Prolonged Mechanical Ventilation is Associated With Pulmonary Complications, Increased Length of Stay, and Unfavorable Discharge Destination Among Patients With Subdural Hematoma

Busl, Katharina M.; Ouyang, Bo; Boland, Torrey; Pollandt, Sebastian; Temes, Richard E.

doi:10.1097/ana.0000000000000085

Cited by 21 publications

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“…It has been reported that MV support was required in 3-6% of patients admitted to the ICU in the postoperative period, and the rate of failed weaning is reportedly 5-8% in all surgical patients (10)(11)(12). That said, it is known that ICU patients requiring prolonged MV in the postoperative period have a higher rate of failed weaning and a higher rate of morbidity and mortality (13,14).…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Weaning Failure in Critically-Ill Patients Undergoing Emergency Gastrointestinal Surgery

Yıldırım¹,

Karabacak²,

Kaya³

2020

J Crit Intensive Care

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Aim: Mechanical ventilation (MV) is one of the most commonly used treatment modalities in critically ill patients in the intensive care unit (ICU). Prolonged MV is associated with increased morbidity and mortality, and so the prevention of unnecessary prolonged MV and reintubation due to early extubation is of great importance. Although studies to date have studied factors that are predictive of weaning success and failure, there have been very few studies to date examining critical surgical patients requiring MV in the postoperative period. The present study investigated the factors affecting weaning failure in patients undergoing emergency gastrointestinal surgery. Material and Method: The data of patients who underwent emergency gastrointestinal surgery between August 2016 and January 2019, that required MV for longer than 48 hours postoperatively and that were followed up in the general surgery ICU, was analyzed retrospectively. Results: Ninety-seven patients with a mean age of 71.8±14.2 years included in study, of which 63 (64.9%) were male and 34 (35.1%) were female. The mean APACHE II score was 25.2±6.7. The main primary disease was gastrointestinal malignancy in 72.1% of the patients and the most common comorbid diseases were hypertension (53.6%) and congestive heart failure (36.1%). The median duration of MV was 9 [2-56] days and the mean length of ICU stay was 18.7±12.2 days. Weaning was started at a median 2 [2-4] days after intubation. The median weaning time was 4 [4-18] days. While 71 (73.2%) of the patients were successfully weaned, 26 (26.8%) experienced weaning failure. Of these patients, 21 (21.6%) experienced simple weaning, 40 (41.2%) experienced prolonged weaning and 36 (37.1%) experienced difficult weaning. The most common causes of weaning difficulty were hypervolemia in 88 (90.7%) patients and postoperative sepsis in 21 (21.6%) patients. Patients who suffered weaning failure had higher lactate levels, a greater need for erythrocyte suspension and vasopressor administration, and a higher rate of sepsis and acute renal failure. The presence of sepsis (OR: 4.034, 95% CI: 1.995-3.450, p= 0.04) was determined as an independent risk factor for weaning failure. Conclusion: Weaning failure and difficult weaning were found common in critically ill patients undergoing emergency gastrointestinal surgery; and sepsis was found as an independent risk factors for weaning failure. We lack sufficient data on this patient population in our country, and so our findings need to be supported by prospective studies involving larger patient series.

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Section: Discussionmentioning

confidence: 99%

“…Weaning was started a median 2 days[2][3][4] after intubation. The mean weaning time was 4[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] days. Of the patients, 21 (21.6%) experienced simple weaning, 36 (37.1%) experienced prolonged weaning and 40 (41.2%) experienced difficult weaning.…”

mentioning

confidence: 99%

Factors Affecting Weaning Failure in Critically-Ill Patients Undergoing Emergency Gastrointestinal Surgery

Yıldırım¹,

Karabacak²,

Kaya³

2020

J Crit Intensive Care

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“…Prolonged MV is associated with many complications [ 17 , 18 ], such as ventilator-associated pneumonia, ventilator-induced diaphragm dysfunction, increased use of medical resources, etc. [ 3 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Left ventricular-arterial coupling is associated with prolonged mechanical ventilation in severe post-cardiac surgery patients: an observational study

Wang

Long

et al. 2018

BMC Anesthesiol

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BackgroundWeaning post-cardiac surgery patients from mechanical ventilation (MV) poses a big challenge to these patients. Optimized left ventricular-arterial coupling (VAC) may be crucial for reducing the MV duration of these patients. However, there is no research exploring the relationship between VAC and the duration of MV. We performed this study to investigate the relationship between left ventricular-arterial coupling (VAC) and prolonged mechanical ventilation (MV) in severe post-cardiac surgery patients.MethodsThis was a single-center retrospective study of 56 severe post-cardiac surgery patients from January 2015 to December 2017 at the Department of Critical Care Medicine of Peking Union Medical College Hospital. Patients were divided into two groups according to the duration of MV (PMV group: prolonged mechanical ventilation group, MV > 6 days; Non-PMV group: non-prolonged mechanical ventilation group, MV ≤ 6 days). Hemodynamics and tissue perfusion data were collected or calculated at admission (T0) and 48 h after admission (T1) to the ICU.ResultsIn terms of hemodynamic and tissue perfusion data, there were no differences between the two groups at admission (T0). Compared with the non-prolonged MV group after 48 h in the ICU (T1), the prolonged MV group had significantly higher values for heart rate (108 ± 13 vs 97 ± 12, P = 0.018), lactate (2.42 ± 1.24 vs.1.46 ± 0.58, P < 0.001), and Ea/Ees (5.93 ± 1.81 vs. 4.05 ± 1.20, P < 0.001). Increased Ea/Ees (odds ratio, 7.305; 95% CI, 1.181–45.168; P = 0.032) and lactate at T1 (odds ratio, 17.796; 95% CI, 1.377–229.988; P = 0.027) were independently associated with prolonged MV. There was a significant relationship between Ea/EesT1 and the duration of MV (r = 0.512, P < 0.01). The area under the receiver operating characteristic (AUC) of the left VAC for predicting prolonged MV was 0.801, and the cutoff value for Ea/Ees was 5.12, with 65.0% sensitivity and 90.0% specificity.ConclusionsLeft ventricular-arterial coupling was associated with prolonged mechanical ventilation in severe post-cardiac surgery patients. The assessment and optimization of left VAC might be helpful in reducing duration of MV in these patients.

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“…4,5 Dari sebuah penelitian didapatkan lebih dari sepertiga pasien dengan SDH dengan riwayat intubasi sebelum operasi akan beresiko tinggi mengalami pemanjangan ventilasi mekanik pascaoperasi evakuasi hematom. 6 Pemanjangan ventilasi mekanik didefinisikan durasi intubasi lebih dari 4 hari, pedoman penatalaksanaan terbaru yang ada saat ini tidak menjelaskan strategi mengenai penyapihan atau ekstubasi pada pasien dengan COT. 5,6 Gambaran klinis, tingkat kesadaran dan kriteria ekstubasi yang menggambarkan angka keberhasilan ekstubasi terhadap pasien dengan COT masih diperdebatkan, terutama bagi pasien yang telah memenuhi kriteria ekstubasi namun belum mencapai level kesadaran untuk mempertahankan jalan nafas.…”

Section: Pendahuluanunclassified

Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Subdural Hematoma

Putri

Rachman

Rahardjo

2020

JNI

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Cedera otak traumatik (COT) adalah suatu proses patologis pada otak yang berasal dari luar tubuh, yang dapat menyebabkan kerusakan permanen atau sementara dari fungsi otak. Salah satu perdarahan otak yang sering menyertai terjadinya COT berat adalah subdural hematoma (SDH). Pasien laki-laki 41 tahun, datang ke rumah sakit dengan penurunan kesadaran GCS E2M2V2 akibat kecelakaan. Pasien dilakukan tatalaksana dan diintubasi di IGD, hasil CT-Scan memperlihatkan SDH, dan edema serebri. Pasien dilakukan evakuasi hematom dengan anestesi umum, diinduksi dengan fentanil 100 μgr, propofol 20 mg dan atracurium 20 mg intravena. Pemeliharaan dengan sevofluran, propofol kontinyu, fentanil dan atracurium intermiten. Pascaoperasi pasien mengalami ventilator associated pneumonia (VAP), diberikan antibiotik sprektum luas untuk pemulihan paru, pada hari ke 10 pasien dilakukan trakeostomi. Pasien dapat disapih dari ventilator hari ke 21 dengan GCS E4M4Vtrach tanpa kontak, dengan skor GOS (Glasgow Outcome Scale) 3, direncanakan untuk homecare. COT berat membutuhkan tatalaksana pascaoperasi yang lebih kompleks, antisipasi penggunaan ventilasi mekanik yang memanjang, risiko VAP serta pertimbangan pemasangan trakeostomi secara cepat hingga pemberian antibiotik yang adekuat untuk mendapatkan hasil luaran terbaik. Prolonged Mechanical Ventilation in Severe Traumatic Brain Injury Patients with Subdural HematomasAbstractTraumatic brain injury (TBI) is a pathological process in the brain that originates from outside the body, which can lead to permanent or temporary damage to brain function. One of the brain hemorrhages that often accompanies severe TBI is subdural hematoma (SDH). Male patient 41 years old, was admitted to our hospital with decreased of consciusness with GCS E2M2V2 due to a motorcycle accident. The patient was intubated in the emergency room and then performed head CT scan examination which showed SDH and cerebral edema as the result. Patients then underwent hematoma evacuation under general anesthesia, induced with fentanyl 100 g, propofol 20 mg and atracurium 20 mg intravenously. Maintenance of anesthesia with sevoflurane, continuous propofol, fentanyl and intermittent atracurium. Postoperatively the patient experienced ventilator associated pneumonia (VAP) and given broad-spectrum antibiotics for lung recovery, then on the 10th day tracheostomy was performed. Patients can be weaned from the ventilator on day 21st with GCS E4M4Vtrach without contact, with a GOS (Glasgow Outcome Scale) score of 3, and was planned for homecare. Severe TBI requires more complex postoperative management, anticipation of prolonged use of mechanical ventilation, risk of VAP and consideration of rapid tracheostomy installation to adequate antibiotic administration to obtain the best outcome.

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Prolonged Mechanical Ventilation is Associated With Pulmonary Complications, Increased Length of Stay, and Unfavorable Discharge Destination Among Patients With Subdural Hematoma

Cited by 21 publications

References 21 publications

Factors Affecting Weaning Failure in Critically-Ill Patients Undergoing Emergency Gastrointestinal Surgery

Factors Affecting Weaning Failure in Critically-Ill Patients Undergoing Emergency Gastrointestinal Surgery

Left ventricular-arterial coupling is associated with prolonged mechanical ventilation in severe post-cardiac surgery patients: an observational study

Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Subdural Hematoma

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