Noninvasive ventilation during the weaning process in chronically critically ill patients

Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process.We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h.231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97).NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

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Cytokines in Chronically Critically Ill Patients After Activity and Rest

Biological Research For Nursing ◽

10.1177/1099800406298168 ◽

2007 ◽

Vol 8 (4) ◽

pp. 261-271 ◽

Cited By ~ 27

Author(s):

Chris Winkelman ◽

Patricia A. Higgins ◽

Yea Jyh Kathy Chen ◽

Alan D. Levine

Keyword(s):

Physical Activity ◽

Mechanical Ventilation ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Serum Levels ◽

Inflammatory Factors ◽

Chronically Critically Ill ◽

Critically Ill Adults

Inflammation, a common problem for patients in the intensive care unit (ICU), frequently is associated with serious and prolonged critical illnesses. To date, no study has examined whether physical activity influences inflammatory factors in critically ill adults. The objectives of this study were to (a) examine the relationships between type and duration of physical activity and serum levels of interleukin 6 (IL-6), a proinflammatory cytokine; IL-10, an anti-inflammatory cytokine; and their ratio and (b) determine if there are associations between cytokines or their ratio and activity or outcomes. This descriptive feasibility study investigated the approaches to measuring levels of physical activity and its relationship to serum levels of IL-6 and IL-10 and the ratio between them in patients with prolonged mechanical ventilation during periods of activity and rest. Measurements included serum IL-6 and IL-10 levels, direct observation and actigraphy, and prospective chart review. Ten critically ill patients who were mechanically ventilated for an average of 10 days in a large, urban, teaching hospital were enrolled. The average ratio of IL-6 to IL-10 improved after an average of 14.7 min of passive physical activity, typically multiple in-bed turns associated with hygiene. IL-6, IL-10, and their ratio were not associated with patient outcomes of weaning success or length of stay. High levels of IL-6 were associated with mortality. Cytokine balance may be improved by low levels of activity among patients with prolonged critical illness. The pattern of cytokines produced after activity may improve patients' recovery from prolonged critical illness and mechanical ventilation.

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The Role of Long-Term Ventilator Hospitals

10.1093/med/9780199653461.003.0004 ◽

2014 ◽

Author(s):

Jeremy M Kahn

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Acute Care ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Acute Care Hospitals ◽

Cost Of Care ◽

Current Evidence ◽

Chronically Critically Ill

Long-term ventilator facilities play an increasingly important role in the care of chronically critically ill patients in the recovery phase of their acute illness. These hospitals can take several forms, depending on the country and health system, including �step-down� units within acute care hospitals and dedicated centres that specialize in weaning patients from prolonged mechanical ventilation. These hospitals may improve outcomes through increased clinical experience at applying protocolized weaning approaches and specialized, multidisciplinary, rehabilitation-focused care; they may also worsen outcomes by fragmenting the episode of acute care across multiple hospitals, leading to communication delays and hardship for families. Long-term ventilator facilities may also have important �spillover effects�, in that they free ICU beds in acute care hospitals to be filled with greater numbers of acute critically ill patients. Current evidence suggests that mortality of chronically critically ill patients is equivalent between acute care hospitals and specialized weaning centres; however, mechanical ventilation may be longer and cost of care higher in patients who remain in acute care hospitals. Given the rising incidence of prolonged mechanical ventilation and capacity constraints on acute care ICUs, long-term ventilator hospitals are likely to serve a key function in critical illness recovery.

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Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial

Intensive Care Medicine ◽

10.1007/s00134-017-4911-0 ◽

2017 ◽

Vol 43 (11) ◽

pp. 1660-1667 ◽

Cited By ~ 22

Author(s):

M. Mar Fernandez ◽

Alejandro González-Castro ◽

Monica Magret ◽

M. Teresa Bouza ◽

Marcos Ibañez ◽

...

Keyword(s):

Mechanical Ventilation ◽

Randomized Controlled Trial ◽

Critically Ill ◽

Critically Ill Patients ◽

Spontaneous Breathing ◽

Controlled Trial ◽

Spontaneous Breathing Trial ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

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ANEMIA AND TRANSFUSIONS AMONG CRITICALLY ILL PATIENTS ON PROLONGED MECHANICAL VENTILATION

CHEST Journal ◽

10.1016/s0012-3692(16)51915-1 ◽

2006 ◽

Vol 130 (4) ◽

pp. 212S

Author(s):

Andrew F. Shorr ◽

Lee S. Stern ◽

Monika K. Raut ◽

Lisa R. Rosenblatt ◽

Samir Mody ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation

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Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit

Critical Care ◽

10.1186/cc10117 ◽

2011 ◽

Vol 15 (2) ◽

pp. R102 ◽

Cited By ~ 74

Author(s):

Nazir I Lone ◽

Timothy S Walsh

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Potential Cost

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Tracheostomy

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0117 ◽

2019 ◽

pp. 850-854

Author(s):

Saba Ghorab ◽

David G. Lott

Keyword(s):

United States ◽

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

The United States ◽

Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

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Distinguishing Features of the Kinetics of Oxygen Consumption During the Spontaneous Breathing Trials for Tracheostomized Patients with Prolonged Mechanical Ventilation

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a5444 ◽

2019 ◽

Author(s):

I.H. Lee ◽

F.-C. Lin ◽

J.-C. Cheng ◽

C.-K. Huang ◽

Y.-C. Chien ◽

...

Keyword(s):

Mechanical Ventilation ◽

Oxygen Consumption ◽

Spontaneous Breathing ◽

Prolonged Mechanical Ventilation ◽

Spontaneous Breathing Trials ◽

Kinetics Of ◽

Distinguishing Features

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Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

Journal of Clinical Medicine ◽

10.3390/jcm7080224 ◽

2018 ◽

Vol 7 (8) ◽

pp. 224 ◽

Cited By ~ 5

Author(s):

Shyh-Ren Chiang ◽

Chih-Cheng Lai ◽

Chung-Han Ho ◽

Chin-Ming Chen ◽

Chien-Ming Chao ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clostridium Difficile ◽

Critically Ill ◽

Clostridium Difficile Infection ◽

Critically Ill Patients ◽

Prolonged Mechanical Ventilation ◽

Comorbidity Scores ◽

Independent Risk Factors ◽

High Comorbidity

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan’s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7–14 days (n = 97,525), 15–21 days (n = 52,068), 22–28 days (n = 35,264), and 29–60 days (n = 70,021). The primary outcome was CDI. Results: Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29–60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46–5.58; p < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15–21 days (AHR = 2.58; 95% CI = 1.12–5.91) and MV 29–60 days (AHR = 4.63; 95% CI = 1.14–10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.

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