scholarly journals Respiratory variation in carotid peak systolic velocity predicts volume responsiveness in mechanically ventilated patients with septic shock: a prospective cohort study

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Miguel Á Ibarra-Estrada ◽  
José A López-Pulgarín ◽  
Julio C Mijangos-Méndez ◽  
José L Díaz-Gómez ◽  
Guadalupe Aguirre-Avalos
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Peak Systolic Velocity ◽  
Respiratory Variation ◽  
Volume Responsiveness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

2008 ◽  
Vol 126 (6) ◽  
pp. 319-322 ◽  
Author(s):  
Bruno Franco Mazza ◽  
José Luiz Gomes do Amaral ◽  
Heloisa Rosseti ◽  
Rosana Borges Carvalho ◽  
Ana Paula Resque Senna ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Before And After ◽  
High Risk Situation ◽  
Change In Mean ◽  
Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

scholarly journals COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK

2021 ◽  
Vol 3 (1) ◽  
pp. e000077
Author(s):  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical History ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pressure Setting ◽  
Uk National Health Service ◽  
Ventilated Patients

ObjectivesCOVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.DesignData on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.SettingUK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.ParticipantsThe cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measuresMortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.ResultsThe median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.ConclusionsTracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration numberThe study is registered with ClinicalTrials.Gov (NCT04572438).

scholarly journals Protocol for a multicentre, prospective cohort study of practice patterns and clinical outcomes associated with emergency department sedation for mechanically ventilated patients: the ED-SED Study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023423 ◽  
Author(s):  
Brian M Fuller ◽  
Nicholas M Mohr ◽  
Brian W Roberts ◽  
Christopher R Carpenter ◽  
Marin H Kollef ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Deep Sedation ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
The Impact ◽  
Ventilated Patients

IntroductionIn mechanically ventilated patients, sedation strategies are a major determinant of outcome. The emergency department (ED) is the earliest exposure to mechanical ventilation for hundreds of thousands of patients annually in the USA. The one retrospective study that exists regarding ED sedation for mechanically ventilated patients showed a strong association between deep sedation in the ED and worse clinical outcomes. This finding suggests that the ED may be an optimal location to study the impact of early sedation on outcome, yet a lack of prospective studies represents a knowledge gap in this arena. This protocol describes a prospective observational study aimed at further characterising ED sedation practices and assessing the relationship between ED sedation and clinical outcomes. An association between ED sedation and clinical outcomes across multiple sites would suggest the need for changes in the current sedation strategies used in the ED, and provide evidence for future interventional studies in this field.Methods and analysisThis is a multicentre, prospective cohort study testing the hypothesis that deep sedation in the ED is associated with worse clinical outcomes. A cohort of over 300 mechanically ventilated ED patients will be included. The primary outcome is ventilator-free days, and secondary outcomes include hospital mortality, incidence of acute brain dysfunction and lengths of stay. Multivariable linear regression will test the hypothesis that deep sedation in the ED is associated with a decrease in ventilator-free days.Ethics and disseminationApproval of the study by the Institutional Review Board (IRB) at each participating site has been obtained prior to data collection on the first patient. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.

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