scholarly journals Factors Associated with Postoperative Prolonged Mechanical Ventilation in Pediatric Liver Transplant Recipients

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Olubukola O. Nafiu ◽  
Katari Carello ◽  
Anjana Lal ◽  
John Magee ◽  
Paul Picton
Keyword(s):  
Mechanical Ventilation ◽  
Liver Transplant ◽  
Prolonged Mechanical Ventilation ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Postoperative Mortality ◽  
Early Postoperative Period ◽  
Hospital Length Of Stay ◽  
Multivariable Logistic Regression Analysis ◽  
Duration Of Surgery

Introduction. Almost all pediatric orthotopic liver transplant (OLT) recipients require mechanical ventilation in the early postoperative period. Prolonged postoperative mechanical ventilation (PPMV) may be a marker of severe disease and may be associated with morbidity and mortality. We determined the incidence and risk factors for PPMV in children who underwent OLT. Methods. This was a retrospective analysis of data collected on 128 pediatric OLT recipients. PPMV was defined as postoperative ventilation ≥ 4 days. Perioperative characteristics were compared between cases and control groups. Multivariable logistic regression analysis was used to calculate odds ratios for PPMV after controlling for relevant cofactors. Results. An estimated 25% (95% CI, 17.4%–32.6%) required PPMV. The overall incidence of PPMV varied significantly by age group with the highest incidence among infants. PPMV was associated with higher postoperative mortality (p=0.004) and longer intensive care unit (p<0.001) and hospital length of stay (p<0.001). Multivariable analysis identified young patient age, preoperative hypocalcemia, and increasing duration of surgery as independent predictors of PPMV following OLT. Conclusion. The incidence of PPMV is high and it was associated with prolonged ICU and hospital LOS and higher posttransplant mortality. Surgery duration appears to be the only modifiable predictor of PPMV.

scholarly journals Delays in presentation and mortality among Black patients with mechanical thrombectomy after large-vessel stroke at a US hospital

2021 ◽  
Vol 51 (1) ◽  
pp. E9
Author(s):  
Joshua S. Catapano ◽  
Kavelin Rumalla ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Dara S. Farhadi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Stroke Onset ◽  
Hospital Length Of Stay ◽  
Multivariable Logistic Regression Analysis ◽  
Delayed Presentation ◽  
Black Race ◽  
Risk Of Death ◽  
Black Patients ◽  
Increased Risk

OBJECTIVE The incidence and severity of stroke are disproportionately greater among Black patients. In this study, the authors sought to examine clinical outcomes among Black versus White patients after mechanical thrombectomy for stroke at a single US institution. METHODS All patients who underwent mechanical thrombectomy at a single center from January 1, 2014, through March 31, 2020, were retrospectively analyzed. Patients were grouped based on race, and demographic characteristics, preexisting conditions, clinical presentation, treatment, and stroke outcomes were compared. The association of race with mortality was analyzed in multivariable logistic regression analysis adjusted for potential confounders. RESULTS In total, 401 patients (233 males) with a reported race of Black (n = 28) or White (n = 373) underwent mechanical thrombectomy during the study period. Tobacco use was more prevalent among Black patients (43% vs 24%, p = 0.04), but there were no significant differences between the groups with respect to insurance, coronary artery disease, diabetes, illicit drug use, hypertension, or hyperlipidemia. The mean time from stroke onset to hospital presentation was significantly greater among Black patients (604.6 vs 333.4 minutes) (p = 0.007). There were no differences in fluoroscopy time, procedural success (Thrombolysis in Cerebral Infarction grade 2b or 3), hospital length of stay, or prevalence of hemicraniectomy. In multivariable analysis, Black race was strongly associated with higher mortality (32.1% vs 14.5%, p = 0.01). The disparity in mortality rates resolved after adjusting for the average time from stroke onset to presentation (p = 0.14). CONCLUSIONS Black race was associated with an increased risk of death after mechanical thrombectomy for stroke. The increased risk may be associated with access-related factors, including delayed presentation to stroke centers.

scholarly journals Outcomes of COVID-19 in Patients With a History of Cancer and Comorbid Cardiovascular Disease

2020 ◽  
pp. 1-10
Author(s):  
Sarju Ganatra ◽  
Sourbha S. Dani ◽  
Robert Redd ◽  
Kimberly Rieger-Christ ◽  
Rushin Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Supplemental Oxygen ◽  
Adverse Outcomes ◽  
Patients With Cancer ◽  
Vulnerable Patient ◽  
History Of ◽  
Secondary Endpoints

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19–associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11–3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

scholarly journals Effects of ABCDE Bundle Implementation on Reduction of Delirium among Mechanically Ventilated Patients at Damietta Hospital, Egypt

2021 ◽  
pp. 1-14
Author(s):  
Khalil NS ◽  
El-Kady EM ◽  
Abdel-kader FA ◽  
EL-shafey MM
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Early Exercise ◽  
Abcde Bundle ◽  
Ventilated Patients

Background: One of the principal complications in intensive care unit particularly those connected to mechanical ventilation is delirium. Delirium. It is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The ABCDE is a bundle intervention that stands for awakening, breathing coordination, delirium monitoring/management, and early exercise/mobility bundle that has been proposed as a multi-component intervention to reduce the incidence of delirium. Aim of the study: This study aimed to evaluate the effect of implementing the ABCDE bundle on the reduction of delirium among mechanically ventilated patients at Damietta hospital. Material and Methods: A quasi-experimental pre/post-intervention design was used to conduct this study. A purposive sample of 65 adult male and female mechanically ventilated patients aged between 18 and 60 years was recruited. Sedation and Delirium instruments measures were utilized in data collection. Result: significant differences were found in delirium scores among the studied patients (x2= 52.52; p-value=0.001). So, the mechanically ventilated patients who exposed to the implementation of the ABCDE bundle were experienced fewer delirium signs than before the ABCDE bundle implementation. Conclusion: Based on the findings of the current study, it can be concluded ABCDE bundle implementation reduced the occurrence of delirium among mechanically ventilated patients. Recommendations: ABCDE bundle should be recommended on mechanically ventilated patients. Keywords: ABCDE bundle; Mechanically Ventilated Patients; Critically Ill Patients

Is Tracheostomy Insertion an Indication for Gastrostomy Insertion?

2019 ◽  
Vol 85 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Justin Dvorak ◽  
David Ridder ◽  
Brendan Martin ◽  
Hieu Ton-That ◽  
Anthony Baldea ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acute Care Surgery ◽  
Patient Demographics ◽  
Endoscopic Gastrostomy ◽  
Concomitant Procedure ◽  
Included Patient ◽  
Care Surgery

The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy versus those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy. Patients who also underwent open gastrostomy or percutaneous endoscopic gastrostomy during the same hospitalization were identified. Data collected included patient demographics, hospital LOS, ICU LOS, and timing of tracheostomy and gastrostomy. Three hundred one trauma and ACS patients who underwent tracheostomy were identified. Seventy- three per cent of tracheostomy patients underwent gastrostomy during the same admission. Of patients who had both tubes inserted, 79 per cent (175) underwent gastrostomy with tracheostomy as the concomitant procedure, whereas 21 per cent received gastrostomy as a delayed procedure. Median hospital LOS for patients who underwent concomitant procedures was 25 days versus 22 days for those who had delayed or no gastrostomy ( P = 0.24). Eighty-four per cent of patients who had tracheostomy for prolonged or anticipated prolonged mechanical ventilation were receiving tube feeds at discharge, and 78 per cent had not been advanced to an oral diet at discharge. Most trauma/ACS patients who undergo tracheostomy also undergo gastrostomy during their hospitalization. Concomitant gastrostomy is not associated with a decrease in hospital LOS; however, most patients who undergo tracheostomy for prolonged mechanical ventilation are discharged receiving enteral nutrition. These patients may benefit from concomitant ICU gastrostomy as a way to improve efficiency and cost-saving.

Race Impacts Outcomes of Patients With Firearm Injuries

2020 ◽  
Vol 86 (9) ◽  
pp. 1113-1118
Author(s):  
Heather Peluso ◽  
John D. Cull ◽  
Marwan S. Abougergi
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Traumatic Shock ◽  
Hospital Length Of Stay ◽  
Firearm Injuries ◽  
Black Patients ◽  
Hospitalization Costs

Background To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. Methods The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). Results The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). Discussion Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.

511 A Retrospective Review of the Timing of Tracheostomy in Mechanically Ventilated Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S102-S103
Author(s):  
Kevin N Foster ◽  
Juzer R Munaim ◽  
Biomedical Engineering ◽  
Claudia Islas ◽  
Suzanne C Osborn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Intubation ◽  
Prolonged Mechanical Ventilation ◽  
Care Facility ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Patient Comfort ◽  
Early Tracheostomy ◽  
Improved Outcomes

Abstract Introduction Tracheostomy is indicated for prolonged mechanical ventilation. Tracheostomy provides various benefits over prolonged endotracheal intubation including improved airway care, diminished need for sedation, reduced airway resistance, and increased patient comfort. However, the timing and effectiveness of tracheostomies has been controversial. Several studies, have indicated that early tracheostomy reduces the length of ICU and hospital stay, decrease the time on mechanical ventilation, and reduces the incidence of nosocomial pneumonia. In contrast other studies have shown that early tracheostomy shows no benefit, or even extends the length of mechanical ventilation in some patients. The purpose of this study was to evaluate the timing and the appropriateness of timing of tracheostomy. Methods This was a retrospective study of burn patients requiring mechanical ventilation over a 5-year period. The main comparison groups were endotracheal tube only (ETT) vs tracheostomy (Trach) and early tracheostomy (ETrach) vs. late tracheostomy (LTrach). Tracheostomies that were performed within the first 7 days were considered to be ETrach. Results Age, gender, ethnicity, % TBSA burned, presence of inhalation injury did not differ between any of the groups. The Trach group demonstrated increased hospital length of stay (LOS) (22 vs. 39 days, p&lt; .0001), greater number of ICU days (11 vs. 31 days, p&lt; .0001), greater number of surgeries (3.7 vs. 6.6, p&lt; .0001) and patients in this group were more likely to be discharged to a post-acute care facility rather than home, when compared to the ETT group (p&lt; .0001). The Trach group also was more likely to develop ventilator-associated pneumonia (VAP) (23% vs. 48%, p&lt; .0001), and more likely to develop swallowing abnormalities. Similarly, the LTrach group demonstrated greater number of ICU days (25 vs. 32 days, p=.04), greater number of ventilator days (23 vs. 29 days, p=.03), greater number of surgeries (4.5 vs 7.2, p=.02), but fewer days to liberate from the ventilator (19.4 vs 13.6 days, p=.04). This group also was more likely to develop VAP than the ETrach group (28% vs 53%, p=.03). Conclusions This study demonstrates a number of improved outcomes of tracheostomy over continued endotracheal intubation, and a number of improved outcomes of early tracheostomy over later tracheostomy. The most significant improved outcomes were decreased incidence of VAP and decreased swallowing difficulties following extubation/decannulation.

Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

2008 ◽  
Vol 109 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Luciana Carrupt Machado Sogame ◽  
Milena Carlos Vidotto ◽  
José Roberto Jardim ◽  
Sonia Maria Faresin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Level Of Consciousness ◽  
Type Of Surgery

Object It has been shown that craniotomy may lead to a decrease in lung volumes and arterial blood gas tensions as well as a change in the respiratory pattern. The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPCs) and the mortality rate in patients who have undergone elective craniotomy and to evaluate the associations between preoperative and postoperative variables and PPCs in this population. Methods Two hundred thirty-six patients were followed up based on a protocol including a clinical questionnaire, physical examination and observation of clinical characteristics in the preoperative period, type of surgery performed, duration of surgery, time spent in the intensive care unit (ICU) and hospital, and the occurrence of any PPCs. Results Postoperative pulmonary complications occurred in 58 patients (24.6%) and 23 other patients (10%) died. Predicting factors for PPCs according to multivariate analyses were as follows: type of surgery performed (p < 0.0001), prolonged mechanical ventilation ≥ 48 hours (p < 0.0001), time spent in the ICU > 3 days (p < 0.0001), decrease in level of consciousness (p < 0.002), duration of surgery ≥ 300 minutes (p < 0.01), and previous chronic lung disease (p < 0.04). Conclusions The incidence from March 2003 to March 2005 of PPCs in patients who had undergone craniotomy was 25% and death occurred in 10%. Some risk factors for PPCs may be predicted such as the type of surgery performed, prolonged mechanical ventilation, a longer time in the ICU, a decreased level of consciousness, duration of surgery, and previous chronic lung disease.

Analysis of the Causal Factors of Prolonged Mechanical Ventilation After Orthotopic Liver Transplant

2006 ◽  
Vol 38 (4) ◽  
pp. 1131-1134 ◽  
Author(s):  
S. Faenza ◽  
M.S. Ravaglia ◽  
M. Cimatti ◽  
A. Dante ◽  
S. Spedicato ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Liver Transplant ◽  
Prolonged Mechanical Ventilation ◽  
Orthotopic Liver Transplant ◽  
Causal Factors

Impact of Regional Cerebral Perfusion on Outcomes Among Neonates Undergoing Norwood Operation

2019 ◽  
Vol 10 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Karl Migally ◽  
Mallikarjuna Rettiganti ◽  
Jeffrey M. Gossett ◽  
Brian Reemtsen ◽  
Punkaj Gupta
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Cerebral Perfusion ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Norwood Operation ◽  
Heart Operation ◽  
Prolonged Hospital ◽  
The Impact

Objectives: To evaluate the impact of regional cerebral perfusion (RCP) during heart operation on outcomes in neonates undergoing Norwood operation. Methods: We performed a retrospective cohort study using data from the Single Ventricle Reconstruction trial data set. The adjusted effect of RCP use on each outcome was studied using a penalized logistic regression model with bootstrap validation. Results: Of 549 patients included in the study, 252 patients (45.9%) received RCP during their heart operation. In univariate comparisons, the majority of the baseline characteristics and preoperative risk factors were similar in the RCP and No RCP group. The total cardiopulmonary bypass (CPB) time and the total cross-clamp (CC) time were longer in the RCP group (RCP vs No RCP, median CPB time: 161 minutes vs 109 minutes; median CC time: 63 minutes vs 43 minutes). In adjusted models, the use of RCP was not associated with decreased mortality and/or need for heart transplant at hospital discharge (odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.43-1.25) or prolonged mechanical ventilation (OR: 1.20, 95% CI: 0.62-2.28) or prolonged hospital length of stay (OR: 1.30, 95% CI: 0.73-2.30). We demonstrated that use of RCP was associated with longer CPB times, increased use of ultrafiltration, and higher probability of open chest after Norwood operation. Conclusions: This study did not demonstrate any impact of RCP on in-hospital mortality and/or heart transplantation, prolonged mechanical ventilation, and prolonged hospital length of stay among neonates undergoing Norwood operation.

Sign in / Sign up

Export Citation Format

Share Document