Long-Term Outcomes for Elderly Survivors of Prolonged Ventilator Assistance

Elpern, Ellen H.; Larson, Ruth; Douglass, Paula S.; Rosen, Robert L.; Bone, Roger C.

doi:10.1378/chest.96.5.1120

Cited by 60 publications

(34 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Factors, such as advanced age, female sex, time of extracorporeal circulation, cardiac dysfunction, and low cardiac output, may lead patients to long-term mechanical ventilation [5][6][7][8] . However, few reports exist about the conjunct use of parameters of respiratory system mechanics and oxygenation, and cardiovascular alterations as factors involved in the successful weaning of patients from long-term mechanical ventilation after cardiac surgery.…”

mentioning

confidence: 99%

“…In these cases, the usual criteria for extubation, such as analysis of the arterial gases and determination of vital capacity and minute volume, many times fail to foretell the success of extubation 11 . The amount of material and financial resources consumed by these patients on long-term mechanical ventilation are high, and some studies were conducted in an attempt to find ways to reduce the costs 5 . Our study aimed at analyzing the parameters of respiratory system mechanics and oxygenation, and cardiovascular alterations, and at assessing the factors involved in the success or failure of weaning tracheostomized patients from prolonged mechanical ventilation after cardiac surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

show abstract

“…[3][4][5] However, approximately 3% to 6% of the patients admitted to the adult ICU require prolonged mechanical ventilation, and criteria and strategies for their successful weaning are less clear. 6) Parameters of respiratory mechanics and oxygenation are commonly used to wean patients with chronic obstructive pulmonary disease (COPD) and other pulmonary disorders from long-term mechanical ventilation.…”

mentioning

confidence: 99%

“…[7][8][9] Yet, as we have previously shown, 10) arterial blood gas analysis and the determination of vital capacity and minute volume often fail to predict extubation success in patients after cardiac surgery. Others have identified advanced age, female sex, (extended) time of extracorporeal circulation, cardiac dysfunction, and low cardiac output as factors associated with the failed weaning of cardiac patients from long-term ventilation 2,4,5) and postoperative cardiac dysfunction and neurological alterations, as factors contributing to their high mortality. 6) But few reports have described parameters of respiratory mechanics, oxygenation, and organ function associated with successful weaning in this population.…”

mentioning

confidence: 99%

Factors Associated With Failure of Weaning From Long-term Mechanical Ventilation After Cardiac Surgery

Nozawa

Azeka

Z³

et al. 2005

Int. Heart J.

View full text Add to dashboard Cite

SUMMARYThe purpose of this prospective, quantitative, comparative study, conducted at the 55 bed cardiothoracic intensive care unit of the Heart Institute (InCor), University of Sao Paulo Medical School, was to identify factors involved in the weaning of patients who require long-term (> 10 days) mechanical ventilation after cardiac surgery.The subjects included all patients who underwent open-heart surgery with cardiopulmonary bypass during a 10 month period from April 2000 to January 2001 (n = 946). From this group, 52 (5.7%) patients who required a tracheotomy for the management of long-term mechanical ventilation after cardiac surgery with cardiopulmonary bypass were selected. Pre-, intra-and postoperative data from patients who were not successfully weaned after reintubation and who underwent an elective tracheotomy were compared.Parameters of respiratory mechanics such as respiratory complications, oxygenation, and cardiac, renal, and neurological function were evaluated. Weaning success was defined as the ability of a patient to tolerate 48 hours without pressure or flow support from a mechanical ventilator. A patient was considered to have failed weaning if they died or remained under ventilation for more than 8 weeks. Of the 52 patients studied, 25 were successfully weaned, 21 died, and 6 remained ventilated for more than 8 weeks. We found significant statistical differences (P <0.05) between the groups with respect to success or failure in LVEF (P = 0.0035), the need for vasoactive agents (P = 0.0018), and renal failure (P = 0.002). Parameters of respiratory mechanics and oxygenation (eg, static airway compliance, airway resistance) did not influence the success or failure of weaning. There was a significant difference in relation to the presence of pneumonia (P = 0.0086) between the two groups. Although neurological complications were more frequent in patients in the weaning success group, the failure group had lower GCS scores, which is indicative of worse prognoses.It is concluded that cardiac dysfunction, the need for dialysis, and pneumonia are determinants for weaning failure in patients undergoing long-term mechanical ventilation after cardiac surgery. (Int Heart J 2005; 46: 819-831)

show abstract

“…One should emphasize that the study by JIMENEZ et al [3], like those of others [4][5][6][7][8], included a mixture of underlying diseases, and the prognosis may be different in adult respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD) and in other diseases. The present study included more than one third of postsurgical and traumatized patients, whose prognosis is known to be good [8], and only 8% of patients with ARDS.…”

mentioning

confidence: 99%

Outcome from mechanical ventilation

Vincent¹

1994

Eur Respir J

View full text Add to dashboard Cite

Long-Term Outcomes for Elderly Survivors of Prolonged Ventilator Assistance

Cited by 60 publications

References 15 publications

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Factors Associated With Failure of Weaning From Long-term Mechanical Ventilation After Cardiac Surgery

Outcome from mechanical ventilation

Contact Info

Product

Resources

About