BackgroundWe aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure.MethodsA retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF), ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV) device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed.ResultsSixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20%) patients were intubated, and the majority had sepsis and septic shock (p < 0.001). Mortality in the ICU was 14.5% (n = 9), reduced pH, IMV, and sepsis/septic shock were significantly higher in the non-survivors (p values 0.02, 0.02, 0.028, 0.012 respectively). Among 46 patients attending the outpatient clinic, 17 were lost to follow up and six were died. The six minute walk distance was significantly increased in the final follow up (306 m versus 419 m, p < 0.001).ConclusionsWe strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.
AimTo evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests.MethodThis prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients' demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters.ResultsThirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40 mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40).ConclusionThe 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.
Aim: To evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests. Method: This prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients’ demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters. Results: Thirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40). Conclusion: The 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.
Background: We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure. Methods: A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF), ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV) device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed. Results: Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20%) patients were intubated, and the majority had sepsis and septic shock (p < 0.001). Mortality in the ICU was 14.5% (n = 9), reduced pH, IMV, and sepsis/septic shock were significantly higher in the non-survivors (p values 0.02, 0.02, 0.028, 0.012 respectively). Among 46 patients attending the outpatient clinic, 17 were lost to follow up and six were died. The six minute walk distance was significantly increased in the final follow up (306 m versus 419 m, p < 0.001). Conclusions: We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.
Amaç: Daha iyi bir yoğun bakım işleyişi sağlanabilmesi, mortalite ve morbiditenin azaltılabilmesi için yoğun bakım performans değerlendirilmesi-nin yapılıp aksayan noktaların saptanması önem taşır. Bu amaçla benzer büyüklükte, benzer hasta profili ve sevk kapasitesindeki yoğun bakım üni-telerinin karşılaştırılmaları bakım kalitesi açısından yol gösterici olacaktır. Literatürde yoğun bakımda kantitatif performans kalite ölçüm kriterlerini kendi ünitemizde saptamak, elde edilen veriler ile aksayan noktaları saptamak ve yoğun bakım kalitemizi yükseltmek adına çözümler üretmek ve gelecekte ünitemizin zaman içerisindeki gelişimini takip etmeyi amaçladık.Gereç ve Yöntemler: Kapalı özellikte, on yataklı, üç hasta başına bir hemşirenin görev yaptığı üçüncü basamak bir üniversite hastanesi genel yoğun bakım ünitesinde; 01 Ocak-31 Aralık 2016 tarihleri arasında takip edilen 347 hastanın demografik özellikleri ve klinik takip verileri retro-spektif olarak tarandı.Bulgular: 2016 yılı yatak kapasitesi kullanım oranı %95.81 olup bir yıl için-de takip edilen hasta sayısı 347 (211 erkek, 136 kadın), hastaların yaş ortalaması 65 (19-96 yaş),ortalama yatış süresi 9 gündü (1-182 gün). Yoğun bakıma kabul edilen hastaların %32.5'i acil servisten, %31'i medikal servislerden, %26.2'si postoperatif, %6.1'i cerrahi servislerden ve %4.2'si ise dış merkezden sevk edilen hastalardı. Bu hastaların % 45,2'si mortal seyretti, taburcu edilen hastaların %27.9'u cerrahi servilere, %27.8'i ise medikal servilere taburcu edildi. APACHE II ortalamaları 23(2-45) olup APACHE II' ye göre beklenen mortalite oranı %49, gerçekleşen kaba mortalite %45,2 (157/347) ve standardize mortalite oranı(SMR= gözlenen mortalite/ beklenen mortalite) ise 0,92 saptandı. Hematolojik tanısı olan hastalarda mortalite %58,1; postresüsite hastalarda ise %64,3 gibi yüksek sevilerdeydi. Bu süreçte 25 hastaya perkütan trakeotomi, 9 hastaya trakeostomi ve 13 hastaya PEG açıldı. İnvaziv santral venöz kateter (SVK) kullanım oranı %82, SVK ilişkili kan dolaşım enfeksiyon hızı %12.7 (32 hasta), invaziv mekanik ventilatör kullanım oranı %71ve ventilatör ilişkili pnömoni oranı %12.7 (32 hasta) saptandı. Taburculuk sonrası 48 saat içinde tekrar yoğun bakıma yatış oranı %2,6 ( 9 hasta), postoperatif 48 saat içinde mortalite oranı %2,2 (2/90), taburculuk sonrası 4 aylık takipte 22 hasta (%5.1) tekrar yatırılmış ve 51 hasta (%13.5) ise mortal seyretmiştir. Acil servisten alınan, respiratuar sistem hastalıkları bulunan ve erkek cinsiyette hastalarda uzun vadede tekrar yatış riski iki kat, 60-70 yaş grubunda ise dört kat daha fazla saptandı. Bu hastaların %56' sı tekrar taburcu edilebildi.Tartışma ve Sonuç: Ölçmediğimiz şeyleri değerlendirmemiz mümkün değildir, bununla birlikte mühim olan ölçmek değil ölçtüğümüzle ne yaptığı-mızdır. Mevcut verileri değerlendirdiğimizde invaziv araç ilişkili hastane enfeksiyon hızlarının azaltılmasına yönelik bundl uygulama planlamaları yapıldı, bası yarası gelişim riskini azaltabilmek adına tüm yataklarımıza kinetik yatak alındı ve personele hasta pozisyonl...
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