scholarly journals High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery

2012 ◽  
Vol 116 (5) ◽  
pp. 1072-1082 ◽  
Author(s):  
François Lellouche ◽  
Stéphanie Dionne ◽  
Serge Simard ◽  
Jean Bussières ◽  
François Dagenais
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Body Weight ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Lung Injury ◽  
Tidal Volume ◽  
Organ Failure ◽  
Predicted Body Weight ◽  
Prolonged Stay

Background High tidal volumes in patients with acute respiratory distress syndrome and acute lung injury lead to ventilator-induced lung injury and increased mortality. We evaluated the impact of tidal volumes on cardiac surgery outcomes. Methods We examined prospectively recorded data from 3,434 consecutive adult patients who underwent cardiac surgery. Three groups of patients were defined based on the tidal volume delivered on arrival at the intensive care unit: (1) low: below 10, (2) traditional: 10-12, and (3) high: more than 12 ml/kg of predicted body weight. We assessed risk factors for three types of organ failure (prolonged mechanical ventilation, hemodynamic instability, and renal failure) and a prolonged stay in the intensive care unit. Results The mean tidal volume/actual weight was 9.2 ml/kg, and the tidal volume/predicted body weight was 11.5 ml/kg. Low, traditional, and high tidal volumes were used in 724 (21.1%), 1567 (45.6%), and 1,143 patients (33.3%), respectively. Independent risks factors for high tidal volumes were body mass index of 30 or more (odds ratio [OR] 6.25; CI: 5.26-7.42; P < 0.001) and female sex (OR 4.33; CI: 3.64-5.15; P < 0.001). In the multivariate analysis, high and traditional tidal volumes were independent risk factors for organ failure, multiple organ failure, and prolonged stay in the intensive care unit. Organ failures were associated with increased intensive care unit stay, hospital mortality, and long-term mortality. Conclusion Tidal volumes of more than 10 ml/kg are risk factors for organ failure and prolonged intensive care unit stay after cardiac surgery. Women and obese patients are particularly at risk of being ventilated with injurious tidal volumes.

Risk Factors for Prolonged Stay in the Intensive Care Unit and on the Ward After Cardiac Surgery

2008 ◽  
Vol 23 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Rony Atoui ◽  
Felix Ma ◽  
Yves Langlois ◽  
Jean-Francois Morin
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Prolonged Stay

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation

2010 ◽  
Vol 13 (4) ◽  
pp. E212-E217 ◽  
Author(s):  
Fevzi Toraman ◽  
Sahin Senay ◽  
Umit Gullu ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Fast Track

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Risk Factors for Mortality and Prolonged Hospitalization in Electric Burn Injuries

2020 ◽  
Author(s):  
Riccardo Schweizer ◽  
Nadine Pedrazzi ◽  
Holger J Klein ◽  
Tony Gentzsch ◽  
Bong-Sung Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
High Voltage ◽  
Morbidity And Mortality ◽  
Prolonged Stay ◽  
Prolonged Hospitalization ◽  
Prolonged Hospital ◽  
Electrical Injuries

Abstract Electrical injuries are rare, but very destructive with high morbidity and mortality, prolonged hospital length of stay and need for repeated procedures. The aim of study was to investigate characteristics and management of electrical injuries and predisposing factors for mortality and prolonged length of stay. Patient charts were reviewed retrospectively to identify patients admitted with electrical injuries at the Zurich Burns Center (2005–2019). Patient characteristics, management, and outcome were analyzed and risk factors for mortality and prolonged hospitalization were assessed. Eighty-nine patients were included, mostly males (86.5%), between 21 and 40 years (50.6%), with high-voltage (74.2%) occupational injuries (66.3%). Median intensive care unit and hospital stays were 6 (first and third IQR: 2.0; 30.0) and 18 (9.0; 48.0) days. Low-voltage patients had a median of 2 (1.5; 3.0) procedures, compared to 4 (2.0; 10.8) in high-voltage. The amputation rate was 13.5%, and a total of 46 flaps were required. Fifty-four patients had at least one serious complication. Mortality was 18% in high-voltage patients, mostly after multiple organ failure (35%). High total body surface area (TBSA), renal failure and cardiovascular complications were risk factors for mortality (P < .001) in multivariate regression models. Determinants for prolonged hospital stay were TBSA and sepsis (P < .01), and additionally abdominal complications and limb loss for intensive care unit stay (P < .05). Electrical injuries are still cause of significant morbidity and mortality, mostly involve young men in their earning period. Several risk factors for in-hospital mortality and prolonged stay were identified and can support physicians in the management and decision making in these patients.

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