Clinical model for predicting prolonged mechanical ventilation

Clark, Paul; Lettieri, Christopher J.

doi:10.1016/j.jcrc.2013.03.013

Cited by 41 publications

(56 citation statements)

References 23 publications

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“…For example, use of ≥ 21 days was most common in Asian countries, particularly Taiwan where this criterion is used to step patients down to a lower level of care 13 . Twenty-one days is also used as a trigger for transfer to an LTAC in the US 14 There is little doubt that there is a distinct cohort of relatively low volume, high cost, and poor outcome patients requiring mechanical ventilation for longer than the average ICU patient [15][16][17][18][19] . In 1989, Wagner and colleagues identified 6% of a cohort of nearly 4,000 ICU patients were ventilated for seven days or more and consumed 37% of ICU costs 20 suggesting this is not necessarily a new phenomenon solely due to advances in technology or worsening population comorbidity.…”

Section: Critiquementioning

confidence: 99%

Variation in Definition of Prolonged Mechanical Ventilation

et al. 2017

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Section: Critiquementioning

confidence: 99%

Variation in Definition of Prolonged Mechanical Ventilation

et al. 2017

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“…They further validated their ndings in a prospective trial. Acute kidney injury is one of the manifestations of insu cient organ perfusion [21]. On the other hand, kidney dysfunction can cause uid accumulation and tissue oedema.…”

Section: Discussionmentioning

confidence: 99%

Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

Zhao

Wang

Lyu

et al. 2020

Preprint

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BackgroundMaternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.MethodsThe clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.ResultsOut of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 hours. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) = 1.296, P = 0.029), acute kidney injury (AKI) (OR = 4.305, P = 0.013), myocardial injury (OR = 4.586, P = 0.012), and PaO2/FiO2 (OR = 0.989, P < 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.ConclusionsEstimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

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“…The existence of a distinct cohort of relatively low volume, high cost, and poor outcome patients requiring mechanical ventilation and ICU admission for longer than the average patient has long been recognized [2, 9, 10, 36–38]. However, for the most part, studies of the effectiveness of interventions in the ICU focus on the acute phase of critical illness.…”

Section: Discussionmentioning

confidence: 99%

Patient- and family-centered performance measures focused on actionable processes of care for persistent and chronic critical illness: protocol for a systematic review

et al. 2017

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BackgroundApproximately 5 to 10% of critically ill patients transition from acute critical illness to a state of persistent and in some cases chronic critical illness. These patients have unique and complex needs that require a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, discharge planning, and in some cases, end-of-life care. However, existing indicators and measures of care quality, and tools such as checklists, that foster implementation of best practices, may not be sufficiently inclusive in terms of actionable processes of care relevant to these patients. Therefore, the aim of this systematic review is to identify the processes of care, performance measures, quality indicators, and outcomes including reports of patient/family experience described in the current evidence base relevant to patients with persistent or chronic critical illness and their family members.MethodsTwo authors will independently search from inception to November 2016: MEDLINE, Embase, CINAHL, Web of Science, the Cochrane Library, PROSPERO, the Joanna Briggs Institute and the International Clinical Trials Registry Platform. We will include all study designs except case series/reports of <10 patients describing their study population (aged 18 years and older) using terms such as persistent critical illness, chronic critical illness, and prolonged mechanical ventilation. Two authors will independently perform data extraction and complete risk of bias assessment. Our primary outcome is to determine actionable processes of care and interventions deemed relevant to patients experiencing persistent or chronic critical illness and their family members. Secondary outcomes include (1) performance measures and quality indicators considered relevant to our population of interest and (2) themes related to patient and family experience.DiscussionWe will use our systematic review findings, with data from patient, family member and clinician interviews, and a subsequent consensus building process to inform the development of quality metrics and tools to measure processes of care, outcomes and experience for patients experiencing persistent or chronic critical illness and their family members.Systematic review registrationPROSPERO CRD42016052715 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0476-9) contains supplementary material, which is available to authorized users.

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Clinical model for predicting prolonged mechanical ventilation

Cited by 41 publications

References 23 publications

Variation in Definition of Prolonged Mechanical Ventilation

Variation in Definition of Prolonged Mechanical Ventilation

Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

Patient- and family-centered performance measures focused on actionable processes of care for persistent and chronic critical illness: protocol for a systematic review

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