Establishment of a prospective cohort of mechanically ventilated patients in five intensive care units in Lima, Peru: protocol and organisational characteristics of participating centres

Denney, Joshua A; Capanni, Francesca; Herrera, Phabiola; Dulanto, Augusto; Roldán, Rollin; Paz, Enrique; Jaymez, Amador A.; Chirinos, Eduardo; Portugal, José Luiz; Quispe, Rocío; Brower, Roy G.

doi:10.1136/bmjopen-2014-005803

Cited by 5 publications

(5 citation statements)

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“…None of the five ICUs participating in this study used protocols for sedation management, nor did they use tools to screen or manage delirium [17]. This is not surprising since data from previous international surveys reported implementation rates between 20% and 80% [1], including a study of 912 ICU practitioners in high-income countries that revealed that only 16% used a valid delirium assessment tool [30].…”

Section: Discussionmentioning

confidence: 99%

“…A detailed description of the protocol and participating ICUs was provided elsewhere [17]. Adults with acute respiratory failure were consecutively screened in a longitudinal, observational study in five ICUs at four public hospitals in Lima, Peru.…”

Section: Methodsmentioning

confidence: 99%

“…Eligibility criteria included age ≥ 18 years, at least 24 h of invasive mechanical ventilation at one of the intensive care units participating in the study and enrollment into the study within 48 h of mechanical ventilation onset. Data collection and quality control methods were reported elsewhere [17]. At enrollment, we obtained demographics, chronic disease, and acute physiological data for all patients meeting eligibility criteria.…”

Section: Methodsmentioning

confidence: 99%

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Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort

et al. 2019

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Objectives We sought to study the association between sedation status, medications (benzodiazepines, opioids, and antipsychotics), and clinical outcomes in a resource-limited setting. Design A longitudinal study of critically ill participants on mechanical ventilation. Setting Five intensive care units (ICUs) in four public hospitals in Lima, Peru. Patients One thousand six hundred fifty-seven critically ill participants were assessed daily for sedation status during 28 days and vital status by day 90. Results After excluding data of participants without a Richmond Agitation Sedation Scale score and without sedation, we followed 1338 (81%) participants longitudinally for 18,645 ICU days. Deep sedation was present in 98% of participants at some point of the study and in 12,942 ICU days. Deep sedation was associated with higher mortality (interquartile odds ratio (OR) = 5.42, 4.23–6.95; p < 0.001) and a significant decrease in ventilator (− 7.27; p < 0.001), ICU (− 4.38; p < 0.001), and hospital (− 7.00; p < 0.001) free days. Agitation was also associated with higher mortality (OR = 39.9, 6.53–243, p < 0.001). The most commonly used sedatives were opioids and benzodiazepines (9259 and 8453 patient days respectively), and the latter were associated with a 41% higher mortality in participants with a higher cumulative dose (75th vs 25th percentile, interquartile OR = 1.41, 1.12–1.77; p < 0.01). The overall cumulative dose of benzodiazepines and opioids was high, 774.5 mg and 16.8 g, respectively, by day 7 and by day 28; these doses approximately doubled. Haloperidol was only used in 3% of ICU days; however, the use of it was associated with a 70% lower mortality (interquartile OR = 0.3, 0.22–0.44, p < 0.001). Conclusions Deep sedation, agitation, and cumulative dose of benzodiazepines were all independently associated with higher 90-day mortality. Additionally, deep sedation was associated with less ventilator-, ICU-, and hospital-free days. In contrast, haloperidol was associated with lower mortality in our study. Electronic supplementary material The online version of this article (10.1186/s13054-019-2394-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort

et al. 2019

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“…There are no established ventilation protocols in use at the Peruvian ICUs; ventilator settings are based on intensivist preference. Details of the characteristics of the participating ICUs and their organization and structure are described elsewhere [22]. We received ethics approval and permission to conduct this study in each of the participating institutions: Hospital Nacional Edgardo Rebagliati Martins, Hospital Nacional Guillermo Almenara Irigoyen, Hospital Nacional Arzobispo Loayza, and Hospital de Emergencias Casimiro Ulloa.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study

et al. 2019

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BackgroundClinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset.MethodsWe consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status.ResultsWe enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p < 0.01). Adults with ARDS had a higher body mass index (BMI) than those without ARDS (27.3 vs 26.5 kg/m2, p < 0.01). Higher peak pressure (adjusted interquartile OR = 1.51, 95% CI 1.21–1.88), higher mean airway pressure (adjusted interquartile OR = 1.41, 95% CI 1.13–1.76), and higher positive end-expiratory pressure (adjusted interquartile OR = 1.29, 95% CI 1.10–1.50) at MV onset were associated with a higher odds of developing ARDS after MV onset.ConclusionsIn this study of mechanically ventilated patients, 31% of study participants had ARDS at some point during their ICU stay. Optimal lung-protective ventilation was not used in a majority of patients. Patients with ARDS after MV onset had a similar 90-day mortality as those with ARDS at MV onset. Higher airway pressures at MV onset, higher PEEP, and higher BMI were associated with the development of ARDS after MV onset.

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“…Secretion clearance is usually used to keep the respiratory tract clear and to improve alveolar ventilation and patients' breathe function. Thus, secretion clearance is one of the most important nursing interventions of ventilated patients' respiratory tract 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Classification of Sputum Sounds Using Artificial Neural Network and Wavelet Transform

Shi¹,

Wang²,

Niu³

et al. 2018

Int. J. Biol. Sci.

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Sputum sounds are biological signals used to evaluate the condition of sputum deposition in a respiratory system. To improve the efficiency of intensive care unit (ICU) staff and achieve timely clearance of secretion in patients with mechanical ventilation, we propose a method consisting of feature extraction of sputum sound signals using the wavelet transform and classification of sputum existence using artificial neural network (ANN). Sputum sound signals were decomposed into the frequency subbands using the wavelet transform. A set of features was extracted from the subbands to represent the distribution of wavelet coefficients. An ANN system, trained using the Back Propagation (BP) algorithm, was implemented to recognize the existence of sputum sounds. The maximum precision rate of automatic recognition in texture of signals was as high as 84.53%. This study can be referred to as the optimization of performance and design in the automatic technology for sputum detection using sputum sound signals.

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Establishment of a prospective cohort of mechanically ventilated patients in five intensive care units in Lima, Peru: protocol and organisational characteristics of participating centres

Cited by 5 publications

References 42 publications

Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort

Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort

Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study

Classification of Sputum Sounds Using Artificial Neural Network and Wavelet Transform

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