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Hays D, Milner KA, Farus-Brown S, Zonsius MC, Fineout-Overholt E. Clinical Inquiry and Problem Identification. Am J Nurs 2024; 124:38-46. [PMID: 38661700 DOI: 10.1097/01.naj.0001016372.73610.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.
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Affiliation(s)
- Deana Hays
- Deana Hays is an associate professor at Oakland University in Rochester, MI. Kerry A. Milner is a professor in the Davis and Henley College of Nursing at Sacred Heart University in Fairfield, CT. Susan Farus-Brown is an associate professor at the Ohio University School of Nursing in Athens. Mary C. Zonsius is an associate professor at the Rush University College of Nursing in Chicago. Ellen Fineout-Overholt is national senior director, Evidence-Based Practice & Implementation Science, at Ascension in St. Louis. Contact author: Kerry A. Milner, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Liu H, Liang Q, Yang Y, Liu M, Zheng B, Sun S. Impact of mechanical ventilation on clinical outcomes in ICU-admitted Alzheimer's disease patients: a retrospective cohort study. Front Public Health 2024; 12:1368508. [PMID: 38601491 PMCID: PMC11004329 DOI: 10.3389/fpubh.2024.1368508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Background Alzheimer's disease (AD) is increasingly recognized as a pressing global public health issue, demanding urgent development of scientific AD management strategies. In recent years, the proportion of AD patients in Intensive Care Units (ICU) has been on the rise. Simultaneously, the use of mechanical ventilation (MV) is becoming more prevalent among this specific patient group. Considering the pathophysiological characteristics of AD, the application of MV in AD patients may lead to different outcomes. However, due to insufficient research data, the significant impact of MV on the prognosis of AD patients in the ICU remains unclear. Therefore, we conducted this study to comprehensively evaluate the potential influence of MV on the survival rate of AD patients in the ICU. Methods We obtained data from the MIMIC-IV database for patients diagnosed with AD. Using propensity score matching (PSM), we paired patients who received MV treatment with those who did not receive treatment. Next, we conducted Cox regression analysis to evaluate the association between MV and in-hospital mortality, 7-day mortality, 28-day mortality, 90-day mortality, 4-year mortality, length of hospital stay, and ICU stay. Results The data analysis involved a cohort of 641 AD patients spanning from 2008 to 2019, inclusive. Following a 1:2 propensity score matching (PSM) procedure, 300 patients were successfully paired, comprising 123 individuals who underwent MV treatment and 177 who did not. MV demonstrated an association with an elevated risk of in-hospital mortality (HR 5.782; 95% CI 2.981-11.216; p < 0.001), 7-day mortality (HR 6.353; 95% CI 3.014-13.392; p < 0.001), 28-day mortality (HR 3.210; 95% CI 1.977-5.210; p < 0.001), 90-day mortality (HR 2.334; 95% CI 1.537-3.544; p < 0.001), and 4-year mortality (HR 1.861; 95% CI 1.370-2.527; p < 0.001). Furthermore, it was associated with a prolonged length of ICU stay [3.6(2.2,5.8) vs. 2.2(1.6,3.7); p = 0.001]. In the subgroup analysis, we further confirmed the robustness of the results obtained from the overall population. Additionally, we observed a significant interaction (p-interaction <0.05) between age, admission type, aspirin use, statin use, and the use of MV. Conclusion In patients with AD who are receiving treatment in the ICU, the use of MV has been linked to higher short-term, medium-term, and long-term mortality rates, as well as prolong ICU stays. Therefore, it is crucial to break away from conventional thinking and meticulously consider both the medical condition and personal preferences of these vulnerable patients. Personalized treatment decisions, comprehensive communication between healthcare providers and patients, formulation of comprehensive treatment plans, and a focus on collaboration between the ICU and community organizations become imperative.
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Affiliation(s)
- Han Liu
- Institute for Global Health, University College London, London, United Kingdom
| | - Qun Liang
- First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Yang
- First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Min Liu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Boyang Zheng
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shilin Sun
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Heilongjiang University of Chinese Medicine, Harbin, China
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Pandian V, Cherukuri SPS, Koneru M, Karne V, Tajrishi FZ, Aloori S, Kota P, Dinglas V, Colantuoni E, Akst L, Hillel AT, Needham DM, Brodsky MB. Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) in the Intensive Care Unit: Protocol of a Prospective Cohort Study. ORL Head Neck Nurs 2024; 42:8-21. [PMID: 38264200 PMCID: PMC10805360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Aims The Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) study systematically evaluates patient symptoms related to endotracheal intubation with mechanical ventilation, assesses laryngeal injury and voice function after extubation, and develops a screening tool to identify patients with clinically important, post-extubation laryngeal injury. Design Single-center, prospective observational cohort study conducted in 6 intensive care units (ICU). Methods Patients ≥18 years old who are orally intubated and mechanically ventilated in an ICU and meet eligibility criteria will undergo flexible laryngoscopy, with a sample size goal of 300 completed laryngoscopies. Primary outcome measures include signs and symptoms of laryngeal injury, including voice symptoms and alterations in swallowing, measured using the Laryngeal Hypersensitivity Questionnaire-Acute and Voice Symptom Scale questionnaires respectively. Data will be collected within 72 hours post-extubation and at 7-day follow-up or hospital discharge (whichever occurs first). Data will be analyzed using descriptive statistics, regression models, and predictive modeling using machine learning. Discussion The findings of this study will describe the clinical signs and symptoms of laryngeal injury post-extubation. Conclusion The PALSS study will provide insights for future studies that explore laryngeal injuries using flexible laryngoscopy after endotracheal intubation. Implications for patient care Identifying signs and symptoms of laryngeal injury after endotracheal intubation will facilitate the development of a screening tool that will assist in early identification of post-extubation laryngeal injury, and aid in decreasing short- and long-term complications of endotracheal intubation. Reporting Method SPIRIT. Patient or Public Contribution Patients were study participants; and family members provided informed consent when the patient lacked decision-making capacity.
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Affiliation(s)
- Vinciya Pandian
- School of Nursing, Johns Hopkins University
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | | | | | - Vidyadhari Karne
- Department of Pathology and Laboratory Medicine, University of Southern California
| | | | - Swetha Aloori
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | - Pooja Kota
- Neurocardiology research program of excellence, University of California, Los Angeles
| | - Victor Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | | | - Lee Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
| | - Dale M Needham
- School of Nursing, Johns Hopkins University
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University
| | - Martin B Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
- Speech-Language Pathology, Head and Neck Institute, Cleveland Clinic
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
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Zhang J, Feng J, Jia J, Wang X, Zhou J, Liu L. Research progress on the pathogenesis and treatment of ventilator-induced diaphragm dysfunction. Heliyon 2023; 9:e22317. [PMID: 38053869 PMCID: PMC10694316 DOI: 10.1016/j.heliyon.2023.e22317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023] Open
Abstract
Prolonged controlled mechanical ventilation (CMV) can cause diaphragm fiber atrophy and inspiratory muscle weakness, resulting in diaphragmatic contractile dysfunction, called ventilator-induced diaphragm dysfunction (VIDD). VIDD is associated with higher rates of in-hospital deaths, nosocomial pneumonia, difficulty weaning from ventilators, and increased costs. Currently, appropriate clinical strategies to prevent and treat VIDD are unavailable, necessitating the importance of exploring the mechanisms of VIDD and suitable treatment options to reduce the healthcare burden. Numerous animal studies have demonstrated that ventilator-induced diaphragm dysfunction is associated with oxidative stress, increased protein hydrolysis, disuse atrophy, and calcium ion disorders. Therefore, this article summarizes the molecular pathogenesis and treatment of ventilator-induced diaphragm dysfunction in recent years so that it can be better served clinically and is essential to reduce the duration of mechanical ventilation use, intensive care unit (ICU) length of stay, and the medical burden.
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Affiliation(s)
- Jumei Zhang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Jianguo Feng
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Jing Jia
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Xiaobin Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Jun Zhou
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Li Liu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan Province, 646000, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Giraldi T, Cecilio Fernandes D, Matos-Souza JR, Santos TM. A Hemodynamic Echocardiographic Evaluation Predicts Prolonged Mechanical Ventilation in Septic Patients: A Pilot Study. Ultrasound Med Biol 2023; 49:626-634. [PMID: 36456376 DOI: 10.1016/j.ultrasmedbio.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/04/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
Prolonged mechanical ventilation (PMV) is common among critically ill septic patients and leads to serious adverse effects. Transthoracic echocardiography (TTE) is an efficient tool for the assessment of septic shock. Our study investigated the relationship between TTE parameters and PMV in mechanically ventilated septic shock patients. TTE was performed in the first 24 h of intensive care unit admission, acquiring data on cardiac output (CO), cardiac index (CI), s' wave (s'), E wave (E), e' wave (e') and E/e' ratio. We compared data on patients who met the criteria for PMV with data on patients who did not. Sixty-four patients were included, 26 of whom met the criteria for PMV. CO, CI and s' were higher in patients who required PMV (5.49 vs. 4.20, p = 0.02; 2.95 vs. 2.34, p = 0.04; and 12.56 vs. 9.81, p = 0.01, respectively). CI correlated with s' (r = 0.37, p < 0.01). The areas under the receiver operating characteristic curves for CO, CI and s' in assessing the need for PMV were, respectively, 0.7 (fair results), 0.69 and 0.68 (poor results). Despite a lack of a prognostic model, the observed differences suggest that hemodynamic TTE could provide information on the risk of PMV in septic shock.
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Affiliation(s)
- Tiago Giraldi
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
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Sahraei Z, Panahi P, Solhjoukhah K, Mesbah M, Afaghi S, Amirdosara M, Salamzadeh J, Esmaeili Tarki F, Alavi Darazam I. The Efficacy of High-Dose Pulse Therapy vs. Low-Dose Intravenous Methylprednisolone on Severe to Critical COVID-19 Clinical Outcomes: A Randomized Clinical Trial. Iran J Pharm Res 2023; 22:e137838. [PMID: 38116548 PMCID: PMC10728836 DOI: 10.5812/ijpr-137838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 12/21/2023]
Abstract
Background It remains unclear which formulation of the corticosteroid regimen has the optimum efficacies on COVID-19 pneumonia. Objectives The aim of this study was to compare the clinical outcomes of 2 different regimens in the treatment of acute respiratory distress syndrome (ARDS) caused by COVID-19: Methylprednisolone at a dose of 1 mg/kg every 12 hours (low-dose group) and 1000 mg/day pulse therapy for 3 days following 1 mg/kg methylprednisolone every 12 hours (high-dose group). Methods In this randomized clinical trial, patients with mild to moderate ARDS due to COVID-19 were randomly assigned to receive either low-dose (n = 47) or high-dose (n = 48) intravenous methylprednisolone regimens. Two groups were matched for age, gender, body mass index (BMI), comorbidities, leukocytes, lymphocytes, neutrophil/lymphocyte, platelet, hemoglobin, and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and ferritin). Both regimens were initiated upon admission and continued for 10 days. The clinical outcome and secondary complications were evaluated. Results Evaluating in-hospital outcomes, no difference was revealed in the duration of intensive care unit (ICU) stays (5.4 ± 4.6 vs. 4.5 ± 4.9; P = 0.35), total hospital stays (8 ± 3.1 vs. 6.9 ± 3.4; P = 0.1), requirement rate for invasive ventilation (29.2% vs. 36.2%; P = 0.4) or non-invasive ventilation (16.6% vs 23.4%; P = 0.4), and hemoperfusion (16.6% vs 11.3%; P = 0.3) between the low- and high-dose groups. There was no significant difference in fatality due to ARDS (29.2% vs. 38.3%; P = 0.3) and septic shock (4.2% vs. 6.4%; P = 0.3) between the low- and high-dose groups. Patients in the high-dose group had significantly higher bacterial pneumonia co-infection events compared with those in the low-dose group (18.7% vs 10.6%; P = 0.01). Conclusions The use of adjuvant pulse therapy with intravenous methylprednisolone did not result in improved in-hospital clinical outcomes among patients with mild to moderate ARDS due to COVID-19. A higher risk of bacterial pneumonia should be considered in such cases as receiving a higher dose of steroids.
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Affiliation(s)
- Zahra Sahraei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnaz Panahi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kouroush Solhjoukhah
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mesbah
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,Iran
| | - Mahdi Amirdosara
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Esmaeili Tarki
- Research Institute of Internal Medicine, Shahid Modarres Hospital, Shahid Behehsti University of Medical Sciences,Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cullum KG, Madani CA, Cutler ER, Reavis KJ. The Lived Experience of Respiratory Therapists During Withdrawal of Advanced Life-Sustaining Therapies at End of Life in the ICU. Respir Care 2022; 67:1568-1577. [PMID: 35944967 PMCID: PMC9994019 DOI: 10.4187/respcare.09249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The act of withdrawing advanced life-sustaining therapies, more specifically mechanical ventilation, is performed in hospitals all over the world. Success involves coordination of several members of the patient care team, including nurses, providers (physicians nurse practitioners, or physician assistants), and respiratory therapists (RTs). The experiences of RTs surrounding this procedure are not well documented. The aim of this study was to explore the lived experience of RTs who have participated in withdrawal of advanced life-sustaining therapies, utilizing a hermeneutical phenomenological approach. METHODS Individual interviews were conducted with experienced RTs that were audio recorded and transcribed. The data were analyzed by 4 health professionals, and data were triangulated. RESULTS Three themes emerged from the study: (1) impact of power relations surrounding the process, (2) needing tools to provide quality withdrawal of advanced life-sustaining therapies, and (3) emotional involvement/exposure. It was clear from the analysis that RTs desire more education, to be part of the decision-making, and to be appreciated for their role in this emotional process. CONCLUSIONS Through this study, the role of RT in withdrawal of advanced life-sustaining therapies is better understood, which can only lead to improvement in the overall process for health care team, patient, and families.
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Affiliation(s)
| | | | - Eloisa R Cutler
- University of California, San Diego Medical Center, San Diego, California
| | - Karen J Reavis
- San Diego State University, School of Nursing, San Diego, California
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Dsouza M, Nagar VS, Radhakrishnan R, Pai KS, Ireddy VK. Modified Nutrition Risk in Critically Ill Score, A Prognostic Marker of Morbidity and Mortality in Mechanically Ventilated Patients: A Prospective Observational Study. J Assoc Physicians India 2022; 70:11-12. [PMID: 37355945 DOI: 10.5005/japi-11001-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Critically ill (CI) patients, especially those requiring mechanical ventilation (MV) are at a higher risk of malnutrition, which in turn is associated with increased hospitalization and excess mortality. The modified Nutrition Risk in Critically Ill (mNUTRIC) score, a predictor of mortality, has not been validated adequately in CI Indian patients. Thus, this study evaluated the mNUTRIC score as a prognostic marker of morbidity and mortality in CI patients requiring MV. MATERIALS AND METHODS This prospective observational study was performed, between January 2018 and June 2019, in the intensive critical care unit (ICCU) of the medicine department of a tertiary care hospital. A total of 250 patients aged above 12 years, admitted in ICCU, and requiring MV for >48 hours were included. Based on the data collected, mNUTRIC score was calculated and patients were classified as at low (0-4) and high (5-9) nutritional risk. Mortality was the outcome variable. RESULTS More than a quarter of patients had a high mNUTRIC score (28.4%) and the overall mortality was 35.6%. A significantly greater proportion of non-survivors had a high mNUTRIC score (p-value<0.0001). Likewise, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and mNUTRIC score (all p-values<0.0001) were significantly higher among the non-survivors than the survivors. On receiver operator characteristic (ROC) curve analysis, a cutoff value of >2 predicted mortality [area under the curve (AUC): 0.83; 95% confidence interval: 0.778-0.874] with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 80.9, 76.4, 65.5, and 87.9%, respectively. CONCLUSION At a cutoff of >2, mNUTRIC score had high sensitivity and specificity in the prediction of mortality.
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Affiliation(s)
| | | | | | | | - Vinay Kumar Ireddy
- Senior Resident, Department of Medicine, Grant Govt. Medical College & Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kim HS, Kim GS, Lee H, Choi J, Kim YS, Oh EG. Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test. Home Health Care Management & Practice 2022. [DOI: 10.1177/10848223221096344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients on home ventilators rely on mechanical ventilation until their death; hence, family caregivers should perform additional caregiving, including tracheostomy, equipment management, and positive pressure ventilation by ambu-bag in emergencies. Therefore, a systematic discharge education program and evaluation of actual caregiver performance are necessary for safe home management. The program consists of suction and tracheostomy management, home ventilator management, emergency management, fundamental caregiving, and video material. To test clinical validity, family caregivers of patients about to be discharged to their homes from S hospital in Seoul, Korea, were selected by convenience sampling with a non-equivalent control group design. Of 18 participants, one refused, one died, and two became unstable after their agreement; therefore, 14 participants were finally included. To compare caregiving performance scores between the groups, we ran repeated measures ANOVA. Intergroup and period interaction of suction ( F = 6.08, p = .001) and tracheostomy management ( F = 3.00, p = .038) crucial for airway management, showed significant statistical differences. In short, the intervention group showed a faster increase in suction and tracheostomy management than the control group. Home ventilator management ( F = 22.53, p < .001), emergency management ( F = 12.01, p < .001), and fundamental caregiving ( F = 7.88, p < .001) showed significant differences within the group regarding the period. According to the results of the clinical validity test, the discharge education program increased the family caregiver’s suction and tracheostomy management performance scores. Further research is needed to demonstrate long-term effects of the program with a larger sample.
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Affiliation(s)
- Hyang Sook Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - JiYeon Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young Sam Kim
- Department of Internal Medicine. Yonsei University Medical College Seoul, Republic of Korea
| | - Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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13
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Huang HY, Huang CY, Li LF. Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med 2022; 11:2451. [PMID: 35566577 DOI: 10.3390/jcm11092451] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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14
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Craven J, Slaughter A, Potter KF. Early tracheostomy: on the cutting edge, some benefit more than others. Curr Opin Anaesthesiol 2022; 35:236-241. [PMID: 35131970 DOI: 10.1097/aco.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neurological and SARS-CoV-2 (COVID-19) patients seem to have an exaggerated benefit from early tracheostomy. RECENT FINDINGS Recent studies of patients undergoing early tracheostomy have shown decreases in ventilator associated pneumonia, ventilator duration and duration of ICU stay. However, these studies have shown mixed data with respect to mortality and length of hospitalization. Such advantages only become apparent with large-scale examination. Confounding the overall discussion is that the research has focused on heterogeneous groups, including neurosurgical ICU patients, general ICU patients, and most recently, intubated COVID-19 patients. SUMMARY Specific populations such as neurosurgical and COVID-19 patients have clearly defined benefits following early tracheostomy. Although the benefit is less pronounced, there does seem to be an advantage in general ICU patients with regards to ventilator-free days and lower incidence of ventilator-associated pneumonia. In these patients, large-scale examination points to a clear mortality benefit.
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Affiliation(s)
- Jack Craven
- Virginia Commonwealth University Health System, Department of Anesthesiology
| | - Ashley Slaughter
- Virginia Commonwealth University Health System, Department of Surgery, Richmond, Virginia, USA
| | - Kenneth F Potter
- Virginia Commonwealth University Health System, Department of Anesthesiology - Division of Critical Care Medicine
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15
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Rose L, Dvorani E, Homenauth E, Istanboulian L, Fraser I. Mortality, Health Care Use, and Costs of Weaning Center Survivors and Matched Prolonged ICU Stay Controls. Respir Care 2022; 67:291-300. [PMID: 35078929 PMCID: PMC9993494 DOI: 10.4187/respcare.09438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Quantification of long-term survival, health care utilization, and costs of prolonged ventilator dependence informs patient/family decision-making, health care policy, and understanding of specialized weaning centers (SWCs) as alternate care models. Our objective was to compare survival trajectory, health care utilization, and costs of SWC survivors with a matched cohort of ≥ 21-d-stay ICU patients. METHODS This was a retrospective longitudinal (12 y) case-control study linking to health administrative databases with matching on age, sex, Charlson comorbidity index, income quintiles, and days in ICU and hospital in preceding 12 months. RESULTS We matched 201 SWC subjects to 201 prolonged ICU survivors (402-subject cohort); 42% had a Charlson score of > 4. Risk of death at 12 months was lower in SWC subjects (hazard ratio [HR] 0.70 [95% CI 0.54-0.91]) adjusting for length of hospital admission (HR 1.02 [95% CI 1.00-1.04]) and number of care location transfers (HR 0.84 [95% CI 0.75-0.93]). By follow-up end, more SWC subjects died, 149 (73%) versus 127 (62%). We found no difference in discharge to home. At 12 months, acute health care utilization was comparable for the entire cohort, except hospital readmission rates (median interquartile range [IQR] 2 [1-3) vs 1 [1-2] d). Median (IQR) cost 12 months after unit discharge was CAD $68,165 ($19,894-$153,475). 12-month costs were higher in the SWC survivors (CAD $82,874 [$29,942-$224,965] vs CAD $55,574 [$6,572-$128,962], P < .001). SWC survivors had higher community health care utilization. Regression modeling demonstrated cost was associated with stay and care transfers but not SWC admission. Over 12-y follow-up, health care utilization and costs were higher in SWC survivors. CONCLUSIONS SWC admission may confer some medium-term survival advantage; however, this may be influenced by selection bias associated with admission criteria.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom; Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Hospital Trust, London, United Kingdom; and Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Canada.
| | - Erind Dvorani
- Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Esha Homenauth
- Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Laura Istanboulian
- Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Canada; and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Ian Fraser
- Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Canada; and Faculty of Medicine, University of Toronto, Toronto, Canada
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16
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Namestnic Y, Shwieke H, Heyman SN, Marcus EL. Severe Protracted Hypophosphatemia in a Patient with Persistent Vegetative State on Long-Term Assisted Respiratory Support. Am J Case Rep 2022; 23:e934532. [PMID: 35217632 PMCID: PMC8889794 DOI: 10.12659/ajcr.934532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Phosphorous is an essential component of cell structure and physiology, and is required for energy conservation and expenditure. Severe hypophosphatemia can lead to profound dysfunction and injury affecting most organs and can be life-threatening. It can also compromise weaning of mechanically ventilated patients. Long-term assisted ventilatory care in ambulatory or inpatient settings is an expanding medical service for patients with various forms of persistent or progressive incapacitating diseases. Hypophosphatemia, caused by respiratory alkalosis, has been reported in critical-care settings, but its occurrence in medically stable patients requiring long-term respiratory support has not been thoroughly investigated. CASE REPORT We report the case of a ventilated patient in a chronic vegetative state displaying progressive hypophosphatemia spanning over 3 months, with plasma levels gradually declining to 0.8 mg/dL. Evaluation did not reveal conditions leading to diminished phosphate absorption or enhanced urinary phosphate excretion, but it identified respiratory alkalosis related to a recent increase in target minute-volume ventilation in the adaptive support ventilation (ASV) mode as the cause of hypophosphatemia. Despite the very low plasma phosphate level, the patient was asymptomatic, probably because this type of hypophosphatemia may not represent physiologically significant intracellular phosphate depletion. The respiratory alkalosis resolved upon decreasing the target minute-volume ventilation settings, and serum phosphate was normalized. CONCLUSIONS Since blood gases are not routinely monitored in respiratory and hemodynamically stable patients on long-term respiratory support, hypophosphatemia may herald the development of significant respiratory alkalosis. Assessment of acid-base balance is thus warranted in patients receiving long-term ventilation, especially in those developing hypophosphatemia.
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Affiliation(s)
- Yulia Namestnic
- Long-Term Respiratory Care Division, Herzog Medical Center; Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Hamza Shwieke
- Long-Term Respiratory Care Division, Herzog Medical Center; Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Samuel N. Heyman
- Long-Term Respiratory Care Division, Herzog Medical Center; Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
- Department of Medicine, Hadassah-Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Esther-Lee Marcus
- Long-Term Respiratory Care Division, Herzog Medical Center; Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
- Corresponding Author: Esther-Lee Marcus, e-mail:
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021; 25:1026-1030. [PMID: 34963721 PMCID: PMC8664038 DOI: 10.5005/jp-journals-10071-23960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Incorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases thepatient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI)method can reduce patients’ respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods. Patients and methods The study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients’ respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressuresupport was then adjusted in the patients according to the RSBI (in the trial group, n = 33)and VT and RR (in the control group, n = 23). The patients’ respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment. Results The results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272). Conclusion These two methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods. How to cite this article Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(9):1026–1030. Key message VT, RR, and RSBI methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods.
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Affiliation(s)
- Pooneh Barati
- Critical Care Nursing, Nursingand Midwifery Care Research Center, Faculty of Nursing and Midwifery, IsfahanUniversity of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmood Saghaei
- Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran. Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim WY, Baek MS. Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge. J Pers Med 2021; 11:jpm11121257. [PMID: 34945729 PMCID: PMC8706308 DOI: 10.3390/jpm11121257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Data regarding the long-term outcomes for tracheostomized patients receiving home mechanical ventilation (HMV) are limited. We aimed to determine the 1-year mortality rate for critically ill tracheostomized patients with and without HMV. Data of tracheostomized patients between 1 January 2015 and 31 December 2019 were analyzed. A Kaplan-Meier analysis was performed to assess the survival curve of the patients. Among the 124 tracheostomized patients, 102 (82.3%) were weaned from mechanical ventilation (MV), and 22 (17.7%) required HMV at discharge. The overall 1-year mortality rate was 47.6%, and HMV group had a significantly higher 1-year mortality rate than those weaned from MV (41.2% vs. 77.3%, p = 0.002). In the Cox proportional hazards regression, BMI (HR 0.913 [95% CI 0.850-0.980], p = 0.012), Sequential Organ Failure Assessment (SOFA) score (HR 1.114 [95% CI 1.040-1.193], p = 0.002), transfer to a nursing facility (HR 5.055 [95% CI 1.558-16.400], p = 0.007), and HMV at discharge (HR 1.930 [95% CI 1.082-3.444], p = 0.026) were significantly associated with 1-year mortality. Critically ill tracheostomized patients with HMV at discharge had a significantly higher 1-year mortality rate than those weaned from MV. Low BMI, high SOFA score, transfer to a nursing facility, and HMV at discharge were significantly associated with 1-year mortality.
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Ambrosino N, Pierucci P. Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure. Life (Basel) 2021; 11:1113. [PMID: 34832989 DOI: 10.3390/life11111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Advances in management have improved mortality of individuals with chronic respiratory failure (CRF), leading to an increase in need for long-term oxygen therapy and/or ventilatory support. These individuals require frequent visits and monitoring of their physiological parameters as well as of the functioning of their devices, such as ventilators or oxygen concentrators. Telemedicine is a clinical application of Information Communication Technology connecting patients to specialised care consultants. This narrative review aims to explore the current available telemonitoring options for individuals with CRF and reported or potential results. Methods: The research focused on EMBASE, CINALH, PubMed, and Scopus databases. Papers published between 2003 and 2021 in English were considered. Results: Different sensors, transmission devices and systems, and interventions are used with promising but not conclusive clinical results. However, legal problems are still unsolved, and economic advantages for health care systems, although potentially high, are still under debate. Conclusions: Telemonitoring systems for individuals with CRF are increasingly used; with promising results still to be clarified, legal, economical and organisational issues must be defined.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rose L, Sutt AL, Amaral AC, Fergusson DA, Smith OM, Dale CM. Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support. Cochrane Database Syst Rev 2021; 10:CD013379. [PMID: 34637143 PMCID: PMC8507432 DOI: 10.1002/14651858.cd013379.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and patient safety. Options for aided communication include non-vocal, speech-generating, and voice-enabling aids. OBJECTIVES To assess effectiveness of communication aids for people requiring an artificial airway (endotracheal or tracheostomy tube), defined as the proportion of people able to: use a non-vocal communication aid to communicate at least one symptom, need, or preference; or use a voice-enabling communication aid to phonate to produce at least one intelligible word. To assess time to communication/phonation; perceptions of communication; communication quality/success; quality of life; psychological distress; length of stay and costs; and adverse events. SEARCH METHODS We searched the Cochrane Library (Wiley version), MEDLINE (OvidSP), Embase (OvidSP), three other databases, and grey literature from inception to 30 July 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs, controlled non-randomised parallel group, and before-after studies evaluating communication aids used in adults with an artificial airway. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Two review authors independently performed data extraction and assessment of risk of bias. MAIN RESULTS We included 11 studies (1931 participants) conducted in intensive care units (ICUs). Eight evaluated non-vocal communication aids and three voice-enabling aids. Usual care was the comparator for all. For six studies, this comprised no aid; usual care in the remaining five studies comprised use of various communication aids. Overall, our confidence in results regarding effectiveness of communication interventions was very low due to imprecision, measurement heterogeneity, inconsistency in results, and most studies at high or unclear risk of bias across multiple domains. No non-vocal aid studies reported our primary outcome. We are uncertain of the effects of early use of a voice-enabling aid compared to routine use on ability to phonate at least one intelligible word (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.18 to 50.08; 2 studies; very low-certainty evidence). Compared to usual care without aids, we are uncertain about effects of a non-vocal aid (communication board) on patient satisfaction (standardised mean difference (SMD) 2.92, 95% CI 1.52 to 4.33; 4 studies; very low-certainty evidence). No studies of non-vocal aids reported quality of life. Low-certainty evidence from two studies suggests early use of a voice-enabling aid may have no effect on quality of life (MD 2.27, 95% CI -7.21 to 11.75). Conceptual differences in measures of psychological distress precluded data pooling; however, intervention arm participants reported less distress suggesting there might be benefit, but our certainty in the evidence is very low. Low-certainty evidence suggest voice-enabling aids have little or no effect on ICU length of stay; we were unable to determine effects of non-vocal aids. Three studies reported different adverse events (physical restraint use, bleeding following tracheostomy, and respiratory parameters indicating respiratory decompensation). Adverse event rates were similar between arms in all three studies. However, uncertainty remains as to any harm associated with communication aids. AUTHORS' CONCLUSIONS Due to a lack of high-quality studies, imprecision, inconsistency of results, and measurement heterogeneity, the evidence provides insufficient information to guide practice as to which communication aid is more appropriate and when to use them. Understanding effectiveness of communication aids would benefit from development of a core outcome measurement set.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Orla M Smith
- Critical Care, St Michael's Hospital, Toronto, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Balasubramanian S, Tran DH, Serra M, Parker EA, Diaz-Abad M, Deepak J, McCurdy MT, Verceles AC. Assessing calorie and protein recommendations for survivors of critical illness weaning from prolonged mechanical ventilation - can we find a proper balance? Clin Nutr ESPEN 2021; 45:449-53. [PMID: 34620353 DOI: 10.1016/j.clnesp.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/07/2022]
Abstract
Background & aims: Survivors of critical illness requiring prolonged mechanical ventilation (PMV) are predisposed to malnutrition, muscle wasting, and weakness. There is a lack of data regarding nutrition adequacy among these patients, and although nitrogen balance has been studied as a marker of adequate protein intake in healthy individuals and acutely critically ill patients, it has not been well studied in critically ill patients with PMV. The purpose of this study was to determine if patients requiring PMV admitted to a long-term acute care hospital (LTACH) achieved registered dietitian (RD) recommended goals for energy and protein intake and if the recommendations were adequate to avoid negative nitrogen balance. Methods: Using a retrospective, cohort study design, patients requiring PMV who had orders for 24-h urine collections for urea nitrogen (24hrUUN) were included. Energy and protein intake was calculated from chart documentation of dietary intake for the 24-h period during which patients underwent a 24hrUUN. Nitrogen intake was estimated from protein intake. Dietary intake was compared to RD-recommendations to determine the percentage of RD-recommendations achieved. Nitrogen balance was calculated as nitrogen intake minus nitrogen loss, with negative balance categorized as less than −1. Results: Subjects (n = 16) were 38% male and 75% African American (mean age 61.5 ± 3.2 years; mean BMI 27.5 ± 2.5 kg/m2). Duration of LTACH hospitalization was 26.5 (6–221) days. Mean energy and protein intake was 21.7 ± 2.9 kcal/kg/d and 1.1 ± 0.1 g/kg/d, respectively, which corresponded to 86% of both RD energy and protein recommendations. Ten patients achieved a positive nitrogen balance (mean 0.9 ± 1.1 g). In addition, there was a positive linear relationship between protein intake and nitrogen balance (r = 0.59, p = 0.016). Conclusion: Survivors of critical illness requiring PMV achieved a high percentage of RD-recommended protein and calories, and prevented a negative nitrogen balance in a majority of patients. Increasing protein intake can prevent a negative nitrogen balance. Future studies should evaluate whether these patients are able to maintain a steady state of nitrogen intake and excretion over time and how this affects time to and/or success of weaning.
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Xu L, El-Jawahri AR, Rubin EB. Tracheostomy Decision-making Communication among Patients Receiving Prolonged Mechanical Ventilation. Ann Am Thorac Soc 2021; 18:848-56. [PMID: 33351720 DOI: 10.1513/AnnalsATS.202009-1217OC] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Kim HS, Lee CE, Yang YS. Factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy: A cross-sectional study. PLoS One 2021; 16:e0254987. [PMID: 34288975 PMCID: PMC8294500 DOI: 10.1371/journal.pone.0254987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background The number of patients on home mechanical ventilation (HMV) worldwide has been steadily rising as medical technological advanced. To ensure the safety and quality care of the patients receiving HMV with tracheostomy, caring behavior of family caregivers is critical. However, studies on caring behavior of family caregivers and its associated factors were remained unexplored. This study aimed to describe the caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy and to identify factors associated with their caring behaviors. Methods This was a cross-sectional study for 95 family caregivers for patients with invasive home mechanical ventilation in South Korea. Caring behaviors were assessed by the Caring Behavior Scale with 74 items with 5-point Likert scale. Data were analyzed using multiple regression analysis. Results Caring behaviors score of caregivers was 304.68±31.05 out of 370. They were significantly associated with knowledge on emergency care (β = 0.22, p = .011), number of required instruments for care (β = 0.21, p = .010), frequency of home visit care (β = 0.19, p = .017), experience of emergency situation for the last six months (β = 0.19, p = .009) and activities of daily living of patient (β = 0.27, p = .002). Conclusion Development of standardized multidisciplinary discharge education for improving the caring capacity of caregivers is required for successful and healthy application of home mechanical ventilation.
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Affiliation(s)
- Hyang Sook Kim
- College of Nursing Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- Severance Hospital, Seoul, Republic of Korea
| | - Chung Eun Lee
- College of Nursing Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- Severance Hospital, Seoul, Republic of Korea
| | - Yong Sook Yang
- College of Nursing Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- * E-mail:
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Núñez SA, Roveda G, Zárate MS, Emmerich M, Verón MT. Ventilator-associated pneumonia in patients on prolonged mechanical ventilation: description, risk factors for mortality, and performance of the SOFA score. ACTA ACUST UNITED AC 2021; 47:e20200569. [PMID: 34190861 PMCID: PMC8332725 DOI: 10.36416/1806-3756/e20200569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/22/2021] [Indexed: 12/30/2022]
Abstract
Objective: Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation (MV). However, data on VAP in patients on prolonged MV (PMV) are scarce. We aimed to describe the characteristics of VAP patients on PMV and to identify factors associated with mortality. Methods: This was a retrospective cohort study including VAP patients on PMV. We recorded baseline characteristics, as well as 30-day and 90-day mortality rates. Variables associated with mortality were determined by Kaplan-Meier survival analysis and Cox regression model. Results: We identified 80 episodes of VAP in 62 subjects on PMV. The medians for age, Charlson Comorbidity Index, SOFA score, and days on MV were, respectively, 69.5 years, 5, 4, and 56 days. Episodes of VAP occurred between days 21 and 50 of MV in 28 patients (45.2%) and, by day 90 of MV, in 48 patients (77.4%). The 30-day and 90-day mortality rates were 30.0% and 63.7%, respectively. There were associations of 30-day mortality with the SOFA score (hazard ratio [HR] = 1.30; 95% CI: 1.12-1.52; p < 0.001) and use of vasoactive agents (HR = 4.0; 95% CI: 1.2-12.9; p = 0.02), whereas 90-day mortality was associated with age (HR = 1.03; 95% CI: 1.00-1.05; p = 0.003), SOFA score (HR = 1.20; 95% CI: 1.07-1.34; p = 0.001), use of vasoactive agents (HR = 4.07; 95% CI: 1.93-8.55; p < 0.001), and COPD (HR = 3.35; 95% CI: 1.71-6.60; p < 0.001). Conclusions: Mortality rates in VAP patients on PMV are considerably high. The onset of VAP can occur various days after MV initiation. The SOFA score is useful for predicting fatal outcomes. The factors associated with mortality could help guide therapeutic decisions and determine prognosis.
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Affiliation(s)
| | | | | | - Mónica Emmerich
- . Unidad de Paciente Critico Crónico, Sanatorio Güemes, Buenos Aires, Argentina
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Keng LT, Liang SK, Tseng CP, Wen YF, Tsou PH, Chang CH, Chang LY, Yu KL, Lee MR, Ko JC. Functional Status After Pulmonary Rehabilitation as a Predictor of Weaning Success and Survival in Patients Requiring Prolonged Mechanical Ventilation. Front Med (Lausanne) 2021; 8:675103. [PMID: 34150808 PMCID: PMC8206270 DOI: 10.3389/fmed.2021.675103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Comprehensive rehabilitation programs are recommended for patients with prolonged mechanical ventilation (PMV) to facilitate functional recovery and ventilator weaning, but whether the functional status after rehabilitation influences outcome has not been clearly evaluated. This study aimed to investigate the association between post-rehabilitation functional status and weaning and survival outcome in PMV patients. Methods: We retrospectively enrolled PMV patients admitted to the respiratory care center (RCC), a post-ICU weaning facility with protocolized rehabilitation program, from January 2016 through December 2017. Functional status was measured by the de Morton Mobility Index (DEMMI), with a cut-off value set at 20 points. The primary outcomes were the weaning status at RCC discharge and hospital survival. The secondary outcomes were overall survival and survival at 3 months after RCC discharge. We followed patients until 3 months after RCC discharge or death. Logistic and Cox regressions were performed to identify significant parameters associated with weaning success and survival. Results: In total, 320 patients were enrolled. The weaning success rate was 71.6%. The survival rate at RCC discharge, hospital discharge, and 3 months after RCC discharge was 89.1, 77.5, and 66.6%, respectively. Post-rehabilitation DEMMI ≥ 20 (odds ratio [OR], 3.514; 95% confidence interval [CI], 1.436-8.598; P = 0.006) was the most significantly associated with weaning success. The weaning success and higher post-rehabilitation DEMMI were the two most significant independent factors associated with both hospital survival (weaning success, OR, 12.272; 95% CI, 5.281-28.517; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 6.298; 95% CI, 1.302-30.477; P = 0.022) and survival at 3 months after RCC discharge (weaning success, OR, 38.788; 95% CI, 11.505-130.762; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 4.830; 95% CI, 1.072-21.756; P = 0.040). Post-rehabilitation DEMMI ≥ 20 remained significantly association with overall survival at 3 months after RCC discharge (hazard ratio, 0.237; 95% CI, 0.072-0.785; P = 0.018). Conclusions: Post-rehabilitation functional status of PMV patients was independently associated with weaning success, as well as hospital and 3-month overall survival after RCC discharge. Post-rehabilitation, but not pre-rehabilitation, functional status was a significant parameter associated with weaning success and survival in patients requiring PMV.
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Affiliation(s)
- Li-Ta Keng
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Sheng-Kai Liang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chi-Ping Tseng
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yueh-Feng Wen
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ping-Hsien Tsou
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Hao Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Lih-Yu Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
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Ossai CI, Wickramasinghe N. Intelligent decision support with machine learning for efficient management of mechanical ventilation in the intensive care unit - A critical overview. Int J Med Inform 2021; 150:104469. [PMID: 33906020 DOI: 10.1016/j.ijmedinf.2021.104469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Effective management of Mechanical Ventilation (MV) is vital for reducing morbidity, mortality, and cost of healthcare. OBJECTIVE This study aims to synthesize evidence for effective MV management through Intelligent decision support (IDS) with Machine Learning (ML). METHOD Databases that include EBSCO, IEEEXplore, Google Scholar, SCOPUS, and the Web of Science were systematically searched to identify studies on IDS for effective MV management regarding Tidal Volume (TV), asynchrony, weaning, and other outcomes such as the risk of Prolonged Mechanical ventilation (PMV). The quality of the articles identified was assessed with a modified Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sessional research. RESULTS A total of 26 articles were identified for the study that has IDS for TV (n = 2, 7.8 %), asynchrony (n = 9, 34.6 %), weaning (n = 12, 46.2 %), and others (n = 3, 11.5 %). It was affirmed that implementing IDS in MV management will enhance seamless ICU patient management following the utilization of various Machine Learning (ML) algorithms in decision support. The studies relied on (n = 14) ML algorithms to predict the TV, asynchrony, weaning, risk of PMV and Positive End-Expiratory Pressure (PEEP) changes of 11-20262 ICU patients records with model inputs ranging from (n = 1) for timeseries analysis of TV to (n = 47) for weaning prediction. CONCLUSIONS The small data size, poor study design, and result reporting, with the heterogeneity of techniques used in the various studies, hampered the development of a unified approach for managing MV efficiency in TV monitoring, asynchrony, and weaning predictions. Notwithstanding, the ensemble model was able to predict TV, asynchrony, and weaning to a higher accuracy than the other algorithms.
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Affiliation(s)
- Chinedu I Ossai
- Faculty of Health, Arts and Design, School of Health Sciences, Department of Health and Medical Sciences, Swinburne University, John street Hawthorn, Victoria, 3122, Australia.
| | - Nilmini Wickramasinghe
- Faculty of Health, Arts and Design, School of Health Sciences, Department of Health and Medical Sciences, Swinburne University, John street Hawthorn, Victoria, 3122, Australia; Epworth Healthcare Australia, Australia.
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Cederwall CJ, Naredi S, Olausson S, Rose L, Ringdal M. Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs. Respir Care 2021; 66:300-306. [PMID: 32843507 PMCID: PMC9994213 DOI: 10.4187/respcare.08117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of patients requiring prolonged mechanical ventilation (PMV) is predicted to escalate due to an aging population. International studies on prevalence and resource utilization of this patient group exist, but data are lacking from Scandinavian ICUs, where there is a relatively low number of ICU beds in relation to population. The primary aim was to identify prevalence of admissions requiring mechanical ventilation ≥ 7-21 d and PMV > 21 d, and their use of ICU bed days in Sweden. Secondary aims were to describe patient characteristics and outcomes. METHODS We obtained data from the Swedish Intensive Care Registry on admissions age ≥ 18 y mechanically ventilated ≥ 7 d and used open source registry data to calculate the prevalence and use of bed days of admissions ventilated ≥ 7-21 d and PMV > 21 d. RESULTS Of the 39,510 ICU admissions to Swedish ICUs in 2017, those mechanically ventilated ≥ 7-21 d accounted for 1,643 (4%) admissions, and those with PMV > 21 d accounted for 307 (0.8%) admissions. Of the 109,457 ICU bed days, 22% were consumed by admissions ventilated ≥ 7-21 d and 10% by those with PMV > 21 d. The ICU mortality of both groups was 21%. Admissions with mechanical ventilation ≥ 7 d had a median age of 65 y and were predominantly male (64%). CONCLUSIONS Admissions to Swedish ICUs who required mechanical ventilation ≥ 7-21 d and PMV > 21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.
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Affiliation(s)
- Carl-Johan Cederwall
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Central Intensive Care Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Lane Fox Respiratory Unit, St Thomas' Hospital, London, United Kingdom
| | - Mona Ringdal
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Critical Care, Kungälvs Hospital, Kungälv, Sweden
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Barach P, Fisher SD, Adams MJ, Burstein GR, Brophy PD, Kuo DZ, Lipshultz SE. Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? Prog Pediatr Cardiol 2020; 59:101254. [PMID: 32837144 PMCID: PMC7274978 DOI: 10.1016/j.ppedcard.2020.101254] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America
- Jefferson College of Population Health, Philadelphia, PA, United States of America
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
| | - Stacy D Fisher
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - M Jacob Adams
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Gale R Burstein
- Erie County Department of Health, Buffalo, NY, United States of America
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Patrick D Brophy
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
- Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, United States of America
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
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Minton C, Batten L. Nurses' experiences of caring for patients during a prolonged critical illness. Nurs Crit Care 2020; 26:485-492. [PMID: 33161643 DOI: 10.1111/nicc.12571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The literature regarding nurses' experiences of caring for chronically critically ill (CCI) patients is scant, however, there are subtleties within the literature, identifying nurses are often challenged providing care to this patient group. This can lead to feeling frustrated, lack of control, and distress. AIMS AND OBJECTIVES As part of a larger study, this paper reports nurses' experiences of caring for patients during a prolonged critical illness in the intensive care unit (ICU). DESIGN A longitudinal, qualitative, instrumental, multi-case study consisting of six cases from four New Zealand ICUs was conducted. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. The principles of consolidated criteria for reporting qualitative research were applied in reporting the methods and findings. METHODS Patients, family members, nurses, and other health care professionals constituted the participant groups in the larger body of work. Data were collected from observations, conversations, interviews, and document review. Data were analysed by identifying themes, developing vignettes, and trajectory mapping. RESULTS Nurses' experiences of caring for CCI patients in the ICU can be framed by a prolonged critical illness trajectory that is unpredictable, problematic, and prolonged. Nurses experienced distress in one of the phases in the trajectory because of uncertainty about a positive outcome for the patient related to multiple complications, with anxiety, delirium, and the suffering they witnessed. Nurses were frustrated and challenged to meet all the patient's needs because of the many tasks they needed to complete over the shift. CONCLUSION Understanding the trajectory of a prolonged critical illness from the perspective of nurses, allows for challenges to be identified and is the first step in improving practice through the education of nurses. RELEVANCE TO CLINICAL PRACTICE Understanding the challenges posed by caring for CCI patients will assist in improving their interactions and prioritizing their care for nurses.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
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Jansson M, Rubio J, Gavaldà R, Rello J. Artificial Intelligence for clinical decision support in Critical Care, required and accelerated by COVID-19. Anaesth Crit Care Pain Med 2020; 39:691-3. [PMID: 33099016 DOI: 10.1016/j.accpm.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/10/2023]
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Pincherle A, Jöhr J, Pancini L, Leocani L, Dalla Vecchia L, Ryvlin P, Schiff ND, Diserens K. Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19? Front Neurol 2020; 11:880. [PMID: 32982916 PMCID: PMC7477378 DOI: 10.3389/fneur.2020.00880] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.
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Affiliation(s)
- Alessandro Pincherle
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland.,Neurology Unit, Department of Medicine, Hopitaux Robert Schuman-Luxembourg, Luxembourg, Luxembourg.,Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Jane Jöhr
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
| | - Lisa Pancini
- Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Letizia Leocani
- Department of Neuro-Rehabilitation, Hospital San Raffaele, University Vita Salute, Milan, Italy
| | - Laura Dalla Vecchia
- Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Philippe Ryvlin
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Karin Diserens
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
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Lehmann Y, Stark S, Ewers M. Providing care to long-term mechanically ventilated patients in Germany – Current situation and needs for action from the perspective of health professionals / Die Versorgung langzeitbeatmeter Patienten in Deutschland – Aktuelle Situation und Handlungsbedarfe aus der Sicht von Gesundheitsberufsangehörigen. International Journal of Health Professions 2020; 7:53-65. [DOI: 10.2478/ijhp-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
The number of patients depending on long-term invasive mechanical ventilation (IMV) has been increasing for several years. Anecdotal reports indicate heterogeneous health structures, opaque patient pathways, nontransparent and sometimes questionable practices in individual areas of care, inadequate quality standards and control mechanisms in Germany. However, there is hardly any empirical data on this topic.
Aim
To report findings from a qualitative study conducted as part of a complex research project to assess the appropriateness of care provided to IMV patients in Germany.
Methods
Thirteen semi-structured expert interviews were conducted with 22 health professionals providing care for IMV patients. The data analysis was conducted with MAXQDA according to the framework by Meuser and Nagel.
Results
Interviewees emphasized similar healthcare deficits. They considered health providers to be nontransparent and influenced by secondary interests. Quality of care is reported to be jeopardized by shortage of trained staff. Warranty of self-determination and participatory decision-making is not a matter of fact. Clarifying issues of sustaining life, quality of life and shaping the end of life is often ignored. The professionals are familiar with the patient pathways, allocation processes and responsibilities described in existing guidelines, but criticize the fact that they are not sufficiently binding. Accordingly, patient pathways are frequently individual results of experience-based, informal networking, and often left to chance.
Conclusions
The results point to a considerable need for action to reach an appropriate, integrated, patient-centered level of care for long-term IMV patients and ensure its quality.
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Vitacca M, Carone M, Clini EM, Paneroni M, Lazzeri M, Lanza A, Privitera E, Pasqua F, Gigliotti F, Castellana G, Banfi P, Guffanti E, Santus P, Ambrosino N. Joint Statement on the Role of Respiratory Rehabilitation in the COVID-19 Crisis: The Italian Position Paper. Respiration 2020; 99:493-499. [PMID: 32428909 PMCID: PMC7316664 DOI: 10.1159/000508399] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/02/2020] [Indexed: 12/22/2022] Open
Abstract
Due to the exponential growth of the number of subjects affected by coronavirus disease 2019 (COVID-19), the entire Italian health care system had to respond promptly and in a very short time with the need of semi-intensive and intensive care units. Moreover, trained dedicated COVID-19 teams consisting of physicians were coming from different specialties (intensivists or pneumologists and infectiologists), while respiratory therapists and nurses have been recruited to work on and on without rest. However, due to still limited and evolving knowledge of COVID-19, there are few recommendations concerning the need in respiratory rehabilitation and physiotherapy interventions. The presentation of this paper is the result of a consensus promoted by the Italian societies of respiratory health care professionals who contacted pulmonologists directly involved in the treatment and rehabilitation of COVID-19. The aim was to formulate the more proper and common suggestions to be applied in different hospital settings in offering rehabilitative programs and physiotherapy workforce planning for COVID-19 patients. Two main areas of intervention were identified: organization and treatment, which are described in this paper to face the emergency.
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Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy,
| | - Mauro Carone
- Respiratory Rehabilitation of the Institute of Bari, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy
| | - Enrico Maria Clini
- Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy
| | - Mara Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Marta Lazzeri
- Department of Cardiothoracic and Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lanza
- Sleep Medicine Center, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emilia Privitera
- Health Professions Department Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Franco Pasqua
- Pulmonary Rehabilitation, Istituto Clinico RiabilitativoVilla delle Querce, Nemi, Rome, Italy
| | - Francesco Gigliotti
- Pulmonary Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi Hospital, Florence, Italy
| | - Giorgio Castellana
- Respiratory Rehabilitation of the Institute of Bari, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy
| | - Paolo Banfi
- Pulmonary Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi Hospital, Milan, Italy
| | - Enrico Guffanti
- Rehabilitative Pneumology, Former INRCA IRCCS, Casatenovo, Lecco, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences L. Sacco, Ospedale Universitario L. Sacco - ASST Fatebenefratelli Sacco, Università degli Studi di Milano, Milan, Italy
| | - Nicolino Ambrosino
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Dale CM, Carbone S, Istanboulian L, Fraser I, Cameron JI, Herridge MS, Rose L. Support needs and health-related quality of life of family caregivers of patients requiring prolonged mechanical ventilation and admission to a specialised weaning centre: A qualitative longitudinal interview study. Intensive Crit Care Nurs 2020; 58:102808. [PMID: 32115334 DOI: 10.1016/j.iccn.2020.102808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/02/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Family caregivers of patients requiring prolonged mechanical ventilation may experience physical and psychological morbidity associated with a protracted intensive care unit experience. Our aim was to explore potentially modifiable support needs and care processes of importance to family caregivers of patients requiring prolonged mechanical ventilation and transition from the intensive care unit to a specialised weaning centre. RESEARCH METHODOLOGY/DESIGN A longitudinal qualitative descriptive interview study. Data was analysed using directed content analysis. SETTING A 6-bed specialised weaning centre in Toronto, Canada. FINDINGS Eighteen family caregivers completed interviews at weaning centre admission (100%), and at two-weeks (40%) and three-months after discharge (22%) contributing 29 interviews. Caregivers were primarily women (61%) and spouses (50%). Caregivers perceived inadequate informational, emotional, training, and appraisal support by health care providers limiting understanding of prolonged ventilation, participation in care and decision-making, and readiness for weaning centre transition. Participants reported long-term physical and psychological health changes including alterations to sleep, energy, nutrition and body weight. CONCLUSIONS Deficits in informational, emotional, training, and appraisal support of family caregivers of prolonged mechanical ventilation patients may increase caregiver burden and contribute to poor health outcomes. Strategies for providing support and maintaining family caregiver health-related quality of life are needed.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Sarah Carbone
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | | | - Ian Fraser
- Division of Respirology, Department of Medicine, Michael Garron Hospital & University of Toronto, Toronto, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, University of Toronto, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Toronto General Hospital Research Institute, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Division of Respirology, Department of Medicine, Michael Garron Hospital & University of Toronto, Toronto, Canada; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, United Kingdom
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Esquinas AM, Karim HMR, Mina B. In response to Na et al.'s long-term mortality of patients discharged from the hospital after successful critical care: do we need more comprehensive data? Korean J Anesthesiol 2019; 73:171-172. [PMID: 31556258 PMCID: PMC7113164 DOI: 10.4097/kja.19366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Habib Md Reazaul Karim
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Bushra Mina
- Department of Pulmonary and Critical Care Medicine, Hofstra Northwell School of Medicine, Lenox Hill Hospital, New York, NY, USA
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Ceriana P, Nava S, Vitacca M, Carlucci A, Paneroni M, Schreiber A, Pisani L, Ambrosino N. Noninvasive ventilation during weaning from prolonged mechanical ventilation. Pulmonology 2019; 25:328-33. [PMID: 31519534 DOI: 10.1016/j.pulmoe.2019.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Non invasive ventilation (NIV) is currently employed for weaning from invasive ventilation (IMV) in the acute setting but its use for weaning from prolonged ventilation is still occasional and not standardized. We wanted to evaluate whether a combined protocol of NIV and decannulation in tracheostomized patients needing prolonged mechanical ventilation was feasible and what would be the one-year outcome. METHODS We studied patients still dependent from invasive mechanical ventilation with the following inclusion criteria: a) tolerance of at least 8h of unsupported breathing, b) progressive hypercapnia/acidosis after invasive ventilation discontinuation, c) good adaptation to NIV, d) favorable criteria for decannulation. These patients were switched from IMV to NIV and decannulated; then they were discharged on home NIV and followed-up for one year in order to evaluate survival and complications rate. RESULTS Data from patients consecutively admitted to a weaning unit were prospectively collected between 2005 and 2018. Out of 587 patients admitted over that period, 341 were liberated from prolonged mechanical ventilation. Fifty-one out of 147 unweaned patients (35%) were eligible for the protocol but only 46 were enrolled. After a mean length of stay of 35 days they were decannulated and discharged on domiciliary NIV. After one year, 38 patients were still alive (survival rate 82%) and 37 were using NIV with good adherence (only one patient was switched again to invasive ventilation). CONCLUSIONS NIV applied to patients with failed weaning from prolonged IMV is feasible and can facilitate the decannulation process. Patients successfully completing this process show good survival rates and few complications.
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Minton C, Batten L, Huntington A. Long-term patients in an ICU: How a new patient group emerges. Contemp Nurse 2019; 56:401-404. [PMID: 31462159 DOI: 10.1080/10376178.2019.1661787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- College of Health, Massey University, Palmerston North, New Zealand
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Rose L, Sutt AL, Amaral AC, Fergusson DA, Hart N, Smith OM, Dale CM. Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support. Hippokratia 2019. [DOI: 10.1002/14651858.cd013379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute; Department of Critical Care Medicine; Toronto Canada
- Kings College London; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; London UK
| | - Anna-Liisa Sutt
- The Prince Charles Hospital; Critical Care Research Group; Brisbane Australia
- The University of Queensland; School of Clinical Medicine; Brisbane Australia
| | | | - Dean A Fergusson
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Nicholas Hart
- National Institute of Health Research, Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust and King's College London; Respiratory & Critical Care Medicine; Lane Fox Respiratory Unit St Thomas's Hospital, Westminster Bridge Road London UK SE1 7EH
| | - Orla M Smith
- St Michael's Hospital; Critical Care; 30 Bond Street Toronto Canada
| | - Craig M Dale
- University of Toronto; Lawrence S. Bloomberg Faculty of Nursing; 155 College Street Toronto Canada
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Aksoy E, Ocaklı B. Long-Term Survival of Patients with Tracheostomy Having Different Diseases Followed up in the Respiratory Intensive Care Unit Outpatient Clinic: Which Patients are Lucky? Turk Thorac J 2019; 20:182-187. [PMID: 30986173 DOI: 10.5152/turkthoracj.2018.18120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Tracheostomy is a method of separating a patient from the mechanical ventilator in the intensive care unit (ICU). The long-term survivors among patients followed up with tracheostomy and ventilator in the respiratory ICU (RICU) outpatient clinic due to different diseases were investigated. MATERIALS AND METHODS This was a retrospectively designed cohort study between January 2004 and July 2018. Patients with chronic respiratory failure followed up with tracheostomy and/or ventilator at the RICU outpatient clinic were included in the study. Age, gender, indications and date of tracheostomy, use of domestic mechanical ventilation, and mortality were recorded. The groups were compared according to age, gender, and tracheostomy indication diseases, and the 1-3-year long-term mortality rates were analyzed by the Kaplan-Meier survival analysis, and the Cox regression test was performed. RESULTS A total of 134 (64% male) patients with a median age of 66 (54-73) years were included in the study. The indications for tracheostomy were heart failure (HF) and cerebrovascular diseases (38.1%), chronic obstructive pulmonary disease (COPD) (23.1%), neuromuscular diseases (22.4%), obesity hypoventilation (9.7%), and kyphoscoliosis (6.7%). Mortality was higher in patients >75 years old in the 3-year follow-up (p=0.022). The 3-year mortality hazard ratio (HR) factors and 95% confidence interval (CI) were as follows: age >75 years HR=1.71 (95% CI, 1.03-2.82; p<0.036) and HF and cerebrovascular disease diseases sequela HR=1.84 (95% CI, 1.03-3.29; p<0.041) significantly increased the 3-year mortality, and having COPD decreased mortality in 46% (p<0.041). CONCLUSION Patients with neuromuscular disorders, kyphoscoliosis, and COPD who have undergone tracheostomy were the luckiest group according to the 3-year survival rates, whereas patients with HF and cerebrovascular diseases were the unluckiest ones. The most important decision triangle is the patient's acceptance (A), family support (B), and tracheostomy indication (C), and this may vary from country to country depending on the beliefs of subjects.
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Affiliation(s)
- Emine Aksoy
- Clinic of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Birsen Ocaklı
- Clinic of Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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Sánchez-Maciá M, Miralles-Sancho J, Castaño-Picó MJ, Pérez-Carbonell A, Maciá-Soler L. Reduction of ventilatory time using the multidisciplinary disconnection protocol. Pilot study. Rev Lat Am Enfermagem 2019; 27:e3215. [PMID: 31826158 PMCID: PMC6896797 DOI: 10.1590/1518-8345.2923.3215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 08/04/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: compare ventilatory time between patients with the application of a disconnection protocol, managed in a coordinated way between doctor and nurse, with patients managed exclusively by the doctor. Method: experimental pilot study before and after. Twenty-five patients requiring invasive mechanical ventilation for 24 hours or more were included, and the protocol-guided group was compared with the protocol-free group managed according to usual practice. Results: by means of the multidisciplinary protocol, the time of invasive mechanical ventilation was reduced (141.94 ± 114.50 vs 113.18 ± 55.14; overall decrease of almost 29 hours), the time spent on weaning (24 hours vs 7.40 hours) and the numbers of reintubation (13% vs 0%) in comparison with the group in which the nurse did not participate. The time to weaning was shorter in the retrospective cohort (2 days vs. 5 days), as was the hospital stay (7 days vs. 9 days). Conclusion: the use of a multidisciplinary protocol reduces the duration of weaning, the total time of invasive mechanical ventilation and reintubations. The more active role of the nurse is a fundamental tool to obtain better results.
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Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration 2018; 97:3-11. [PMID: 30380534 DOI: 10.1159/000493691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients' symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. OBJECTIVE This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. METHODS We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords "chronic respiratory failure AND exercise," "non invasive ventilation AND exercise," "pulmonary rehabilitation" and "exercise training." RESULTS Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. CONCLUSION We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Pulmonary Rehabilitation, Institute of Lumezzane (BS), Lumezzane,
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Institute of Montescano (PV), Montescano, Italy
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