Reason For Mechanical Ventilation Research Articles

Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes.

There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis. Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population. After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42-3.56; P=0.001). Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.

Clinical Profile and Outcome of Ventilated Children Admitted to Paediatrics Intensive Care Unit in a Tertiary Care Centre

Introduction: Mechanical Ventilation is an essential tool in paediatric critical care unit. Judicious use of ventilation when indicated, is essential along with very close clinical and hemodynamic monitoring, for successful outcome. As prolonged ventilation is associated with numerous adverse outcomes, we tried to find out common complications associated with invasive mechanical ventilation and its outcome. Methods: The study is an observational descriptive study conducted on mechanically ventilated children admitted to Paediatric Intensive Care Unit during 48 months period (November 2019 to October 2021). Demographic features included age, sex, reason for mechanical ventilation, duration of mechanical ventilation and any other comorbidities. Outcomes parameters included death in hospital, discharge from intensive care unit or shift to ward and left against medical advice (LAMA). Results: Among 1352 children admitted to PICU, 212 children (15.68%) required invasive mechanical ventilation. Common causes for mechanical ventilation were sepsis / MODS in 22.64% cases, followed by pulmonary (20.28%) and CNS infections 39 (18.39%). 166 (78.30%) children were extubated successfully, 24 (11.32%) children expired and 22 (10.37%) went on LAMA. Mortality rate of 14.18% was found in children, who were ventilated for &gt; 72 hours, which was statistically significant. Conclusions: Ventilatory support is essential and lifesaving tool for critically ill children. Mortality rate was higher and statistically significant in children who were ventilated for &gt; 72 hours.

Retrospective evaluation of transportation and outcome of dogs on a mechanical ventilator: 9 cases.

To describe the transportation and clinical outcome of 9 dogs transported to a referral hospital on mechanical ventilation (MV). Retrospective case series (2015-2020). University teaching hospital. Nine dogs transported to a referral center on MV. All dogs underwent MV during vehicular transport. The medical records of 9 dogs transported on a MV to a university teaching hospital were reviewed. Data collected included signalment, reason for MV, ventilator settings, sedation protocol, monitoring in transit, distance traveled, complications, clinical outcome, and cost. All dogs transported survived transport to the referral hospital and 8 of 9 were successfully weaned from the ventilator and discharged home. MV during transport in this setting was practical and safe. Dogs in this study had a high survival rate compared to previous studies of dogs undergoing MV, likely due to selection of cases assessed to have a correctable underlying disease.

Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation.

To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. Post-hoc analysis of four cohort studies. 138 Spanish ICUs. 2141 patients scheduled extubated. None. Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Risk factors of mortality and severe disability in the patients with cerebrovascular diseases treated with perioperative mechanical ventilation.

BACKGROUNDThe prognosis of cerebrovascular diseases treated with mechanical ventilation during perioperative has not been clearly reported.AIMTo analyze mortality and functional disability and to determine predictors of unfavorable outcome in the patients with cerebrovascular diseases treated with mechanical ventilation. METHODSA retrospective follow-up study of 111 cerebrovascular disease patients who underwent mechanical ventilation during the perioperative period in the First Hospital of Jilin University from June 2016 to June 2019 was performed. Main measurements were mortality and functional outcome in-hospital and after 3-month follow-up. According to the modified rankin scale (mRS), the functional outcome was divided into three groups: Good recovery (mRS ≤ 3), severe disability (mRS = 4 or 5) and death (mRS = 6). Univariate analysis was used to compare the differences between three functional outcomes. Multivariate logistic regression analysis was used to for risk factors of mortality and severe disability.RESULTSThe average age of 111 patients was 56.46 ± 12.53 years, 59 (53.15%) were males. The mortality of in-hospital and 3-month follow-up were 36.9% and 45.0%, respectively. Of 71 discharged patients, 46.47% were seriously disabled and 12.67% died after three months follow-up. Univariate analysis showed that preoperative glasgow coma scale, operation start time and ventilation reasons had statistically significant differences in different functional outcomes. Multiple logistic regression analysis showed that the cause of ventilation was related to the death and poor prognosis of patients with cerebrovascular diseases. Compared with brainstem compression, the risk of death or severe disability of pulmonary disease, status epilepticus, impaired respiratory center function, and shock were 0.096 (95%CI: 0.028-0.328), 0.026 (95%CI: 0.004-0.163), 0.095 (95%CI: 0.013-0.709), 0.095 (95%CI: 0.020-0.444), respectively.CONCLUSIONThe survival rate and prognostic outcomes of patients with cerebrovascular diseases treated with mechanical ventilation during the perioperative period were poor. The reason for mechanical ventilation was a statistically significant predictor for mortality and severe disability.

Mechanical ventilation in Spain, 1998–2016: Changes in the disconnection of mechanical ventilation

PurposeTo evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DesignPost-hoc analysis of four cohort studies. Ambit138 Spanish ICUs. Patients2141 patients scheduled extubated. InterventionsNone. Variables of interestDemographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. ResultsThere was a significant increase (p < 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435). ConclusionsThere have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Not all patients with convulsive status epilepticus intubated in pre-hospital settings meet the criteria for refractory status epilepticus

Mechanically ventilated patients admitted to the intensive care unit (ICU) for generalized convulsive status epilepticus (GCSE) are a heterogeneous population. Our objective was to evaluate the number of patients who fulfilled the diagnostic criteria for refractory GCSE and describe their initial management and prognosis. This multicenter retrospective study was conducted in four French ICUs in Pitié-Salpêtrière University Hospital in Paris and in the Hospital of Jossigny. Mechanically ventilated patients admitted to the ICU for GCSE between, January 1, 2014, and, December 31, 2016, were included. Patients with anoxia and traumatic brain injury were excluded. Their pre-hospital and ICU medical records were reviewed. The collected data included pre-hospital clinical status, pre-hospital antiepileptic treatment, reason for mechanical ventilation, duration of general anesthesia, and prognosis in the ICU. A retrospective initial diagnosis based on the findings of the analysis of the clinical records was attributed to each patient. Among the 98 patients included, 88.8% (n=87/98) fulfilled the diagnostic criteria for GCSE; of these cases, 16.1% (n=14/87) were refractory. Eleven percent of the patients did not fulfill the criteria for GCSE at the time of initial management (retrospective diagnosis of single convulsive seizure, repetitive convulsive seizures, or psychogenic non-epileptic seizures). Most patients were intubated for coma (58.9%, n=56/95, missing data: n=3). In the ICU, the median [Q1-Q3] duration of general anesthesia before weaning was 12.3 h (5.0-18.0 h); 7% of the patients had a relapse of status epilepticus, and 2% died in the ICU. Among the cases of confirmed GCSE in the mechanically ventilated patients admitted to the ICU, 16.1% were refractory, with an overall good prognosis. A significant proportion of patients did not fulfill the diagnostic criteria for refractory GCSE.

Mechanical ventilation in Spain, 1998-2016: Epidemiology and outcomes.

To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. A post hoc analysis of four cohort studies was carried out. A total of 138 Spanish ICUs. A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h. None. Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p<0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9ml/kg actual b.w. in 1998 and 6.6ml/kg in 2016; p<0.001) as well as an increase in PEEP (3cmH2O in 1998 and 6cmH2O in 2016; p<0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p<0.001), without geographical variability (median OR 1.43; p=0.258). A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.

Identification of ventilator‐associated pneumonia in dogs and evaluation of empiric antimicrobial therapy: 13 cases (2012–2016)

AbstractObjectiveTo evaluate criteria used for diagnosis of ventilator‐associated pneumonia (VAP) in dogs and to determine whether appropriate empiric antimicrobial therapy affects outcome.DesignRetrospective observational study from 2012 to 2016.SettingPrivate small animal emergency and specialty center.AnimalsThirteen client‐owned dogs requiring positive‐pressure ventilation for over 48 hours.Measurements and main resultsMedical records of dogs requiring mechanical ventilation (MV) were reviewed. Dogs receiving MV for over 48 hours that had endotracheal lavages (ETL) and thoracic radiographs performed both at initiation of MV and at 48 hours were included. Signalment, body weight, temperature, reason for MV, WBC count, cytology, and semiquantitative aerobic cultures obtained via ETL were recorded. Outcome was defined as survival to discharge or nonsurvival (euthanasia). Six patients (46.2%) were diagnosed with VAP based on the presence of a new bacterial isolate identified on ETL culture at 48 hours. All patients with VAP had new pulmonary infiltrates present on radiographs. The majority of patients with VAP had a leukocytosis (4/6; 66.7%). Six patients (46.2%) survived to discharge. Of the survivors, 3 of 6 (50%) had VAP.ConclusionsBacterial cultures should be obtained at initiation of MV and at 48 hours. A diagnosis of VAP should be suspected in patients that have a new bacterial isolate identified by ETL culture at 48 hours. Radiographic changes and an increase in WBC count may help support a diagnosis of VAP, while culture results are pending. Further studies are needed to evaluate the effect of appropriate antimicrobial therapy on patient outcome.

Mechanical ventilation in Spain, 1998–2016: Epidemiology and outcomes

PurposeTo evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. DesignA post hoc analysis of four cohort studies was carried out. SettingA total of 138 Spanish ICUs. PatientsA sample of 4293 patients requiring invasive mechanical ventilation for more than 12 h or noninvasive ventilation for more than one hour. InterventionsNone. Variables of interestDemographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. ResultsThere was an increase in severity (SAPS II 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p < 0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9 ml/kg actual b.w. in 1998 and 6.6 ml/kg in 2016; p < 0.001) as well as an increase in PEEP (3 cmH2O in 1998 and 6 cmH2O in 2016; p < 0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p < 0.001), without geographical variability (median OR 1.43; p = 0.258). ConclusionsA significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.

Factors affecting occurrence of post intubation and post tracheostomy tracheal stenosis in intensive care units

Objective: Iatrogenic tracheal stenosis is a life threatening iatrogenic complication of prolonged endotracheal intubation and tracheostomy in intensive care units (ICUs). It is one of the toughest morbidities in otolaryngology.Aim of the Study: This prospective observational study was conducted to detect the factors affecting occurrence of tracheal stenosis in patients subjected to tracheostomy after endotracheal intubation in ICUs.Patients and Methods: Sixty eight patients were included in this prospective study. They were admitted to (ICUs) and were subjected to endotracheal intubation, mechanical ventilation and tracheostomy due to prolonged intubation during their stay in (ICUs). The patients were followed up after being discharged for six months to detect incidence and factors affecting occurrence of tracheal stenosis. They were followed up using flexible fiber optic tracheobronchoscopy under local anesthesia, just after weaning from mechanical ventilation three and six months later.Results: Of the studied patients, 50 patients had no tracheal stenosis until the end of follow up period (without tracheal stenosis (WTS) group) while, 18 patients had tracheal stenosis (TS group). The mean duration of mechanical ventilation in WTS group (12.1 ± 7.6 days) was statistically shorter than that of TS groups (16.6 ± 10.4 days) (P = 0.048). Tracheostomy stoma wound sepsis was recorded in 4 patients in TS group and in 2 patients in WTS group.Conclusion: The main predisposing factors for post intubation and post tracheostomy tracheal stenosis are tracheostomy stomal wound sepsis and prolonged duration of mechanical ventilation. In contrary, tracheal cartilage injury during tracheostomy, age, sex and reason for mechanical ventilation was found to have no role in occurrence of tracheal stenosis.

Demographic Profile and Outcome of Mechanically Ventilated Children in a Tertiary Care Hospital of a Developing Country

Introduction: The need for mechanical ventilation (MV) is an absolute indication for admission to Paediatric intensive care unit (PICU). Management of children requiring invasive ventilation in resource limited developing countries is challenging. Scare data is available from Asian countries regarding use of MV in PICUs. The objectives of this study were to determine the clinical profile, characteristics, common causes for ventilation, ventilation related complications and final outcome of these patients.Material and Methods: A retrospective study of children requiring ventilator support in PICU of Kalinga Institute of Medical Sciences from January 2014 to December 2016 was done. Data collected included epidemiological trends, indications for ventilation, complications, length of stay on ventilator and outcome.Results: A total of 1172 patients were admitted to PICU, 101 (8.6%) patients required MV. 42% of the mechanically ventilated patients were infants and 75% were males. Impending respiratory failure (34.6%) and low Glasgow coma scale (17.8%) were the commonest indication for ventilation in this study. The median length of MV was 2.1 days. The mortality rate of these children was 38.6%. We report the epidemiological trends, frequency, indications and outcomes of children requiring ventilator support in PICU. Analysis of this data can be helpful in improving outcome in future by planning better treatment strategies.Conclusion: The frequency of MV in our PICU is low. Respiratory failure was the most common reason for mechanical ventilation.  

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China.

In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs). A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up. On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio = 2.78, 95% CI 1.05-7.40, P = .041) and chronic congestive heart failure (odds ratio =12.23, 95% CI 1.48-101.05, P = .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio = 0.14, 95% CI 0.04-0.52, P = .003) was associated with successful weaning. The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure.

Pleural effusion in difficult weaning from mechanical ventilation

Objectives To describe the incidence of pleural effusion in patients who failed a first spontaneous breathing trial (SBT) and to describe the characteristics of these patients. Methods We conducted a prospective observational study in three medical ICU. All mechanically ventilated patients were screened daily. In patients who failed their first SBT, a pleural ultrasonography was performed and the presence of PE was qualitatively quantified according to a 4-steps classification: 0: no PE; 1: small PE; 2: moderate PE and 3: large PE. In addition the main clinical characteristics of patients were collected. For statistical analysis, patients with classes 0 and 1 were regrouped, as were patients with classes 2 and 3. Results From November 2014 to March 2015, 336 patients were screened and 56 (17%) failed their first SBT. Among them, 28 patients (50%) had no PE, 18 patients (32%) had small PE (left or right), 8 (14%) patients had moderate PE and 2 (4%) patients had large PE. Patients with moderate and large PE stayed longer in ICU (19 ± 7 vs. 9 ± 7 days, p < 0.01) and had a longer duration of mechanical ventilation (14 ± 9 vs. 24 ± 12 days, p < 0.01) as compared with patients without PE and with small PE. Patients with moderate or large PE and patients without PE or with small PE shared similar characteristics at admission (age: 66 ± 14 and 61 ± 15 and SAPS 2: 55 ± 18 53 ± 15, p > 0.05). Shock as the cause of initiation of mechanical ventilation was more frequent in patients with moderate and large PE as compared to patients without and small PE (40% vs. 4%, p < 0.01). Only one patient with a large PE had a pleural evacuation but without clinical improvement. Conclusions Significant pleural effusion is often detected in difficult to wean patients (18%), and is associated with shock state as the reason for mechanical ventilation. The interest of pleural drainage in this population deserves further studies.

Hyperoxemia in mechanically ventilated, critically ill subjects: incidence and related factors.

Excessive supplemental oxygen causes injurious hyperoxemia. Before establishing the best P(aO2) targets for mechanically ventilated patients, it is important to understand the incidence of hyperoxemia and related factors. We investigated oxygenation in mechanically ventilated subjects in our ICU and evaluated factors related to hyperoxemia (P(aO2) > 120 mm Hg) at 48 h after initiation of mechanical ventilation. We retrospectively reviewed the medical records of patients admitted to our ICU from January 2010 to May 2013. Inclusion criteria were 15 y of age or older and administration of mechanical ventilation for > 48 h. Patients at risk of imminent death on admission or who had received noninvasive ventilation were excluded. We collected subject demographics, reasons for mechanical ventilation, and during mechanical ventilation, we collected arterial blood gas data and ventilator settings on the first day of intubation (T1), 48 h after initiation of mechanical ventilation (T2), and on the day of extubation (T3). Multivariable logistic regression analysis was performed to clarify independent variables related to hyperoxemia at T2. For the study period, data for 328 subjects were analyzed. P(aO2) statistically significantly increased over time to 90 (interquartile range of 74-109) mm Hg at T1, 105 (89-120) mm Hg at T2, and 103 (91-119) mm Hg at T3 (P < .001), coincident with decreases in F(IO2) of 0.4 (0.3-0.5) at T1, 0.3 (0.3-0.4) at T2, and 0.3 (0.3-0.35) at T3 (P < .001). Hyperoxemia occurred in 15.6% (T1), 25.3% (T2), and 22.4% (T3) of subjects. Multivariable logistic regression analysis revealed that hyperoxemia was independently associated with age of < 40 y (odds ratio 2.6, 95% CI 1.1-6.0), Acute Physiology and Chronic Health Evaluation II scores of ≥ 30 (odds ratio 0.53, 95% CI 0.3-1.0), and decompensated heart failure (odds ratio 1.9, 95% CI 1.1 to 3.5). During mechanical ventilation of critically ill subjects, P(aO2) increased, and F(IO2) decreased. One in 4 subjects were hyperoxemic at T2, and hyperoxemia persisted until T3.

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Introduction: Hyperoxia with excessive supplemental oxygen (O2) may be injurious. While several studies have provided epidemiological data for oxygen administration in critically ill patients, evidence is inadequate for deciding the best target values for arterial O2 tension (PaO2). Methods: We retrospectively reviewed medical records of patients admitted to the ICU from January 2010 to May 2013. We included patients who were older than 15 years and had received mechanical ventilation (MV) for more than 48 hours. Patients at risk of imminent death on admission or treated by non-invasive positive pressure ventilation were excluded. We collected patient demographics, reasons for MV, arterial blood gas analyses and ventilator settings at 48 hours or later after beginning of MV. Performing multivariable logistic regression analysis to clarify independent factors related to hyperoxemia, we compared the hyperoxemia and non-hyperoxemia groups. Results: During the study period, 328 out of 1,664 patients were enrolled. Hyperoxemia occurred in 83 (25.3%) patients. Comparable values for each group were (hyperoxemia vs. non-hyperoxemia): PaO2, 133 (124–145) vs. 98 (84–108) mmHg; inspired O2 fraction, 0.3 (0.3–0.4) vs. 0.3 (0.3–0.4); positive end-expiratory pressure, 6 (6–8) vs. 8 (6–8) cmH2O; and duration of MV 144 (72–387) vs. 170 (105–325) hours. Hyperoxemia correlated with younger age (p = 0.027), lower serum lactate level (p = 0.029) and decompensated heart failure (p = 0.042). Multivariable logistic regression analysis revealed hyperoxemia to be independently associated with age ≤ 39 (odds ratio[OR], 2.6, 95% confidence interval [CI], 1.1 to 6.0) and decompensated heart failure (OR, 1.9, CI, 1.1 to 3.5). APACHE II score ≥ 30 was associated with lower incidence of hyperoxyemia (OR, 0.53, CI, 0.3 to 1.0). Conclusions: Hyperoxemia was common in younger and APACHE II score

Prognosis of elderly patients subjected to mechanical ventilation in the ICU

Abstract Objective To analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit (ICU). Design and scope Sub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain was carried out. Patients Adult patients who required mechanical ventilation (MV) for longer than 24 h. Interventions None. Study variables Demographic data, APACHE II, SOFA, reason for MV, comorbidity, functional condition, reintubation, duration of MV, tracheotomy, ICU mortality, and in-hospital mortality. Results A total of 1661 patients were recruited. Males accounted for 67.9% (n = 1127), with a mean age of 62.1 ± 16.2 years. APACHE II: 20.3 ± 7.5. Total SOFA: 8.4 ± 3.5. Four hundred and twenty-three patients (25.4%) were ≥75 years of age. Comorbidity and functional condition rates were poorer in these patients (p  Conclusion Older patients (≥75 years) have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation. Differences in mortality were at the expense of pneumonia, sepsis and trauma.

Prolonged mechanical ventilation probability model

ObjectiveTo design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24h of the start of MV. DesignAn observational, prospective, multicenter cohort study. ScopeThirteen Spanish medical-surgical intensive care units. PatientsAdult patients requiring mechanical ventilation for more than 24h. InterventionsNone. Study variablesAPACHE II, SOFA, demographic data, clinical data, reason for mechanical ventilation, comorbidity, and functional condition. A multivariate risk model was constructed. The model contemplated a dependent variable with three possible conditions: 1. Early mortality; 2. Early extubation; and 3. PMV. ResultsOf the 1661 included patients, 67.9% (n=1127) were men. Age: 62.1±16.2years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. The APACHE II and SOFA scores were higher in patients ventilated for 7 or more days (p=0.04 and p=0.0001, respectively). Noninvasive ventilation failure was related to PMV (p=0.005). A multivariate model for the three above exposed outcomes was generated. The overall accuracy of the model in the training and validation sample was 0.763 (95%IC: 0.729–0.804) and 0.751 (95%IC: 0.672–0.816), respectively. The likelihood ratios (LRs) for early extubation, involving a cutoff point of 0.65, in the training sample were LR (+): 2.37 (95%CI: 1.77–3.19) and LR (−): 0.47 (95%CI: 0.41–0.55). The LRs for the early mortality model, for a cutoff point of 0.73, in the training sample, were LR (+): 2.64 (95%CI: 2.01–3.4) and LR (−): 0.39 (95%CI: 0.30–0.51). ConclusionsThe proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria.

Pronóstico de los ancianos ventilados mecánicamente en la UCI

ObjectiveTo analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit (ICU). Design and scopeSub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain. PatientsAdult patients who required mechanical ventilation (MV) for longer than 24hours. InterventionsNone. Study variablesDemographic data, APACHE II, SOFA, reason for MV, comorbidity, functional condition, reintubation, duration of MV, tracheotomy, ICU mortality, in-hospital mortality. ResultsA total of 1661 patients were recruited. Males accounted for 67.9% (n=1127), with a mean age of 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. Four hundred and twenty-three patients (25.4%) were ≥ 75 years of age. Comorbidity and functional condition rates were poorer in these patients (p<0.001 for both variables). Mortality in the ICU was higher in the elderly patients (33.6%) than in the younger subjects (25.9%) (p=0.002). Also, in-hospital mortality was higher in those ≥ 75 years of age. No differences in duration of MV, prevalence of tracheostomy or reintubation incidence were found. Regarding the indication for MV, only the patient ≥ 75 years of age with pneumonia, sepsis or trauma had a higher in-ICU mortality than the younger patients (46.3% vs 33.1%, p=0.006; 55% vs 25.8%, p=0.002; 63.6% vs 4.5%, p<0,001, respectively). No differences were found referred to other reasons for MV. ConclusionOlder patients (≥ 75 years) have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation. Differences in mortality were at the expense of pneumonia, sepsis and trauma.

Modelo de probabilidad de ventilación mecánica prolongada

ObjectiveTo design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24hours of the start of MV. DesignAn observational, prospective, multicenter cohort study. ScopeThirteen Spanish medical-surgical intensive care units. PatientsAdult patients requiring mechanical ventilation for more than 24hours. InterventionsNone. Study variablesAPACHE II, SOFA, demographic data, clinical data, reason for mechanical ventilation, comorbidity, and functional condition. A multivariate risk model was constructed. The model contemplated a dependent variable with three possible conditions: 1. Early mortality; 2. Early extubation; and 3. PMV. ResultsOf the 1661 included patients, 67.9% (n=1127) were men. Age: 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. The APACHE II and SOFA scores were higher in patients ventilated for 7 or more days (p=0.04 and p=0.0001, respectively). Noninvasive ventilation failure was related to PMV (p=0.005). A multivariate model for the three above exposed outcomes was generated. The overall accuracy of the model in the training and validation sample was 0.763 (95%IC: 0.729-0.804) and 0.751 (95%IC: 0.672-0.816), respectively. The likelihood ratios (LRs) for early extubation, involving a cutoff point of 0.65, in the training sample were LR (+): 2.37 (95%CI: 1.77-3.19) and LR (-): 0.47 (95%CI: 0.41-0.55). The LRs for the early mortality model, for a cutoff point of 0.73, in the training sample, were LR (+): 2.64 (95%CI: 2.01-3.4) and LR (-): 0.39 (95%CI: 0.30-0.51). ConclusionsThe proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria.