Evaluation of the Accurate Prediction of Prolonged Ventilation Score for Predicting Post-Operative Respiratory Failure

Introduction: Re-intubation and re-ventilation after complete weaning of patients with prolonged ventilation are considered a major problem in ICU. The re-intubation in such patients associated with higher mortalities prolongs the duration of ICU stay. The mortality rate in those patients may exceed 40% in some studies. Aims: The study aimed to compare and evaluate the effect of use of two new maneuvers with control after fulfilling criteria of weaning from prolonged ventilation, either immediate use of NIV post-extubation and every 12 hours for 24 hours or MV for one hour on both re-intubation and ICU discharge of traumatic ARDS patients who ventilated for one week or more. Materials and Methods: It is a prospective double-blind study done on total 300 patients, admitted with respiratory failure ARDS due to severe lung contusion. All of them were selected to be ventilated for > one week. All of them fulfilled the criteria of weaning at the end of the studied period. Patients were randomly allocated in three groups; each group contained 100 patients. Group A was considered the control group. They extubated and followed our routine protocol; patients of group B used our first new maneuver and reconnected to mechanical ventilation before extubation for one hour, while patients of group C used our second new maneuver; patients of this group extubated and immediately connected to NIV with BIPAP mode for 1 hour every 12 hours for 24 hours. Results: There was a significant reduction in the number of patients who experienced deterioration in conscious level throughout the study in patients of both groups B and C compared to group A. Also, a significant reduction was seen in the number of patients who experienced deterioration in clinical parameters of respiration, of both groups B and C compared to group A with regard to high respiratory rate, desaturation and development of hyperdynamic circulation (tachycardia and hypertension). Also, a significant reduction was seen in the number of patients who had multiple quadrant parenchymatous infiltration throughout the study in patients of both groups B and C compared to group A. significant reduction in the number of patients marked limitation to FEV1, FVC and MVV in patients of both groups B and C compared to group A. Conclusion: Use of either immediate NIV every 12 hours for 24 hours or MV for one hour after fulfillment of weaning criteria reduced reintubation, re-ventilation and post-extubation respiratory failure and decreased the ICU stay in prolonged ventilated patients due to ARDS from severe lung trauma with no significant difference between them.

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Mycoplasma Pneumoniae Associated with Stevens Johnson Syndrome

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500317 ◽

2007 ◽

Vol 35 (3) ◽

pp. 414-417 ◽

Cited By ~ 24

Author(s):

J. M. Mulvey ◽

A. Padowitz ◽

M. Lindley-Jones ◽

R. Nickels

Keyword(s):

Respiratory Failure ◽

Mycoplasma Pneumoniae ◽

Multiple Organ ◽

Stevens Johnson Syndrome ◽

Skin Reactions ◽

Genital Ulceration ◽

Johnson Syndrome ◽

Organ Systems ◽

Prolonged Ventilation ◽

Tract Involvement

We describe a case of Mycoplasma pneumoniae chest infection associated with Stevens Johnson syndrome. The patient had extensive epidermal bullous vesicles, oropharyngeal and genital ulceration and required prolonged ventilation due to respiratory failure. Mycoplasma pneumoniae infections are often asymptomatic but can involve multiple organ systems. Respiratory tract involvement is generally benign though 3 to 10% of patients develop clinical pneumonia. Secondary skin reactions are common (20 to 25%), although few patients infected develop Stevens Johnson syndrome. It has been suggested that Mycoplasma pneumoniae may be the most common infectious cause of Stevens Johnson syndrome.

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Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure

The Lancet Respiratory Medicine ◽

10.1016/s2213-2600(18)30366-7 ◽

2019 ◽

Vol 7 (1) ◽

pp. 90-98 ◽

Cited By ~ 41

Author(s):

Ewan C Goligher ◽

Laurent J Brochard ◽

W Darlene Reid ◽

Eddy Fan ◽

Olli Saarela ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Patient Outcomes ◽

Poor Patient ◽

Prolonged Ventilation

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Outcome of patients with OPC poisoning who require mechanical ventilation: a statistical analysis

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20170913 ◽

2017 ◽

Vol 4 (2) ◽

pp. 357

Author(s):

Puja Madala ◽

. Aravind ◽

Mohini Singh

Keyword(s):

Mechanical Ventilation ◽

Statistical Analysis ◽

Respiratory Failure ◽

Methyl Parathion ◽

Pesticide Poisoning ◽

Ventilator Support ◽

Deliberate Self Harm ◽

Sex Type ◽

Prolonged Ventilation ◽

Self Harm

Background: Poisoning constitutes about 60% of deliberate self-harm in rural Asia. OPCs account for 80% of pesticide poisoning. Ravi et al reported the incidence of organophosphorous poisoning as around 1.26 lakhs in India. Patients will be required ventilator support for management in most of cases and hence study is being done to find the association of factors in patients with prolonged ventilator support.Methods: Statistical analysis was carried out for 50 patients after categorizing each variable like age, sex, type of compound, quantity, serum pseudo cholinesterase levels, respiratory failure, intermediate syndrome and other clinical signs.Results: Out of 50 patients 74% of patients required more than 10 days of ventilation and methyl parathion was the frequent compound associated with prolonged ventilation and 60% of patients who required 4-8 days of atropinisation and also patients who had low pseudocholinesterase levels at the onset had required prolonged ventilation.Conclusions: The results show that outcome of patients with OPC poisoning is associated with type of compound, period of atropinisation, quantity, pseudocholinesterase levels. So immediate treatment is most important to improve mortality in OPC poisoning.

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Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.4137/ccrpm.s6649 ◽

2011 ◽

Vol 5 ◽

pp. CCRPM.S6649 ◽

Cited By ~ 14

Author(s):

A. James Mamary ◽

Shrikant Kondapaneni ◽

Gwendolyn B. Vance ◽

John P. Gaughan ◽

Ubaldo J. Martin ◽

...

Keyword(s):

Respiratory Failure ◽

Hospital Mortality ◽

Severity Of Illness ◽

Charlson Index ◽

Apache Ii ◽

Apache Ii Score ◽

Moderate Severity ◽

Social Security Death Index ◽

Prolonged Ventilation

Background Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival. Methods 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires. Results Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL), anemic (hemoglobin 9.6 ± 1.4 g/dL), with moderate severity of illness (APACHE II score 10.7 + 4.1), and multiple comorbidities (Charlson index 4.3 + 2.3). In-hospital mortality (19%) was related to a higher Charlson Index score ( P = 0.006; OR 1.08-1.6), and APACHE II score ( P = 0.016; OR 1.03-1.29). In-hospital mortality was inversely related to admission albumin levels ( P = 0.023; OR 0.17-0.9). The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006). Conclusion Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.

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