scholarly journals Open Tracheostomy for Critically Ill Patients with COVID-19

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Estefanía Hernández-García ◽  
Mar Martínez-RuizCoello ◽  
Andrés Navarro Mediano ◽  
Nuria Pérez-Martín ◽  
Victoria García-Peces ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Admissions ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Epidemiological Data ◽  
Orotracheal Intubation ◽  
Safe Procedure ◽  
Before And After ◽  
A Prospective Study ◽  
Mean Time

Background. COVID-19 is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy can shorten ICU length of stay and help weaning. Aims/Objectives. To describe the long-term evolution of the critically patient with COVID-19 and the need for invasive mechanical ventilation and orotracheal intubation (OTI), with or without tracheostomy. Material and Methods. A prospective study was performed including all patients admitted to the ICU due to COVID-19 from 10th March to 30th April 2020. Epidemiological data, performing a tracheostomy or not, mean time of invasive mechanical ventilation until tracheotomy, mean time from tracheotomy to weaning, and final outcome after one month of minimum follow-up were recorded. The Otolaryngology team was tested for COVID-19 before and after the procedures. Results. Out of a total of 1612 hospital admissions for COVID-19, only 5.8% (93 patients) required ICU admission and IOT. Twenty-seven patients (29%) underwent a tracheostomy. After three months, within the group of tracheotomized patients, 29.6% died and 48.15% were extubated in a mean time of 28.53 days. In the nontracheostomized patients, the mortality was 42.4%. Conclusions. Tracheostomy is a safe procedure for COVID-19 and helps weaning of prolonged OTI. Mortality after tracheostomy was less common than in nontracheostomized patients.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Lídia Miranda Barreto ◽  
◽  
Cecilia Gómez Ravetti ◽  
Thiago Bragança Athaíde ◽  
Renan Detoffol Bragança ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Judgment ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Orotracheal Intubation ◽  
Icu Mortality ◽  
Factors Associated ◽  
Non Invasive ◽  
Ventilation Failure

Abstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.

scholarly journals Post-COVID recovery: characteristics of chronically critically ill patients admitted to a long-term acute care hospital

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1241
Author(s):  
Meg Stearn Hassenpflug ◽  
Dale Jun ◽  
David R. Nelson ◽  
Tamas Dolinay
Keyword(s):  
Mechanical Ventilation ◽  
Acute Care ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Survival Rates ◽  
Acute Care Hospital ◽  
Infectious Complications ◽  
Care Hospital ◽  
Chronic Critical Illness

Background: Survivors of COVID-19 pneumonia often suffer from chronic critical illness (CCI) and require long-term hospitalization. Long-term acute care (LTAC) hospitals are vital in the care of CCI patients, but their role for patients post COVID-19 infection is not known. Barlow Respiratory Hospital (BRH) is a 105-bed, LTAC hospital network serving ventilator-dependent and medically-complex patients transferred from the ICUs of hospitals in southern California. We report patient characteristics of our first series of COVID-19 survivors admitted to the post-acute venue of an LTAC hospital. Methods: Single-center observational descriptive report of patients recovering from acute infectious complications of COVID-19 pneumonia requiring long-term respiratory support. Results: From 28 April to 7 September 2020, 41 patients were admitted to BRH for continued recovery from COVID-19 pneumonia. Median age: 68 [44-94] years, 25/41 (61%) male, 33/41 (80.5%) with tracheostomy, 21/41 (51.2%) on invasive mechanical ventilation, 9/41 (22%) receiving hemodialysis. All mechanical ventilation and hemodialysis interventions were initiated at the transferring hospital. Conclusions: To our knowledge, this is the first report to characterize CCI and medically complex COVID-19 patients transferred to the post-acute venue of an LTAC hospital. Patients on average spent over six weeks in the transferring hospital mostly in the ICU, are largely elderly, carry the known risk factors for COVID-19 infection, and experienced respiratory failure necessitating prolonged mechanical ventilation via tracheostomy. Our findings suggest that these patients will continue to require considerable medical interventions and treatments, including weaning from mechanical ventilation, owing to the numerous sequelae of the infection and the burden of acute-on-chronic diseases. As ICU survival rates improve, this research further emphasizes the important role of the LTAC hospital in responding to the COVID-19 crisis.

scholarly journals Prognostic Role of Malnutrition Diagnosed by Bioelectrical Impedance Vector Analysis in Older Adults Hospitalized with COVID-19 Pneumonia: A Prospective Study

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4085
Author(s):  
Andrea Da Porto ◽  
Carlo Tascini ◽  
Maddalena Peghin ◽  
Emanuela Sozio ◽  
Gianluca Colussi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Nutritional Status ◽  
Hospital Stay ◽  
Invasive Mechanical Ventilation ◽  
Bioelectrical Impedance ◽  
Vector Analysis ◽  
Bioelectrical Impedance Vector Analysis ◽  
Increased Risk ◽  
Impedance Vector ◽  
A Prospective Study

Background: Little is known on the clinical relevance of the nutritional status and body composition of patients hospitalized with SARS-CoV-2 infection. The aim of our study was to assess the prevalence of malnutrition in patients with COVID-19 pneumonia using bioelectrical impedance vector analysis (BIVA), and to evaluate the relationship of their nutritional status with the severity and outcome of disease. Methods: Among 150 consecutive patients who were hospitalized with COVID-19 pneumonia, 37 (24.3%) were classified as malnourished by BIVA, and were followed-up for 60 days from admission. Outcome measures were differences in the need for invasive mechanical ventilation, in-hospital mortality, and the duration of hospital stay in survivors. Results: During 60 days of follow-up, 10 (27%) malnourished patients and 13 (12%) non-malnourished patients required invasive mechanical ventilation (p = 0.023), and 13 (35%) malnourished patients and 9 (8%) non-malnourished patients died (p < 0.001). The average duration of the hospital stay in survivors was longer in patients with malnutrition (18.2 ± 15.7 vs. 13.2 ± 14.8 days, p < 0.001). In survival analyses, mechanical ventilation free (log-rank 7.887, p = 0.050) and overall (log-rank 17.886, p < 0.001) survival were significantly longer in non-malnourished than malnourished patients. The Cox proportional ratio showed that malnutrition was associated with an increased risk of mechanical ventilation (HR 4.375, p = 0.004) and death (HR 4.478, p = 0.004) after adjusting for major confounders such as age, sex, and BMI. Conclusions: Malnutrition diagnosed with BIVA was associated with worse outcomes in hospitalized patients with COVID-19 pneumonia.

Dynamic Changes in Respiratory Frequency/Tidal Volume May Predict Failures of Ventilatory Liberation in Patients on Prolonged Mechanical Ventilation and Normal Preliberation Respiratory Frequency/Tidal Volume Values

2012 ◽  
Vol 78 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Raeanna C. Adams ◽  
Oliver L. Gunter ◽  
Jonathan R. Wisler ◽  
Melissa L. Whitmill ◽  
James Cipolla ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Frequency ◽  
Dynamic Changes ◽  
Mechanically Ventilated ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Mean Time ◽  
Better Than

Rapid shallow breathing index (RSBI, respiratory frequency [f] divided by tidal volume [Vt]) has been used to prognosticate liberation from mechanical ventilation (LMV). We hypothesize that dynamic changes in RSBI predict failed LMV better than isolated RSBI measurements. We conducted a retrospective study of patients who were mechanically ventilated (MV) for longer than 72 hours. Failed LMV was defined as need for reinstitution of MV within 48 hours post-LMV. Ventilatory frequency (f) and Vt (liters) were serially recorded. The instantaneous RSBI (i-RSBI) was defined as f/Vt. Dynamic f/Vt ratio (d-RSBI) was defined as the ratio between two consecutive i-RSBI (f/Vt) measurements ([f2/Vt2]/[f1/Vt1]). RSBI Product (RSB-P) was defined as (i-RSBI 3 d-RSBI). Data from 32 patients were analyzed (Acute Physiology and Chronic Health Evaluation II 13.4, male 69%, mean age 57 years). Mean length of stay was 19.5 days (11.5 ventilator; 14.1 intensive care unit days). For LMV failures, mean time to reinstitution of invasive MV was 20.8 hours. All patients had pre-LMV i-RSBI less than 100. Failed LMVs had higher i-RSBI values (68.9, n = 18) than successful LMVs (44.2, n = 23, P < 0.01). Failures had higher d-RSBI (1.48) than successful LMVs (1.05, P < 0.04). The RSB-P was higher for failed LMVs (118) than for successful LMVs (48.8, P < 0.01) with failures having larger proportion of pre-LMV d-RSBI values greater than 1.5 (39.0 vs 10.7%, P < 0.03). Pre-LMV RSB-P may offer early prediction of failed LMV in patients on MV for longer than 72 hours despite normal pre-LMV i-RSBI. Divergence between RSB-P for successful and failed LMVs occurred earlier than i-RSBI divergence with a greater proportion of pre-LMV d-RSBI greater than 1.5 among failures.

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

2015 ◽  
Vol 35 (4) ◽  
pp. 58-66 ◽  
Author(s):  
Rachel A. Joseph
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Technological Advances ◽  
Improved Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Careful Handling ◽  
Preterm Babies

Worldwide, about 15 million infants are born prematurely each year. Technological advances, including invasive mechanical ventilation, play a major role in the survival of extremely preterm babies. Those who survive may have prolonged morbid conditions that result in long-term sequelae. Nurses face several challenges during the hospitalization of these infants. Vigilant care, monitoring, and careful handling of the infants can prevent infections and long-term complications. Newer, less invasive technologies are promising for improved outcomes in extremely preterm infants.

scholarly journals Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation

2020 ◽  
pp. 1-10
Author(s):  
A Takhar ◽  
C Tornari ◽  
N Amin ◽  
D Wyncoll ◽  
S Tricklebank ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Multidisciplinary Approach ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Interquartile Range ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation

Abstract Objectives Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT–anaesthetics department led tracheostomy team. Method A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. Results Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13–20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23–40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7–16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. Conclusion Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.

scholarly journals Relationship of Timings and Outcome of Tracheostomy Among Patients Requiring Prolonged Mechanical Ventilation

2019 ◽  
Vol 10 (1) ◽  
pp. 12-16
Author(s):  
Muhammad Asim Shafique ◽  
Muhammad Amir Nadeem ◽  
Muhammad Afzal
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Secondary Data ◽  
Orotracheal Intubation ◽  
Age And Gender ◽  
Good Outcome ◽  
Male Patients ◽  
And Gender ◽  
Relationship Of ◽  
The Relationship

Objective: To assess the indications of tracheostomy among patients requiring prolonged mechanical ventilation and to observe the relationship of the timings and outcome of tracheostomy with age and gender. Study Design and Setting: It was a descriptive study conducted at intensive care unit (ICU) of Department of Otorhinolaryngology at Bahawal Victoria Hospital from January 2017 to December 2018. Methodology: Secondary data was collected with the help of charts of ICU patients in which elective tracheostomy was done to replace orotracheal intubation for mechanical ventilation. Inclusion and exclusion criteria were designed. Clinical record was reviewed for the assessment of indications of the procedure (medical or surgical) along with age and gender distribution. The timing of tracheostomy in these patients with its outcome in terms of decannulation and weaning were recorded. Proforma was used to enter the findings. Finally results were obtained and assessed on SPSS Version 23. Results: Out of total 551 tracheostomies 42(7.6%) were indicated for the patients of ICU requiring prolonged mechanical ventilation. From the 42 mechanical ventilated patients majority had Guillain-Barre syndrome (GBS) 20(47.6%). Twenty six patients were adults (61.9%) and sixteen were children (38%).Twenty four were male patients (57.1%) and eighteen were females (42.8%). The timing of tracheostomy among majority of the patients (40) was from 7-10 days, with mean of 9th day with good outcome. Only two patients who underwent tracheostomy after two weeks had to face poor outcome (failed decannulation, late weaning) (4.7%). Conclusion: Neuroparalytic lesions were the common indication among the patients requiring prolonged mechanical ventilation with tracheostomy. Tracheostomy if performed earlier in such patients carries good outcome

scholarly journals Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

2021 ◽  
Vol 7 ◽  
Author(s):  
Xiaobo Yang ◽  
Ming Hu ◽  
Yuan Yu ◽  
Xijing Zhang ◽  
Minghao Fang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Median Duration ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Before And After

Background: The data on long-term outcomes of patients infected by SARS-CoV-2 and treated with extracorporeal membrane oxygenation (ECMO) in China are merely available.Methods: A retrospective study included 73 patients infected by SARS-CoV-2 and treated with ECMO in 21 intensive care units in Hubei, China. Data on demographic information, clinical features, laboratory tests, ECMO durations, complications, and living status were collected.Results: The 73 ECMO-treated patients had a median age of 62 (range 33–78) years and 42 (63.6%) were males. Before ECMO initiation, patients had severe respiratory failure on mechanical ventilation with a median PO2/FiO2 of 71.9 [interquartile range (IQR), 58.6–87.0] mmHg and a median PCO2 of 62 [IQR, 43–84] mmHg on arterial blood analyses. The median duration from symptom onset to invasive mechanical ventilation, and to ECMO initiation was19 [IQR, 15–25] days, and 23 [IQR, 19–31] days. Before and after ECMO initiation, the proportions of patients receiving prone position ventilation were 58.9 and 69.9%, respectively. The median duration of ECMO support was 18.5 [IQR 12–30] days. During the treatments with ECMO, major hemorrhages occurred in 31 (42.5%) patients, and oxygenators were replaced in 21 (28.8%) patients. Since ECMO initiation, the 30-day mortality and 60-day mortality were 63.0 and 80.8%, respectively.Conclusions: In Hubei, China, the ECMO-treated patients infected by SARS-CoV-2 were of a broad age range and with severe hypoxemia. The durations of ECMO support, accompanied with increased complications, were relatively long. The long-term mortality in these patients was considerably high.

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