700

Abstract

instability or need for continuous moderate sedation or neuromuscular blockade. Data from the control period (Pre) including demographics, severity of illness, ventilator days, and LOS data was compared to Post intervention (Post) data (also 6 months). Complications were also compared. Results: A total of 69 Pre patients (age 54.8 ± 10.9 yrs) were compared to 52 Post patients (age 55.6 ± 12.2 yrs). Mean ventilator days were similar (Pre 6.3 ± 9.0 vs Post 6.0 ± 8.2 days, p=0.708); however, the median duration favored Post intervention (4.0 versus 2.0 days). Mean ICU LOS decreased by an average of 1.7 days from 12.8 ± 11.5 to 11.1 ± 9.7 and total hospital LOS decreased slightly from 20.2 ± 15.6 to 19.5 ± 12.2 although not statistically different. There was no difference in complications between Pre and Post intervention groups related to PUM. Conclusions: Our study demonstrated a trend towards decreased ventilator days as well as both ICU and hospital length of stays in cancer patients requiring mechanical ventilation through the use of an early Progressive Upright Mobility Program. Moreover, our study demonstrated this technique can be used safely in patients with advanced malignancy, a previously unstudied group.Learning Objectives: Acute pulmonary embolism (PE) is a diagnostic challenge as symptoms vary widely and are often nonspecific. Definitive diagnosis requires costly testing that involves exposure to radiation and intravenous contrast. PE increases alveolar dead space (AVDS). Exhaled carbon dioxide, capnography, may assist with the diagnosis of PE by providing estimates of AVDS. Methods: Research utilizing capnography for PE diagnosis was systematically reviewed using electronic data bases, ancestry searches and personal communication. Included studies contained capnography data and PE diagnosis confirmed by conventional radiologic methods. Data from 21 studies (n = 3417 subjects) published between 1950 and 2012 were synthesized. Three separate meta-analyses were conducted using random-effects models. Standardized mean differences (d) were calculated to compare the capnography values of end-tidal carbon dioxide (EtCO2) (k=13), AVDS fraction (AVDSf ) (k=10) and EtCO2 gradient (PaCO2 -EtCO2) (k=6) in patients with and without PE. Heterogeneity statistics were calculated using Q and I 2 . Results: Overall prevalence of PE was 22%. Mean EtCO2 was lower for patients with PE (28.4mmHg) versus without (36.0mmHg) (d = -1.229 p <.001; 95% confidence interval (CI) -1.521 to -.936). Mean AVDSf was higher for patients with PE (.276 L) versus without (.117 L) (d = 2.250 p < .001; 95% CI 1.030 to 3.469). Mean End-tidal CO2 gradient was higher in patients with PE (7.0mmHg) versus without (3.6mmHg) (d = 3.004 p = 0.010; 95% CI 0.717 to 5.290). The true variation among effects was substantial across studies (Q = 49.06, I 2 =75.54; Q =366.95, I 2 = 97.55; Q = 224.48, I 2 = 97.77 respectively). Conclusions: These meta-analyses suggest capnography assessment can detect differences between patients with and without PE by ident...