scholarly journals Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated critically ill patients: a multicenter prospective observational study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
François Bagate ◽  
Anahita Rouzé ◽  
Farid Zerimech ◽  
Florence Boissier ◽  
Vincent Labbe ◽  
...  
Keyword(s):  
Observational Study ◽  
Transesophageal Echocardiography ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Cuff Pressure ◽  
Ventilator Associated Pneumonia ◽  
Salivary Amylase ◽  
Before And After ◽  
Tracheal Cuff

Abstract Background Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. Methods It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. Results We enrolled 100 patients (35 females), with a median age of 64 (53–72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. Conclusions We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.

Impact of polyurethane on variations in tracheal cuff pressure in critically ill patients: a prospective observational study

2010 ◽  
Vol 36 (7) ◽  
pp. 1156-1163 ◽  
Author(s):  
Saad Nseir ◽  
Farid Zerimech ◽  
Julien De Jonckheere ◽  
Isabelle Alves ◽  
Malika Balduyck ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Cuff Pressure ◽  
Tracheal Cuff

scholarly journals Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study

Critical Care ◽  
2010 ◽  
Vol 14 (2) ◽  
pp. R64 ◽  
Author(s):  
Michael Fischer ◽  
Stephan Rüegg ◽  
Adam Czaplinski ◽  
Monika Strohmeier ◽  
Angelika Lehmann ◽  
...  
Keyword(s):  
Observational Study ◽  
Glasgow Coma Scale ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Rater Reliability ◽  
Coma Scale

scholarly journals Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G A Gerges ◽  
H M M Elazzazi ◽  
M H S A Elsersi ◽  
S A R Mustafa ◽  
M A Saeed
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
University Hospitals ◽  
Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

scholarly journals Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aiko Tanaka ◽  
Akinori Uchiyama ◽  
Yu Horiguchi ◽  
Ryota Higeno ◽  
Ryota Sakaguchi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Leak Test ◽  
Endotracheal Suctioning ◽  
Cuff Leak ◽  
The Impact

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

scholarly journals Nutrient pattern analysis in critically ill patients using Omics technology (NAChO) – Study protocol for a prospective observational study

Medicine ◽  
2019 ◽  
Vol 98 (1) ◽  
pp. e13937 ◽  
Author(s):  
Joerg C. Schefold ◽  
Anna S. Messmer ◽  
Stefanie Wenger ◽  
Lionel Müller ◽  
Stephan von Haehling ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Study Protocol ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Pattern Analysis ◽  
Omics Technology
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