The Effect of Early Mobilization on Respiratory Parameters of Mechanically Ventilated Patients With Respiratory Failure

Background: Sleep disruptions frequently occur in hospitalized patients, especially with critically ill, mechanically ventilated patients. Severely altered sleep architectures result in unclassifiable sleep stages as listed by the conventional Rechtschaffen and Kales (R&K) criteria, and a new classification for sleep scoring including atypical sleep (AS) and pathological wakefulness (PW) has recently been proposed. Objective: To demonstrate the feasibility of performing objective sleep qualification in patients receiving mechanical ventilation due to acute respiratory failure. Materials and Methods: In the present prospective cohort study, polysomnography was performed in 38 patients requiring invasive mechanical ventilation due to acute respiratory failure at the respiratory care unit (RCU) of Siriraj Hospital between February and December 2017. Their sleep stages were analyzed by conventional rules and the new classifications of AS and PW. The associations between the presence of AS or PW and the patients’ characteristics were analyzed. Correlations between sleep quality and clinical parameters were also determined. Results: Most of the patients had poor sleep quality with median sleep efficiency (IQR) of 35.9% (18.5, 62.3) and significantly decreased slowwave sleep [median (IQR) 0.4% (0.00, 5.70)] and REM [median (IQR) 1.3% (0.00, 6.43)]. According to the new classifications, 14 out of 38 (prevalence of 36.8%) mechanically ventilated patients had AS. The prevalence of PW and either AS or PW were 36.8% and 52.6%, respectively. A higher baseline respiratory rate was observed among patients who had either AS or PW at 24 versus 20 breaths/minute (p=0.02), while a longer duration of mechanical ventilator support was found in patients with PW at nine versus five (p=0.003). Patient-ventilator asynchrony was also noted in all patients. Conclusion: Sleep quality among critically ill and mechanically ventilated patients was severely disturbed. A higher prevalence of AS and PW were noted. The technical feasibility of sleep recording in Thai intensive care unit (ICU) settings was established. Keywords: Polysomnography, Atypical sleep, ICU

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Outcomes in mechanically ventilated patients with hypoxaemic respiratory failure caused by COVID-19

British Journal of Anaesthesia ◽

10.1016/j.bja.2020.08.047 ◽

2020 ◽

Vol 125 (6) ◽

pp. e480-e483

Author(s):

Luigi Camporota ◽

Barnaby Sanderson ◽

Alison Dixon ◽

Francesco Vasques ◽

Andrew Jones ◽

...

Keyword(s):

Respiratory Failure ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Assessment Of The Inflammatory Effect Of The Low-Dose Oxygen Routinely Administered In Mechanically Ventilated Patients Without Respiratory Failure

10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a1711 ◽

2011 ◽

Author(s):

Rafael Fernandez ◽

Gisela Gili ◽

Ana Villagra ◽

Josefina López-Aguilar ◽

Antonio Artigas

Keyword(s):

Respiratory Failure ◽

Low Dose ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients ◽

Inflammatory Effect

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Mobilization of Mechanically Ventilated Patients in Switzerland

Journal of Intensive Care Medicine ◽

10.1177/0885066617728486 ◽

2017 ◽

Vol 35 (1) ◽

pp. 55-62 ◽

Cited By ~ 18

Author(s):

Alberto Sibilla ◽

Peter Nydahl ◽

Nicola Greco ◽

Giuseppe Mungo ◽

Natalie Ott ◽

...

Keyword(s):

Organ Failure ◽

Early Mobilization ◽

Bed Rest ◽

Point Prevalence Study ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Potential Safety ◽

Failure Assessment ◽

Active Mobilization ◽

Ventilated Patients

Purpose: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. Materials and Methods: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. Results: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. Conclusion: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.

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An evidence-based guideline on early mobilization of mechanically ventilated patients

10.5353/th_b5088275 ◽

2013 ◽

Author(s):

Mei-yee Cheung

Keyword(s):

Early Mobilization ◽

Evidence Based ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Evidence Based Guideline ◽

Ventilated Patients

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Association of weaning preparedness with extubation outcome of mechanically ventilated patients in medical intensive care units: a retrospective analysis

PeerJ ◽

10.7717/peerj.8973 ◽

2020 ◽

Vol 8 ◽

pp. e8973

Author(s):

Feng-Ching Lin ◽

Yao-Wen Kuo ◽

Jih-Shuin Jerng ◽

Huey-Dong Wu

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Intensive Care Units ◽

Extubation Failure ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Failure Group ◽

Medical Intensive Care ◽

Ventilated Patients

Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure (p = 0.037). The failure group also had a higher WEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291–6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560–16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness.

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