Mechanically assisted ventilation in a community hospital. Immediate outcome, hospital charges, and follow-up of patients

Witek, T. J.

doi:10.1001/archinte.145.2.235

Cited by 11 publications

(6 citation statements)

References 1 publication

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“…Their survival to discharge from hospital was around 60-75%, and at 1 year was around 50% and 2 years around 35% [3][4][5][6]. The major areas of interest with noninvasive techniques have been to show whether they can adequately ventilate these patients, reduce the intubation rate and improve survival.…”

Section: Acute Respiratory Failurementioning

confidence: 99%

The changing role of mechanical ventilation in COPD

Shneerson¹

1996

Eur Respir J

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For many years, mechanical ventilation has been employed in patients with chronic obstructive pulmonary disease (COPD) but the recent development of noninvasive techniques, particularly nasal and face mask ventilation, have considerably increased its use. The enthusiasm for these methods, however, has not been matched by the results from well-constructed studies, and the role of ventilatory support both in acute and chronic respiratory failure is still not settled. Acute respiratory failureThe steadily increasing number of publications on the use of noninvasive ventilation in acute infective exacerbations of COPD are hard to evaluate for several reasons. Firstly, most of the studies are uncontrolled or use historical or other unsatisfactory control groups. The definition of an infective exacerbation and its severity also varies considerably between the studies. Some studies compare the results of ventilation against "standard" medical treatment but this is frequently unspecified and, where details are given, oxygen appears to have been provided in flow rates sufficiently high to risk precipitating hypercapnia. Lastly, the criteria for the success or failure of noninvasive ventilation, such as the need for intubation, differ between studies.Series published before the use of noninvasive ventilation indicated that the intubation rate was around 25% for hospitalized COPD patients with an acute infective exacerbation [1,2]. Their survival to discharge from hospital was around 60-75%, and at 1 year was around 50% and 2 years around 35% [3-6]. The major areas of interest with noninvasive techniques have been to show whether they can adequately ventilate these patients, reduce the intubation rate and improve survival. Approximately 60-80% of patients tolerate both positive pressure ventilation by face or nasal mask [7,8] and negative pressure ventilation [9]. With mask ventilation, the arterial blood gases can usually be improved within 1-2 h, especially if the initial arterial carbon dioxide tension (Pa,CO 2 ) is raised [10][11][12][13][14][15][16], although in a controlled study there was no difference in the blood gases between the ventilated and nonventilated patients [17]. Early studies with negative pressure ventilation also showed that ventilation could be adequately supported [18][19][20][21][22], and these findings have been confirmed in subsequent uncontrolled studies [9,[23][24][25]. The mechanisms by which noninvasive ventilation achieves these effects have not been established.It can reduce respiratory muscle activity [26] and increase maximum inspiratory pressures [9, 24], but whether these or any changes in respiratory drive or mechanics are clinically significant is still uncertain.There are few data regarding the ability of negative pressure systems to avoid or delay intubation, but this question has been addressed in several reports of mask ventilation. Three series using historical controls suggested that the intubation rate could be reduced [27][28][29]. The results of a fourth are published in this ...

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Section: Acute Respiratory Failurementioning

confidence: 99%

The changing role of mechanical ventilation in COPD

Shneerson¹

1996

Eur Respir J

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“…Once admitted to IC, even patients who have an order to withhold resuscitation receive many other expensive and invasive life‐sustaining treatments 8,9 . Although most IC patients survive more than a year, a subset characterized by severe chronic disease 10–14 , cancer 14,15 , very advanced age 16,17 , or functional dependency 13,14,18 may have mortality rates of 50 to 70% in the year following IC admission. Some of these patients may feel that the disadvantages of IC — loss of contact with family, lack of privacy, discomfort, and cost — outweigh the potential survival benefits.…”

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confidence: 99%

Emergency Triage to Intensive Care: Can We Use Prognosis and Patient Preferences?

Hanson

Danis²,

Lazorick³

1994

J American Geriatrics Society

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Patients with poor performance status or very advanced age have increased mortality within 6 months of emergent triage to IC. Mental status changes, absence of advance directives, and time constraints are common barriers to communication of patient preferences at the time of triage. Primary care physicians need to elicit and record patients' preferences before the time of emergent decisions about IC.

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“…A high mortality suggests insufficient capacity and therefore strict criteria for admission to the ICU, whereas a low mortality indicates abundant facilities for this type of therapy. The much lower mortality we observed among our respirator patients compared to other reports (26,27) further illustrates the problem of comparing different patient materials. Our results reflect the frequent use of positive pressure ventilation postoperatively, which is emphaskd by the fact that half of our patients were ventilated for less than 24 h.…”

Section: I1000 U S $ )mentioning

confidence: 42%