Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit

Kock, Kelser de Souza; Silva, Rosemeri Maurici da

doi:10.5492/wjccm.v7.i1.24

Cited by 13 publications

(19 citation statements)

References 37 publications

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“…In the present study, the mean Cst rs values obtained were similar to those found in another study ( 6 ) and remained below the values found by others. ( 11 , 13 ) The total respiratory system compliance in ventilated and anesthetized patients is approximately 70 - 80mL/cmH 2 O, which almost double the measurement found in the present study.…”

Section: Discussionsupporting

confidence: 75%

“…( 16 ) Kock et al assessed the risk of changes in respiratory mechanics for the determination of outcomes such as mortality and observed that the measurement results are strongly associated with the risk of death. ( 6 ) These data reinforce the clinical importance of these measurements for the management of critically ill patients.…”

Section: Discussionsupporting

confidence: 61%

“…The measures used in this study are compliance and resistance. ( 6 ) Compliance is associated with pulmonary distensibility and is equivalent to the volume variation divided by the pressure variation. Resistance is related to air conduction and is influenced by factors such as the presence of secretions in the airways and narrowing of the airways.…”

Section: Introductionmentioning

confidence: 99%

“…The monitoring of these variables allows the longitudinal comparison of data over the period during which the patient remains on MV. ( 1 , 6 , 7 ) To allow such comparisons, there must be good reproducibility among examiners to confer clinical significance for the management of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation

Júnior¹,

Silva²,

Santos

et al. 2020

Revista Brasileira De Terapia Intensiva

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Objective To evaluate the intra- and interexaminer reproducibility of measurements of the resistance and static and dynamic compliance of the respiratory system in patients on mechanical ventilation. Methods This was an analytical study conducted with individuals aged ≥ 18 years who were on invasive mechanical ventilation and had no clinical diagnosis of respiratory system disease and/or chest abnormality. Three measurements of respiratory mechanics were performed with a 1-minute interval between them. The first and third measurements were performed by examiner A, the second by examiner B. The values for the resistance and static and dynamic compliance of the respiratory system were compared using the intraclass correlation coefficient. Results A total of 198 measurements of respiratory mechanics were performed for 66 patients on mechanical ventilation. The patients had a mean age of 52.6 ± 18.6 years and a mean body mass index of 21.6 ± 2.1kg/m 2 ; a surgical profile (61.5%) and female sex (53.8%) were predominant. Mean values were obtained for the three measurements of respiratory system resistance (A1: 15.7 ± 6.8cmH 2 O/L/s; B1: 15.7 ± 6.4cmH 2 O/L/s and A2: 15.9 ± 6.2cmH 2 O/L/s), respiratory system static compliance (A1: 42.1 ± 13.7mL/cmH 2 O; B1: 42.4 ± 14.6mL/cmH 2 O and A2: 42.2 ± 14.5mL/cmH 2 O) and respiratory system dynamic compliance (A1: 21.3 ± 7.3mL/cmH 2 O; B1: 21.4 ± 7.5mL/cmH 2 O and A2: 21.3 ± 6.2mL/cmH 2 O). The intraclass correlation coefficient was also calculated for respiratory system resistance (R = 0.882 and p = 0.001; R = 0.949 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.932 and p = 0.001 - intraexaminer); respiratory system static compliance (R = 0.951 and p = 0.001; R = 0.958 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.965 and p = 0.001 - intraexaminer) and respiratory system dynamic compliance (R = 0.957 and p = 0.001; R = 0.946 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.926 and p = 0.001 - intraexaminer). Conclusion The measurements of resistance and static and dynamic compliance of the respiratory system show good intra- and interexaminer reproducibility for ventilated patients.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation

Júnior¹,

Silva²,

Santos

et al. 2020

Revista Brasileira De Terapia Intensiva

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show abstract

“…Pre-hospital intubation is considered to be a risk factor for developing VAP (Arumugam et al 2018), some evidence additionally pointing to a possible association between pre-hospital endobronchial intubation and the early onset of VAP (Padilla et al 2019). Male gender, immunodeficiency and old age are also linked with an increased incidence of VAP, according to the recent literature (Kock and Maurici 2018;Timsit et al 2017).…”

Section: Criteria Selectionmentioning

confidence: 99%

Multi-criteria risk evaluation model for developing ventilator-associated pneumonia

Drnovšek

Kapun

Rajkovič

2020

Cent Eur J Oper Res

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Ventilator-associated pneumonia is a hospital-acquired infection of the lungs occurring in mechanically ventilated patients. An active risk management approach can prevent the occurrence of the disease and promote positive organizational changes, subsequently decreasing mortality and hospitalization costs. Using scientific and clinical practice knowledge, a risk evaluation model was developed to identify patients more at risk of developing the disease. For this purpose, a Decision Expert qualitative multi-criteria decision method was used, in which alternatives are evaluated according to predetermined hierarchically arranged criteria. Characteristics of each evaluated alternative are described by the members of an interdisciplinary expert team and are represented by the values of the basic criteria. Values of hierarchically higher aggregated criteria are computed in an upwards fashion according to utility functions, which are defined as simple logical rules. This method is integrated into a software solution, DEXi. The approach is applicable to vastly diverse decision problems and has been successfully used before for health-related decision support. The designed model was tested using actual clinical data. Evaluations of alternatives that most distinctly demonstrated the functionality of the evaluation model were selected and are presented in the results. The evaluation model is intended to assist a holistic evaluation of the risk of developing ventilator-associated pneumonia, by considering patient-related risk factors and the use of preventive measures. The model incorporates nursing-specific data that have hitherto been poorly utilized in preventing ventilator-associated pneumonia and promotes the active engagement of nurses in confronting this interdisciplinary healthcare problem, which has gained more prominence with the onset of COVID-19 disease.

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Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study

Moretti

Laethem

Minini

et al. 2021

Journal of Infection and Chemotherapy

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Introduction: Severe coronavirus 2019 disease (CoViD-19) may lead to respiratory failure and mechanical ventilation. Therefore, ventilator associated pneumonia (VAP) may complicate the course of the disease. The aim of the current article was to investigate possible predictive factors for bacterial VAP on a retrospective manner, in a cohort of mechanically ventilated CoViD-19 patients. Additionally, determinant factors of lethality were analyzed. Methods: Medical records of patients hospitalized in the intensive care units (ICU) at the university hospital UZ Brussel during the epidemic were reviewed. VAP was defined following the National Healthcare Safety Network 2017 criteria. Univariate and multivariate logistic regressions analyses were performed. Results: Among the 39 patients included in the study, 54% were diagnosed with bacterial VAP. Case fatality rate was 44%, but 59% of the deceased patients had a do-not-resuscitate status. Multivariate logistic regression for prediction of VAP showed significant differences in duration of ICU hospitalization and in minimal lung compliance. Additional analyses were performed on CoViD-19 patients who were affected by bacterial respiratory superinfection. The responsible pathogens correspond to the commonly found bacteria in VAP. However, 71% of the isolated germs were multi-drug resistant and bacteraemia was reported in 38%. Multivariate analyses for prediction of lethality found significant difference in SOFA score. Conclusions: Mechanically ventilated CoViD-19 patients might frequently develop VAP. Longer ICU hospitalization was associated with pulmonary superinfection in the current cohort. Moreover, decreased minimal lung compliance was correlated to VAP and higher SOFA score at VAP diagnosis was associated with lethality.

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Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit

Cited by 13 publications

References 37 publications

Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation

Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation

Multi-criteria risk evaluation model for developing ventilator-associated pneumonia

Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study

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