scholarly journals Predictive Associations of Music, Anxiety, and Sedative Exposure on Mechanical Ventilation Weaning Trials

2017 ◽  
Vol 26 (3) ◽  
pp. 210-220 ◽  
Author(s):  
Breanna Hetland ◽  
Ruth Lindquist ◽  
Craig R. Weinert ◽  
Cynthia Peden-McAlpine ◽  
Kay Savik ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Proportional Hazards ◽  
Ventilatory Support ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Music Listening ◽  
Weaning From Mechanical Ventilation ◽  
Music Intervention ◽  
Dose Frequency ◽  
Successful Weaning

Background Weaning from mechanical ventilation requires increased respiratory effort, which can heighten anxiety and later prolong the need for mechanical ventilation. Objectives To examine the predictive associations of music intervention, anxiety, sedative exposure, and patients’ characteristics on time to initiation and duration of weaning trials of patients receiving mechanical ventilation. Methods A descriptive, correlational design was used for a secondary analysis of data from a randomized trial. Music listening was defined as self-initiated, patient-directed music via headphones. Anxiety was measured daily with a visual analog scale. Sedative exposure was operationalized as a daily sedation intensity score and a sedative dose frequency. Analyses consisted of descriptive statistics, graphing, survival analysis, Cox proportional hazards regression, and linear regression. Results Of 307 patients, 52% were women and 86% were white. Mean age was 59.3 (SD, 14.4) years, mean Acute Physiology and Chronic Health Evaluation III score was 62.9 (SD, 21.6), mean duration of ventilatory support was 8 (range, 1–52) days, and mean stay in the intensive care unit was 18 (range, 2–71) days. Music listening, anxiety levels, and sedative exposure did not influence time to initial weaning trial or duration of trials. Clinical factors of illness severity, days of weaning trials, and tracheostomy placement influenced weaning patterns in this sample. Conclusions Prospective studies of music intervention and other psychophysiological factors during weaning from mechanical ventilation are needed to better understand factors that promote successful weaning.

scholarly journals Reinstitution of Mechanical Ventilation within 14 Days as a Poor Predictor in Prolonged Mechanical Ventilation Patients following Successful Weaning

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Mei-Lien Tu ◽  
Ching-Wan Tseng ◽  
Yuh Chyn Tsai ◽  
Chin-Chou Wang ◽  
Chia-Cheng Tseng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Proportional Hazards ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Group Versus ◽  
Cox Proportional Hazards ◽  
Poor Predictor ◽  
Significant Difference ◽  
Successful Weaning ◽  
One Year

Although many parameters were investigated about weaning and mortality in critical patients in intensive units, no studies have yet investigated predictors in prolonged mechanical ventilation (PMV) patients following successful weaning. A cohort of 142 consecutive PMV patients with successful weaning in our respiratory care center was enrolled in this study. Successful weaning is defined as a patient having smooth respiration for more than 5 days after weaning. The results showed as follows: twenty-seven patients (19%) had the reinstitution within 14 days, and 115 patients (81%) had the reinstitution beyond 14 days. Renal disease RIFLE-LE was associated with the reinstitution within 14 days (P=0.006). One year mortality rates showed significant difference between the two groups (85.2% in the reinstitution within 14 days group versus 53.1% in the reinstitution beyond 14 days;P<0.001). Kaplan-Meier analysis showed that age ≥70 years (P=0.04), ESRD (P=0.02), and the reinstitution within 14 days (P<0.001) were associated with one-year mortality. Cox proportional hazards regression model showed that only the reinstitution within 14 days was the independent predictor for mortality (P<0.001). In conclusion, the reinstitution within 14 days was a poor predictor for PMV patients after successful weaning.

scholarly journals OR26-02 The Effect on Ketogenesis of Withholding Early Parenteral Nutrition in Critically Ill Children, as a Potential Mediator of the Improved Acute Outcome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Astrid De Bruyn ◽  
Jan Gunst ◽  
Chloë Goossens ◽  
Gonzalo G Guerra ◽  
Sascha Verbruggen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Ventilatory Support ◽  
Secondary Analysis ◽  
Baseline Risk ◽  
Critically Ill Children ◽  
Maximal Effect ◽  
Weaning From Mechanical Ventilation

Abstract Introduction: In adults and children, withholding parenteral nutrition (PN) for 1 week in ICU (late PN), hereby accepting macronutrient deficit early during critical illness, as compared with supplementing insufficient enteral nutrition with PN (early PN), accelerates weaning from mechanical ventilation, reduces infections, and shortens ICU stay1,2. We hypothesized that these benefits are in part mediated by fasting-induced ketogenesis. Methods: This is a secondary analysis of the Early versus Late Parenteral Nutrition in the Pediatric ICU (PEPaNIC) RCT (N=1440)2. First, for a matched subset of 96 patients with a PICU stay of ≥5 days, daily plasma 3-hydroxybutyrate (3HB) concentrations were determined to identify the time point of maximal effect of late PN versus early PN, if any, on 3HB. Thereafter, for all patients with a plasma sample available on that “maximal effect day” (or last day for shorter stayers), plasma 3HB and insulin concentrations were quantified (N=1142). The independent association between plasma 3HB on that day and outcome was assessed by multivariable Cox proportional hazard analysis for time to live weaning from mechanical ventilation and for time to live PICU discharge and by multivariable logistic regression for incidence of new infection and PICU mortality, adjusted for randomization to late PN versus early PN and baseline risk factors (demographics, diagnosis, illness severity). In a sensitivity analysis, models were further adjusted for key regulators of ketogenesis (plasma insulin, blood glucose, corticosteroids and catecholamines) to assess whether any effect was direct or indirect. Results: In the matched cohort, late PN increased plasma 3HB as compared with early PN (P&lt;0.0001 for PICU-days 1 to 5), with maximal effect observed on PICU day 2. In the 1142 patients, plasma 3HB concentration on that “maximal effect day” was (mean±SEM) 0.19±0.05 mM in early PN patients and 1.17±0.02 mM in late-PN patients (P&lt;0.0001). Adding these plasma 3HB concentrations to the multivariable models, adjusted for baseline risk factors and randomization, showed that higher plasma 3HB concentrations were independently associated with a higher likelihood of early live weaning from mechanical ventilatory support (P=0.0002) and of early live PICU discharge (P=0.004). As the 3HB concentrations replaced the effect of the randomization, this suggested that the 3HB effect statistically explained these effects of the randomization. Further adjustment for key regulators of ketogenesis did not alter these findings. The effect of late PN versus early PN on plasma 3HB did not explain its impact on infections and was not related to mortality. Conclusion: Withholding early PN increased plasma 3HB concentrations in critically ill children, a direct effect that mediated an important part of its beneficial impact on recovery. 1Casaer M. et al, N Engl J Med 20112Fivez T. et al, N Engl J Med 2016

Lung Ultrasound to Monitor Disease Severity and Aid Prognostication in COVID-19 Pneumonia: A Retrospective Analysis of Serial Lung Ultrasound Assessments

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 109-116
Author(s):  
Matthew Llewelyn Gibbins ◽  
Quentin Otto ◽  
Paul Adrian Clarke ◽  
Stefan Gurney
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Analysis ◽  
Disease Severity ◽  
Scoring System ◽  
Lung Ultrasound ◽  
Weaning From Mechanical Ventilation ◽  
Icu Discharge ◽  
Successful Weaning ◽  
Ultrasound Assessment ◽  
Disease Free

Background: The aim of this retrospective analysis was to assess if serial lung ultrasound assessments in patients with COVID-19 pneumonia, including a novel simplified scoring system, correlate with PaO2:FiO2 ratio, as a marker of disease severity, and patient outcomes. Methods: Patients treated for COVID-19 pneumonia in a tertiary intensive care unit who had a lung ultrasound assessment were included. Standardised assessments of anterior and lateral lung regions were prospectively recorded. A validated lung ultrasound score-of-aeration and a simplified scoring system based on the number of disease-free lung regions were correlated with: PaO2:FiO2 ratio,  successful weaning from mechanical ventilation, and status (alive or dead) at discharge.  MedCalc© statistical software was used for statistical analysis. Results: 28 patients (109 assessments) were included. Correlation was seen between score-of-aeration and PaO2:FiO2 ratio (r = -0.61, p<0.0001) and between the simplified scoring system and PaO2:FiO2 ratio (r = 0.52 p<0.0001). Achieving a score-of-aeration of ≤9/24 or ≥2 disease-free regions was associated with successful weaning from mechanical ventilation and survival to ICU discharge (accuracy of 94% and 97% respectively). Conclusion: Retrospective analysis from this small cohort of patients demonstrates that scores-of-aeration and a simplified scoring system based on the number of disease-free antero-lateral regions from serial LUS assessments correlate with PaO2:FiO2 ratio as a marker of disease severity in patients with COVID-19 pneumonia. In addition, lung ultrasound may help identify patients who will have favourable outcomes. 

scholarly journals Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

2022 ◽  
Author(s):  
John M. Jakicic ◽  
Robert I. Berkowitz ◽  
Paula Bolin ◽  
George A. Bray ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Look Ahead ◽  
The Look

OBJECTIVE: To conduct <i>post-hoc</i> secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. <p>RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes.</p> <p>RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in <u>></u>10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes.</p> <p>CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.</p>

scholarly journals Perceptions of Patients and Families who Received a Music Intervention During Mechanical Ventilation

2015 ◽  
Vol 7 (3) ◽  
pp. 54 ◽  
Author(s):  
Mary F. Tracy ◽  
Abbey Staugaitis ◽  
Linda Chlan ◽  
Annie Heiderscheit
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Research Study ◽  
Music Listening ◽  
Music Intervention ◽  
Emotional Experiences ◽  
Family Experiences ◽  
Mechanically Ventilated ◽  
Integrative Intervention

The intensive care unit (ICU) is a technologically-driven environment where critically ill patients and their families have significant physical and emotional experiences. Mechanically ventilated (MV) patients can experience significant distress from anxiety and pain. Music listening is one integrative intervention that has been shown to reduce anxiety as well as other symptoms that contribute to distress in MV patients. This is a report of MV patient and family experiences from a larger research study aiming to evaluate levels of anxiety and sedative exposure with use of a patient-directed music intervention. Understanding perceptions of MV patients and families regarding the effectiveness of music listening might serve as a useful guide to improvement of their care.

scholarly journals Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer’s Disease

2018 ◽  
Vol 31 (2) ◽  
pp. 322-342 ◽  
Author(s):  
Shanna L. Burke ◽  
Tianyan Hu ◽  
Christine E. Spadola ◽  
Aaron Burgess ◽  
Tan Li ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sleep Disturbance ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Data Set ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
Research Questions

Objective: This study explored two research questions: (a) Does sleep medication neutralize or provide a protective effect against the hazard of Alzheimer’s disease (AD)? (b) Do apolipoprotein (APOE) e4 carriers reporting a sleep disturbance experience an increased risk of AD? Method: This study is a secondary analysis of the National Alzheimer’s Coordinating Center’s Uniform Data Set ( n = 6,782) using Cox proportional hazards regression. Results: Sleep disturbance was significantly associated with eventual AD development. Among the subset of participants taking general sleep medications, no relationship between sleep disturbance and eventual AD was observed. Among individuals not taking sleep medications, the increased hazard between the two variables remained. Among APOE e4 carriers, sleep disturbance and AD were significant, except among those taking zolpidem. Discussion: Our findings support the emerging link between sleep disturbance and AD. Our findings also suggest a continued need to elucidate the mechanisms that offer protective factors against AD development.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
Eva Mistry ◽  
Mohammad Anadani ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Adjusted Risk ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

scholarly journals Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e024893 ◽  
Author(s):  
Sanne M Thysen ◽  
Amabelia Rodrigues ◽  
Peter Aaby ◽  
Ane B Fisker
Keyword(s):  
Mortality Rate ◽  
Child Mortality ◽  
Proportional Hazards ◽  
Child Survival ◽  
Secondary Analysis ◽  
Oral Polio Vaccine ◽  
Vaccination Schedule ◽  
Cox Proportional Hazards ◽  
Vaccination Status ◽  
Guinea Bissau

ObjectivesTo assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence.DesignProspective cohort study analysed using the landmark approach.SettingBandim Health Project’s Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age.ParticipantsChildren aged 9–17 months (main analysis) and 18–35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996.MethodsSurvival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster.Main outcome measureMortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations.ResultsAmong children aged 9–17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared.ConclusionOut-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.

scholarly journals Bi-directional association between epilepsy and dementia

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3241-e3247 ◽  
Author(s):  
Maria Stefanidou ◽  
Alexa S. Beiser ◽  
Jayandra Jung Himali ◽  
Teng J. Peng ◽  
Orrin Devinsky ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Heart Study ◽  
Allele Status ◽  
Ε4 Allele ◽  
Nested Case Control

ObjectiveTo assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).MethodsWe analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case–control designs and matched each case to 3 age-, sex- and FHS cohort–matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.ResultsA total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05–3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11–3.57, p = 0.021). In this group, among participants with any post–high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.ConclusionsThere is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

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