Obesity as a Predictor of Prolonged Mechanical Ventilation

2020 ◽  
Vol 163 (4) ◽  
pp. 750-754
Author(s):  
Diana Shao ◽  
Jeffrey Straub ◽  
Laura Matrka
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Prolonged Mechanical Ventilation ◽  
Statistical Significance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Medical Intensive Care

Objective To examine the effect of including obesity with parameters of the I-TRACH scale in predicting the need for prolonged mechanical ventilation. Study Design A retrospective cohort study. Setting Tertiary care academic medical center. Subjects and Methods Consecutive patients were identified retrospectively over a 45-month period based on need for mechanical ventilation in the medical intensive care unit. Chart review was performed to collect demographic information as well as clinical data, including duration of mechanical ventilation, body mass index (BMI), and I-TRACH parameters (heart rate >110, serum urea nitrogen >25, serum pH <7.25, serum creatinine >2, serum bicarbonate <20). Statistical analysis was performed to identify any predictors of prolonged mechanical ventilation, defined as ≥14 days and as ≥10 days. Results In total, 455 patients were identified, with an average duration of mechanical ventilation of 10.4 days (range, 0-248 days). On univariate and multivariate regression analysis, only BMI >30 reached statistical significance with respect to prolonged mechanical ventilation ( P < .05). The I-TRACH parameters—either alone or in combination—were not significantly predictive. Conclusion This study challenges previous findings regarding the I-TRACH scale and the relation of its parameters to prolonged mechanical ventilation. Furthermore, BMI >30 alone was predictive of prolonged intubation. Inclusion of BMI in predictive models could assist current decision making in determining the likelihood of prolonged mechanical ventilation in medical intensive care unit patients going forward, and obesity should be considered a predictor of prolonged mechanical ventilation.

scholarly journals The Timing of Family Meetings in the Medical Intensive Care Unit

2019 ◽  
Vol 36 (12) ◽  
pp. 1049-1056 ◽  
Author(s):  
Gina M. Piscitello ◽  
William M. Parham ◽  
Michael T. Huber ◽  
Mark Siegler ◽  
William F. Parker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Death ◽  
Family Meeting ◽  
Family Meetings ◽  
Medical Intensive Care

Purpose: Family meetings in the medical intensive care unit can improve outcomes. Little is known about when meetings occur in practice. We aimed to determine the time from admission to family meetings in the medical intensive care unit and assess the relationship of meetings with mortality. Methods: We performed a prospective cohort study of critically ill adult patients admitted to the medical intensive care unit at an urban academic medical center. Using manual chart review, the primary outcome was any attempt at holding a family meeting within 72 hours of admission. Competing risk models estimated the time from admission to family meeting and to patient death or discharge. Results: Of the 131 patients who met inclusion criteria in the 12-month study period, the median time from admission to family meeting was 4 days. Fewer than half of patients had a documented family meeting within 72 hours of admission (n = 60/131, 46%), with substantial interphysician variability in meeting rates ranging from 28% to 63%. Patients with family meetings within 72 hours were 30 times more likely to die within 72 hours (32% vs 1%, P < .001). Of the 55 patients who died in the intensive care unit, 27 (49%) had their first family meeting within 1 day of death. Conclusions: Family meetings occur considerably later than 72 hours and are often held in close proximity to a patient’s death. This suggests for some physicians, family meetings may primarily be used to negotiate withdrawal of life support rather than to support the patient and family.

Educational Intervention to Improve Delirium Recognition by Nurses

2018 ◽  
Vol 27 (4) ◽  
pp. 270-278 ◽  
Author(s):  
Cheri S. Blevins ◽  
Regina DeGennaro
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Providers ◽  
Educational Intervention ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Providers ◽  
Medical Intensive Care

Background Delirium poses increased morbidity and mortality risks for hospitalized patients. Underrecognition by health care providers contributes to poor outcomes for patients. Little has been published about methods used to teach health care providers how to screen for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Objective To evaluate the effectiveness of a multimodal educational intervention for nurses in the medical intensive care unit to improve their knowledge and skills regarding delirium and delirium recognition. Methods An educational intervention was done in the medical intensive care unit of an academic medical center. Effectiveness was evaluated via a quasi-experimental design and using preintervention and postintervention assessments. Procedural correctness of performing the CAM-ICU delirium screening also was measured. Results Nurses participated in 1 small-group session (n = 34). Fifteen sessions were conducted from June to September 2016, and assessments were completed before and after the intervention. The sample consisted of predominantly nurses with a bachelor’s degree (56%) who had 1 to 5 years’ experience (59%). Mean scores overall and on the knowledge subscale differed significantly (P &lt; .001) from before to after the intervention. No correlation was found between demographic groups and score differences. Seventy-nine percent of participants used the tool correctly after the intervention. Conclusions The educational intervention provided for these nurses further validated published reports of the benefits of an educational program about delirium. The content of the educational intervention should be targeted for the setting, the risk factors for the patient population in question, and the specific delirium screening tool used.

Early versus late tracheostomy in patients who require prolonged mechanical ventilation

2000 ◽  
Vol 9 (5) ◽  
pp. 352-359 ◽  
Author(s):  
AD Brook ◽  
G Sherman ◽  
J Malen ◽  
MH Kollef
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medical Intensive Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Early Tracheostomy ◽  
Total Cost ◽  
Medical Intensive Care

OBJECTIVES: To compare the clinical outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. METHODS: A prospective observational study was done. The sample was a cohort of 90 patients who had tracheostomy in the medical intensive care unit of a university-affiliated teaching hospital. Primary outcome measures were duration of mechanical ventilation and total cost of hospitalization. Tracheostomy was defined as early if performed by day 10 of mechanical ventilation and late if performed thereafter. RESULTS: Fifty-three patients had early tracheostomy (mean +/- SD = day 5.9 +/- 7.2 of ventilation), and 37 patients had late tracheostomy (mean +/- SD = day 16.7 +/- 2.9) (P &lt; .001). The mean (+/- SD) duration of mechanical ventilation was 28.3 +/- 28.2 days in the early-tracheostomy group versus 34.4 +/- 17.8 days in the late-tracheostomy group (P = .005). Total cost of hospitalization was significantly lower in the early-tracheostomy group (mean +/- SD = $86,189 +/- $53,570) than in the late-tracheostomy group (mean +/- SD = $124,649 +/- $54,282) (P = .001). Male sex (adjusted odds ratio = 3.84; 95% CI = 2.32-6.34; P = .007) and higher ratios of PaO2 to fraction of inspired oxygen (adjusted odds ratio = 1.01; 95% CI = 1.00-1.01; P = .03) were associated with early tracheostomy. The timing of tracheostomy was not associated with hospital mortality. CONCLUSION: Early tracheostomy is associated with shorter lengths of stay and lower hospital costs than is late tracheostomy among patients in the medical intensive care unit. Prospective clinical trials are necessary to determine the optimal timing of tracheostomy in that setting.

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