Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients

Wu, Yi-Ming; Tsai, Ying Huang; Lan, Chou Chin; Huang, Chun Yao; Lee, Chih Hsin; Kao, Kuo Chin; Fu, Jui Ying

doi:10.1186/cc8890

Cited by 32 publications

(30 citation statements)

References 12 publications

(18 reference statements)

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“…8,22 Second, the RSBI tends to be higher in PMV patients, probably because these chronically ill patients are more likely to assume a rapid shallow breathing respiratory pattern, due to muscle wasting and weakness, and does not predict weaning outcome in these patients. 23,24 Accordingly, it is not surprising that the present study did not find an association between the RSBI and extubation outcome in the IRCU setting.…”

Section: Discussioncontrasting

confidence: 46%

“…Consistent with prior studies, 11,25 we did not demonstrate an association between long-term survival and the APACHE II score. Although such an association has been reported in a few studies, 24,26,27 they primarily investigated mortality over a short period of time, and found that the APACHE II score was poor at discriminating between individual patients in terms of risk of death. 27 Development of a severity scoring system for PMV patients is important because these patients consume a disproportionate amount of healthcare resources and have high medical costs.…”

Section: Discussionmentioning

confidence: 95%

“…There is conflicting evidence about whether early tracheostomy improves outcomes for PMV patients. 24,32 In this regard, the timing of tracheostomy should be individualized according to ongoing assessment of a patient's progress, readiness to wean, and preference.…”

Section: Discussionmentioning

confidence: 99%

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Conventional Weaning Parameters Do Not Predict Extubation Outcome in Intubated Subjects Requiring Prolonged Mechanical Ventilation

Huang

2013

Respir Care

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BACKGROUND: Approaches to respiratory care of patients needing prolonged mechanical ventilation (PMV) might be varied. In this study we assessed the predictive value of usual variables for extubation outcome in PMV patients. METHODS: From 2005 to 2007, intubated patients who were admitted to the intermediate respiratory care unit, had been on mechanical ventilation for > 21 days at the time of admission, and underwent extubation after successful spontaneous breathing trials were included. Comparisons between subjects with successful extubation and failed extubation in terms of weaning parameters and clinical predictors of extubation outcome were performed. Also, 1-year survival of subjects with regard to extubation outcome was analyzed. RESULTS: Twentyseven (23.7%) of 119 PMV subjects required reintubation within 7 days. Multivariate logistic regression analysis demonstrated that the only variable associated with extubation failure was ineffective cough (P < .001). Possessing 2 or more acceptable weaning parameters was not helpful in predicting extubation outcome. Subjects with failed extubation had worse 1-year survival (hazard ratio 0.49, 95% CI 0.28 -0.87, P ‫؍‬ .02) compared with those with successful extubation. CONCLUSIONS: In PMV subjects who tolerated spontaneous breathing trials and were ready to extubate, ineffective cough was the best predictor of extubation failure. Furthermore, extubation failure was associated with future mortality; thus, different management strategies need to be developed for improving patient outcome.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 95%

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Conventional Weaning Parameters Do Not Predict Extubation Outcome in Intubated Subjects Requiring Prolonged Mechanical Ventilation

Huang

2013

Respir Care

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“…These results are comparable with those of other studies reported in Taiwan 12,16 . Because the NHIB established a policy of gradual care reduction for these patients, as demonstrated by their transfer from the ICU after 21 days to an RCC and then to a respiratory care ward (RCW) after 42 days in the RCC, the outcome of patients with PMV became favorable as compared with recent studies 17e19 .…”

Section: Discussionsupporting

confidence: 96%

Tracheostomy versus Endotracheal Intubation Prior to Admission to a Respiratory Care Center: A Retrospective Analysis

Tseng

Shieh

Cheng

et al. 2015

International Journal of Gerontology

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s u m m a r yBackground: This study was conducted to examine the hypothesis that a tracheostomy prior to admission to a respiratory care center (RCC) with a specialized weaning setting would improve the outcome of patients transferred from intensive care unit previously maintained on prolonged mechanical ventilation. Methods: A retrospective review of medical records from intubated adult patients admitted to the ChiMei Medical Center, a 16-bed RCC in Southern Taiwan from January 1, 2001 through July 31, 2012, was performed. The outcomes at weaning (without ventilator support within 120 hours), mortality, and expenditure at hospital discharge were compared between the tracheostomy group (n ¼ 1216) and the endotracheal tube group (n ¼ 1187), and the predictors of weaning in all patients were determined. Results: The overall weaning rate and the in-hospital mortality rate were 68.2% and 16.4%, respectively. The tracheostomy group showed significantly higher weaning rate and shorter hospital stay (73.5% vs. 62.8% and 57.4 vs. 61.0 days, both p < 0.01) compared with the endotracheal tube group. In-hospital mortality, total ventilator days, and cost of hospitalization were comparable between groups. Factors predictive of successful weaning were surgical origin [odds ratio (OR) 2.165], higher albumin (OR 1.937), tracheostomy group (OR 1.543), higher PaO 2 /fraction of inspired oxygen (OR 1.345), and lower blood urea nitrogen (OR 0.984). Conclusion: Tracheostomy creation prior to RCC admission was associated with a significantly higher weaning rate and reduced hospital stays. The provision of assessment of the aforementioned markers may be helpful in the clinical setting to facilitate the optimal management and the accreditation of medical care quality of patients with prolonged mechanical ventilation.

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“…The APACHE II was useful in predicting mortality in pulmonary ICU patients with a cut-off point of 16 points (AUROC = = 0.81) [16]. In a comparison between tracheostomized and translaryngeally intubated patients, those with an APACHE II score < 18 points were more likely to be successfully weaned and be kept alive [17]. Jubran et al confirmed that the comorbidity score might increase mortality by 24% [18].…”

Section: Discussionmentioning

confidence: 99%

APACHE II score predicts mortality in patients requiring prolonged ventilation in a weaning center

Rojek-Jarmuła

Hombach²,

Krzych

2016

Anaesthesiol Intensive Ther

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Background: Little is known about the diagnostic accuracy of the APACHE II scoring system in prolonged mechanical ventilation. The aim of this study was to assess the utility of APACHE II in order to predict in-hospital mortality, length of stay (LOS) and discharge destination of patients in a weaning centre. Methods: The study group included 130 consecutive patients (median age 71 years; IQR 62−77). APACHE II was assessed based on the worst values taken during the first 24 hours post admission. The primary outcome was in-hospital mortality. LOS and discharge destination were considered secondary outcomes. Results: The APACHE II median score was 11 points (IQR 9−14) while 15 patients (11.5%) died. Mortality was lower in men (10.3%) than in women (14%) (P = 0.04). APACHE II was higher in non-survivors (15; IQR 10.25−19.5) compared to survivors (11; 8.25−14) (P < 0.001). In a bivariate analysis, APACHE II predicted mortality with good diagnostic accuracy (AUROC = 0.714; P = 0.007). In a multivariate analysis APACHE II (OR = 1.22; 95% CI: 1.06−1.40 per 1 point) and mode of ventilation (OR = 0.28; 95% CI: 0.08−0.99; CPAP vs. BIPAP) only predicted mortality. The median length of stay (LOS) was 28 days (IQR 20−39). There was weak correlation between APACHE II and LOS (R = 0.23; P = 0.01). Most patients were transferred to a rehabilitation center (53.9%) or a geriatric ward (13.9%). APACHE II did not differ between patients discharged to different healthcare facilities (P = 0.14). Conclusion:The APACHE II score is a powerful tool for predicting mortality of patients undergoing weaning from prolonged mechanical ventilation.

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Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients

Cited by 32 publications

References 12 publications

Conventional Weaning Parameters Do Not Predict Extubation Outcome in Intubated Subjects Requiring Prolonged Mechanical Ventilation

Conventional Weaning Parameters Do Not Predict Extubation Outcome in Intubated Subjects Requiring Prolonged Mechanical Ventilation

Tracheostomy versus Endotracheal Intubation Prior to Admission to a Respiratory Care Center: A Retrospective Analysis

APACHE II score predicts mortality in patients requiring prolonged ventilation in a weaning center

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