Risk Factors for Mortality Among Mechanically Ventilated Patients Requiring Pleural Drainage

Park, Sojung; Kim, Won-Young; Baek, Moon Seong

doi:10.2147/ijgm.s349249

Cited by 5 publications

(2 citation statements)

References 25 publications

(33 reference statements)

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“…37 The effect of ventilator circuit changes on ventilator-associated pneumonia was proved by many researchers. 45 In this research, 89.5% of MPs changed the disposable ventilator circuit regularly, and 55.3% of MPs controlled and maintained cuff pressure properly. There was 34.2% compliance in repositioning the ETT and 34.9% in controlling and maintaining the cuff pressure regularly.…”

Section: Discussionmentioning

confidence: 75%

Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units

Jalal¹,

Rajeh²,

Al-Abdulwahed³

2022

IJGM

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Purpose Ventilator-associated pneumonia (VAP) is one of the most common infections in intensive care units (ICU) with a 6–52% incidence. The VAP mortality rate is 50% to 70%. Medical professionals (MPs) working in the ICU are expected to follow the guidelines to prevent VAP. The study aimed to assess the performance of MPs in preventing VAP and to associate the performance with the baseline information. Methods An observational cross-sectional study was conducted in the ICUs of selected hospitals in eastern Saudi Arabia. A total of 152 MPs were selected by random sampling. A structured questionnaire including baseline information, knowledge and performance-related questions was used to collect the data. Frequency, mean, and chi-square tests were used for analysis. Results Out of 152 MPs, 40.8% had adequate and 7.9% had inadequate knowledge. A high mean score of 12.9 ± 2.2 was obtained by physicians, followed by 11.3 ± 1.6 by nurses, 9.8 ± 2.2 by RTs, and 8.6 ± 2.1 by interns. Overall, 52.6% had satisfactory performance. Approximately 57.9% and 67.8% of MPs cleaned their hands before touching the patient and the ventilator, respectively. Many (79.6%) MPs used personal protective equipment in the ICU. Some (47.4%) of the MPs changed the patient’s position regularly. About 77.6% of MPs followed the sterile technique when suctioning the airway. There was a significant association found between the performance of MPs on the prevention of VAP with age ( p < 0.001), designation ( p < 0.05), professional experience ( p < 0.05), managing chronic obstructive pulmonary disease conditions ( p < 0.05) and training attended ( p < 0.001). Conclusion Although some of the MPs had satisfactory performance regarding VAP prevention in the ICU, more attention should be paid to training them on clinical guidelines to improve health care quality and reduce the rate of VAP.

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Section: Discussionmentioning

confidence: 75%

Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units

Jalal¹,

Rajeh²,

Al-Abdulwahed³

2022

IJGM

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“…Patients on MV who received vasopressor medication were 19.06 times more likely to die than those who did not. Another study conducted in Korea found that the use of vasopressors was strongly related to in-hospital mortality in mechanically ventilated patients [ 59 ]. This could be explained by the possibility of ICU-acquired weakness linked to the use of vasoactive drugs [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis

Ayenew,

Gedfew,

Fetene

et al. 2024

PLoS ONE

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Background In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger’s regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses. Results In this systematic review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality. Conclusion Our review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.

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Efficacy and safety outcomes of drainage of intensive care pleural effusions: Study protocol for the ESODICE randomized controlled trial

Fysh,

Mevavala,

Wigston

et al. 2023

Medicine: Case Reports and Study Protocols

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Background: Pleural effusions are common in intensive care patients. Without strong evidence to guide management, clinicians variably undertake either intervention with drainage procedures, or expectant management, that is, observation, whilst treating the underlying cause. Early drainage may be associated with improved diagnostic accuracy and oxygenation, without increased complications. However, randomized evidence is needed to confirm these observations. Hypotheses: In patients diagnosed with a safely drainable pleural effusion while admitted to the intensive care units (ICU) and in whom there is no absolute indication for immediate drainage, intervention with early pleural drainage compared with initial expectant management: improves oxygenation and is safe. Aims: To undertake a phase II multicenter randomized controlled trial evaluating the safety and efficacy of early pleural effusion drainage compared with expectant management in the intensive care setting. Methods: Population – patients admitted in intensive care units and diagnosed with a safely drainable pleural effusion in whom there is no absolute indication for immediate drainage. Co-primary endpoints – ratio of arterial oxygen partial pressure to fraction of inspired oxygen ratio at 48 hours after randomization and number of Pleural Effusion Related Serious Adverse Events at 90 days. Inclusion criteria – admitted to intensive care, age > 18 years, pleural effusion safely drainable, and no absolute indication for immediate drainage. Exclusion criteria – in the opinion of treating clinician trial not in patient’s best interests, inability to gain consent from patient or responsible decision-maker, and patient requiring extracorporeal membrane oxygenation. Randomization – open-label, 1:1 patient ratio using permuted block randomization. Intervention and comparator – drainage of pleural effusion as opposed to expectant management. Outcomes – physiological data including ratio of arterial oxygen partial pressure to fraction of inspired oxygen and/or ratio of oxygen saturation measured by pulse oximetry to fraction of inspired oxygen ratio will be collected at randomization and 6 hourly until 72 hours or ICU discharge (whichever sooner). Adverse event and clinical data will be recorded daily to ICU discharge, hospital discharge and death up to 90 days after randomization.

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Risk Factors for Mortality Among Mechanically Ventilated Patients Requiring Pleural Drainage

Cited by 5 publications

References 25 publications

Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units

Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units

Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis

Efficacy and safety outcomes of drainage of intensive care pleural effusions: Study protocol for the ESODICE randomized controlled trial

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