scholarly journals Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS

2017 ◽  
Vol 63 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Richard H Kallet ◽  
Hanjing Zhuo ◽  
Vivian Yip ◽  
Antonio Gomez ◽  
Michael S Lipnick
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Spontaneous Breathing Trials

scholarly journals Impact of Permissive Hypoxia and Hyperoxia Avoidance on Clinical Outcomes in Septic Patients Receiving Mechanical Ventilation: A Retrospective Single-Center Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kota Nishimoto ◽  
Takeshi Umegaki ◽  
Sayaka Ohira ◽  
Takehiro Soeda ◽  
Natsuki Anada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
University Hospital ◽  
Icu Mortality ◽  
Respiratory Dysfunction ◽  
Mechanically Ventilated ◽  
Icu Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Before And After ◽  
Clinical Records

Background. Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients. Methods. In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO2: ≥96%) to more conservative targets with permissive hypoxia (SpO2: 88-92% or PaO2: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for Pa O 2 > 110   mmHg ). Patients were divided into a prechange group (April 2015 to March 2017; n = 83 ) and a postchange group (April 2017 to March 2019; n = 130 ). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO2/FiO2 ratios. Results. The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; P = 0.31 ) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; P = 0.01 ) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; P = 0.02 ). Conclusions. Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.

scholarly journals Relationship between Intracranial Pressure Monitoring and Outcomes in Severe Traumatic Brain Injury Patients

2011 ◽  
Vol 39 (6) ◽  
pp. 1043-1050 ◽  
Author(s):  
S. Haddad ◽  
A. S. Aldawood ◽  
A. Alferayan ◽  
N. A. Russell ◽  
H. M. Tamim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intracranial Pressure ◽  
Hospital Mortality ◽  
Icp Monitoring ◽  
Icu Mortality ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Significant Difference ◽  
Severe Tbi

Intracranial pressure (ICP) monitoring is recommended in patients with a severe traumatic brain injury (TBI) and an abnormal computed tomography (CT) scan. However, there is contradicting evidence about whether ICP monitoring improves outcome. The purpose of this study was to examine the relationship between ICP monitoring and outcomes in patients with severe TBI. From February 2001 to December 2008, a total of 477 consecutive adult (>18 years) patients with severe TBI were included retrospectively in the study. Patients who underwent ICP monitoring (n=52) were compared with those who did not (n=425). The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, mechanical ventilation duration, the need for tracheostomy, and ICU and hospital length of stay (LOS). After adjustment for multiple potential confounding factors, ICP monitoring was not associated with significant difference in hospital or ICU mortality (odds ratio [OR]=1.71, 95% confidence interval [CI]=0.79 to 3.70, P=0.17; OR=1.01, 95% CI=0.41 to 2.45, P=0.99, respectively). ICP monitoring was associated with a significant increase in mechanical ventilation duration (coefficient=5.66, 95% CI=3.45 to 7.88, P <0.0001), need for tracheostomy (OR=2.02, 95% CI=1.02 to 4.03, P=0.04), and ICU LOS (coefficient=5.62, 95% CI=3.27 to 7.98, P <0.0001), with no significant difference in hospital LOS (coefficient=8.32, 95% CI=-82.6 to 99.25, P=0.86). Stratified by the Glasgow Coma Scale score, ICP monitoring was associated with a significant increase in hospital mortality in the group of patients with Glasgow Coma Scale 7 to 8 (adjusted OR=12.89, 95% CI=3.14 to 52.95, P=0.0004). In patients with severe TBI, ICP monitoring was not associated with reduced hospital mortality, however, with a significant increase in mechanical ventilation duration, need for tracheostomy, and ICU LOS.

The impact of time to tracheostomy on mechanical ventilation duration, length of stay, and mortality in intensive care unit patients

2009 ◽  
Vol 24 (3) ◽  
pp. 435-440 ◽  
Author(s):  
Yaseen M. Arabi ◽  
Jamal A. Alhashemi ◽  
Hani M. Tamim ◽  
Andres Esteban ◽  
Samir H. Haddad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
The Impact

Should Benzodiazepine Sedation be Delivered by Infusion or Bolus?

2013 ◽  
Vol 14 (1) ◽  
pp. 24-27
Author(s):  
James Hutchinson ◽  
Georgina Harlow ◽  
David Sinton ◽  
Tony Whitehouse
Keyword(s):  
Mechanical Ventilation ◽  
Mode Of Delivery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Data ◽  
Mechanically Ventilated ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Observational Cohort ◽  
Randomised Controlled

Benzodiazepine sedation for mechanically ventilated patients in intensive care (ICU) is common practice worldwide. We performed a literature review to investigate whether benzodiazepine sedation is best delivered by continuous infusion or intermittent bolus. PubMed, Ovid and Cochrane databases were searched. Only four studies, involving 481 patients, were found. Three were randomised controlled trials and one was an observational cohort study; all used different benzodiazepines, sometimes in conjunction with opiates. The studies measured different outcomes including mechanical ventilation duration, length of ICU and hospital stay, quality and complications of sedation and mortality. Use of intermittent sedation or opiate boluses alone reduced mechanical ventilation duration, ICU and hospital length of stay. However such limited data means that the optimal mode of delivery for benzodiazepine sedation remains unresolved.

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