Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults

Khalil, Yehia; Ibrahim, Emad; Shabaan, Ahmed; Imam, Mohamed Hassan; Behairy, Amany E.L.

doi:10.1016/j.ejcdt.2012.10.005

Cited by 9 publications

(5 citation statements)

References 43 publications

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“…[ 3 8 ] The ideal sedative agent after the cardiovascular surgery should be cheap and have a short duration without cumulative effects, allowing for rapid recovery of effective spontaneous respiration after interruption of its administration in patients underwent mechanical ventilation after the cardiovascular surgery. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Elgebaly

Sabry

2018

Ann Card Anaesth

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Objective:The objective of this study was to compare the suitability (efficacy and safety) of dexmedetomidine versus propofol for patients admitted to the intensive care unit (ICU) after the cardiovascular surgery for the postoperative sedation before weaning from mechanical ventilation.Background:Sedation is prescribed in patients admitted to the ICU after cardiovascular surgery to reduce the patient discomfort, ventilator asynchrony, to make mechanical ventilation tolerable, prevent accidental device removal, and to reduce metabolic demands during respiratory and hemodynamic instability. Careful drug selection for sedation by the ICU team, postcardiovascular surgery should be done so that patients can be easily weaned from mechanical ventilation after sedation is stopped to achieve a shorter duration of mechanical ventilation and decreased the length of stay in ICU.Methods:A total of 50 patients admitted to the ICU after cardiovascular surgery, aged from 18 to 55 years and requiring mechanical ventilation on arrival to the ICU were enrolled in a prospective and comparative study. They were randomly divided into two groups as follows: Group D patients (n = 25) received dexmedetomidine in a maintenance infusion dose of 0.8 μg/kg/h and Group P patients (n = 25) received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The patients were assessed for 12 h postoperatively, and dosing of the study drug was adjusted based on sedation assessment performed with the Richmond Agitation-Sedation Scale (RASS). The patients were required to be within the RASS target range of −2 to +1 at the time of study drug initiation. At every 4 h, the following information was recorded from each patient such as heart rate (HR), mean arterial pressure (MAP), arterial blood gases (ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure, respiratory rate and the rapid shallow breathing index, duration of mechanical ventilation, midazolam and fentanyl dose requirements, and financial costs.Results:The study results showed no statistically significant difference between both groups with regard to age and body mass index. Group P patients were more associated with lower MAP and HR than Group D patients. There was no statistically significant difference between groups with regard to ABG findings, oxygenation, ventilation, and respiratory parameters. There was significant difference between both the groups in midazolam and fentanyl dose requirement and financial costs with a value of P < 0.05.Conclusion:Dexmedetomidine is safer and equally effective agent for the sedation of mechanically ventilated patients admitted to the ICU after cardiovascular surgery compared to the patients receiving propofol, with good hemodynamic stability, and equally rapid extubation time.

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Section: Discussionmentioning

confidence: 99%

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Elgebaly

Sabry

2018

Ann Card Anaesth

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“…Researchers have drawn attention to the effect of neuromuscular dysfunctions on the outcome of MV, which are risk factors for difficult weaning. In their study, 33% of the patients with polyneuropathy failed weaning trials and finally died [26].…”

Section: Discussionmentioning

confidence: 99%

Prolonged mechanical ventilation patient outcome after discharge from an intensive care unit

Potrichi¹,

Saintrain²,

Saintrain³

et al. 2022

IJAERS

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Background: Mechanical ventilation (MV) is one of the pillars of therapy in the Intensive Care Unit (ICU) as many patients require ventilatory support. This study aimed to analyze the outcome of Prolonged Mechanical Ventilation (PMV) patients after discharge from an Intensive Care Unit (ICU). Methods: This is a retrospective cross-sectional study of 142 medical charts of patients admitted to an ICU and a Special Care Unit (SCU) in Brazil from 2012 to 2014. Results: Participants' mean age was 66.5 and the majority were men (58.5%). Outcome in the ICU was correlated with laparotomies before (p=0.043) and after (p=0.049) admission, sepsis (p=0.013), dialysis-requiring acute kidney injury (AKI) (p<0.001), and hemodynamic instability (p=0.003). Dialysisrequiring AKI (p=0.012), non-dialysis-requiring AKI (p=0.023) and atelectasis (p=0.045) during ICU stay were correlated with death in SCU patients. Only hemodynamic instability (p=0.002) and diarrhea (p=0.045) were correlated with outcome in the SCU. Additionally, 91 (64.1%) PMV patients in the ICU were discharged to the SCU, 50 (35.2%) died, and one (0.7%) was transferred to another hospital. Furthermore, 15 (16.5%) SCU patients were discharged to the Home Care Program and one (1.1%) was transferred to another hospital. Conclusions: PMV patients exhibited longer hospital stay and higher mortality. Dialysis-requiring AKI and hemodynamic instability were associated with increased risk of death. Only a few PMV patients were successfully discharged or referred to Home Care.

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“…Ventilator dependence was considered in cases with failure in at least three trials of weaning or weaning process persisting for more than 7 days after the first spontaneous breathing trial [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Association between Thyroid Dysfunction and Intensive Care Unit-Acquired Weakness: A Case-Control Study

Shabana

Anis

Ibrahim

2021

Critical Care Research and Practice

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Background. Thyroid disorders may decrease the threshold for developing myopathy. Nonthyroidal illness syndrome (NTIS) is a common form of thyroid dysfunction in critically ill patients who are prone to the development of intensive care unit-acquired weakness (ICUAW). We therefore tested the hypothesis that patients with abnormalities in thyroid function are at a higher risk of developing ICUAW. Methods. We assessed blood samples from patients admitted to the ICU for ≥7 days for thyroid functions. Patients were classified into 4 categories (euthyroid, hyperthyroid, hypothyroid, and NTIS). Patients were then evaluated daily for ICUAW development. Patients with ICUAW were considered as cases, whereas patients who did not develop ICUAW served as controls. We compared demographic and clinical variables, such as APACHE II score; length of ICU stay; free T3 (FT3), free T4, and thyroid-stimulating hormone levels; incidence of the four categories of thyroid function; and other risk factors for ICUAW. Logistic regression was used to determine independent risk factors for ICUAW. Results. This case-control study included 114 patients: 57 cases (ICUAW) and 57 controls. FT3 levels were significantly lower in the cases (2.13 ± 0.96 mU/L) than in controls (2.69 ± 1.07 mU/L; P = 0.004 ). There were no significant differences between cases and controls regarding the incidence of all categories of thyroid function. In univariate analysis, five independent variables had P < 0.25 (sepsis, vasopressors, mechanical ventilation duration, NTIS, and FT3 levels). Among these variables, multiple regression showed that only FT3 level (CI = 0.157–0.82, P = 0.015 ) was an independent risk factor. Conclusion. The study revealed an inverse association between ICUAW incidence and FT3 levels.

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Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults

Cited by 9 publications

References 43 publications

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Prolonged mechanical ventilation patient outcome after discharge from an intensive care unit

Association between Thyroid Dysfunction and Intensive Care Unit-Acquired Weakness: A Case-Control Study

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