Factors Influencing Weaning Older Adults From Mechanical Ventilation

Stieff, Karen V.; Lim, Fidelindo; Chen, Leon

doi:10.1097/cnq.0000000000000154

Cited by 13 publications

(10 citation statements)

References 37 publications

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“…The use of SAPS 3 is able to show scores that infer prognosis beyond 24 hours of admission and reflect the complexity of the care demanded considering the patient’s clinical status ( 32 ) . Other authors ( 20 , 25 , 33 ) also found an association between SAPS 3 and the occurrence of weaning failure, concluding that the SAPS 3 system has a good discriminatory power during the ventilatory weaning process.…”

Section: Discussionmentioning

confidence: 81%

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Silva

Tonelli²,

Costa³

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to clinically validate the nursing diagnosis of Dysfunctional Ventilatory Weaning Response in adult patients admitted to Intensive Care Units. Method: a concurrent cohort performed with 93 patients admitted to Intensive Care Units. The incidence and incidence density of the diagnosis were estimated, its related factors were identified based on bivariate analysis and clinical indicators for determining its occurrence, according to the global and temporal presentation. Results: the overall incidence of the diagnosis was 44.09% and the incidence density was 14.49 occurrences for every 100 extubations/day. The factors related to the diagnosis were the following: age, clinical severity, fluid balance, oliguria, hemodialysis, edema in upper/lower limbs, anasarca, number of antibiotics, hypothermia, hyperthermia, amount of secretion, muscle retraction, anxiety score, heart rate, use of vasopressors and non-invasive ventilation after extubation. The clinical indicators most frequently identified for determining the diagnosis were the following: tachypnea, drop of saturation and tachycardia. Temporal progression in the severity of these manifestations was found. Conclusion: the Dysfunctional Ventilatory Weaning Response is a common finding in critically ill patients. Some components of the diagnosis of the NANDA-International (2018) version could be clinically validated. It is noteworthy that there are variables not yet described in the taxonomy, demonstrating the need to review this nursing diagnosis.

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Section: Discussionmentioning

confidence: 81%

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Silva

Tonelli²,

Costa³

et al. 2020

Rev. Latino-Am. Enfermagem

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“…Patients with prolonged weaning are characterized by evident cardiac and pulmonary comorbidities and/or having undergone severe acute critical illness resulting in long-term ventilation and subsequent muscular weakness [19], as well as impaired fluid balance [20, 21]. The main therapeutic goal is a stepwise reduction of ventilatory support (either by gradually reducing the ventilator’s pressure support or by interrupting the ventilator support on a T-piece trial) and a successive transfer of the patients’ respiratory load [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

et al. 2017

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BackgroundSpontaneous breathing trials (SBTs) on a T-piece can be difficult in patients with prolonged weaning because of remaining de-recruitment phenomena and/or insufficient ventilation. There is no clinically established method existent other than experience for estimating whether an SBT is most probably beneficial. Electrical impedance tomography (EIT) is a clinical useful online monitoring technique during mechanical ventilation, particularly because it enables analysis of effects of regional ventilation distribution. The aim of our observational study was to examine if EIT can predict whether patients with prolonged weaning will benefit from a planned SBT.MethodsThirty-one patients were examined. Blood gas analysis, vital parameter measurements, and EIT recordings were performed at three time points: (1) baseline with pressure support ventilation (PSV) (t0), (2) during a T-piece trial (t1), and (3) after resumption of PSV (t2). Calculation of EIT parameters was performed, including the impedance ratio (IR), the tidal variation of impedance (TIV), the changes in end-expiratory lung impedance (ΔEELI), the global inhomogeneity index (GI), and the regional ventilation delay (RVD) index with use of different thresholds of the percentage inspiration time (RVD40, RVD60, RVD80). The predictive power of the baseline GI with regard to clinical impairment of an SBT was analyzed by means of ROC curves. Clinical deterioration was assumed when tidal volume was decreased by at least 20 ml after the T-piece trial, measured at t2.ResultsPartial pressure of arterial oxygen significantly decreased at t1 (71 ± 15 mmHg) compared with t0 (85 ± 17 mmHg, p < 0.05) and t2 (82 ± 18 mmHg, p < 0.05). The IR trended toward higher values during t1. At t1, TIV and ΔEELI significantly decreased. The GI was significantly increased at t1 (t0 59.3 ± 46.1 vs t1 81.5 ± 62.5, p = 0.001), as were all RVD indexes. Assuming a GI cutoff value of >40, sensitivity of 85% and specificity of 50% were reached for predicting an increased future tidal volume.ConclusionsEIT enables monitoring of regional ventilation distribution during SBTs and is suitable to estimate whether an SBT probably will be beneficial for an individual patient. Therefore, the application of EIT can support clinical decisions regarding patients in the phase of prolonged weaning.

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“…Previous studies have found a variety of factors are associated with extubation failure, including: (1) demographics and clinical status, such as age, fluid balance, comorbidity burden, cardiac function, mental status, and severity of illness; (2) laboratory abnormalities, such as hypercapnia, serum albumin, and blood urea nitrogen (BUN); (3) respiratory mechanics, such as maximal inspiratory pressure and diaphragmatic function; and (4) treatment interventions, such as sedatives [5,[7][8][9]. However, these predictors are identified from a cluster of diseases including pneumonia, chronic obstructive pulmonary disease, heart failure, and…”

Section: Introductionmentioning

confidence: 99%

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

Luo

et al. 2020

Bioscience Reports

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Backgroud: Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods: From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results: A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ratio (OR) 1.141, 95% confident interval (CI) 1.022–1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008–1.249, P = 0.035, cutoff at 9.87 mmol/l), dose of fentanyl (OR 3.010, 95%CI 1.100–8.237, P = 0.032, cutoff at 1.135 mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062–7.252, P = 0.037) were independent risk factors for extubation failure. Conclusion: In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87 mmol/l, fentanyl usage > 1.135 mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

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Factors Influencing Weaning Older Adults From Mechanical Ventilation

Cited by 13 publications

References 37 publications

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Electrical impedance tomography for predicting failure of spontaneous breathing trials in patients with prolonged weaning

Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study

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