scholarly journals Intra-Abdominal Hypertension and Gastrointestinal Symptoms in Mechanically Ventilated Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Annika Reintam Blaser ◽  
Pille Parm ◽  
Reet Kitus ◽  
Joel Starkopf
Keyword(s):  
Small Group ◽  
Gastrointestinal Symptoms ◽  
Abdominal Pressure ◽  
Icu Mortality ◽  
Lethal Outcome ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Abdominal Hypertension ◽  
Gi Symptoms ◽  
Ventilated Patients

Background. We aimed to describe the incidence of intra-abdominal hypertension (IAH) and gastrointestinal (GI) symptoms and related outcome in mechanically ventilated (MV) patients.Methods. Intra-abdominal pressure (IAP) and gastric residual volumes were measured at least twice daily. IAH was defined as a mean daily value ofIAP≥12 mmHg.Results. 398 patients were monitored for all together 2987 days. GI symptom(s) occurred in80.2%patients. 152 (38.2%) patients developed IAH. Majority (93.4%) of patients with IAH had GI symptoms. The more severe IAH was associated with the higher number of concomitant GI symptoms (P<.001). 142 (35.7%) patients developed both IAH and at least one GI symptom at any time in ICU, and in 77 patients they occurred simultaneously on the same day. This subgroup had the highest ICU mortality (21.8%). In contrast, the small group of patients presenting only IAH, but not GI symptoms (10 patients), had no lethal outcome. Three patients (4.4%) died without showing either IAH or GI symptoms.Conclusions. GI symptoms and IAH often, but not always, occur together. The patients having IAH solely without developing GI symptoms have rather good outcome.

scholarly journals Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

2018 ◽  
Vol 3 (2) ◽  
pp. 90-97
Author(s):  
Claudiu Puiac ◽  
Theodora Benedek ◽  
Lucian Puscasiu ◽  
Nora Rat ◽  
Emoke Almasy ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Abdominal Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Abdominal Hypertension ◽  
Group 2 ◽  
Ventilated Patients ◽  
Group 1

Abstract Objective: To demonstrate the relationship between intra-abdominal hypertension (IAH) and cardiac output (CO) in mechanically ventilated (MV), critically ill patients. Material and methods: This was a single-center, prospective study performed between January and April 2016, on 30 mechanically ventilated patients (mean age 67.3 ± 11.9 years), admitted in the Intensive Care Unit (ICU) of the Emergency County Hospital of Tîrgu Mureș, Romania, who underwent measurements of intra-abdominal pressure (IAP). Patients were divided into two groups: group 1 – IAP <12 mmHg (n = 21) and group 2 – IAP >12 mmHg (n = 9). In 23 patients who survived at least 3 days post inclusion, the variation of CO and IAP between baseline and day 3 was calculated, in order to assess the variation of IAP in relation to the hemodynamic status. Results: IAP was 8.52 ± 1.59 mmHg in group 1 and 19.88 ± 8.05 mmHg in group 2 (p <0.0001). CO was significantly higher in group 1 than in the group with IAH: 6.96 ± 2.07 mmHg (95% CI 6.01–7.9) vs. 4.57 ± 1.23 mmHg (95% CI 3.62–5.52) (p = 0.003). Linear regression demonstrated an inverse correlation between CO and IAP (r = 0.48, p = 0.007). Serial measurements of CO and IAP proved that whenever accomplished, the decrease of IAP was associated with a significant increase in CO (p = 0.02). Conclusions: CO is significantly correlated with IAP in mechanically ventilated patients, and IAH reduction is associated with increase of CO in these critically ill cases.

Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension

2016 ◽  
Vol 32 (3) ◽  
pp. 218-222 ◽  
Author(s):  
Bram G.A.D.H. Heijnen ◽  
Angelique M.E. Spoelstra-de Man ◽  
A.B. Johan Groeneveld
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Intrathoracic Pressure ◽  
Respiratory Cycle ◽  
Abdominal Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Respiratory Compliance ◽  
Abdominal Hypertension ◽  
Ventilated Patients

Purpose: Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. Methods and Results: We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than “total” intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than “true” intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Conclusions: Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

scholarly journals Airway Pseudomonas aeruginosa density in mechanically ventilated patients: clinical impact and relation to therapeutic efficacy of antibiotics

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yohei Migiyama ◽  
Shinya Sakata ◽  
Shinji Iyama ◽  
Kentaro Tokunaga ◽  
Koichi Saruwatari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Pseudomonas Aeruginosa ◽  
High Peak ◽  
Weaning From Mechanical Ventilation ◽  
Icu Mortality ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Peak Density ◽  
Ventilated Patients

Abstract Background The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics. Methods We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤ 104 cfu/mL), moderate (105‒106 cfu/mL), and high (≥ 107 cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses. Results Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group. Conclusions Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

scholarly journals Renal Resistive Index on Intensive Care Unit Admission Correlates with Tissue Hypoperfusion Indices and Predicts Clinical Outcome

2021 ◽  
Author(s):  
Georgia Fotopoulou ◽  
Ioannis Poularas ◽  
Stelios Kokkoris ◽  
Efstratia Charitidou ◽  
Ioannis Boletis ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Resistive Index ◽  
Renal Resistive Index ◽  
Central Venous ◽  
Icu Mortality ◽  
Arterial Lactate ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Tissue Hypoperfusion ◽  
Ventilated Patients

Abstract Background: Recent advancements in the context of shock pathophysiology, support ultrasound assessment of organ perfusion. Renal resistive index (RRI) has been used to evaluate renal blood flow. Our aim was to investigate the relation between RRI, and global tissue hypoperfusion indices, in mechanically ventilated critically ill patients and their association with clinical outcome.Methods: In this prospective observational study, RRI was measured within 24 hours of intensive care unit (ICU) admission. Clinical and laboratory data, routine hemodynamic variables and gas exchange at the time of RRI assessment were recorded. The ratio of central venous-to-arterial carbon dioxide partial pressure difference by arterial-to-central venous oxygen content difference (P(cv-a)CO2/C(a-cv)O2) and lactate were used as global tissue hypoperfusion indices. Results A total of 126 mechanically ventilated patients were included [median age 61 (IQR 28) years, 74% males]. Seventy-seven patients had RRI values >0.7. P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate, were significantly higher in patients with RRI > 0.7 compared to those with RRI ≤0.7 [2.4 (2.2) versus 1.2 (0.6) and 2.88 (3.39) versus 0.62 (0.57) mmol/l respectively, both p<0.001)]. RRI was significantly correlated with P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate for the whole patient population (rho=0.64, both p<0.0001) as well as for the subset of patients with shock (rho=0.47, p=0.001; and r=0.64, p<0.0001 respectively).All-cause ICU mortality was 27.8%. Compared to survivors, ICU non-survivors had a higher RRI [0.80 (0.10) versus 0.70 (0.10), p<0.001] and higher P(cv-a)CO2 / C(a-cv)O2 ratio [3.67 (3.8) versus 0.91 (1.4)] and lactate levels [2.80 (2.00) versus 1.50 (1.20)], both p <0.001). Logistic regression models showed a significant association between RRI and P(cv-a)CO2/C(a-cv)O2 ratio with clinical outcome. RRI showed good ability to predict ICU mortality (AUC 74.9% (95% CI 61% - 88.8%). The combination of RRI with P(cv-a)CO2)/(C(a-cv)O2 ratio and lactate better predicted mortality than RRI alone [AUC 84.8% (95% CI 5.1% - 94.4%)] versus 0.74.9%, respectively, p<0.001).Conclusions: In mechanically ventilated patients, renal blood flow impairment, assessed by the RRI on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation is more valuable in predicting clinical outcome than RRI alone.

scholarly journals Deterioration of mechanically ventilated patients in the presence of intra-abdominal hypertension

2018 ◽  
Vol 8 (8) ◽  
pp. 105
Author(s):  
Ghada Shalaby Khalaf Mahran ◽  
Amal Ismael Abd El-Hafez ◽  
Mostafa Samy Abbas
Keyword(s):  
Elevated Pressure ◽  
Critical Care Nurses ◽  
Abdominal Pressure ◽  
P Value ◽  
Mechanical Ventilator ◽  
Mechanically Ventilated ◽  
Abdominal Hypertension ◽  
Significant Difference ◽  
Failure Assessment ◽  
Ventilated Patients

Background and objective: Elevated pressure within the cavity of the abdomen is a serious complication that can threat the life of critically ill patients. Thus, there is an intense need to highlight the outcomes of intra-abdominal hypertension (IAH) that can face critical care nurses. This work aimed to explore the deterioration of mechanical ventilated patients in the presence of IAH.Methods: Design: A non-randomized prospective study. Procedures: This trial was implemented in trauma and general intensive care in the period between December 2015 and August 2016. The pressure within the abdomen was measured for each patient, three times with 8-hr interval, at the third day of mechanical ventilator (MV). Sepsis-related organ failure assessment score was measured for all patients at first day of admission. All patients who had normal intra-abdominal pressure (IAP) or developed IAH were observed, monitored and evaluated for the clinical outcomes until discharged. Results: Of the 60 MV patients, 83.3% developed IAH. Higher mean of MV and stay period among patients with increased pressure within the abdomen (14.04 ± 10.30 and 16.30 ± 9.36) than normotensive patients (6.90 ± 2.80 and 11.000 ± 3.77) with significant difference (p = .001). Non-survivor had a significantly higher mean IAP than survivor (23.266 ± 2.37 vs. 7.91 ± 3.17) (p value < .001).Conclusions: The occurrence of IAH complicated 83.3% of mechanical ventilated clients in the study period: like longer stay and use of ventilator, and high mortality rate.

scholarly journals A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in mechanically ventilated patients with ventilator-associated pneumonia (VAP)

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Dalia M. El Fawy ◽  
Azza Yousef Ibrahim ◽  
Ahmed Mostafa Mohamed Abdulmageed ◽  
Eman Abo Bakr El Seddek
Keyword(s):  
Mechanical Ventilation ◽  
Ventilator Associated Pneumonia ◽  
Icu Mortality ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Stay ◽  
Drug Concentrations ◽  
Group A ◽  
Group B ◽  
Ventilated Patients

Abstract Background Aerosolized antibiotic administration offers the theoretical advantages of achieving high drug concentrations at the infection site together with lower systemic absorption. This study aims to compare the effect of combining nebulized amikacin with intravenous amikacin to the effect of the usual intravenous route alone in the treatment of patients with ventilator-associated pneumonia and its impact on the duration of mechanical ventilation, laboratory, and clinical picture of the patients. Results This study was carried out on 64 mechanically ventilated patients with Gram-negative VAP. The patients were divided into 2 groups. Group A included 32 patients treated with nebulized amikacin plus IV amikacin, and group B included 32 patients treated with IV amikacin alone. The duration of treatment for both groups was 8 days with a daily assessment of Clinical Pulmonary Infection Score (CPIS) and monitoring of clinical and laboratory parameters. Sputum cultures were obtained thereafter. In our study, the CPIS score and overall ICU mortality were less in the nebulized than in the IV group but the difference failed to be statistically significant. Increase of oxygenation level (Pao2/Fio2 ratio), organism clearance, decrease in serum creatinine level, duration of mechanical ventilation, and length of ICU stay were significantly different in favor of group A than group B. Conclusion Nebulized and IV amikacin offered better oxygenation, organism clearance, less nephrotoxicity, and less duration of mechanical ventilation and ICU stay than the IV group. Combined and IV routes were comparable regarding the decrease in CPIS score and ICU mortality with no significant difference between them. However, we prefer to use the combined regimen for the mentioned reasons. Further large-scale studies are required to confirm these findings and to establish a definite conclusion.

scholarly journals Airway Pseudomonas aeruginosa Density in Mechanically Ventilated Patients: Clinical Impact and Relation to Therapeutic Efficacy of Antibiotics

2021 ◽  
Author(s):  
Yohei Migiyama ◽  
Shinya Sakata ◽  
Shinji Iyama ◽  
Kentaro Tokunaga ◽  
Koichi Saruwatari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Pseudomonas Aeruginosa ◽  
High Peak ◽  
Weaning From Mechanical Ventilation ◽  
Icu Mortality ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Peak Density ◽  
Ventilated Patients

Abstract Background: The bacterial density of Pseudomonas aeruginosa is closely related to its pathogenicity. We evaluated the effect of airway P. aeruginosa density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics.Methods: We retrospectively analyzed data of mechanically ventilated ICU patients with P. aeruginosa isolated from endotracheal aspirates. Patients were divided into three groups according to the peak P. aeruginosa density during ICU stay: low (≤104 cfu/mL), moderate (105‒106 cfu/mL), and high (≥107 cfu/mL) peak density groups. The relationship between peak P. aeruginosa density and weaning from mechanical ventilation, risk factors for isolation of high peak density of P. aeruginosa, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses.Results: Four-hundred-and-sixty-one patients were enrolled. Patients with high peak density of P. aeruginosa had higher inflammation and developed more severe respiratory infections. High peak density of P. aeruginosa was independently associated with few ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high peak density of P. aeruginosa were prolonged mechanical ventilation (odd ratio [OR] 3.07 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizer was associated with lower risks of high peak density of P. aeruginosa (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analysis revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high peak P. aeruginosa group.Conclusions: Patients with high peak density of P. aeruginosa had worse ventilator outcome and ICU mortality. In patients with ventilator-associated tracheobronchitis, antibiotic therapy was associated with favorable ventilator weaning only in the high peak P. aeruginosa density group, and bacterial density could be a good therapeutic indicator for ventilator-associated tracheobronchitis due to P. aeruginosa.

scholarly journals Long-Term Survival of Mechanically Ventilated Patients with Severe COVID-19: An Observational Cohort Study

2021 ◽  
Author(s):  
Oscar Penuelas ◽  
Laura del Campo-Albendea ◽  
Amanda Lesmes González de Aledo ◽  
José Manuel Añón ◽  
Carmen Rodríguez-Solís ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Invasive Mechanical Ventilation ◽  
Icu Mortality ◽  
Term Survival ◽  
Long Term Survival ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Abstract Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 90-day and 180-day survival of patients with COVID-19 requiring invasive ventilation and to develop a predictive model for intensive care unit mortality.Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID–19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes were 90-day and 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model and a nomogram were developed to estimate the probability of ICU mortality. Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The 90-day and 180-day survival rates were 69% (95% confidence interval [CI] 66%-72%) and 59% (95% CI 56%-62%) respectively. The predictive factors associated with ICU mortality were: age (odds ratio [OR] 1.049 [95% CI 1.032-1.066] per 1-year increase), SAPS3 (OR 1.025 [95% CI 1.008-1.041] per 1-point increase), neutrophil to lymphocyte ratio (OR 1.009 [95% CI 1.002-1.016]), a failed attempt of noninvasive positive pressure ventilation previous to orotracheal intubation(OR 2.131 [95% CI 1.279-3.550]), and use of selective digestive decontamination (OR 0.587 [95% CI 0.358-0.963]).Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

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