scholarly journals Predictive factors for successful INTELLiVENT-ASV® use: A retrospective observational study

2020 ◽  
Author(s):  
Shinshu Katayama ◽  
Ken Tonai ◽  
Jun Shima ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Observational Study ◽  
Predictive Factors ◽  
Organizational Factors ◽  
Apache Ii ◽  
Retrospective Observational Study ◽  
Receiver Operating Curve ◽  
Apache Ii Score ◽  
Successful Management ◽  
Factors Associated ◽  
Success Group

Abstract Background: INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. Although a number of studies have reported the usefulness of I-ASV, the clinical situations in which it may be useful have not yet been clarified. We aimed to report our initial 3 years of experience using I-ASV, particularly the clinical conditions and the technical and organizational factors associated with its use. Furthermore, we evaluated the usefulness of I-ASV and determined the predictive factors for successful management with I-ASV. Methods: This single-center, retrospective observational study included patients who were ventilated using the Hamilton G5® ventilator (Hamilton Medical AG, Rhäzüns, Switzerland) from January 2016 to December 2018. The patients were categorized into the “I-ASV success” group and “I-ASV failure” group (those receiving mechanical ventilation with I-ASV along with any other mode). Multivariate analysis was performed to identify factors associated with successful I-ASV management.Results : Of the 189 patients, 135 (71.4%) were categorized into the I-ASV success group. In the I-ASV success group, the reasons for ICU admission included post-elective surgery (94.1%), post-emergent surgery (81.5%), and other medical reasons (55.6%). I-ASV failure was associated with a low P/F ratio (278 vs. 167, P = 0.0003) and high Acute Physiology and Chronic Health Evaluation (APACHE) II score (21 vs. 26, P < 0.0001). The main reasons for not using I-ASV included strong inspiratory effort and asynchrony. The APACHE II score was an independent predictive factor for successful management with I-ASV, with an odds ratio of 0.92 (95% confidential interval 0.87–0.96, P = 0.0006). The area under the receiver operating curve for the APACHE II score was 0.722 (cut-off: 24). Conclusions :In this study, we found that 71.4% of the fully mechanically ventilated patients could be managed successfully with I-ASV. The APACHE II score was an independent factor that could help predict the successful management of I-ASV. To improve I-ASV management, it is necessary to focus on patient-ventilator interactions.

scholarly journals Predictive factors for successful INTELLiVENT-ASV® use: A retrospective observational study

2020 ◽  
Author(s):  
Shinshu Katayama ◽  
Ken Tonai ◽  
Jun Shima ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Observational Study ◽  
Predictive Factors ◽  
Organizational Factors ◽  
Apache Ii ◽  
Retrospective Observational Study ◽  
Receiver Operating Curve ◽  
Apache Ii Score ◽  
Successful Management ◽  
Factors Associated ◽  
Success Group

Abstract Background: INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. Although a number of studies have reported the usefulness of I-ASV, the clinical situations in which it may be useful have not yet been clarified. We aimed to report our initial 3 years of experience using I-ASV, particularly the clinical conditions and the technical and organizational factors associated with its use. Furthermore, we evaluated the usefulness of I-ASV and determined the predictive factors for successful management with I-ASV. Methods: This single-center, retrospective observational study included patients who were ventilated using the Hamilton G5® ventilator (Hamilton Medical AG, Rhäzüns, Switzerland) from January 2016 to December 2018. The patients were categorized into the “I-ASV success” group and “I-ASV failure” group (those receiving mechanical ventilation with I-ASV along with any other mode). Multivariate analysis was performed to identify factors associated with successful I-ASV management.Results : Of the 189 patients, 135 (71.4%) were categorized into the I-ASV success group. In the I-ASV success group, the reasons for ICU admission included post-elective surgery (94.1%), post-emergent surgery (81.5%), and other medical reasons (55.6%). I-ASV failure was associated with a low P/F ratio (278 vs. 167, P = 0.0003) and high Acute Physiology and Chronic Health Evaluation (APACHE) II score (21 vs. 26, P < 0.0001). The main reasons for not using I-ASV included strong inspiratory effort and asynchrony. The APACHE II score was an independent predictive factor for successful management with I-ASV, with an odds ratio of 0.92 (95% confidential interval 0.87–0.96, P = 0.0006). The area under the receiver operating curve for the APACHE II score was 0.722 (cut-off: 24). Conclusions : In this study, we found that 71.4% of the fully mechanically ventilated patients could be managed successfully with I-ASV. The APACHE II score was an independent factor that could help predict the successful management of I-ASV. To improve I-ASV management, it is necessary to focus on patient-ventilator interactions.

scholarly journals Predictive factors for successful INTELLiVENT-ASV® use: A retrospective observational study

2020 ◽  
Author(s):  
Shinshu Katayama ◽  
Ken Tonai ◽  
Jun Shima ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Observational Study ◽  
Predictive Factors ◽  
Organizational Factors ◽  
Apache Ii ◽  
Retrospective Observational Study ◽  
Receiver Operating Curve ◽  
Apache Ii Score ◽  
Successful Management ◽  
Factors Associated ◽  
Success Group

Abstract Background: INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. Although a number of studies have reported the usefulness of I-ASV, the clinical situations in which it may be useful have not yet been clarified. We aimed to report our initial 3 years of experience using I-ASV, particularly the clinical conditions and the technical and organizational factors associated with its use. Furthermore, we evaluated the usefulness of I-ASV and determined the predictive factors for successful management with I-ASV. Methods: This single-center, retrospective observational study included patients who were ventilated using the Hamilton G5® ventilator (Hamilton Medical AG, Rhäzüns, Switzerland) from January 2016 to December 2018. The patients were categorized into the “I-ASV success” group and “I-ASV failure” group (those receiving mechanical ventilation with I-ASV along with any other mode). Multivariate analysis was performed to identify factors associated with successful I-ASV management.Results : Of the 189 patients, 135 (71.4%) were categorized into the I-ASV success group. In the I-ASV success group, the reasons for ICU admission included post-elective surgery (94.1%), post-emergent surgery (81.5%), and other medical reasons (55.6%). The main reasons for not using I-ASV included strong inspiratory effort and asynchrony. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was an independent predictive factor for successful management with I-ASV, with an odds ratio of 0.92 (95% confidential interval 0.87–0.96, P = 0.0006). The area under the receiver operating curve for the APACHE II score was 0.722 (cut-off: 25). Conclusions : In this study, we found that 71.4% of the fully mechanically ventilated patients could be managed successfully with I-ASV. The APACHE II score was an independent factor that could help predict the successful management of I-ASV. To improve I-ASV management, it is necessary to focus on patient-ventilator interactions.

scholarly journals Predictive factors for successful INTELLiVENT-ASV® use: a retrospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shinshu Katayama ◽  
Ken Tonai ◽  
Jun Shima ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Observational Study ◽  
Predictive Factors ◽  
Retrospective Observational Study

Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles

2007 ◽  
Vol 41 (6) ◽  
pp. 929-936 ◽  
Author(s):  
Jeffrey J Fong ◽  
Karen Cecere ◽  
John Unterborn ◽  
Erik Garpestad ◽  
Mark Klee ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Quality Indicators ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthcare Organizations ◽  
Patient Factors ◽  
Sepsis Bundles ◽  
Factors Associated ◽  
Healthcare Improvement ◽  
Bundle Compliance

BACKGROUND: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data. OBJECTIVE: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability. METHODS: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 ± 6, organ failure 2 ± 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital. RESULTS: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences. CONCLUSIONS: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care. TRANSFONDO: Tres diferentes organizaciones [“Voluntary Hospitals of America” (VHA), “Institute for Healthcare Improvement” (IHI), “Joint Commission on Accreditation of Healthcare Organizations” (JCAHO)] encargados con mejorar el cuidado médico en instituciones han desarrollado criterios de indicadores de calidad para el manejo apropiado de sepsis. Estas guiás de tratamiento han sido desarrollados con el propósito de proveer instituciones con un mecanismo para comparar la calidad de cuidado que ofrecen a sus pacientes que son admitidos con sepsis severa. Mientras que se han aprobado o propuesto tres diversos criterios de indicadores de calidad para evaluar las prácticas clínicas del manejo de sepsis severa, se sospecha que las diferencias entre estos indicadores pueden resultar en datos de comparación discrepantes.

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