Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation&lt;SUBTITLE&gt;A 28-Day International Study&lt;/SUBTITLE&gt;

Esteban, Andrés; Anzueto, Antonio; Frutos, Fernando de; Alía, Inmaculada; Brochard, Laurent; Stewart, Thomas E.; Benito, S.; Epstein, Scott K.; Apezteguía, Carlos; Nightingale, Peter; Arroliga, Alejandro C.; Tobin, Martin J.

doi:10.1001/jama.287.3.345

Cited by 1,537 publications

(1,131 citation statements)

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“…The mean age of sepsis patients in our study was 66.77 ± 0.14 years, similar to that reported in a prior study [8]. Men accounted for more than half of patients receiving mechanical ventilation, as reported previously [9]. …”

Section: Discussionsupporting

confidence: 89%

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Dhital

Basnet

Poudel

2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Sepsis is a significant cause of mechanical ventilation in hospitalized patients.Objective: The aim of our study was to recognize the demographic and clinical characteristics associated with an increased need for invasive mechanical ventilation in hospitalized sepsis patients.Methods: We used National Inpatient Sample database from the years 2009–2011 to identify sepsis patients requiring invasive mechanical ventilation. We compared demographic and clinical characteristics of sepsis patients requiring and not requiring ventilator support and conducted univariate and multivariate analyses to determine odds ratio (OR) of association.Results: A total of 4,827,769 sepsis patients were identified among which 21.38% required invasive ventilation. Multivariate logistic regression [OR (95% CI), p<0.001] determined the following to be associated with increased odds of ventilator use: morbid obesity [1.37 (1.31–1.42)] and age group 35-64 years [1.18 (1.14–1.22)] compared to 18–34 years, whereas females [0.90 (0.88–0.91)] and age >85 years [0.49 (0.47–0.52)] had reduced odds of invasive ventilation. Hyperkalemia [1.12 (1.09–1.16)] and hypernatremia [2.26 (2.16–2.36)] were associated with increased odds while hypokalemia [0.94 (0.91–0.97)] had reduced odds of invasive ventilation. Septic patients requiring IMV had higher length of stay by 9.72 ± 0.17 days, hospitalization cost by US $ 43010.31 ± 988.24 and in-hospital mortality (41.33% vs 8.91%). Conclusion: Sepsis is a major cause of intensive care unit admission and initiation of invasive ventilation. Baseline demographic and clinical features affect the need for invasive ventilation. A clear understanding of these risk factors is integral for an appropriate and timely management.

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Section: Discussionsupporting

confidence: 89%

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Dhital

Basnet

Poudel

2018

Journal of Community Hospital Internal Medicine Perspectives

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“…It remains to be determined whether the alternative approaches liberate patients who use comparable techniques at similar or different time points during weaning. Third, in contrast to the findings of Esteban et al, 20 our respondents preferred to conduct SBTs with techniques that permit adding low levels of PEEP. Use of a T-piece may be a less desirable technique in Canada, as it physically separates the patient from the monitoring capabilities of the ventilator, and it is cumbersome for RTs to assemble.…”

Section: Discussioncontrasting

confidence: 81%

“…3 In contrast to our findings, patients in this study were supported using either AC (55%) or SIMV (26%), and few were managed with PS (8%). In a subsequent observational study involving 5,131 patients in 20 countries, Esteban et al 20 found that once-daily or multiple daily weaning trials were used in 77.8% and 14.0% of weaning attempts. The authors observed that gradual reductions in PS with SIMV, PS or SIMV were utilized in 21.8%, 20.7% and 8.5% of weaning attempts, respectively, and weaning trials were predominantly conducted using T-piece (51.6%), PS (28.2%), and CPAP (19.2%).…”

Section: Discussionmentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

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“…B. ventilatorassoziierter Pneumonie (VAP), Atrophie der Atemmuskulatur oder ventilatorinduzierter diaphragmaler Dysfunktion (VIDD) sowie zunehmendem Patientendyskomfort assoziiert, sodass eine prolongierte maschinelle Beatmung mit einer erhöhten Morbidität und Letalität einhergeht [2,4]. Darüber hinaus ist und bleibt die maschinelle Beatmung eine vorübergehende supportive Therapie, die helfen kann, Atem-und Gasaustauschstörungen infolge schwerer akuter Krankheitsbilder wie "acute respiratory distress syndrome" (ARDS), Sepsis, Polytrauma etc.…”

Section: Primäres Ziel: Zeit Gewinnenunclassified

Augmentierte Spontanatmung im Entwöhnungsprozess

Ragaller

2014

Anaesthesist

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Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation<SUBTITLE>A 28-Day International Study</SUBTITLE>

Abstract: Survival among mechanically ventilated patients depends not only on the factors present at the start of mechanical ventilation, but also on the development of complications and patient management in the intensive care unit.

Cited by 1,537 publications

References 35 publications

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Augmentierte Spontanatmung im Entwöhnungsprozess

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