Academic literature on the topic 'VENTILATOR WEANING/mortality'
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Journal articles on the topic "VENTILATOR WEANING/mortality"
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Liu, Ling, Xiaoting Xu, Qin Sun, Yue Yu, Feiping Xia, Jianfeng Xie, Yi Yang, Leo Heunks, and Haibo Qiu. "Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning." Anesthesiology 132, no. 6 (June 1, 2020): 1482–93. http://dx.doi.org/10.1097/aln.0000000000003207.
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Abstract Background Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient–ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation. Methods In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient–ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning. Results Weaning duration in all patients was statistically significant shorter in the neurally adjusted ventilatory assist group (n = 47) compared with the pressure support ventilation group (n = 52; 3.0 [1.2 to 8.0] days vs. 7.4 [2.0 to 28.0], mean difference: −5.5 [95% CI, −9.2 to −1.4], P = 0.039). Post hoc sensitivity analysis also showed that the neurally adjusted ventilatory assist group had shorter weaning duration (hazard ratio, 0.58; 95% CI, 0.34 to 0.98). The proportion of patients with successful weaning from invasive mechanical ventilation was higher in neurally adjusted ventilatory assist (33 of 47 patients, 70%) compared with pressure support ventilation (25 of 52 patients, 48%; respiratory rate for neurally adjusted ventilatory assist: 1.46 [95% CI, 1.04 to 2.05], P = 0.026). The number of ventilator-free days at days 14 and 28 was statistically significantly higher in neurally adjusted ventilatory assist compared with pressure support ventilation. Neurally adjusted ventilatory assist improved patient ventilator interaction. Mortality and length of stay in the intensive care unit and in the hospital were similar among groups. Conclusions In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Couto, Suelayne Gomes, Paula Elaine Diniz Dos Reis, and Priscilla Roberta Silva Rocha. "Preditores de mortalidade em pacientes ventilados mecanicamente: revisão integrativa." Online Brazilian Journal of Nursing 16, no. 4 (August 31, 2018): 486. http://dx.doi.org/10.17665/1676-4285.20175874.
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Aim: To identify, by means of scientific evidence, the predictive factors of mortality in patients using Invasive Mechanical Ventilation. Method: Integrative literature review. The search was performed in Pubmed, Cochrane and Web of Science databases, using the descriptors: “humans”, “respiration”, “artificial”, “mechanical ventilation”, “ventilator weaning”, “mechanical ventilator weaning", "Mortality" and "hospital mortality", mediated by the Boolean operators AND and OR. Results: Twenty-six articles were selected. The analysis of these articles allowed a discussion directed to the identification of predictors of mortality, classified in clinical and ventilatory predictors; and the main changes in ventilation during the years. Of the 26 articles found, 96% were published in English, 92% were observational studies, 4% were meta-analyzes and 4% were clinical trials. Conclusion: Prolonged weaning, extubation failure and reintubation were the main predictors identified by the studies analyzed.
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Surani, Salim, Munish Sharma, Kevin Middagh, Hector Bernal, Joseph Varon, Iqbal Ratnani, Humayun Anjum, and Alamgir Khan. "Weaning from Mechanical Ventilator in a Long-term Acute Care Hospital: A Retrospective Analysis." Open Respiratory Medicine Journal 14, no. 1 (December 18, 2020): 62–66. http://dx.doi.org/10.2174/1874306402014010062.
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Background: Prolonged Mechanical Ventilation (PMV) is associated with a higher cost of care and increased morbidity and mortality. Patients requiring PMV are referred mostly to Long-Term Acute Care (LTAC) facilities. Objective: To determine if protocol-driven weaning from mechanical ventilator by Respiratory Therapist (RT) would result in quicker weaning from mechanical ventilation, cost-effectiveness, and decreased mortality. Methods: A retrospective case-control study was conducted that utilized protocol-driven ventilator weaning by respiratory therapist (RT) as a part of the Respiratory Disease Certification Program (RDCP). Results: 51 patients on mechanical ventilation before initiation of protocol-based ventilator weaning formed the control group. 111 patients on mechanical ventilation after implementation of the protocol formed the study group. Time to wean from the mechanical ventilation before the implementation of protocol-driven weaning by RT was 16.76 +/- 18.91 days, while that after the implementation of protocol was 7.67 +/- 6.58 days (p < 0.0001). Mortality proportion in patients after implementation of protocol-based ventilator weaning was 0.21 as compared to 0.37 in the control group (p=0.0153). The daily cost of patient care for the LTAC while on mechanical ventilation was $2200/day per patient while it was $ 1400/day per patient while not on mechanical ventilation leading to significant cost savings. Conclusion: Protocol-driven liberation from mechanical ventilation in LTAC by RT can significantly decrease the duration of a mechanical ventilator, leading to decreased mortality and cost savings.
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Eweas, Amany S., Sahar Y. Mohammad, Jehan S. A. Sayyed, Marwa M. Abd Elbaky, and Magda M. Bayoumi. "Application of Modified Ventilator Bundle and Its Effect on Weaning and Ventilation Days among Critical Ill Patients." Evidence-Based Nursing Research 2, no. 4 (January 12, 2021): 9. http://dx.doi.org/10.47104/ebnrojs3.v2i4.178.
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Context: Modified ventilator bundle is the group of interventions supported by evidence to prevent ventilator-associated pneumonia and other related complications that commonly occurred in mechanically ventilated patients. Furthermore, it helps in reducing the mortality rates and hospital length of stay.
Aim: The current study aimed to apply a modified ventilator bundle and evaluate its effect on weaning and ventilation days among critically ill patients.
Methods: A quasi-experimental research (study/control group) design was utilized. This study was conducted at the following critical care units (surgical, medical, and cardiac care units) affiliated to Bani Suief University Hospital in Bani Suief city, Egypt. A Purposive sample of 100 mechanically ventilated patients was divided into two groups. The study group included patients who received a modified ventilator bundle, while the control group included patients who received routine hospital nursing care. Data collection tools included two tools. The first tool is a patient assessment record, and the second tool is the weaning process assessment checklists using burns wean assessment program score.
Results: 68.0% of the study group, compared with only (40.0%) of the control group, had a shorter duration of mechanical ventilation support between (4- 6) days with mean ± SD of 6.1 ± 1.6 and 7.3 ± 1.9, respectively after modified bundle implementation with statistical significance differences (p-value 0.005). The study group of patients obtained higher weaning scores than the control group according to burns weaning scores.
Conclusion: The study group demonstrated higher weaning scores and shorter ventilation support duration than the control group. Developing a simplified and comprehensive training associated with demonstrative booklet, including information about ventilator-associated pneumonia, components of modified ventilator bundle, and its importance for ventilated patients to improve nurses' knowledge and practice. Furthermore, replicating the current study on a larger probability sample from different geographical locations to generalize results.
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Zhao, Kun, Shu-juan Bai, Zhi-tao Wang, Yu-he Zhang, Chao Liu, Hai-gang Song, Hai-bo Wang, Xin Li, and Wen-laing You. "Association of high-resolution computed tomography score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome." Journal of International Medical Research 48, no. 6 (June 2020): 030006052091296. http://dx.doi.org/10.1177/0300060520912966.
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Objective This study was performed to explore the association of the high-resolution computed tomography (HRCT) score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome (ARDS). Method In total, 197 patients treated for ARDS from October 2004 to December 2015 were retrospectively analyzed. Univariate analysis and multifactor regression analysis were used to determine the relationship of the HRCT score with ventilator weaning and 28-day mortality. Curve-fitting analysis and threshold analysis were further used to explore the association of the HRCT score with ventilator weaning and 28-day mortality. Results The multifactor regression analysis showed that the HRCT score was significantly associated with a lower rate of ventilator weaning and a higher risk of 28-day mortality in patients with ARDS. HRCT scores of 257.0 and 243.2 were the thresholds for ventilator weaning and 28-day mortality, respectively. When the HRCT score was below the threshold, every 1-point increase in the HRCT score was associated with a 4.6% decrease in the ventilator weaning rate and a 4.6% increase in the 28-day mortality rate. Conclusion The HRCT score was associated with ventilator weaning and 28-day mortality with a threshold of 257.0 and 243.2 points, respectively.
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Holanda, Marcelo Alcantara, Renata dos Santos Vasconcelos, Juliana Carvalho Ferreira, and Bruno Valle Pinheiro. "Patient-ventilator asynchrony." Jornal Brasileiro de Pneumologia 44, no. 4 (July 6, 2018): 321–33. http://dx.doi.org/10.1590/s1806-37562017000000185.
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ABSTRACT Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.
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Carmichael, Heather, Franklin L. Wright, Robert C. McIntyre, Thomas Vogler, Shane Urban, Sarah E. Jolley, Ellen L. Burnham, Whitney Firth, Catherine G. Velopulos, and Juan Pablo Idrovo. "Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection." Trauma Surgery & Acute Care Open 6, no. 1 (January 2021): e000591. http://dx.doi.org/10.1136/tsaco-2020-000591.
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BackgroundSince the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature.MethodsThis is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit. Patients underwent percutaneous tracheostomy at the bedside; the procedure was performed with limited staffing to reduce risk of disease transmission.ResultsBetween March 1 and June 30, 2020, a total of 206 patients with COVID-19 infection required mechanical ventilation and 26 underwent tracheostomy at a mean of 25±5 days after initial intubation. Overall, 81% of tracheostomy patients were liberated from the ventilator at a mean of 9±6 days postprocedure, and 54% were decannulated prior to hospital discharge at a mean of 21±10 days postprocedure. Sedation and pain medication requirements decreased significantly in the week after the procedure. In-hospital mortality was 15%. Among tracheostomy survivors, 68% were discharged to a facility.DiscussionThe management of patients with COVID-19 related respiratory failure can be challenging due to prolonged ventilator dependency. In our initial experience, outcomes post-tracheostomy in this population are encouraging, with short time to liberation from the ventilator, a high rate of decannulation prior to hospital discharge, and similar mortality to tracheostomy performed for other indications. Barriers to weaning ventilation in this cohort may be high sedation needs and ventilator dyssynchrony.Level of evidenceLevel V—Therapeutic/care management.
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Tseng, Chia-Cheng, Kuo-Tung Huang, Yung-Che Chen, Chin-Chou Wang, Shih-Feng Liu, Mei-Lien Tu, Yu-Hsiu Chung, Wen-Feng Fang, and Meng-Chih Lin. "Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia." Scientific World Journal 2012 (2012): 1–10. http://dx.doi.org/10.1100/2012/547241.
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Objectives. To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP).Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008.Methods. This study evaluated 163 adult patients (aged ≥18 years). Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA) score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis.Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40%) had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P=0.009), initial high oxygenation index value (P=0.04), increased SOFA scores (P=0.01), and increased APACHE II scores (P=0.02) as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test,P<0.001).Conclusions. Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.
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Lewis, Kimberley A., Dipayan Chaudhuri, Gordon Guyatt, Karen E. A. Burns, Karen Bosma, Long Ge, Tim Karachi, et al. "Comparison of ventilatory modes to facilitate liberation from mechanical ventilation: protocol for a systematic review and network meta-analysis." BMJ Open 9, no. 9 (September 2019): e030407. http://dx.doi.org/10.1136/bmjopen-2019-030407.
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IntroductionTimely liberation from invasive mechanical ventilation is important to reduce the risk of ventilator-associated complications. Once a patient is deemed ready to tolerate a mode of partial ventilator assist, clinicians can use one of multiple ventilatory modes. Despite multiple trials, controversy regarding the optimal ventilator mode to facilitate liberation remains. Herein, we report the protocol for a systematic review and network meta-analysis comparing modes of ventilation to facilitate the liberation of a patient from invasive mechanical ventilation.Methods and analysisWe will search MEDLINE, EMBASE, PubMed, the Cochrane Library from inception to April 2019 for randomised trials that report on critically ill adults who have undergone invasive mechanical ventilation for at least 24 hours and have received any mode of assisted invasive mechanical ventilation compared with an alternative mode of assisted ventilation. Outcomes of interest will include: mortality, weaning success, weaning duration, duration of mechanical ventilation, duration of stay in the acute care setting and adverse events. Two reviewers will independently screen in two stages, first titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, two investigators will extract all data, and assess risk of bias in all eligible studies using the Modified Cochrane Risk of Bias tool. Reviewers will resolve disagreement by discussion and consultation with a third reviewer as necessary. Using a frequentist framework, we will perform random-effect network meta-analysis, including all ventilator modes in the same model. We will calculate direct and indirect estimates of treatment effect using a node-splitting procedure and report effect estimates using OR and 95% CI. We will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation methodology.Ethics and disseminationResearch ethics board approval is not necessary. The results will be disseminated through publication in a peer-reviewed journals.PROSPERO registration numberCRD42019137786
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Mushtaq, Nasir, Kellie Brown, Vanette Littlefield, Roger Barton, and Shawn Sood. "Neurally Adjusted Ventilatory Assist Is Associated with Greater Initial Extubation Success in Postoperative Congenital Heart Disease Patients when Compared to Conventional Mechanical Ventilation." Journal of Pediatric Intensive Care 07, no. 03 (February 5, 2018): 147–58. http://dx.doi.org/10.1055/s-0038-1627099.
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AbstractExtubation failure is associated with considerable morbidity and mortality in postoperative patients with congenital heart disease (CHD). The study purpose was to investigate initial extubation success utilizing neurally adjusted ventilatory assist (NAVA) compared with pressure-regulated volume controlled, synchronized intermittent mandatory ventilation with pressure support (SIMV-PRVC + PS) for ventilatory weaning in patients who required prolonged mechanical ventilation (MV). Also, total days on MV, inotropes, sedation, analgesia, and pediatric intensive care unit (PICU) length of stay (LOS) between both groups were compared. This was a non-randomized pilot study utilizing historical controls (SIMV-PRVC + PS; n = 40) compared with a prospective study population (NAVA; n = 35) in a Level I PICU and was implemented to help future trial designs. All patients (n = 75) required prolonged MV ≥96 hours due to their complex postoperative course. Ventilator weaning initiation and management was standardized between both groups. Ninety-seven percent of the NAVA group was successfully extubated on the initial attempt, while 80% were in the SIMV-PRVC + PS group (p = 0.0317). Patients placed on NAVA were eight times more likely to have successful initial extubation (odds ratio [OR]: 8.50, 95% confidence interval [CI]: 1.01, 71.82). The NAVA group demonstrated a shorter median duration on MV (9.0 vs. 11.0 days, p = 0.032), PICU LOS (9.0 vs. 13.5 days, p < 0.0001), and shorter median duration of days on dopamine (8.0 vs. 11.0 days, p = 0.0022), milrinone (9.0 vs. 12.0 days, p = 0.0002), midazolam (8.0 vs. 12.0 days, p < 0.0001), and fentanyl (9.0 vs. 12.5 days, p < 0.0001) compared with the SIMV-PRVC + PS group. NAVA compared with SIMV-PRVC + PS was associated with a greater initial extubation success rate. NAVA should be considered as a mechanical ventilator weaning strategy in postoperative congenital heart disease (CHD) patients and warrants further investigation.
Dissertations / Theses on the topic "VENTILATOR WEANING/mortality"
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Yamauchi, Liria Yuri. ""Falência do desmame: risco, fatores associados e prognóstico de pacientes sob ventilação mecânica prolongada"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-10082005-102441/.
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OBJETIVOS: Estimar a taxa de falência de desmame, identificar fatores de risco para a falência, estimar a taxa de mortalidade na unidade de terapia intensiva e hospitalar em um grupo heterogêneo de pacientes com ventilação mecânica prolongada. MÉTODOS: Trata-se de um estudo de coorte prospectivo de pacientes adultos consecutivamente internados em 11 unidades de terapia intensiva e que receberam ventilação mecânica por 3 dias ou mais. As variáveis de desfecho incluíram o resultado do desmame (falência ou sucesso) e o desfecho da UTI (alta ou óbito).RESULTADOS: Dos 189 pacientes incluídos, 149 (79%) foram desmamados com sucesso e 40 (21%) necessitaram de reintubação dentro de 48 horas, constituindo o grupo falência.Através da análise de regressão logística, o sexo feminino foi identificado como fator independentemente associado com a falência do desmame. Os pacientes com falência permaneceram por mais tempo na UTI (p < 0,01). A freqüência de traqueostomia foi maior no grupo com falência (p < 0,01). A taxa de mortalidade na UTI foi de 21%; IC de 95%: 15-27%. O modelo de regressão de Cox ajustado para a gravidade à admissão na UTI identificou que a falência do desmame aumentou o risco de morte na UTI (RR: 3,08; p < 0,01). CONCLUSÔES: Após o controle para variáveis clínicas e gravidade à internação na UTI, o sexo feminino apresentou associação independente com a falência do desmame. Pacientes com falência apresentaram maior tempo de internação na UTI, maior taxa de traqueostomia e maior risco de morte na UTIOBJECTIVE: To determine the rate of weaning failure, risk factors, intensive care unit (ICU) and hospital outcomes in a number of heterogeneous patients with prolonged MV. DESIGN, SETTING, AND SUBJECTS: Prospective cohort of consecutive adult patients admitted to 11 ICU who received MV (³ 72 hours). Study endpoints included weaning failure vs success and ICU death vs survival. RESULTS: Of 189 intubated patients, 149 (79%) were succesfully extubated, and 40 (21%) required reintubation within 48 hours.Using multiple logistic regression, female gender was an independent predictor of weaning failure. The mean ICU length of stay was significantly longer in weaning failure group (p < 0.01). The rate of tracheostomy was higher in the failure group (p < 0.01). The ICU mortality rate was 21%; 95% CI, 15 - 27%. In a Cox model adjusting on severity at ICU admission, weaning failure increased the risk of death in the ICU (RR: 3.08; p < 0,01). CONCLUSION: After adjusting for severity of ilness and medical conditions, female gender had a significant independent association with increased risk of weaning failure (WF). WF had association with prolonged ICU stay and higher rate of tracheostomy. Patients with weaning failure were 3 times more likely to die in the ICU
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Lai, Hui-Hsuan, and 賴慧瑄. "Successfully Weaning from Mechanical Ventilation and Mortality among Patients with Tracheostomy：A NationwideSurvival Analysis." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/2644yd.
Full textBooks on the topic "VENTILATOR WEANING/mortality"
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Nava, Stefano, and Luca Fasano. Ventilator Liberation Strategies. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0039.
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The weaning process should ideally begin as soon as the patient is intubated and continue through the treatment of the cause inducing acute respiratory failure. Weaning includes the assessment of readiness to extubate, extubation, and post-extubation monitoring; it also includes consideration of non-invasive ventilation which has been shown to reduce the duration of invasive mechanical ventilation in selected patients. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation and should be achieved rapidly, since prolonged mechanical ventilation is associated with increased risk of complications and mortality and with increased costs. During mechanical ventilation, medical management should seek to correct the imbalance between respiratory load and ventilatory capacity (reducing the respiratory and cardiac workload, improving gas exchange and the ventilatory pump power). Ventilator settings delivering partial ventilatory pump support may help prevent ventilator-induced respiratory muscles dysfunction. Daily interruption of sedation has been associated with earlier extubation. Critically ill patients should be repeatedly and carefully screened for readiness to wean and readiness to extubate, and objective screening variables should be fully integrated in clinical decision making.
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Kahn, Jeremy M. The Role of Long-Term Ventilator Hospitals. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0004.
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Long-term ventilator facilities play an increasingly important role in the care of chronically critically ill patients in the recovery phase of their acute illness. These hospitals can take several forms, depending on the country and health system, including �step-down� units within acute care hospitals and dedicated centres that specialize in weaning patients from prolonged mechanical ventilation. These hospitals may improve outcomes through increased clinical experience at applying protocolized weaning approaches and specialized, multidisciplinary, rehabilitation-focused care; they may also worsen outcomes by fragmenting the episode of acute care across multiple hospitals, leading to communication delays and hardship for families. Long-term ventilator facilities may also have important �spillover effects�, in that they free ICU beds in acute care hospitals to be filled with greater numbers of acute critically ill patients. Current evidence suggests that mortality of chronically critically ill patients is equivalent between acute care hospitals and specialized weaning centres; however, mechanical ventilation may be longer and cost of care higher in patients who remain in acute care hospitals. Given the rising incidence of prolonged mechanical ventilation and capacity constraints on acute care ICUs, long-term ventilator hospitals are likely to serve a key function in critical illness recovery.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0025.
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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_001.
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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_002.
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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_003.
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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.
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Creagh-Brown, Benedict, Joerg Steier, and Nicholas Hart. Prolonged Weaning. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0049.
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In 25% of critically ill patients, weaning from mechanical ventilation takes longer than 10 days; indeed, 5–10% of patients still require ventilation at 30 days. Those with prolonged weaning, after adjustment for other variables, have a higher mortality within the intensive care unit than those without weaning delay or failure. The pathophysiological processes that result in weaning failure are complex and result of an imbalance between the neural respiratory drive, respiratory muscle load, and capacity. The clinical conditions resulting in these pathophysiological conditions should be methodically considered in patients requiring prolonged weaning. These patients often need a personalized weaning and rehabilitation approach, based on their underlying pathological condition as well as their psychological and physiological status.
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Carlucci, Annalisa, and Paolo Navalesi. Weaning failure in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0103.
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Weaning failure has been defined as failure to discontinue mechanical ventilation, as assessed by the spontaneous breathing trial, or need for re-intubation after extubation, so-called extubation failure. Both events represent major clinical and economic burdens, and are associated with high morbidity and mortality. The most important mechanism leading to discontinuation failure is an unfavourable balance between respiratory muscle capacity and the load they must face. Beyond specific diseases leading to loss of muscle force-generating capacity, other factors may impair respiratory muscle function, including prolonged mechanical ventilation, sedation, and ICU-acquired neuromuscular dysfunction, potentially consequent to multiple factors. The load depends on the mechanical properties of the respiratory system. An increased load is consequent to any condition leading to increased resistance, reduced compliance, and/or occurrence of intrinsic positive-end-expiratory pressure. Noteworthy, the load can significantly increase throughout the spontaneous breathing trial. Cardiac, cerebral, and neuropsychiatric disorders are also causes of discontinuation failure. Extubation failure may depend, on the one hand, on a deteriorated force-load balance occurring after removal of the endotracheal tube and, on the other hand, on specific problems. Careful patient evaluation, avoidance and treatment of all the potential determinants of failure are crucial to achieve successful discontinuation and extubation.
Book chapters on the topic "VENTILATOR WEANING/mortality"
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Vivar, F. Frutos, I. Alía Robledo, and A. Esteban de la Torre. "Factors Associated with Mortality in Mechanically Ventilated Patients." In Mechanical Ventilation and Weaning, 133–51. Berlin, Heidelberg: Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-56112-2_8.
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Masip, Josep, Kenneth Planas, and Arantxa Mas. "Non-invasive ventilation." In The ESC Textbook of Intensive and Acute Cardiovascular Care, edited by Marco Tubaro, Pascal Vranckx, Eric Bonnefoy-Cudraz, Susanna Price, and Christiaan Vrints, 267–83. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198849346.003.0022.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.
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Hilton, Andrew. "Left ventricular diastolic function." In Oxford Textbook of Advanced Critical Care Echocardiography, edited by Anthony McLean, Stephen Huang, and Andrew Hilton, 93–117. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198749288.003.0007.
Full textAbstract:
Abnormalities of diastolic function in the critically ill have been demonstrated to be associated with important intensive care outcomes such as mortality and ventilator weaning failure. The assessment of left ventricular (LV) diastolic function refers requires the analysis of the onset, pattern, and termination of left ventricular filling as determined by the time course and magnitude of the pressure gradient between the left atrium (LA) and LV. Echocardiographic two-dimensional and Doppler findings can provide an indirect assessment of the pattern of LV filling and LA–LV pressure gradients. Current guidelines suggest as a minimum the measurement of LA area and volume, mitral inflow velocities, mitral annular velocities, and tricuspid regurgitant flow velocity (as an indirect assessment of left atrial pressure). Other measurable parameters are also available (e.g. pulmonary venous inflow velocities, isovolumic relaxation time, Colour M-mode mitral propagation velocity) and these may help in identifying and characterizing diastolic dysfunction. Generally, however, they are more difficult to perform. Irrespective of the echocardiographic findings measured and the guidelines followed, there is a paucity of data that validates either the individual measures or the guidelines themselves in the critically ill.
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Walden, Andrew. "Failure to wean from mechanical ventilation." In Focused Intensive Care Ultrasound, edited by Marcus Peck and Peter Macnaughton, 199–204. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198749080.003.0023.
Full textAbstract:
Failure to wean from mechanical ventilation is a common problem in intensive care and represents a significant burden in terms of prolonged intensive care stay with associated morbidity and mortality. Ultrasound examination can aid the systematic assessment of the underlying pathophysiology that is often complex and multifactorial. This chapter reviews the role of ultrasound in assessing the contribution of inadequate lung aeration, pleural effusion, and diaphragmatic and cardiac function to weaning failure.