Duration Of Ventilator Use Research Articles

Effectiveness of spiritual care interventions among patients in the intensive care unit: A systematic review and meta-analysis.

Spiritual care interventions can be an important source of emotional support for patients in the intensive care unit (ICU). However, there is wide variation in the literature and no quantitative assessment to synthesize the results of these studies. To examine the effectiveness of spiritual care interventions on disease-related physiological parameter and treatment outcomes and psychosocial well-being outcomes among patients in the ICU. A comprehensive search was conducted across 11 databases from inception to 27 May 2024. Studies involving the implementation of spiritual care interventions for patients in the ICU were included. Cochrane's bias risk tool and JBI Critical Appraisal Checklist were used to examine the methodological quality of included studies. Review Manager 5.3 was used to conduct meta-analyses. A total of 18 studies were included. Meta-analysis showed that spiritual care interventions could significantly reduce mean arterial pressure (MAP) (MD: -12.12, 95% CI: [-23.68, -0.56], p = .04), length of stay in the ICU (MD: -5.49, 95% CI: [-8.99, -2.00], p = .002), and improved consciousness (MD: 3.91, 95% CI: [1.42, 6.39], p = .002), anxiety (SMD: -1.78, 95% CI: [-3.06, -0.50], p = .006), spiritual well-being (SMD: 1.57, 95% CI: [0.05, 3.08], p = .04) and comfort (MD: 15.53, 95% CI: [10.81, 20.25], p < .01) among patients in the ICU, but had no significant effects on heart rate (HR), respiratory rate (RR), pulse rate (PR), blood pressure (BP), oxygen saturation (SpO2), duration of ventilator use and pain. Spiritual care interventions could reduce MAP and length of stay in the ICU; improve consciousness, anxiety, spiritual well-being and comfort among patients in the ICU; and are still inconclusive for HR, RR, PR, BP, SpO2, duration of ventilator use and pain. Urgent efforts are needed to better integrate spiritual care interventions into clinical care to enhance patient well-being. Spiritual care interventions could improve well-being of patients in the ICU.

Mortality rate analysis of patients on invasive mechanical ventilation in the intensive care unit on day 28.

Outcomes in patients receiving invasive mechanical ventilation (IMV) are currently unclear. The present study aimed to explore the prognostic factors of the mortality rate on day 28 in patients treated in the intensive care unit (ICU) and undergoing IMV. The IMV Mortality Prediction Score (IMPRES) of 129 patients in the ICU receiving IMV after emergency (or selective) endotracheal intubation from March 2018 to August 2020 was calculated. The patients were divided into survival (n=73) and death groups (n=56) on day 28. The predictive factors of independent and combined mortality rates were determined using a receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). The AUC of the IMPRES for predicting patient death on day 28 was 0.785 (95% confidence interval (CI): 0.704-0.864, P<0.01). When the IMPRES cut-off was 4.50, the Youden index was at its maximum (0.487) with a sensitivity of 85.7% and a specificity of 63.0%. The AUC of the ventilator use time (days) at 12.5 days cut-off was 0.653 (95% CI: 0.56-0.746, P<0.01), the Youden index was 0.235 with a sensitivity of 52.1% and a specificity of 71.4%. The AUC of the IMPRES combined with the duration of ventilator use was 0.856 (95% CI: 0.789-0.922, P<0.001), the Youden index was 0.635 with a sensitivity of 84.9% and a specificity of 78.6%. The IMPRES was observed to be the main factor influencing the mortality rate of patients receiving IMV at the ICU on day 28, and the IMPRES combined with the duration of ventilator use had a significant predictive value for the 28-day mortality rates of these patients.

Impact of early swallowing rehabilitation on oral feeding in patients with dysphagia following traumatic brain injury

ABSTRACT Objective This study aimed to evaluate the effects of early swallowing rehabilitation on safe oral feeding in dysphagia patients following traumatic brain injury. Methods Sixty-nine patients were divided into intervention and control groups, with the intervention group receiving swallowing rehabilitation therapy. The severity of swallowing disorders, cognitive function, and level of consciousness were assessed using the Mann Assessment of Swallowing Ability (MASA), Rancho Los Amigos (RLA), and Glasgow Coma Scale (GCS) before and after the intervention. Additionally, data on ventilator use duration and hospital stay length were collected. Result The intervention group exhibited a significant improvement in MASA scores (68.58) compared to the control group (38.10). No significant differences were observed in GCS and RLA scores post-intervention, indicating similar levels of consciousness and cognitive function between groups. While the duration of ventilator use was comparable, the intervention group achieved safe oral swallowing 12.12 days earlier than the control group. Discussion The findings demonstrate that early swallowing rehabilitation significantly enhances recovery dysphagia post-brain injury, as evidenced by improved MASA scores and earlier achievement of safe oral feeding, despite no notable changes in cognition or consciousness. This underscores the importance of implementing early rehabilitation strategies in clinical practice.

Study of Association of Infection-related Biomarkers and Inflammatory Cytokines with the Severity of Coronavirus Disease 2019: A Prospective Observational Study.

Sepsis-linked biomarkers and inflammatory cytokines are markedly associated with potential risks of progression to severity in coronavirus disease 2019 (COVID-19). Clinical studies that find a plausible association between sepsis biomarkers and the inflammatory cytokine response in the Indian community need to be studied with clarity. To study the relationship between sepsis-linked biomarkers and inflammatory cytokines interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, and D-dimer linked to clinical severity resulting from COVID-19 infection. The present prospective observational cohort study was conducted between March and December 2021 in the Department of Critical Care Medicine at a tertiary care hospital in Pune, Maharashtra, India, on COVID-19 patients. Upon patient admission, inflammatory biomarkers such as IL-6, CRP, ferritin, and D-dimer were recorded. Oxygen requirements during hospitalization, invasive mechanical ventilation (IMV), high-flow nasal cannula (HFNC), noninvasive mechanical ventilation (NIV), duration of ventilator use, intensive care unit (ICU) stay, and mortality were documented. The average levels of IL-6, CRP, D-dimer, and serum ferritin protein recorded at the time of patient arrival were notably higher in the severe (S) group compared to the nonsevere (NS) group. The average duration of ventilator use, ICU stay, and hospital stay was significantly longer in the S group than in the NS group. The percentage of patients who required HFNC, NIV, IMV, and mortality was significantly higher in the S group compared to the NS group. Sepsis-linked biomarkers and inflammatory cytokines such as IL-6, CRP, D-dimer, and serum ferritin levels at the time of admission were markedly associated with severity outcomes in COVID-19 infection.

Effects of mechanical insufflation-exsufflation on ventilator-free days in intensive care unit subjects with sputum retention; a randomized clinical trial.

Mechanical insufflation-exsufflation (MI-E) facilitates extubation. However, its potential to reduce the duration of ventilator use remains unclear. Therefore, the present study investigated whether the use of MI-E shortened the duration of mechanical ventilation in patients with high sputum retention. A randomized open-label trial was conducted at a single intensive care unit (ICU) in Japan between November 2017 and June 2019. Ventilated subjects requiring suctioning at least once every hour due to sputum retention were randomly assigned to the MI-E group or conventional care group. The primary endpoint was the number of ventilator-free days on day 28. Secondary endpoints were ventilator days in surviving subjects, the length of ICU stay, and mortality and tracheostomy rates among survivors. Forty-eight subjects (81% males) with a median age of 72 years (interquartile range [IQR], 65-85 years) were enrolled. There were 27 subjects in the MI-E group and 21 in the control group. The median number of ventilator-free days was 21 (IQR, 13-24) and 18, respectively (IQR, 0-23) (P = .38). No significant differences were observed in the ICU length of stay (median, 10 days (IQR, 7-12) vs 12 days (IQR, 6-15); P = .31), mortality rate (19% vs 15%; odds ratio [OR], 1.36 [0.28-6.50]; P = .69), or tracheostomy rate among survivors (14% vs 28%; OR, 0.40 [0.08-1.91]; P = .25). In ventilated subjects in the ICU with high sputum retention, the use of MI-E did not significantly increase the number of ventilator-free days over that with conventional care.

Relationship Between the Use of Topical Hypothermia with Ice Water to Postoperative Pulmonary Complications of Coronary Artery Bypass Graft

Introduction: Open heart surgery such as coronary artery bypass graft (CABG) is a heart surgery technique that uses a machine cardiopulmonary bypass (CPB) which can cause postoperative complications such as systemic inflammatory response syndrome (SIRS) and myocardial damage. Myocardial protection can be achieved through topical hypothermia techniques by lowering the heart temperature using a cold solution or ice cubes. Although several studies have shown its benefit in protecting the myocardium, the use of topical hypothermia remains controversial due to its uneven cooling effect and risk of tissue injury. This study aims to evaluate the relationship between the use of topical hypothermia of ice water and pulmonary complications of open heart surgery.&#x0D; Methods: This research is an analytical observational cohort retrospective comparison of pulmonary complications postoperatively in cardiac surgery patients who received systemic cardioplegia alone versus those who received a combination of systemic cardioplegia and topical hypothermia. Data collection was carried out using techniques consecutive sampling.&#x0D; Results: Of the 32 research subjects, the results of the analysis showed that the use of topical hypothermia did not have a statistically significant relationship (p&gt;0.05) on the incidence of leukocytosis, pulmonary edema, duration of surgery, duration of ventilator use, duration of hospitalization, and mortality compared to the group that only received systemic cardioplegia. There was a significant relationship (p&lt;0.05) between the incidence of pleural effusion in the topical hypothermia group.&#x0D; Conclusion: The use of topical hypothermia in cardiac surgery has a significant association with a higher incidence of pleural effusion.

Prolonged use of neuromuscular blocking agents is associated with increased long-term mortality in mechanically ventilated medical ICU patients: a retrospective cohort study

BackgroundNeuromuscular blockade agents (NMBAs) can be used to facilitate mechanical ventilation in critically ill patients. Accumulating evidence has shown that NMBAs may be associated with intensive care unit (ICU)-acquired weakness and poor outcomes. However, the long-term impact of NMBAs on mortality is still unclear.MethodsWe conducted a retrospective analysis using the 2015–2019 critical care databases at Taichung Veterans General Hospital, a referral center in central Taiwan, as well as the Taiwan nationwide death registry profile.ResultsA total of 5709 ventilated patients were eligible for further analysis, with 63.8% of them were male. The mean age of enrolled subjects was 67.8 ± 15.8 years, and the one-year mortality was 48.3% (2755/5709). Compared with the survivors, the non-survivors had a higher age (70.4 ± 14.9 vs 65.4 ± 16.3, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (28.0 ± 6.2 vs 24.7 ± 6.5, p < 0.001), a longer duration of ventilator use (12.6 ± 10.6 days vs 7.8 ± 8.5 days, p < 0.001), and were more likely to receive NMBAs for longer than 48 h (11.1% vs 7.8%, p < 0.001). After adjusting for age, sex, and relevant covariates, the use of NMBAs for longer than 48 h was found to be independently associated with an increased risk of mortality (adjusted HR: 1.261; 95% CI: 1.07–1.486). The analysis of effect modification revealed that this association was tended to be strong in patients with a Charlson Comorbidity Index of 3 or higher.ConclusionsOur study demonstrated that prolonged use of NMBAs was associated with an increased risk of long-term mortality in critically ill patients requiring mechanical ventilation. Further studies are needed to validate our findings.

Association of Neutrophil-to-lymphocyte Ratio with Prognosis in Sepsis – An Observational Study from a Tertiary Care Center

Objectives: This study aims to determine the association of neutrophil-lymphocyte ratio (NLR) with sequential organ failure assessment (SOFA) score, ventilator use, duration of intensive care unit (ICU) stay, and mortality among patients with sepsis. Methods: This prospective observational study included 220 patients with sepsis admitted to the ICU. Details such as age, gender, comorbidities, complaints, SOFA score, diagnosis, and outcomes were collected. Routine investigations included complete blood count, C-reactive protein, and procalcitonin. NLR was derived using the Beckman Coulter DXH-800 Hematology Analyser. A cutoff of 9.11 was taken as high NLR. Patients were followed up till 28 days after treatment. The outcomes studied included 28-day mortality and ICU stay. Results: The mean SOFA score were 7.07 ± 2.56. Based on NLR cutoffs, 146 (66.36%) patients had high NLR while 74 (33.64%) cases had normal or low NLR. SOFA score showed no significant association with high NLR (P = 0.62). Ventilator was used in 118 (53.6%) cases with median of 3.5 days’ duration. The overall ICU stay was 5.6 ± 4.9 days. Mortality was seen in 46 (20.9%) cases. Compared to those with normal NLR, patients with high NLR had significantly more ventilator use (60.9% vs. 39.1%, P = 0.0027) and mortality (30.14% vs. 2.7%, P = 0.0004). The duration of ventilator use and ICU stay was statistically comparable. Conclusion: High NLR shows a significant association with adverse outcomes of sepsis patients in terms of ventilator use and mortality. Since it is cheap and easy to use, it can be applied in more basic settings while monitoring sepsis patients.

Effect of different ventilation methods combined with pulmonary surfactant on neonatal acute respiratory distress syndrome.

Acute respiratory distress syndrome precipitates is widespread pulmonary injury in impacted individuals, the neonatal respiratory distress syndrome (NRDS), primarily observed in preterm infants, represents a prevalent critical condition in neonatal clinical settings. To investigate the clinical efficacy of various ventilation strategies combined with pulmonary surfactant (PS) therapy in the treatment of NRDS. A total of 20 neonates diagnosed with respiratory distress syndrome, admitted between May 2021 and June 2022, were randomly assigned to either a research group or a control group. Neonates in the research group received treatment involving high-frequency oscillatory ventilation (HFOV) in conjunction with PS. In contrast, neonates in the control group were administered either controlled mechanical ventilation or synchronous intermittent mandatory ventilation, combined with PS. Arterial blood samples from the neonates in both groups were collected before treatment, as well as 6 h, 12 h, 24 h, and 48 h post-treatment. These samples underwent blood gas analysis, with measurements taken for pH value, partial pressures of oxygen (O2) and carbon dioxide. Concurrently, data was collected on the duration of ventilator use, length of hospitalization time, O2 treatment time, treatment outcomes, and complications of the ventilator. From 6-48 h post-treatment, both groups demonstrated significant improvements in arterial blood pH and oxygen partial pressure, along with a significant decrease in carbon dioxide partial pressure compared to pre-treatment values (P < 0.05). Although these changes progressed over time, there were no significant differences between the two groups (P > 0.05). However, the research group had significantly lower X-ray scores, shorter hospitalization time, and less time on O2 therapy compared to the control group (P < 0.05). Mortality rates were similar between the two groups (P > 0.05), but the research group had a significantly lower incidence of complications (P < 0.05). The integration of HFOV combine with PS has proven to effectively expedite the treatment duration, decrease the occurrence of complications, and secure the therapeutic efficacy in managing NRDS.

Impact of spinal injury on mortality in patients with major trauma: A propensity-matched cohort study.

Major trauma is defined as a significant injury or injury that has the potential to be life-threatening and is quantitatively identified as an injury severity score (ISS) >15. Spinal injuries are common in patients with major trauma; however, because spinal injury is not independently included in the ISS calculation, the impact of spinal injury on mortality in patients with major trauma has not been fully elucidated. The purpose of this study is to identify the association between spinal injury and mortality in patients with major trauma. From January 1, 2016, to December 31, 2020, retrospective analysis was conducted on 2893 major trauma adult patients admitted to a level 1 trauma center. There were 781 patients in the spinal injury group and 2112 patients in the group without spinal injury. After matching the 2 groups 1:1, we compared injury mechanism, mortality, cause of death, intensive care unit length of stay (ICU LOS), and duration of ventilator use between spinal injury group and matched cohorts. Falls and traffic accidents were the most common injury mechanisms in the spinal injury group and the matched cohort, respectively. The mortality was significantly lower in the spinal injury group compared with the matched cohort (4.0% vs 7.9%, P = .001), and the ICU LOS was longer than the matched cohort (8.8 ± 17.4 days vs 7.2 ± 11.7 days, P = .028). In the spinal injury group, multiple organ failure (MOF) was the most common cause of death (41.9%), while that in the matched cohort was central nervous system (CNS) damage (61.3%). In patients with major trauma, spinal injury may act as a shock absorber for internal organs, which is thought to lower the mortality rate.

Isocaloric nutritional support reduces ventilator duration time in major trauma patients.

Major trauma patients need adequate nutrition for recovery. This study aimed to evaluate the adequacy of nutritional supply and the correlation between nutritional supply and clinical outcome. A single-centre retrospective observational study was undertaken, describing the amounts of energy and proteins provided to 320 critically ill trauma patients during the first 10 days after admission. The data were collected from the electronic medical records of patients admitted to the trauma intensive care unit during the study period and descriptive statistical analyses were performed with the SPSS software. The mean proportion of supplied energy to recommended energy during the first 10 days after admission was 57.5%, and the mean percentage of supplied protein to recommended protein intake was 51.3%. The patients were divided into those who received ≥70% (isocaloric nutrition group) and those who received <70% (hypocaloric nutrition group) of their estimated requirements. Both the duration of ventilator use (12.7 ± 10.5 vs. 16.0 ± 15.8 days, respectively, p = 0.009) and duration of parenteral nutrition (1.1 ± 1.4 vs. 2.0 ± 2.0 days, respectively, p = 0.001) were shorter in the isocaloric nutrition group (n = 83) than in the hypocaloric nutrition group (n = 237). Total energy and the amount of protein supplied were insufficient compared to the recommended amount. The duration of ventilator use was shorter in the isocaloric nutrition group than in the hypocaloric nutrition group. The association between shortened ventilator use and isocaloric nutrition requires further investigation as a potential intervention to reduce the risk of complications such as ventilator-related pneumonia.

Prevalence and characteristics of Postoperative Cognitive Dysfunction (POCD) in on-pump cardiac surgery patients at Dr. Kariadi General Hospital Semarang

Background: Postoperative Cognitive Dysfunction or POCD is a reversible decline in the cognitive function of patients after surgery. The risk factors for POCD are age, comorbidities, duration of CPB, intraoperative hypoperfusion, duration of ventilator use, and postoperative sedation are risk factors of POCD. This study aims to determine the prevalence and characteristics of postoperative cognitive dysfunction (POCD) in patients who undergo on-pump cardiac surgery at Dr. Kariadi General Hospital. Methods: This study's population was all patients undergoing on-pump cardiac surgery at Dr. RSUP. Kariadi in July 2021-December 2021. The study subject was 97 patients, obtained by total sampling technique. The study subjects were examined for cognitive function with MoCA-INA one day before surgery and the third day after surgery. Data were analyzed using SPSS version 23 for Windows. Results: There were 68 (70.1%) patients who experienced POCD and 29 (29.9%) patients who did not experience POCD. The median age of patients with POCD is 50 (18-68) years and 36 (18-63) years for patients without POCD. Based on MAP during CPB, patients with POCD had a median of 64 (51-80) minutes. In patients with POCD, the median length of CPB was 53 (22-92) minutes, and the median length of the aortic cross-clamp clamp was 35 (11-69) minutes. Conclusion: We found a high prevalence of POCD patients after on-pump cardiac surgery, as many as 70.1% at Dr. Kariadi General Hospital.

Risk factors of ventilator-associated pneumonia in intensive care patients at tertiary referral hospital

Link of Video Abstract: https://youtu.be/YEQ3ICJPmxA Background: Ventilator-associated pneumonia (VAP) occurs after endotracheal intubation and ventilator for more than 48 hours therefore it is an emerging threat to patient safety. The aim of this study is to determine the incidence and compare the risk factors of ventilator patients diagnosed with ventilator-associated pneumonia and patients with ventilators who are not diagnosed with ventilator-associated pneumonia. Methods: This study used a retrospective observational with a case-control approach. Data was collected from January 2019 to December 2021. The risk factors to be analysed were comorbidities, antibiotic therapy, length of stay in the intensive care unit, duration of ventilator use, and history of surgery. Results: There were 18 patients in the VAP and the control groups met the inclusion and exclusion criteria. The incidence of incidents in 2019 was 3.2 per 1000 ventilator days; in 2020, it was 1.2 per 1000 ventilator days; and in 2021, it was 1.2 per 1000 ventilator days. Comparison test results using Mann-Whitney showed a difference with a p&lt;0.05. Patients with prolonged use of ventilators (p&lt;0.05) and prolonged hospitalization (p&lt;0.05) have a higher risk of developing ventilator-associated pneumonia. The average VAP occurs on the fourth day on a ventilator. Gram-negative bacteria, Pseudomonas aeruginosa, Acinetobacter baumanii, and Klebsiella pneumoniae cause most bacterial infections Conclusion: There is a high risk of developing VAP in patients with prolonged use of ventilators and extended stays in the intensive care unit of the Tertiary Referral Hospital.

The Characteristics and Duration of Mechanical Ventilator Use on Patient with Neuromuscular Paralysis Diseases in Intensive Care Unit (ICU) Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar in December 2019 - December 2022

Background: Amyotrophic Lateral Sclerosis (ALS), Guillain-Barre Syndrome (GBS), and Myasthenia Gravis (MG) are neuromuscular diseases which involved the dysfunction of peripheral nerves or muscles. Respiratory muscle weakness often happens in neuromuscular diseases, where it leads to the requirement of mechanical ventilation or even death from respiratory failure. This study aims to determine the characteristics and duration of mechanical ventilator usage in patients with neuromuscular paralysis diseases at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar. Results: From December 2019 to December 2022, there were 5 GBS patients (20%), 19 MG crisis patients (76%), and 1 ALS patient (4%). The mean of age was 40.8 years and the majority was female. The average duration of ventilator use in GBS patients was 25.8 days, in MG crisis was 26.2 days, and in ALS was 30 days, therefore all of them were prolonged. The outcomes were 3 GBS patients (12%) lived and 2 GBS patients (8%) died; 14 MG crisis patients (56%) lived and 5 MG crisis patients (20%) died; and 1 ALS patient (4%) died. The ICU diagnosis which complicated the patients were electrolyte disturbances, hypoalbuminemia, and community or ventilator acquired pneumonia. Conclusion: Neuromuscular disease mostly causes respiratory muscle weakness and results in increased mortality and morbidity requiring mechanical ventilation. Risk factors affecting the prolonged duration of ventilator use were electrolyte disturbances, hypoalbuminemia, and pneumonia. Keywords: length of ventilator usage, neuromuscular paralysis disease, amyotrophic lateral sclerosis, Guillain-Barre syndrome, myasthenia gravis, intensive care unit, Bali

PROLONGED VENTILATOR IN ICU PUTRI HIJAU HOSPITAL WHAT SHOULD WE DO IN BPJS ERA

Number of patients with chronic kidney disease (CKD) is increasing progressively worldwide, especially in developing countries. In Indonesia, the largest proportion of hemodialysis patients is due to hypertension and diabetes. Chronic kidney disease (CKD) is a progressive disease and causes variety of complications, which contribute to high mortality, morbidity and poor quality of life. In many cases, chronic kidney disease affects lung function directly or indirectly. Impaired renal filtration results in tissue edema that affects gas exchange processes and lead to life-threatening conditions. The clinical manifestations of patients with pulmonary edema are shortness of breath, tachypnea, cyanosis and use of accessory muscles of respirations and develop into acute respiratory distress syndrome (ARDS). The goals of treatment for pulmonary edema are to reduce symptoms, improve ventilation and adequate oxygenation, maintain cardiac output and perfusion to vital organs. Patients with pulmonary edema require mechanical ventilation and intensive care support. The duration of ventilator use in pulmonary edema varies from 1 to 40 days. Prolonged ventilator use is a challenge to hospital financing in BPJS Kesehatan era with current INA-CBGs tariff system.

Efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection: a retrospective cohort study

Systemic inflammatory response syndrome (SIRS) after surgery for acute Stanford type A aortic dissection (ATAAD) via cardiopulmonary bypass (CPB) are strongly associated with mortality. Although the sivelestat sodium has been approved for the treatment of patients with acute lung injury, there is currently no enough evidence for improving inflammatory response and reducing the associated mortality. Our study aims to investigate the efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection. A total of 71 ATAAD patients who received surgical treatment at our center from January 2021 to December 2021 retrospectively reviewed. Patients were divided into the sivelestat sodium group and the control group. Clinical information including the postoperative oxygenation index (PaO2/FiO2), white blood cell (WBC) count, procalcitonin (PCT) level, interleukin-6 (IL-6) level, duration of ventilator use (hours), intensive care unit stay (days), and 28-day mortality rate, were collected. The statistical inference differences between the groups were compared using the non-paired Student's t-test, Wilcoxon rank sum test, chi squared test and repeated analysis of variance (ANOVA). There were no significant differences between the sivelestat sodium group and the control group in terms of baseline characteristics (all P>0.05). The mortality rate was decreased in the sivelestat sodium group than the control group (10% vs. 13.73%). The subgroup analysis showed that for patients with a mechanical ventilation duration >96 h, the 48-h oxygenation index (149±53 vs. 260±66, P=0.001), and the 72-h oxygenation index (165±66 vs. 288±95, P=0.002) were significantly lower in the control group than the sivelestat sodium group. And the postoperative WBC count (P=0.015) and PCT level (P=0.033) were significantly lower in the sivelestat sodium group than the control group in post-operative day 4. Sivelestat sodium can improves the postoperative oxygenation index and inflammatory response for ATAAD patients requiring mechanical ventilation for extended periods.

The Significance of Implementing Bilevel Positive Airway Pressure under Cluster Nursing in Improving the Survival Possibility of Patients with Severe Pulmonary Infection Complicated by Respiratory Failure.

Objective To explore the significance of bilevel positive airway pressure (BIPAP) under cluster nursing in improving the survival probability of patients with severe pulmonary infection (SPI) complicated by respiratory failure (RF). Methods This research included 153 SPI patients complicated by RF (SPI + RF) admitted between January 2020 and March 2022, including 55 cases in group A who were treated with BIPAP under cluster care during hospitalization, 47 cases in group B receiving invasive continuous mechanical ventilation during hospitalization, and 51 cases in group C treated with BIPAP under routine care during hospitalization. The three cohorts were compared regarding pre- and posttreatment serum inflammatory factors (IFs), blood gas (BG) parameters, heart rate (HR), and respiratory rate (RR). Besides, the cumulative time of ventilator use, successful ventilator weaning rate, mortality, and incidence of adverse events were counted. Finally, patients were scored for their psychological state using the Hamilton Anxiety/Depression Scale (HAMA/HAMD). Results The posttreatment TNF-α, IL-6, PCT, WBC, and PaCO2 reduced statistically in all the three groups, with the lowest levels found in group A and the highest in group B (P < 0.05); while PaO2 and SpO2 increased, with the highest values found in group A and the lowest in group B (P < 0.05). Among the three groups, group A had the shortest duration of ventilator use, the highest successful weaning rate, and the lowest incidence of adverse events (P < 0.05). Besides, HAMA and HAMD scores were the lowest in group A among the three groups, while those in group B were higher compared with group C (P < 0.05). Conclusion The implementation of BIPAP under cluster nursing can effectively reduce inflammatory responses of SPI + RF patients, improve their vital signs, and enhance their psychological state, which has extremely high clinical application value.

Efficacy of Oropharyngeal Administration of Pasteurized Colostrum in Very Low Birthweight Newborns in Reducing Late Onset Sepsis at a Tertiary Government Hospital in Manila City: A Randomized Control Trial

Background. Early administration of colostrum is beneficial because of the number of its immunologic components. The problem with very low birthweight (VLBW) patients is the establishment of early, tolerated, and sustained feeding. The study aimed to determine if early initiation of colostrum through oropharyngeal administration within the first hour of life reduces the risk of late-onset sepsis (LOS) among VLBW newborns.Methods. In this single-blinded randomized control trial, 84 VLBW infants with pediatric aging equal to greater than 28 weeks requiring oxygen support were enrolled. They were allocated to receive either pasteurized colostrum via oropharyngeal administration (treatment group) or none (control group). The occurrence of LOS, duration of ventilator use and oxygen support, time to reach full feeds, length of NICU stay, the occurrence of NEC, and mortality were documented.Results. A significantly greater proportion of patients who developed LOS were noted in the control group (n=38 (90.4%)) than in the treatment group (n=30 (71.4%)) (p=0.013). The use of colostrum, had a protective effect for LOS (RR=0.77; 95% CI=0.63-0.94). There were no significant differences in the secondary outcomes. Still, there was a trend towards a lower proportion of mortality (p=0.08), shorter duration of ventilator use (p=0.24) and oxygen support (p=0.17), shorter time to reach full feeds (p=0.30), and shorter NICU stay (p=0.33) in the treatment group.Conclusion. Patients given pasteurized colostrum had significantly less occurrence of LOS. The treatment group had a lower mortality rate, shorter ventilator use and oxygen support duration, faster time to reach full feeds, and shorter NICU stay, but the differences were not statistically significant. Oropharyngeal administration of pasteurized colostrum within the first hour of life reduces the risk of LOS among VLBW infants admitted to the NICU.

Prognosis of hospital-acquired pneumonia/ventilator-associated pneumonia with Stenotrophomonas maltophilia versus Klebsiella pneumoniae in intensive care unit: A retrospective cohort study.

IntroductionWe collected data on ventilator‐associated pneumonia (VAP) and hospital‐acquired pneumonia (HAP) induced by Stenotrophomonas maltophilia (SM) and Klebsiella pneumoniae (KP) and compared differences between two bacteria in mortality, duration of ventilator use, length of hospital stay, and risk factors for infection.ObjectivesThis study aimed to evaluate the prognosis and to find risk factors of SM‐HAP/VAP versus KP‐HAP/VAP in the intensive care unit (ICU).MethodsThis retrospective cohort study included patients admitted to the ICU between June 2019 and June 2021 and diagnosed with SM‐HAP/VAP or KP‐HAP/VAP. The primary outcome was 28‐day mortality.ResultsNinety‐two HAP/VAP patients (48 with SM‐HAP/VAP and 44 with KP‐HAP/VAP) were included. The 28‐day mortality was 16.7% (8/48 patients) in SM‐HAP/VAP and 15.9% (7/44 patients) in KP‐HAP/VAP (P = 0.922). After adjustment for potential confounders, the hazard ratios for 28‐day mortality in SM‐HAP/VAP were 1.3 (95% CI:0.5–3.7), 1.0 (95% CI:0.4–3.0), 1.4 (95% CI:0.5–4.0), and 1.1 (95% CI:0.4–3.4), respectively.ConclusionSM‐HAP/VAP and KP‐HAP/VAP patients in ICU might have a similar prognosis in mortality, the total duration of the artificial airway and ventilator use, the total length of ICU stay, and hospital stay. The risk factors of SM‐HAP/VAP versus KP‐HAP/VAP might be the artificial airway, ventilator use, gastric tube placement, acid suppressant and antibiotics (especially carbapenem).

Machine learning for predicting successful extubation in patients receiving mechanical ventilation.

Ventilator liberation is one of the most critical decisions in the intensive care unit; however, prediction of extubation failure is difficult, and the proportion thereof remains high. Machine learning can potentially provide a breakthrough in the prediction of extubation success. A total of seven studies on the prediction of extubation success using machine learning have been published. These machine learning models were developed using data from electronic health records, 8–78 features, and algorithms such as artificial neural network, LightGBM, and XGBoost. Sensitivity ranged from 0.64 to 0.96, specificity ranged from 0.73 to 0.85, and area under the receiver operating characteristic curve ranged from 0.70 to 0.98. The features deemed most important included duration of mechanical ventilation, PaO2, blood urea nitrogen, heart rate, and Glasgow Coma Scale score. Although the studies had limitations, prediction of extubation success by machine learning has the potential to be a powerful tool. Further studies are needed to assess whether machine learning prediction reduces the incidence of extubation failure or prolongs the duration of ventilator use, thereby increasing tracheostomy and ventilator-related complications and mortality.