Cumulative Probability and Time to Reintubation in U.S. ICUs

Miltiades, Andrea; Gershengorn, Hayley B.; Hua, May; Kramer, Andrew A.; Li, Guohua; Wunsch, Hannah

doi:10.1097/ccm.0000000000002327

Cited by 51 publications

(41 citation statements)

References 32 publications

(43 reference statements)

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“…We report that 47% of infants ≤ 1,250 g and 58% of infants ≤ 1,000 g were reintubated at least once during hospitalization, a finding consistent with results of other large cohort studies (4,11). However, these reintubation rates are much higher than those reported for adult (10%) and children (6%) patients (12,13). Given the morbidities associated with reintubation and resumption of MV, clinicians and investigators alike are increasingly searching for strategies that can reduce rates of reintubation in this population (7).…”

Section: Discussionsupporting

confidence: 90%

“…First, with the increased use of non-invasive ventilation following extubation, reintubation may be delayed rather than actually prevented. This phenomenon has actually been described in the adult population, whereby the increased use of non-invasive respiratory support has shifted the window of observation from the traditional 48 to 96 h postextubation (12,16). Indeed, in our cohort, although infants were extubated to continuous positive airway pressure or nasal intermittent positive pressure ventilation equally often, the majority had escalated to nasal intermittent positive pressure ventilation by the time they were reintubated.…”

Section: Discussionsupporting

confidence: 51%

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Patterns of reintubation in extremely preterm infants: a longitudinal cohort study

et al. 2018

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BackgroundThe optimal approach for reporting reintubation rates in extremely preterm infants is unknown. This study aims to longitudinally describe patterns of reintubation in this population over a broad range of observation windows following extubation.MethodsTiming and reasons for reintubation following a first planned extubation were collected from infants with birth weight ≤1,250 g. An algorithm was generated to discriminate between reintubations attributable to respiratory and non-respiratory causes. Frequency and cumulative distribution curves were constructed for each category using 24 h intervals. The ability of observation windows to capture respiratory-related reintubations while limiting non-respiratory reasons was assessed using a receiver operating characteristic curve.ResultsOut of 194 infants, 91 (47%) were reintubated during hospitalization; 68% for respiratory and 32% for non-respiratory reasons. Respiratory-related reintubation rates steadily increased from 0 to 14 days post-extubation before reaching a plateau. In contrast, non-respiratory reintubations were negligible in the first post-extubation week, but became predominant after 14 days. An observation window of 7 days captured 77% of respiratory-related reintubations while only including 14% of non-respiratory cases.ConclusionReintubation patterns are highly variable and affected by the reasons for reintubation and observation window used. Ideally, reintubation rates should be reported using a cumulative distribution curve over time.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 51%

Patterns of reintubation in extremely preterm infants: a longitudinal cohort study

et al. 2018

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“…8 Both delayed and premature extubation may be correlated to an increased risk of various complications, 31,32 and the need for reintubation or tracheostomy was viewed as a potential adverse event after CABG. [31][32][33] Previous studies found that requiring reintubation or tracheostomy was associated with organ dysfunction, especially respiratory failure, secondary to physiologic stress, increased mortality, higher hospital costs and longer length of ICU stay. [34][35][36] Among CHD patients following CABG, OSA was correlated to a longer intubation time.…”

Section: Discussionmentioning

confidence: 99%

OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

Wang¹,

Wang²,

Yu³

et al. 2020

Preprint

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Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function, including cardiac and cerebral vascular, respiratory as well as renal postoperative complications, among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases, including PubMed, ISI Web of Science, Directory of Open Access Journals, and the Cochrane Library electronic databases, were searched manually and automatically for relevant English articles. All of the selected articles focused on a comparison of the incidence of primary and secondary outcomes in CHD patients undergoing elective CABG with and without OSA. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls (odds risk (OR), 1.97; 95% confidence interval (CI), 1.50 to 2.59, p <0.0001). In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, p <0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased (OR, 3.43; 95% CI, 1.35 to 8.71; p =0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; p=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P < 0.0001). Finally, our results demonstrated that OSA increased medical resource utilization including length of postoperative hospital stay and ICU stay. Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications. Peri- and postoperative management of CHD patients with OSA may be optimized to minimize the rate of postoperative parameters of multi-organ dysfunction, further reducing the consumption of limited medical resources.

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“…A anticoagulação durante a ECMO é utilizada para prevenir complicações trombóticas, e tem sido muito estudada na tentativa de encontrar formas para aprimorar as técnicas de anticoagulação (MILTIADES et al, 2017;LO-PINTO et al, 2018). A heparina é mais frequentemente usada, e o monitoramento normalmente é feito através dos testes de tempo de coagulação ativada (TCA) e de tempo de tromboplastina parcial ativada (TTPa), de níveis de fibrinogênio, tempo de atividade da protrombina (TAP) e a contagem de plaquetas que são rotineiramente conferidos e corrigidos se necessário.…”

Section: Anticoagulação Durante a Ecmounclassified

Suporte Respiratório Extracorpóreo Em Pacientes

Oliveira¹,

Moura²,

Oliveira³

et al. 2020

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RESUMO O termo oxigenação por membrana extracorpórea (ECMO) foi inicialmente usado para descrever o suporte extracorporal a longo prazo que se concentrou sobre a função de oxigenação. O objetivo da terapia é para dar tempo para a recuperação intrínseca dos pulmões e do coração, assim uma circulação extracorpórea padrão fornece suporte durante vários tipos de procedimentos cirúrgicos cardíacos. O objetivo deste trabalho foi verificar os aspectos técnicos e clínicos sobre o uso de oxigenação por membrana extracorporal (ECMO). Para tanto, foi realizada pesquisa bibliográfica em diversas bases de dados (Bireme, Chest, Lilacs, PubMed e Scielo), além de Revista Intensiva, diversos livros, teses e textos eletrônicos onde foram buscados artigos nacionais ou internacionais, escritos por profissionais da saúde especializados no tema. Principalmente no caso de pacientes neonatos, a ECMO é indicada através dos seguintes aspectos: Recém-nascido com 34 semanas de idade, maior que 2,5kg ao nascer e sem coagulopatia. Em geral o paciente apoiado pela ECMO deve ser tratado como um paciente crítico, sendo que a analgesia pode ser administrada preemptivamente em todos os pacientes canulados, pelo menos até que seja possível uma avaliação objetiva da dor. Concluiu-se que não oferecer ECMO é como não oferecer a ventilação convencional, pois a ECMO é utilizada enquanto busca-se um diagnóstico e melhor estratégia terapêutica, dando ao paciente a chance de melhorar sua condição cardiorrespiratória aumentando as chances de recuperar a própria vida. PALAVRAS-CHAVE: Disfunção cardiopulmonar; Ecmo; Sistema de oxigenação extracorpóreo.

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Cumulative Probability and Time to Reintubation in U.S. ICUs

Cited by 51 publications

References 32 publications

Patterns of reintubation in extremely preterm infants: a longitudinal cohort study

Patterns of reintubation in extremely preterm infants: a longitudinal cohort study

OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients

Suporte Respiratório Extracorpóreo Em Pacientes

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