Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study

Abstract Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Design: Multicenter, retrospective cohort study Setting: ICUs at 5 tertiary hospitals in Beijing Participants: Patients who required PMV after surgery between January 2007 and June 2016 were enrolled. Interventions: None Measurements and Main Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P<0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P<0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P=0.01), blood platelet count ≤150´10 9 /L (HR 1.77, 95% CI 1.14-2.75; P=0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P=0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P=0.047) on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150´10 9 /L, vasopressor requirement, and renal replacement therapy on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.

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Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study

10.21203/rs.2.16468/v3 ◽

2020 ◽

Author(s):

Yue-ming Sun ◽

Shuangling Li ◽

Shupeng Wang ◽

Chen Li ◽

Gang Li ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Platelet Count ◽

Renal Replacement Therapy ◽

Cancer Diagnosis ◽

Retrospective Cohort ◽

Prolonged Mechanical Ventilation ◽

Blood Platelet ◽

Blood Platelet Count

Abstract Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Design: Multicenter, retrospective cohort study Setting: ICUs at 5 tertiary hospitals in Beijing Participants: Patients who required PMV after surgery between January 2007 and June 2016 were enrolled. Interventions: None Measurements and Main Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P<0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P<0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P=0.01), blood platelet count ≤150´10 9 /L (HR 1.77, 95% CI 1.14-2.75; P=0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P=0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P=0.047) on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150´10 9 /L, vasopressor requirement, and renal replacement therapy on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.

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Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-020-0942-0 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Yueming Sun ◽

Shuangling Li ◽

Shupeng Wang ◽

Chen Li ◽

Gang Li ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prolonged Mechanical Ventilation

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Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

Colombia Medica ◽

10.25100/cm.v44i3.1285 ◽

2013 ◽

pp. 184-188 ◽

Cited By ~ 4

Author(s):

Alvaro Sanabria ◽

Ximena Gomez ◽

Valentin Vega ◽

Luis Carlos Dominguez ◽

Camilo Osorio

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Critically Ill ◽

Medical Condition ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Adult Patients ◽

Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

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Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: a Retrospective Cohort Study

10.1101/2020.03.16.20036780 ◽

2020 ◽

Cited By ~ 5

Author(s):

Yi Yang ◽

Jia Shi ◽

Shuwang Ge ◽

Shuiming Guo ◽

Xue Xing ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Invasive Mechanical Ventilation ◽

Risk Of Mortality ◽

Increased Risk ◽

Intermittent Renal Replacement Therapy

AbstractBackgroundFor the coronavirus disease 2019 (COVID-19), critically ill patients had a high mortality rate. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation.MethodsIn this retrospective cohort study, we included all patients with COVID-19 undergoing invasive mechanical ventilation from February 12nd to March 2nd, 2020. All patients were followed until death or March 28th, and all survivors were followed for at least 30 days.ResultsFor 36 hospitalized COVID-19 patients with invasive mechanical ventilation, the mean age was 69.4 (± 10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group) and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments and most of the laboratory findings. During median follow-up period of 9.5 (interquartile range 4.3-33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (P = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in three different models, with adjusted hazard ratios varying from 0.332 to 0.398. Higher levels of IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP were significantly associated with an increased risk of mortality in patients with PIRRT.ConclusionPIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

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Efficacy of tocilizumab in the intensive care unit patients with COVID-19: a retrospective cohort study

Clinical pharmacology and therapy ◽

10.32756/0869-5490-2020-4-17-25 ◽

2020 ◽

Vol 29 (4) ◽

pp. 17-25

Author(s):

S.V. Moiseev ◽

S.N. Avdeev ◽

E.A. Tao ◽

M.Yu. Brovko ◽

A.G. Yavorovsky ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort

To evaluate the efficacy of earlier and late tocilizumab (TCZ) infusion, that is, prior to and after initiation of mechanical ventilation, in reducing mortality in a cohort of patients with severe COVID-19 pneumonia who required support in the intensive care unit (ICU).

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Low hematocrit on ICU admission is a risk factor of long term outcome in patients who required prolonged mechanical ventilation after cardiovascular surgery. A single center retrospective cohort study

10.26226/morressier.57108e30d462b80290b4a6b4 ◽

2016 ◽

Author(s):

Akito Tsukinaga

Keyword(s):

Mechanical Ventilation ◽

Risk Factor ◽

Cohort Study ◽

Retrospective Cohort ◽

Cardiovascular Surgery ◽

Prolonged Mechanical Ventilation ◽

Single Center ◽

Term Outcome ◽

Long Term Outcome

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Population-based incidence, mortality and quality of life in critically ill patients treated with renal replacement therapy: a nationwide retrospective cohort study in finnish intensive care units

Critical Care ◽

10.1186/cc11158 ◽

2012 ◽

Vol 16 (1) ◽

pp. R13 ◽

Cited By ~ 37

Author(s):

Suvi T Vaara ◽

Ville Pettilä ◽

Matti Reinikainen ◽

Kirsi-Maija Kaukonen ◽

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Population Based

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Effects of Chlorhexidine Oral Decontamination on Respiratory Colonization during Mechanical Ventilation in Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/665325 ◽

2012 ◽

Vol 33 (5) ◽

pp. 527-530

Author(s):

Douwe F. Postma ◽

Sanjay U. C. Sankatsing ◽

Steven F. T. Thijsen ◽

Henrik Endeman

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Differential Effect ◽

Retrospective Cohort ◽

Fungal Colonization ◽

Before And After ◽

Oral Decontamination

We conducted a retrospective cohort study to assess respiratory colonization before and after the use of chlorhexidine oral decontamination among a cohort of intensive care unit patients who received mechanical ventilation. We observed a decrease in the prevalence of Enterobacteriaceae and an increase in the incidence of fungal colonization. Chlorhexidine oral decontamination might have a differential effect on respiratory colonization.

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Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Retrospective Cohort Study

Blood Purification ◽

10.1159/000512099 ◽

2020 ◽

pp. 1-8

Author(s):

Yi Yang ◽

Jia Shi ◽

Shuwang Ge ◽

Shuiming Guo ◽

Xue Xing ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Invasive Mechanical Ventilation ◽

Risk Of Mortality ◽

Increased Risk ◽

Intermittent Renal Replacement Therapy

Background: The mortality rate of critically ill patients with coronavirus disease 2019 (COVID-19) was high. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation. Methods: This retrospective cohort study included all COVID-19 patients receiving invasive mechanical ventilation between February 12 and March 2, 2020. All patients were followed until death or March 28, and all survivors were followed for at least 30 days. Results: For 36 hospitalized COVID-19 patients receiving invasive mechanical ventilation, the mean age was 69.4 (±10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group), and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments, and most of the laboratory findings. During the median follow-up period of 9.5 (interquartile range 4.3–33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (p = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in 3 different models, with adjusted hazard ratios varying from 0.332 to 0.398. Increased IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP levels were significantly associated with an increased risk of mortality in patients with PIRRT. Conclusion: PIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

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