Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

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Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽

10.1093/qjmed/hcaa039.002 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M G A Gerges ◽

H M M Elazzazi ◽

M H S A Elsersi ◽

S A R Mustafa ◽

M A Saeed

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Critically Ill ◽

Fluid Balance ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Mortality Rates ◽

Morbidity And Mortality ◽

University Hospitals ◽

Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

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The impact of frailty in critically ill patients after trauma: A prospective observational study

Australian Critical Care ◽

10.1016/j.aucc.2019.11.001 ◽

2020 ◽

Vol 33 (3) ◽

pp. 228-235 ◽

Cited By ~ 1

Author(s):

Claire J. Tipping ◽

Emily Bilish ◽

Meg Harrold ◽

Anne E. Holland ◽

Terry Chan ◽

...

Keyword(s):

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

The Impact

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Assisted mechanical ventilation promotes recovery of diaphragmatic thickness in critically ill patients: a prospective observational study

Critical Care ◽

10.1186/s13054-020-2761-6 ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 1

Author(s):

Alice Grassi ◽

Daniela Ferlicca ◽

Ermes Lupieri ◽

Serena Calcinati ◽

Silvia Francesconi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Assisted Mechanical Ventilation

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Variation in the practice of discontinuing mechanical ventilation in critically ill adults: study protocol for an international prospective observational study

BMJ Open ◽

10.1136/bmjopen-2019-031775 ◽

2019 ◽

Vol 9 (9) ◽

pp. e031775 ◽

Cited By ~ 1

Author(s):

Karen E A Burns ◽

Leena Rizvi ◽

Deborah J Cook ◽

Peter Dodek ◽

Arthur S Slutsky ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Research Ethics ◽

Critically Ill ◽

Prospective Observational Study ◽

Demographic Data ◽

Spontaneous Breathing Trial ◽

Primary Objective ◽

Critically Ill Adults ◽

Ill Adults

IntroductionResearch supports the use of specific strategies to discontinue mechanical ventilation (MV) in critically ill patients. Little is known about how clinicians actually wean and discontinue MV in practice or the association between different discontinuation strategies and outcomes. The primary objective of this study is to describe international practices in the use of (1) daily screening for readiness to discontinue MV, (2) modes of MV used before initial discontinuation attempts, (3) weaning and spontaneous breathing trial (SBT) protocols, (4) SBT techniques and (5) sedation and mobilisation practices to facilitate weaning and discontinuation. The secondary objectives are to identify patient characteristics and time-dependent factors associated with use of selected strategies, investigate associations between SBT outcome (failure vs success) and outcomes, explore differences between patients who undergo an SBT early versus later in their intensive care unit (ICU) stay, and investigate the associations between different SBT techniques and humidification strategies on outcomes.Methods and analysisWe will conduct an international, prospective, observational study of MV discontinuation practices among critically ill adults who receive invasive MV for at least 24 hours at approximately 150 ICUs in six geographic regions (Canada, USA, UK, Europe, India and Australia/New Zealand). Research personnel at participating ICUs will collect demographic data, data to characterise the initial strategy or event that facilitated discontinuation of MV (direct extubation, direct tracheostomy, initial successful SBT, initial failed SBT or death before any attempt could be made), clinical outcomes and site information. We aim to collect data on at least 10 non-death discontinuation events in each ICU (at least 1500 non-death discontinuation events).Ethics and disseminationThis study received Research Ethics Approval from St. Michael’s Hospital (11-024) Research ethics approval will be sought from all participating sites. The results will be disseminated through publications in peer-reviewed journals.Trial registration numberNCT03955874.

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