Clinical and economic outcome of patients undergoing tracheostomy for prolonged mechanical ventilation in New York state during 1993

Kurek, C.; Cohen, Ian L.; Lambrinos, James; Minatoya, Kenji; Booth, Frank; Chalfin, Donald B.

doi:10.1097/00003246-199706000-00015

Cited by 72 publications

(35 citation statements)

References 12 publications

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“…This percentage is compatible with those of other reports in the literature 1,14,15 . The causes of failure to wean from mechanical ventilation in these patients related mainly to the presence of cardiac dysfunction and prolonged time of extracorporeal circulation.…”

Section: Discussionsupporting

confidence: 93%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation

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Section: Discussionsupporting

confidence: 93%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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show abstract

“…Although specific epidemiological data do not exist, one study showed that this population represents ,10% of ICU admissions and consumes a significant amount of the overall ICU patient-days and ,50% of financial resources [154]. Two other studies demonstrated that up to 20% of medical ICU patients remained dependent on ventilatory support after 21 days [155,156].…”

Section: Question 5: How Should Patients With Prolonged Weaning Failumentioning

confidence: 99%

“…Proposed advantages for tracheostomy include easier airway management, improved patient comfort and communication, reduction in sedative use, earlier weaning from respiratory support, improved respiratory mechanics, earlier transition to oral feeding, reduced oropharyngeal trauma and prevention of ventilator-acquired pneumonia [156,160]. Adverse effects include misplacement, haemorrhage, obstruction, displacement, impairment of swallowing reflexes and late tracheal stenosis.…”

Section: Question 5: How Should Patients With Prolonged Weaning Failumentioning

confidence: 99%

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Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

European Respiratory Journal

1,619

1,499

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“…The use of mechanical ventilation in elderly patients is increasing [26,27], and age may play a factor in mortality and morbidity for those with respiratory conditions that require mechanical ventilation [26,[28][29][30][31][32][33]. Mortality rates after respiratory failure are higher with increasing age although other factors such as premorbid health status also impact prognosis.…”

mentioning

confidence: 99%

Characteristics of Dysphagia in Elderly Patients Requiring Mechanical Ventilation

Davis

Stanton

2004

Dysphagia

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The purpose of this study was to describe the swallowing characteristics of elderly patients requiring mechanical ventilation with tracheostomy admitted to a long-term, acute-care hospital. The study was conducted through retrospective record review of patients on mechanical ventilation who had received a Modified Barium Swallow Study (MBSS) during their hospitalization. In a period from 1994 to 2002, 58 patients met the inclusion criteria. The study examined the results of both the clinical and the MBSS evaluations and compared the results and recommendations of the two examinations. Data were obtained from the MBSS records to describe the group in terms of dysphagia symptoms, frequency and occurrence of aspiration, respiratory status, and demographic variables. Parametric and nonparametric statistics were used to determine differences between the evaluations and any significant associations between aspiration and demographic variables, pharyngeal symptoms, and cognitive deficits. Significant differences were found between diet recommendations before and after the MBSS, and significant associations were found between aspiration and three pharyngeal symptoms. Although aspiration and especially silent aspiration occurred frequently in this group, most individuals were able to begin some level of oral intake after the MBSS evaluation. Due to the lack of reliable clinical evaluation measures, the MBSS is necessary for differential diagnosis of dysphagia and dietary recommendations for these individuals.

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Clinical and economic outcome of patients undergoing tracheostomy for prolonged mechanical ventilation in New York state during 1993

Abstract: Care of patients who undergo tracheostomy for prolonged mechanical ventilation is expensive. The older the patient, the less satisfactory the outcome from an economic, clinical, and possibly social perspective.

Cited by 72 publications

References 12 publications

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Weaning from mechanical ventilation

Characteristics of Dysphagia in Elderly Patients Requiring Mechanical Ventilation

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