I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation

Clark, Paul; Inocencio, Ryan; Lettieri, Christopher J.

doi:10.1177/0885066616679974

Cited by 22 publications

(28 citation statements)

References 25 publications

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“…The adjusted OR of death in the high shedding group versus the low shedding reference group was 0.43 (95% CI = 0.01–1.67, P = 0.23) for the subgroup with ARDS and 0.53 (95% CI = 0.20–1.30, P = 0.17) for the entire cohort, suggestive that the relationship between GAG shedding and days on mechanical ventilation was not confounded by mortality. Given that airspace GAG concentrations were determined using HMEF collected within 24 hours of intubation, these findings may be useful for the care of ICU patients, as there are few clinically available tools to predict the duration of respiratory failure at the bedside ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

Alveolar epithelial glycocalyx degradation mediates surfactant dysfunction and contributes to acute respiratory distress syndrome

Rizzo¹,

Haeger²,

Oshima³

et al. 2022

JCI Insight

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Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure yet has few pharmacologic therapies, reflecting the mechanistic heterogeneity of lung injury. We hypothesized that damage to the alveolar epithelial glycocalyx, a layer of glycosaminoglycans interposed between the epithelium and surfactant, contributes to lung injury in patients with ARDS. Using mass spectrometry of airspace fluid noninvasively collected from mechanically ventilated patients, we found that airspace glycosaminoglycan shedding (an index of glycocalyx degradation) occurred predominantly in patients with direct lung injury and was associated with duration of mechanical ventilation. Male patients had increased shedding, which correlated with airspace concentrations of matrix metalloproteinases. Selective epithelial glycocalyx degradation in mice was sufficient to induce surfactant dysfunction, a key characteristic of ARDS, leading to microatelectasis and decreased lung compliance. Rapid colorimetric quantification of airspace glycosaminoglycans was feasible and could provide point-of-care prognostic information to clinicians and/or be used for predictive enrichment in clinical trials.

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Section: Resultsmentioning

confidence: 99%

Alveolar epithelial glycocalyx degradation mediates surfactant dysfunction and contributes to acute respiratory distress syndrome

Rizzo¹,

Haeger²,

Oshima³

et al. 2022

JCI Insight

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“…Comparison of diagnosis profiles with other studies is difficult due to different methods of documenting a primary ICU diagnosis 7,9,18,19 . However, earlier studies also report sepsis as a primary reason of PMV 11,20 . The only difference in this study found between mechanical ventilation ≥7-21 days and PMV >21 days was that a primary ICU diagnosis of pancreatitis or respiratory insufficiency was more likely to require PMV >21 days.…”

Section: Use Of Bed Daysmentioning

confidence: 96%

Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs

et al. 2020

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“…In addition to patients in medical or surgical ICUs without further specification, there were studies that included patients surviving sepsis with respiratory failure, tracheotomized patients undergoing MV, patients admitted to respiratory ICUs, or patients admitted to the ICU after cardiac surgery. Risk factors identified as relevant for PMV or prolonged weaning include age [1,16], comorbidities (previous stroke, renal impairment, poor cardiac function, chronic obstructive pulmonary disease [COPD]) [17][18][19][20][21] and various laboratory parameters (low platelets, elevated blood urea nitrogen, elevated creatinine, low serum albumin, elevated blood glucose levels or hypernatremia) [16, 18-20, 22, 23]. Blood gas analysis values (lower HCO 3 or pH values or higher PaCO 2 ) as well as parameters of ventilator settings (FiO 2 ≥ 0.39, level of PEEP) [19,24] or gas exchange (PaO 2 /FiO 2 <200 mm Hg) [16] were also identified as relevant.…”

Section: Risk Factors For Prolonged MVmentioning

confidence: 99%

Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review

et al. 2022

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Introduction: Prolonged mechanical ventilation (PMV) and weaning failure are factors associated with prolonged hospital length of stay and increased morbidity and mortality. In addition to the burden these places on patients and their families, it also imposes high costs on the public health system. The aim of this systematic review was to identify risk factors for PMV and weaning failure. Methods: The study was conducted according to PRISMA guidelines. After a comprehensive search of the COCHRANE Library, CINHAL, Web of Science, MEDLINE, and the LILACS Database a PubMed request was made on June 8, 2020. Studies that examined risk factors for PMV, defined as mechanical ventilation ≥96 h, weaning failure, and prolonged weaning in German and English were considered eligible; reviews, meta-analyses, and studies in very specific patient populations whose results are not necessarily applicable to the majority of ICU patients as well as pediatric studies were excluded from the analysis. This systematic review was registered in the PROSPERO register under the number CRD42021271038. Results: Of 532 articles identified, 23 studies with a total of 23,418 patients met the inclusion criteria. Fourteen studies investigated risk factors of PMV including prolonged weaning, 9 studies analyzed risk factors of weaning failure. The concrete definitions of these outcomes varied considerably between studies. For PMV, a variety of risk factors were identified, including comorbidities, site of intubation, various laboratory or blood gas parameters, ventilator settings, functional parameters, and critical care scoring systems. The risk of weaning failure was mainly related to age, previous home mechanical ventilation (HMV), cause of ventilation, and preexisting underlying diseases. Elevated PaCO2 values during spontaneous breathing trials were indicative of prolonged weaning and weaning failure. Conclusion: A direct comparison of risk factors was not possible because of the heterogeneity of the studies. The large number of different definitions and relevant parameters reflects the heterogeneity of patients undergoing PMV and those discharged to HMV after unsuccessful weaning. Multidimensional scores are more likely to reflect the full spectrum of patients ventilated in different ICUs than single risk factors.

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I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation

Abstract: Similar to our previous retrospective study, these findings validate I-TRACH in determining the subsequent need for MV >7 and >14 days at the time of intubation.

Cited by 22 publications

References 25 publications

Alveolar epithelial glycocalyx degradation mediates surfactant dysfunction and contributes to acute respiratory distress syndrome

Alveolar epithelial glycocalyx degradation mediates surfactant dysfunction and contributes to acute respiratory distress syndrome

Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs

Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review

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