Predictors Of Respiratory Failure Research Articles

Magnetic resonance imaging predictors for respiratory failure after cervical spinal cord injury

BackgroundPatients after cervical spinal cord injury (CSCI) may experience ventilator-dependent respiratory failure during the acute hospitalization period. The aim of the study is to identify imaging factors that predict respiratory failure after acute CSCI. Materials and methodsWe enrolled 108 patients diagnosed with CSCI in 4 years. The definition of respiratory failure consisted of the requirement of a definitive airway and the assistance of mechanical ventilation. Objective neurological function was determined using the classification of the American Spinal Injury Association (ASIA). We evaluated the characteristics of magnetic resonance imaging (MRI) of the cervical spine. ResultsRespiratory failure occurred in 8 (7.40%) of 108 CSCI patients. The ASIA classification of the 108 patients were A (6), B (3), C (60), D (27), and E (12), and the 8 respiratory failure patients were A (3), B (1), and C (4). Seven of 8 patients with respiratory failure and 78 of 100 patients without respiratory failure had a neurological level of C5 or above by the ASIA standards (p=1.000). The imaging level of injury at C3 by MRI was identified in 5 of 8 patients that developed respiratory failure and more frequent than injury at the lower cervical levels (p<0.001). The presence of spinal cord edema was another predictor of respiratory failure (p=0.009). ConclusionMRI can accurately localize CSCI and identify those patients at risk of respiratory failure. Imaging level of injury at C3 and presence of spinal cord edema are both predictors. To prevent secondary cord injury from prolonged hypoxia and facilitate pulmonary care, definitive airways should be established early in high risk patients.

Relevance of anxiety in clinical practice of Guillain-Barré syndrome: a cohort study

ObjectivesIllness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent...

Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study

Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study

Síndrome de fragilidade aumenta a suscetibilidade à ventilação mecânica?

Alguns marcadores clínicos da síndrome de fragilidade, como desnutrição, sarcopenia e delírio são preditores de insuficiência respiratória em idosos. Dessa forma, esses fatores de risco podem levar os pacientes considerados frágeis a uma maior suscetibilidade à intubação e ventilação mecânica. Objetivo: identificar evidências de associação causal entre a síndrome de fragilidade e ventilação mecânica invasiva. Métodos: busca no MEDLINE por coortes que demonstrem que a síndrome de fragilidade aumenta o risco de intubação e ventilação mecânica invasiva. Além do termo síndrome de fragilidade, foram incorporados e considerados também os marcadores clínicos da síndrome que podem apresentar associação à insuficiência respiratória, reconhecidos na literatura como sarcopenia, delírio e desnutrição. A busca foi realizada através de estratégia de busca específica, incluindo os termos de busca (Medical Subject Headings – MeSH) e respectivos sinônimos. Além disso, foi realizada uma busca adicional na lista de referências dos estudos incluídos.Resultados: nenhum estudo preencheu os critérios de inclusão desta revisão. Conclusões: Em nosso estudo, não foram encontradas evidências de que a síndrome de fragilidade possa ser um fator de risco para ventilação mecânica invasiva. Existem indícios, no entanto, de que o delírio possa aumentar o tempo de um paciente submetido à ventilação mecânica. Apesar disso, há considerável carência de informações nessa área e muita incerteza, talvez por ainda não haver um consenso estabelecido sobre a síndrome. Há uma expressa necessidade de realização de estudos que avaliem se marcadores clínicos da síndrome de fragilidade são fatores de risco para ventilação mecânica invasiva.

Predictors of respiratory failure among previously healthy children with respiratory syncytial virus infection

Background Respiratory syncytial virus (RSV)–related disease is the leading cause of hospitalization among infants, with approximately 7% to 21% of these patients developing acute respiratory failure. Objective The aim of this study was to identify clinical variables at initial presentation in the emergency department (ED) that may predict the subsequent need for mechanical ventilation among previously healthy, RSV-infected children who require pediatric intensive care unit (PICU) hospitalization. Study design This is a retrospective study of 67 previously healthy, RSV-infected patients admitted from January 1997 to March 2000 to the PICU. The primary outcome for this study was the need for mechanical ventilation. The relationship between clinical variables at initial ED presentation and the need for mechanical ventilation were explored using univariate and multiple logistic regression analysis. Results On multivariate analysis, the presence of lethargy (odds ratio [OR], 12.2; P = .005), grunting (OR, 9.3; P = .01), and a Pa co 2 65 mm Hg or greater (OR, 11.8; P = .013) were clinical factors at initial presentation in the ED associated with the subsequent need for mechanical ventilation among the study cohort. A developmental model that included lethargy, grunting, and a Pa co 2 of 65 mm Hg or greater performed well as a prediction model. The developmental model had a sensitivity of 71%, specificity of 96%, a positive predictive value of 86%, and a negative predictive value of 91%. Conclusions The presence of lethargy, grunting, and a Pa co 2 of 65 mm Hg or greater at initial presentation in the ED were predictive for the subsequent need for mechanical ventilation in previously healthy, RSV-infected children admitted to the PICU.

Clinical predictors of mechanical ventilation in Fisher/Guillain–Barré overlap syndrome

Background: Some patients with Fisher syndrome (FS) developed subsequent descending tetraparesis (Fisher/Guillain–Barré overlapping syndrome: FS/GBS). The assumption is that such descending progression may frequently lead to respiratory failure. Objective: To...

NMO05 The predictors of respiratory failure in childhood Guillain-Barre syndrome

NMO05 The predictors of respiratory failure in childhood Guillain-Barre syndrome

Predictors of respiratory failure in Guillain–Barré syndrome

Predictors of respiratory failure in Guillain–Barré syndrome

Elective Repair of Type IV Thoraco-abdominal Aortic Aneurysms; Experience of a Subcostal (Transabdominal) Approach

Objective preoperative pulmonary function has been shown by univariate analysis to be an independent predictor of outcome following Crawford Type IV thoraco-abdominal aortic aneurysm repair. The aim of this study was to determine if outcome had been improved by the introduction of a subcostal approach for the elective repair of these aneurysms.Methods 39 patients studied (19 subcostal, 20 thoracolaparotomy) all operated on between 1993 and 1998 by a single surgeon using a standard technique. No significant difference in median age (69 years) or weight (64 kg vs. 69 kg) between the two groups.Results preoperative co-morbidities, pulmonary function and predictors of respiratory failure did not vary significantly between the two groups, despite a trend towards greater respiratory, cardiac and renal disease in the subcostal group. Preoperative median pulmonary function in both groups was 80% of that predicted for age, sex and height. The subcostal approach did not significantly reduce blood loss (3500 ml vs. 4500 ml) or anaesthetic time (255 min vs. 253 min). Overall 30 day mortality was 10.2%. The rate of re-operation was significantly higher in the subcostal group (21% vs. 0%,p =0.05). No differences were observed in intensive care unit stay, total hospital stay or respiratory complications, despite earlier extubation of the subcostal group (47% vs. 10% extubated at 12 h,p =0.01). Conclusion the introduction of a subcostal approach for type IV thoraco-abdominal aneurysm repair in selected “high risk” patients has been associated with an unacceptably high rate of complications requiring early re-operation. We feel that this relates to the problems inherent in the introduction of a new technique and reduced exposure in patients of inappropriate body habitus. The predicted benefit to pulmonary function is realised in shorter intubation times, but has not translated into earlier recovery or improved outcome. Operation duration and blood loss have not been significantly reduced. Based on these outcomes, we do not currently recommend the general adoption of this approach in all type IV repairs. We will continue to evaluate this approach in patients with poor pulmonary function and a suitable body habitus.