children: A Multicenter Experience. Pediatr Crit Care Med 2019; 20:e231-e239. [PMID: 31058792 DOI: 10.1097/pcc.0000000000001919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Stenotrophomonas maltophilia is a gram-negative opportunistic bacterium that may cause a myriad of clinical diseases in immunocompromised individuals. We aimed to describe the clinical characteristics, risk factors, mortality, and treatment of S. maltophilia bacteremia in critically ill children, a topic on which data are sparse. DESIGN A multicenter observational retrospective study in which medical charts of critically ill children with S. maltophilia bacteremia were reviewed between 2012 and 2017. SETTING Data were collected from each of the four largest PICUs nationwide, allocated in tertiary medical centers to which children with complex conditions are referred regularly. PATIENTS A total of 68 suitable cases of S. maltophilia bacteremia were retrieved and reviewed. MEASUREMENTS AND MAIN RESULTS The total occurrence rate of S. maltophilia isolation had increased significantly during the study period (r = 0.65; p = 0.02). The crude mortality was 42%, and the attributed mortality was 18%. Significant risk factors for mortality were a longer length of hospital stay prior to infection (33 d in nonsurvivors vs 28 in survivors; p = 0.03), a nosocomial source of infection (p = 0.02), presentation with septic shock (p < 0.001), and treatment with chemotherapy (p = 0.007) or carbapenem antibiotics (p = 0.05) prior to culture retrieval. On multivariate analysis, septic shock (odds ratio, 14.6; 95% CI, 1.45-147.05; p = 0.023) and being treated with chemotherapy prior to infection (odds ratio, 5.2; 95% CI, 1.59-17.19; p = 0.006)] were associated with mortality. The combination of ciprofloxacin, trimethoprim-sulfamethoxazole, and minocycline resulted in the longest survival time (p < 0.01). CONCLUSIONS The significant attributed mortality associated with S. maltophilia bacteremia in critically ill children calls for an aggressive therapeutic approach. The findings of this investigation favor a combination of trimethoprim-sulfamethoxazole, ciprofloxacin, and minocycline.
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Patient and Family Centered Actionable Processes of Care and Performance Measures for Persistent and Chronic Critical Illness: A Systematic Review. Crit Care Explor 2019; 1:e0005. [PMID: 32166252 PMCID: PMC7063874 DOI: 10.1097/cce.0000000000000005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Supplemental Digital Content is available in the text. To identify actionable processes of care, quality indicators, or performance measures and their evidence base relevant to patients with persistent or chronic critical illness and their family members including themes relating to patient/family experience.
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Ambrosino N, Vitacca M. The patient needing prolonged mechanical ventilation: a narrative review. Multidiscip Respir Med 2018; 13:6. [PMID: 29507719 PMCID: PMC5831532 DOI: 10.1186/s40248-018-0118-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/07/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field. MAIN BODY There is great variability in terminology and definitions of prolonged mechanical ventilation.There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units.There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients.Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition.There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications. CONCLUSION Present medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.
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Affiliation(s)
- Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, 27040 Montescano, PV Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Unit, Istituto Scientifico di Lumezzane, Lumezzane, BS Italy
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