Weaning centre — siedmioletnie doświadczenia jednego ośrodka

Rojek-Jarmuła, Anna; Hombach, Rainer; Gierek, Danuta; Krzych, Łukasz J.

doi:10.5603/ait.2015.0033

Cited by 4 publications

(2 citation statements)

References 11 publications

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“… 14 Treatment strategy and weaning procedures were implemented according to the nationwide recommendations, 14 after adjustment to local standards, as previously described. 15 …”

Section: Methodsmentioning

confidence: 99%

APACHE II score cannot predict successful weaning from prolonged mechanical ventilation

2017

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At least 5% of all intensive care unit patients require prolonged respiratory support. Multiple factors have been suggested as possible predictors of successful respiratory weaning so far. We sought to verify whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) can predict freedom from prolonged mechanical ventilation (PMV) in patients treated in a regional weaning centre. The study group comprised 130 consecutive patients (age; median (interquartile range): 71 (62–77) years), hospitalized between 1 January 2012, and 31 December 2013. APACHE II score was assessed based on the worst values taken during the first 24 hours after admission. Glasgow coma scale was excluded from calculations due to the likely influence of sedative agents. The outcome was defined as freedom from mechanical ventilation, with or without tracheostomy on discharge. Among survivors (n = 115), 88.2% were successfully liberated from mechanical ventilation and 60.9% from tracheostomy. APACHE II failed to predict freedom from mechanical ventilation (area under the receiver–operating characteristic curve [AUROC] = 0.534; 95% confidence interval [CI]: 0.439–0.628; p = 0.65) and tracheostomy tube removal (AUROC = 0.527; 95% CI: 0.431–0.621; p = 0.63). Weaning outcome was unrelated to the aetiology of respiratory failure on admission (p = 0.41). APACHE II cannot predict weaning outcome in patients requiring PMV.

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“… 14 Treatment strategy and weaning procedures were implemented according to the nationwide recommendations, 14 after adjustment to local standards, as previously described. 15 …”

Section: Methodsmentioning

confidence: 99%

APACHE II score cannot predict successful weaning from prolonged mechanical ventilation

2017

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“…The treatment strategy and weaning procedures were implemented according to the nationwide recommendations [12], with adjustment to local standards. More details regarding this issue have been published previously [13]. …”

Section: Methodsmentioning

confidence: 99%

Does the APACHE II score predict performance of activities of daily living in patients discharged from a weaning center?

Rojek-Jarmuła

Hombach

Krzych

2016

kitp

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IntroductionData regarding the functional status of patients after prolonged mechanical ventilation are scarce, and little is known about its clinical predictors.AimTo investigate whether the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission may predict performance in activities of daily living on discharge from a weaning center.Material and methodsAll consecutive patients admitted between January 1, 2012 and December 31, 2013 were enrolled (n = 130). During this period, 15 subjects died, and 115 were successfully discharged (34 women; 81 men). APACHE II was calculated based on the worst values taken during the first 24 hours after admission. On discharge, the Barthel Index (BI) and its extended version, the Early Rehabilitation Barthel Index (ERBI), were assessed.ResultsMedian BI was 20 points (IQR 5; 40), and ERBI was 20 points (–50; 40). There was no correlation between APACHE II and either BI (R = –0.07; p = 0.47) or ERBI (R = –0.07; p = 0.44). APACHE II predicted the need for assistance with bathing (AUROC = 0.833; p < 0.001), grooming (AUROC = 0.823; p < 0.001), toilet use (AUROC = 0.887; p < 0.001), and urination (AUROC = 0.658; p = 0.04). APACHE II had no impact on any ERBI items associated with ventilator weaning, including the need of further mechanical ventilation (AUROC = 0.534; p = 0.65) or tracheostomy (AUROC = 0.544; p = 0.42).ConclusionsAlthough APACHE II cannot predict the overall functional status in patients discharged from a weaning center, it helps identify subjects who will need support with bathing, grooming, and toilet use. The APACHE II score is inadequate to predict performance in activities associated with further respiratory support.

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Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

Shin¹,

Chang²,

Ahn³

et al. 2017

J. Thorac. Dis.

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Background: For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU). Results: Among the 127 patients requiring PMV, 41 (32.3%) were successfully weaned from MV. The median age of the weaning failure group was higher than that of the weaning success group (74.0 vs. 70.0 years; P=0.003). The proportion of male patients was 58.5% in the weaning success group and 72.1% in the weaning failure group, respectively. The most common reasons for ICU admission were respiratory causes (66.1%) followed by cardiovascular causes (16.5%) in both groups. ICU mortality and in-hospital mortality rates were 55.1% and 55.9%, respectively. In the multivariate analysis, respiratory causes of ICU admission [odds ratio (OR), 3.98; 95% confidence interval (CI), 1.29-12.30; P=0.016] and a high sequential organ failure assessment (SOFA) score on day 21 of MV (OR, 1.47; 95% CI, P=0.001) were significantly associated with weaning failure in patients requiring PMV. The area under the receiver operating characteristic (ROC) curve of the SOFA score on day 21 of MV for predicting weaning failure was 0.77 (95% CI, 0.67-0.87; P=0.000).Conclusions: Respiratory causes of ICU admission and a high SOFA score on day 21 of MV could be predictive of weaning failure in patients requiring PMV.

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Weaning centre — siedmioletnie doświadczenia jednego ośrodka

Cited by 4 publications

References 11 publications

APACHE II score cannot predict successful weaning from prolonged mechanical ventilation

APACHE II score cannot predict successful weaning from prolonged mechanical ventilation

Does the APACHE II score predict performance of activities of daily living in patients discharged from a weaning center?

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

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