scholarly journals Functional Status After Pulmonary Rehabilitation as a Predictor of Weaning Success and Survival in Patients Requiring Prolonged Mechanical Ventilation

2021 ◽  
Vol 8 ◽  
Author(s):  
Li-Ta Keng ◽  
Sheng-Kai Liang ◽  
Chi-Ping Tseng ◽  
Yueh-Feng Wen ◽  
Ping-Hsien Tsou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Overall Survival ◽  
Functional Status ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Ventilator Weaning ◽  
Rehabilitation Program ◽  
Hospital Survival ◽  
Rehabilitation Programs ◽  
Comprehensive Rehabilitation

Background: Comprehensive rehabilitation programs are recommended for patients with prolonged mechanical ventilation (PMV) to facilitate functional recovery and ventilator weaning, but whether the functional status after rehabilitation influences outcome has not been clearly evaluated. This study aimed to investigate the association between post-rehabilitation functional status and weaning and survival outcome in PMV patients.Methods: We retrospectively enrolled PMV patients admitted to the respiratory care center (RCC), a post-ICU weaning facility with protocolized rehabilitation program, from January 2016 through December 2017. Functional status was measured by the de Morton Mobility Index (DEMMI), with a cut-off value set at 20 points. The primary outcomes were the weaning status at RCC discharge and hospital survival. The secondary outcomes were overall survival and survival at 3 months after RCC discharge. We followed patients until 3 months after RCC discharge or death. Logistic and Cox regressions were performed to identify significant parameters associated with weaning success and survival.Results: In total, 320 patients were enrolled. The weaning success rate was 71.6%. The survival rate at RCC discharge, hospital discharge, and 3 months after RCC discharge was 89.1, 77.5, and 66.6%, respectively. Post-rehabilitation DEMMI ≥ 20 (odds ratio [OR], 3.514; 95% confidence interval [CI], 1.436–8.598; P = 0.006) was the most significantly associated with weaning success. The weaning success and higher post-rehabilitation DEMMI were the two most significant independent factors associated with both hospital survival (weaning success, OR, 12.272; 95% CI, 5.281–28.517; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 6.298; 95% CI, 1.302–30.477; P = 0.022) and survival at 3 months after RCC discharge (weaning success, OR, 38.788; 95% CI, 11.505–130.762; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 4.830; 95% CI, 1.072–21.756; P = 0.040). Post-rehabilitation DEMMI ≥ 20 remained significantly association with overall survival at 3 months after RCC discharge (hazard ratio, 0.237; 95% CI, 0.072–0.785; P = 0.018).Conclusions: Post-rehabilitation functional status of PMV patients was independently associated with weaning success, as well as hospital and 3-month overall survival after RCC discharge. Post-rehabilitation, but not pre-rehabilitation, functional status was a significant parameter associated with weaning success and survival in patients requiring PMV.

scholarly journals The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

2021 ◽  
Vol 11 ◽  
Author(s):  
Patrick Schuss ◽  
Niklas Schäfer ◽  
Christian Bode ◽  
Valeri Borger ◽  
Lars Eichhorn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Brain Metastases ◽  
Prolonged Mechanical Ventilation ◽  
Postoperative Phase ◽  
Significant Prognostic Factor ◽  
Cancer Disease ◽  
Definition Of ◽  
The Impact

ObjectiveSurgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases.Methods360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed.Results14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001).ConclusionsThe present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.

scholarly journals Effects of Exercise Training on Pulmonary Mechanics and Functional Status in Patients With Prolonged Mechanical Ventilation

2012 ◽  
Vol 57 (5) ◽  
pp. 727-734 ◽  
Author(s):  
Y.-H. Chen ◽  
H.-L. Lin ◽  
H.-F. Hsiao ◽  
L.-T. Chou ◽  
K.-C. Kao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Exercise Training ◽  
Functional Status ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Mechanics

scholarly journals Assessment of anxiety and pain in patients with lumbosacral radiculopathy at the early stage of rehabilitation with various rehabilitation programs after microdiscectomy

2020 ◽  
Vol 48 (1) ◽  
pp. 13-21
Author(s):  
V. N. Blokhina ◽  
E. G. Melikyan
Keyword(s):  
Analogue Scale ◽  
Early Stage ◽  
Rehabilitation Program ◽  
Leg Pain ◽  
Lumbosacral Radiculopathy ◽  
Rehabilitation Programs ◽  
Russian Version ◽  
Comprehensive Rehabilitation ◽  
Anxiety Levels

Rationale: The role of the psychogenic component in chronic pain and delayed rehabilitation in patients with lumbosacral radiculopathy (LSR) has been extensively studied. However, there is a paucity of studies evaluating anxiety and pain in LSR patients early after microdiscectomy. Only a few studies have performed a differentiated assessment of state (SA) and trait (TA) anxiety. The effects of repetitive peripheral magnetic stimulation (rPMS) on the TA level in the Russian LSR patients have not been investigated. Aim: To assess changes in anxiety and pain over time in LSR patients with various rehabilitation programs at the early stage after microdiscectomy. Materials and methods: The study included 71 patients with LSR after microdiscectomy (mean age 46.8 ± 10.5 years). At Day 7 after surgery, the patients were randomized into two groups. The patients in the 1st group (n = 35) received a rPMS course in addition to conventional rehabilitation, whereas the patients in the 2nd group (n = 36) were rehabilitated only conventionally. Pain was assessed by a visual analogue scale (VAS), and anxiety levels by Spielberger StateTrait Anxiety Inventory (validated Russian version). Results: There was a significant decrease of SA and TA levels in the patients of both groups at Day 21 of rehabilitation, compared to those at Day 7 (p < 0.001). At Day 21, there was a significant inter-group difference (p = 0.036) in the leg pain VAS score and the TA frequency distribution (p = 0.042, Fisher test). Conclusion: Better improvement of pain and trait anxiety in the patients treated with rPMS indicates that it would be reasonable to include an rPMS course into the comprehensive rehabilitation program after microdiscectomy.

scholarly journals Neurally Adjusted Ventilatory Assist Is Associated with Greater Initial Extubation Success in Postoperative Congenital Heart Disease Patients when Compared to Conventional Mechanical Ventilation

2018 ◽  
Vol 07 (03) ◽  
pp. 147-158 ◽  
Author(s):  
Nasir Mushtaq ◽  
Kellie Brown ◽  
Vanette Littlefield ◽  
Roger Barton ◽  
Shawn Sood
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Median Duration ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Initial Attempt ◽  
Ventilatory Assist

AbstractExtubation failure is associated with considerable morbidity and mortality in postoperative patients with congenital heart disease (CHD). The study purpose was to investigate initial extubation success utilizing neurally adjusted ventilatory assist (NAVA) compared with pressure-regulated volume controlled, synchronized intermittent mandatory ventilation with pressure support (SIMV-PRVC + PS) for ventilatory weaning in patients who required prolonged mechanical ventilation (MV). Also, total days on MV, inotropes, sedation, analgesia, and pediatric intensive care unit (PICU) length of stay (LOS) between both groups were compared. This was a non-randomized pilot study utilizing historical controls (SIMV-PRVC + PS; n = 40) compared with a prospective study population (NAVA; n = 35) in a Level I PICU and was implemented to help future trial designs. All patients (n = 75) required prolonged MV ≥96 hours due to their complex postoperative course. Ventilator weaning initiation and management was standardized between both groups. Ninety-seven percent of the NAVA group was successfully extubated on the initial attempt, while 80% were in the SIMV-PRVC + PS group (p = 0.0317). Patients placed on NAVA were eight times more likely to have successful initial extubation (odds ratio [OR]: 8.50, 95% confidence interval [CI]: 1.01, 71.82). The NAVA group demonstrated a shorter median duration on MV (9.0 vs. 11.0 days, p = 0.032), PICU LOS (9.0 vs. 13.5 days, p < 0.0001), and shorter median duration of days on dopamine (8.0 vs. 11.0 days, p = 0.0022), milrinone (9.0 vs. 12.0 days, p = 0.0002), midazolam (8.0 vs. 12.0 days, p < 0.0001), and fentanyl (9.0 vs. 12.5 days, p < 0.0001) compared with the SIMV-PRVC + PS group. NAVA compared with SIMV-PRVC + PS was associated with a greater initial extubation success rate. NAVA should be considered as a mechanical ventilator weaning strategy in postoperative congenital heart disease (CHD) patients and warrants further investigation.

A tracheostomy shared decision making program in respiratory care center patients in Taiwan

2020 ◽  
Author(s):  
Chienhsiu Huang ◽  
Ihung Chen
Keyword(s):  
Decision Making ◽  
Mechanical Ventilation ◽  
Survival Rate ◽  
Shared Decision Making ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Optimal Decision ◽  
Respiratory Care ◽  
Shared Decision ◽  
Methods Of Treatment

Abstract Background: Tracheostomy is recommended for respiratory care center prolonged mechanical ventilation patients who cannot be liberated from the ventilator in the short term. However, most patients or their families oppose having this procedure. We applied [If my family is difficulty liberated from the ventilator, do he/she need to undergo tracheostomy?] tracheostomy shared decision making program for respiratory care center prolonged mechanical ventilation patients. The program is expected to enable patients to undergo tracheostomy, improving patients’ medical care and outcomes. Methods: We apply tracheostomy shared decision making program to patients who were admitted to a respiratory care center. Data of patients in the respiratory care center who participated in tracheostomy shared decision making program were collected and analyzed. The survival of patients and the optimal decision marking of tracheostomy shared decision making program were tracked. Results: A total of 57 patients participated in tracheostomy shared decision making program. Of these, 39 patients (68.4%) were men, and 18 (31.6%) were women. The mean age was 69.6 years. At the end of the study, 37 patients underwent tracheostomy (64.9%), and 20 patients maintained endotracheal tube intubation (35.1%). There was no significant difference in the factors of concern and the degree of concern about the methods of treatment in the two group patients. Patients or their families of the two groups have a good understanding of the two methods of treatment. The survival rate of patients undergoing tracheostomy was 86.5%, but only 86.5% of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision making program. Conversely, the survival rate of patients who maintained endotracheal tube intubation was 40%, but the all of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision making program. The overall 91.2% of participants made an optimal decision marking of the tracheostomy shared decision making program. Conclusions: The clinical application of tracheostomy shared decision making program has achieved excellent results. Patients who underwent tracheostomy will have a longer survival time.

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