Shock on Admission Day Is the Best Predictor of Prolonged Mechanical Ventilation in the ICU

Bakker, Jan; González, Francisco E.; Laffaire, Enrique; Canales, Héctor Saúl; Sáenz, Gabriela; Reina, Rosa; Dubin, Arnaldo

doi:10.1378/chest.127.2.598

Cited by 94 publications

(81 citation statements)

References 33 publications

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“…The potential risk factors for the occurrence of the outcomes were included in the multivariable models based on previously reported studies on risk. (10,(12)(13)(14) The severity scores were included in the regression model separately in order to avoid the phenomenon of autocorrelation. The level of significance was set at p < 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…(10,12,14,24,25) The prospective nature of the study design made it possible to collect variables based on the study objective, not limiting data collection to a review of historical records stored for various purposes, a practice that can produce selection bias. Enrollment procedures followed a strict restriction (exclusion) protocol, based on the presence of AIDS, advanced neoplastic disease, prior cognitive impairment (GCS ≤ 8) and advanced neuromuscular disease.…”

Section: In-icu Mortalitymentioning

confidence: 99%

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Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

et al. 2009

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Objective: Although ventilator-associated pneumonia (VAP) is a major cause of nosocomial infection, its role in the prognosis of patients remains undefined. The objective of this study was to evaluate the impact of VAP on the clinical evolution of patients. Methods: This was a prospective cohort study involving 233 patients on mechanical ventilation (VAP group, n = 64; control group, n = 169). Primary outcomes were time on mechanical ventilation (TMV), time in ICU (TICU), overall length of hospital stay (LHS) and in-ICU mortality. Secondary outcomes were in-hospital mortality, microbiological profile, prior use of antibiotics and risk factors for VAP acquisition. Results: Control and VAP group outcomes were, respectively, as follows: median TMV (days), 9 (interquartile range [IQR]: 5-15) and 23 (IQR: 15-37; p < 0.0001); median TICU (days), 12 (IQR: 8-21) and 27 (IQR: 17-42; p < 0.0001); median LHS (days), 33 (IQR: 18-64) and 46 (IQR: 25-90; p = 0.05); and in-ICU mortality, 38% (95% CI: 31-45) and 55% (95% CI: 42-67; p = 0.02). VAP was a predictor of in-ICU mortality (OR = 3.40; 95% CI: 1.54-7.48). TMV (OR = 2.27; 95% CI: 1.05-4.87) and prior use of antibiotics (OR = 1.07; 95% CI: 1.04-1.10) were risk factors for VAP. VAP did not affect in-hospital mortality. Acinetobacter spp. was the most common isolate (28%). Inappropriate empirical antibiotic therapy was administered in 48% of cases. Conclusions: In this study, there was a high incidence of infection with resistant bacteria and inappropriate initial antibiotic therapy. Long TMV and prior use of antibiotics are risk factors for VAP.Keywords: Pneumonia, ventilator-associated; Cross infection; Intensive care units; Hospital mortality; Risk factors. ResumoObjetivo: Apesar de representar uma das principais causas de infecção nosocomial, o papel da pneumonia associada à ventilação mecânica (PAVM) no prognóstico ainda permanece indefinido. O objetivo deste estudo foi avaliar o impacto dessa doença na evolução clínica dos pacientes. Métodos: Estabeleceu-se uma coorte prospectiva de 233 pacientes sob ventilação mecânica (grupo PAV, n = 64; grupo controle, n = 169). Os desfechos primários foram tempo de ventilação mecânica (TVM), tempo de permanência na UTI (TUTI), tempo de permanência hospitalar (TH) e mortalidade na UTI. Os desfechos secundários foram mortalidade hospitalar, perfil microbiológico, uso prévio de antibióticos e fatores de risco para PAVM. Resultados: Os desfechos dos grupos controle e PAVM foram, respectivamente, os seguintes: mediana do TVM (dias), 9 (intervalo interquartílico [II]: 5-15) e 23 (II: 15-37; p < 0,0001); mediana do TUTI (dias), 12 (II: 8-21) e 27 (II: 17-42; p < 0,0001); mediana do TH (dias), 33 (II: 18-64) e 46 (II: 25-90; p = 0,02); e mortalidade na UTI, 38% (IC95%: 31-45) e 55% (IC95%: 42-67; p = 0,02). A PAVM foi um preditor de mortalidade na UTI (OR = 3,40; IC95%: 1,78). O TVM (OR = 2,27; IC95%: 1,05-4,87) e o uso prévio de antibióticos (OR = 1,07; IC95%: 1,04-1,10) foram fatores de risco para PAVM. A PAVM não afetou a morta...

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Section: Methodsmentioning

confidence: 99%

Section: In-icu Mortalitymentioning

confidence: 99%

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

et al. 2009

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“…This finding implies that patients with low CO are at risk of developing DVWR after CABG surgery. This finding is consistent with findings of Estenssoro (2005) who reported that low cardiac output has the highest association with DVWR (89). From these findings, this study suggests that CO is a significant predictor for DVWR after CABG surgery.…”

Section: Cardiopulmonary Indicators and Dysfunctional Ventilator Weansupporting

confidence: 93%

“…The results revealed that there were no significant differences in the hourly mean heart rate between cases and controls except at the first hour. The increase in heart rate among cases during the first hour was consistent with Estenssoro (2005), who reported that weaning from ventilation after CABG surgery involves stress to the heart, which is reflected as increased heart rate during the weaning process (89). However, this finding contrasts with Ely's (1996) report, which indicated that increases in HR are associated with DVWR (36,90).…”

Section: Cardiopulmonary Indicators and Dysfunctional Ventilator Weansupporting

confidence: 79%

Cardiopulmonary Predicators of Dysfunctional Ventilator Weaning Response after Coronary Artery Bypass Graft

Mary¹

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“…In many cases of respiratory diseases, the use of ventilatory support is required. Besides that, a ventilatory support is needed in other situations, including sepsis and sepsis shock; neuromuscular disease; during postoperative state; and in cases of altered mental status with loss of consciousness 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Short courses of mechanical ventilation with high-O2 levels in elderly rat lungs

et al. 2011

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Purpose:To evaluate the effects of mechanical ventilation (MV) of high-oxygen concentration in pulmonary dysfunction in adult and elderly rats. Methods: Twenty-eight adult (A) and elderly (E), male rats were ventilated for 1 hour (G-AV1 and G-EV1) or for 3 hours (G-AV3 and G-EV3). A and E groups received a tidal volume of 7 mL/kg, a positive end-expiratory pressure of 5 cm H2O, respiratory rate of 70 cycles per minute, and an inspiratory fraction of oxygen of 1. We evaluated total protein content and malondialdehyde in bronchoalveolar lavages (BAL) and performed lung histomorphometrical analyses. Results: In G-EV1 animals, total protein in BAL was higher (33.0±1.9 µg/mL) compared with G-AV1 (23.0±2.0 µg/mL). Upon 180 minutes of MV, malondialdehyde levels increased in elderly (G-EV3) compared with adult (G-AV3) groups. Malondialdehyde and total proteins in BAL after 3 hours of MV were higher in elderly group than in adults. In G-EV3 group we observed alveolar septa dilatation and significative increase in neutrofiles number in relation to adult group at 60 and 180 minutes on MV. Conclusion: A higher fraction of inspired oxygen in short courses of mechanical ventilation ameliorates the parameters studied in elderly lungs.

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Shock on Admission Day Is the Best Predictor of Prolonged Mechanical Ventilation in the ICU

Cited by 94 publications

References 33 publications

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

Pneumonia associada à ventilação mecânica: epidemiologia e impacto na evolução clínica de pacientes em uma unidade de terapia intensiva

Cardiopulmonary Predicators of Dysfunctional Ventilator Weaning Response after Coronary Artery Bypass Graft

Short courses of mechanical ventilation with high-O2 levels in elderly rat lungs

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