Both the BI and the KI revealed significant deterioration of functional status after ICU discharge. The IRT analysis suggested that the Barthel Index might be a better scale than the Katz Index for the assessment of functional status of patients discharged from ICU, since it presented better discrimination of the ability to carry out the tasks.
ObjectiveTo describe postextubation noninvasive positive pressure ventilation use in
intensive care unit clinical practice and to identify factors associated with
noninvasive positive pressure ventilation failure.MethodsThis prospective cohort study included patients aged ≥ 18 years
consecutively admitted to the intensive care unit who required noninvasive
positive pressure ventilation within 48 hours of extubation. The primary outcome
was noninvasive positive pressure ventilation failure.ResultsWe included 174 patients in the study. The overall noninvasive positive pressure
ventilation use rate was 15%. Among the patients who used noninvasive positive
pressure ventilation, 44% used it after extubation. The failure rate of
noninvasive positive pressure ventilation was 34%. The overall mean ± SD
age was 56 ± 18 years, and 55% of participants were male. Demographics;
baseline pH, PaCO2 and HCO3; and type of equipment used were similar between
groups. All of the noninvasive positive pressure ventilation final parameters were
higher in the noninvasive positive pressure ventilation failure group
[inspiratory positive airway pressure: 15.0 versus 13.7cmH2O (p = 0.015),
expiratory positive airway pressure: 10.0 versus 8.9cmH2O (p = 0.027), and FiO2:
41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was
longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality
rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure
ventilation failure group. After fitting, the logistic regression model allowed us
to state that patients with inspiratory positive airway pressure ≥
13.5cmH2O on the last day of noninvasive positive pressure ventilation support are
three times more likely to experience noninvasive positive pressure ventilation
failure compared with individuals with inspiratory positive airway pressure <
13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040).ConclusionThe noninvasive positive pressure ventilation failure group had a longer intensive
care unit length of stay and a higher mortality rate. Logistic regression analysis
identified that patients with inspiratory positive airway pressure ≥
13.5cmH2O on the last day of noninvasive positive pressure
ventilation support are three times more likely to experience noninvasive positive
pressure ventilation failure.
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