Factors Associated with Respiratory Support after Cesarean Hysterectomy

2021 ◽  
Vol 104 (8) ◽  
pp. 1347-1353
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Blood Components ◽  
Factors Associated ◽  
Cesarean Hysterectomy ◽  
Asa Classification ◽  
The Relationship ◽  
Postoperative Mechanical Ventilation

Background: Cesarean hysterectomy is a major operation that causes massive hemorrhage and larger fluid resuscitation. Thus, postoperative mechanical ventilation support is required in some patients, involving longer hospital stay and high cost of hospital care. Objective: To find the predictive factors for postoperative respiratory support in pregnant women underwent cesarean hysterectomy. Materials and Methods: A retrospective review of patients underwent cesarean hysterectomy between January 2014 and June 2019 was conducted. Patient characteristics, anesthetic records and hospital length of stay were reviewed. The relationship between factors and postoperative mechanical ventilator (PMV) was also analyzed. Results: A total of 180 patients were included in the present study, wherein, 64 patients (35%) required PMV and 30 patients (16%) needed postoperative oxygen support. Multivariable logistic regression was used to identify the relationship between PMV and the associated factors. The authors found the American Society of Anesthesiologists (ASA) classification and the volume of intraoperative blood components replacement (packed red blood cells [PRC] and fresh frozen plasma [FFP]) were significantly related to PMV: ASA3 16.51 (95% CI 1.89 to 144.33), ASA4 183.25 (95% CI 2.92 to 11,500.65), p=0.003; PRC 1.0028 (95% CI 1.0008 to 1.0047), p=0.001; FFP 1.0022 (95% CI 1.0000 to 1.0043), p=0.029, respectively. Conclusion: Postoperative mechanical ventilation was found in one-third of the cesarean hysterectomy patients and associated with ICU admission along with increased in post-operative length of hospital stay. The ASA classification and intraoperative volume of blood components replacement were significantly associated with PMV. Factors associated significantly with respiratory support were ASA classification and duration surgery. Keywords: Factors associated; Respiratory support; Cesarean hysterectomy

scholarly journals 1002. Epidemiology of Pneumococcal Bacteremia in a Large Tertiary Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S298-S298
Author(s):  
Aristotle Asis ◽  
Esmeralda Gutierrez-Asis ◽  
Ali Hassoun
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
High Morbidity ◽  
Icu Stay ◽  
Pneumococcal Bacteremia ◽  
Tertiary Center

Abstract Background Streptococcus pneumoniae remains an important cause of bacteremia in the United States with high morbidity and mortality despite readily available treatment and vaccines. Increased incidence of bacteremia observed during 2017–2018 season. Methods Retrospective chart review of patients admitted with pneumococcal bacteremia over the last two winter seasons. Demographics, laboratory data, ICU stay, need for ventilation or pressor, comorbidities, and mortality were collected. Results Fifty-three patients enrolled. 62% admitted during 2017–2018. Sixty-six percent white, 60% male, mean BMI 27 (38% had normal BMI). Mean age was 55 years (1–93) (57% > 61). Mean hospital length of stay was 7.8 days (1–30). More than 40% required ICU stay. The use of NPPV, vasopressors, and mechanical ventilation were 6%, 15%, and 17%, respectively. Most common presentation: dyspnea 30% and fever 18%. Smoking history (55%). Eighty percent of these patients had pneumonia. Resistance to penicillin 9% and intermediate susceptibility 6%. Resistance to erythromycin 44% and trimethoprim-sulfamethoxazole 12% which increased during winter 2017 (52% and 12%) compared with winter 2016 (30% and 10%). Only 2% of patients with pneumonia had positive sputum culture for pneumococcus and 62% had positive serum pneumococcal antigen with bacteremia. Positive co-detection of bacterial or viral targets in sputum using Multiplex PCR did not correlate with mortality and hospital stay but they were more likely needed ICU stay, use of vasopressor and mechanical ventilation. 43% of empiric therapy was as recommended by IDSA guidelines. Comparing 2016 vs. 2017 seasons, mortality (15% vs. 6%), hospital stay (9 days vs. 7 days), use of NPPV (5% vs. 6%) mechanical ventilation (15% vs. 18%) and vasopressor (5% vs. 21%). No correlation between influenza infection and bacteremia. Overall 6-month mortality and re-admission rate was 9% and 2%, respectively. Mortality was higher in overweight patients (60% vs. 20%), non-smokers (40% vs. 20%), coronary artery disease (40%) and congestive heart failure (40%). Conclusion Pneumococcal bacteremia cause significant morbidity and mortality, we observed less mortality and hospital stay, but more use of NPPV, mechanical ventilation, and vasopressor during 2017–2018 season which had widespread influenza like activity. Disclosures All authors: No reported disclosures.

scholarly journals Factors associated to the length of time on mechanical ventilation in the postoperative period of cardiac surgery

2014 ◽  
Vol 35 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Laura Fonseca ◽  
Fernando Nataniel Vieira ◽  
Karina De Oliveira Azzolin
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Medical Records ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Factors Associated ◽  
Continuous Sedation ◽  
The Mean

Our objective was to identify factors associated with the duration of mechanical ventilation (MV) postoperative to cardiac surgery and assess the association between duration of endotracheal intubation, length of stay in the Intensive Care Unit (ICU) and hospital. Longitudinal, retrospective study of medical records of 116 adults undergoing cardiac surgery from March 2012 to May 2013. The mean age was 57±14 years, predominantly male and coronary artery bypass grafting surgery (52.6%). The MV time was 15.25(7.66 to 23.68) hours. Associated with longer MV was the age (r=0.5,p<0.001), comorbidities (r=0.344,p<0.001), cardiopulmonary bypass time (r=0.244,p=0.008), duration of continuous sedation (r=0.607,p<0.001), sedative doses (r=0.4, p<0.001), time of vasoconstrictors and vasodilators (r=0.711, p< 0.001, r=0.368, p<0.001), drainage of the 1st time (r=0.201, p<0.031), presence of drains (r=0.445, p<0.001), postoperative complications (r=0.524, p< 0.001) and hospital stay. Our data confirms that both preoperative, transoperative and postoperative variables prolong the VM and therefore the hospital stay.

scholarly journals Correlation of Vitamin D Deficiency with Predictors of Mortality in Critically Ill Children at a Tertiary Care Centre in North India—A Prospective, Observational Study

2020 ◽  
Author(s):  
Shilpa Bansal ◽  
Amarpreet Kaur ◽  
Seema Rai ◽  
Gurmeet Kaur ◽  
Gitanjali Goyal ◽  
...  
Keyword(s):  
Vitamin D ◽  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
North India ◽  
Factors Associated ◽  
Predictors Of Mortality ◽  
The Relationship

AbstractThis study was conducted to assess the relationship of vitamin D deficiency (VDD) with various demographic characteristics, laboratory parameters, and predictors of mortality. This prospective observational study was performed at pediatric intensive care unit (PICU) of a tertiary care hospital situated in north India. A total of 125 children admitted in PICU with age from 2 months to 14 years were analyzed. The subjects were classified as Vitamin D deficient (≤20 ng/mL) and nondeficient (>20 ng/mL). The relationship between VDD and predictors of mortality were analyzed using correlation and multivariate analysis. Respiratory system (40%) was most commonly involved. VDD was seen in 72% of the patients. There was statistically significant correlation of VDD with age (p = 0.019), season (p = 0.018), height (p = 0.005), and weight (p = 0.003). On multivariate analysis factors associated with VDD were age (odds ratio [OR] = 1.01, 95% confidence interval [CI] 1.00–1.03, p = 0.006), season (OR = 3.98, 95% CI 1.09–14.50, p = 0.036). VDD was also correlated to bacteriuria (p = 0.033), cardiovascular sequential sepsis-related organ failure assessment score (CV-SOFA score) (p = 0.001), and mechanical ventilation (p = 0.043). On multivariate analysis, factors associated with VDD were bacteriuria (OR = 4.88, 95% CI 1.04–22.89, p = 0.04), mechanical ventilation requirement (OR = 2.95, 95% CI 1.12–7.85, p = 0.029), and CV-SOFA score (OR = 2.33, 95% CI 1.14–4.76, p = 0.021). Median (interquartile range) duration of PICU stay in VDD patients was (3–7) days while in nondeficient patients it was (2–6) days (p = 0.107). VDD was a significant risk factor for the need of mechanical ventilation, bacteriuria, and mortality among patients in our cohort.

scholarly journals Performance of The Decarboxylation Index To Predict CO2 Removal And Mechanical Ventilation Reduction Under VV-ECMO Or High-Flow ECCO2R

2022 ◽  
Author(s):  
Thomas Laumon ◽  
Elie Courvalin ◽  
Geoffrey Dagod ◽  
Pauline Deras ◽  
Mehdi Girard ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gas Flow ◽  
Blood Gases ◽  
High Flow ◽  
Trial Registration ◽  
Respiratory Support ◽  
Co2 Removal ◽  
Linear Regression Models ◽  
The Relationship ◽  
Simple Parameter

Abstract Background: Optimal decarboxylation dose under extracorporeal respiratory support to ensure sufficient reduction of mechanical ventilation stress remains unclear and understudied. The aim of this study was to assess the interdependence of blood flow (BF) and gas flow (GF) in predicting CO2 removal and mechanical ventilation reduction (MVR) under extracorporeal respiratory support. Methods: All patients who benefited from veno-venous ECMO (HLS-maquet 7.0, 1.8 m²) and high-flow ECCO2R (HLS-maquet 5.0, 1.3 m²) in our intensive care unit over a period of 18 months were included. CO2 removal was calculated from inlet/outlet blood gases performed in clinical practice during the first 7 days of oxygenator use. The relationship between the BF × GF product and CO2 removal or MVR was studied using linear regression models. Results: Eighteen patients were analysed, corresponding to 24 oxygenators and 261 datasets. CO2 removal was 393 mL/min (IQR, 310–526 mL/min) for 1.8 m2 oxygenators and 179 mL/min (IQR, 165–235 mL/min) for 1.3 m2 oxygenators. The decarboxylation index was associated linearly with CO2 removal (R2 = 0.62 and R2 = 0.77 for the two oxygenators, respectively) and MVR (R2 = 0.72 and R2 = 0.62, respectively). Values in the range 20−30L2/min2 were associated with an MVR ratio between 38% and 58% for 1.8 m2 oxygenators, and between 37% and 55% for 1.3 m2 oxygenators. Conclusion: The decarboxylation index is a simple parameter to predict CO2 removal and MVR under extracorporeal respiratory support. A BF of 2 L2/min2 or more may be necessary to obtain a significant reduction of mechanical convection.Trial Registration: Being a retrospective study, no trial registration was made.

scholarly journals Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

2021 ◽  
Author(s):  
Marcello Guarnieri ◽  
Patrizia Andreoni ◽  
Hedwige Gay ◽  
Riccardo Giudici ◽  
Maurizio Bottiroli ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Single Center ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Factors Associated ◽  
Ventilated Patients

Abstract Background: The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare, but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. Aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence.Methods. Retrospective, single-center study performed in an Italian teaching hospital. All adult patients admitted to the Intensive Care Unit (ICU) between February 24 and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, while information regarding airway management was collected daily.Results. A total of 151 patients were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 39.7%. A tracheostomy was performed in 73 (48.3%) patients: open surgical technique in 54 patients (74%) and percutaneous Ciaglia technique in 19 patients (26%). Patients in whom a tracheostomy was performed had, compared to the other patients, a longer duration of mechanical ventilation and longer ICU and hospital length of stay. Tracheomalacia was diagnosed in 8 (5%) patients. The factors associated with tracheomalacia were female sex, obesity, and tracheostomy.Conclusions. In our population, approximately 50% of patients with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized patients had a longer ICU and hospital length of stay. Five percent of our population was diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature and the underlying mechanisms are not fully understood.

scholarly journals Fluctuations of driving pressure during mechanical ventilation indicates elevated central venous pressure and poor outcomes

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402097036
Author(s):  
Jia-Yu Mao ◽  
Dong-Kai Li ◽  
Xin Ding ◽  
Hong-Min Zhang ◽  
Yun Long ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Central Venous Pressure ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Driving Pressure ◽  
Hospital Length Of Stay ◽  
Central Venous ◽  
College Hospital ◽  
Wide Range ◽  
The Relationship

Inappropriate mechanical ventilation may induce hemodynamic alterations through cardiopulmonary interactions. The aim of this study was to explore the relationship between airway pressure and central venous pressure during the first 72 h of mechanical ventilation and its relevance to patient outcomes. We conducted a retrospective study of the Department of Critical Care Medicine of Peking Union Medical College Hospital and a secondary analysis of the MIMIC-III clinical database. The relationship between the ranges of driving pressure and central venous pressure during the first 72 h and their associations with prognosis were investigated. Data from 2790 patients were analyzed. Wide range of driving airway pressure (odds ratio, 1.0681; 95% CI, 1.0415–1.0953; p < 0.0001) were independently associated with mortality, ventilator-free time, intensive care unit and hospital length of stay. Furthermore, wide range of driving pressure and elevated central venous pressure exhibited a close correlation. The area under receiver operating characteristic demonstrated that range of driving pressure and central venous pressure were measured at 0.689 (95% CI, 0.670–0.707) and 0.681 (95% CI, 0.662–0.699), respectively. Patients with high ranges of driving pressure and elevated central venous pressure had worse outcomes. Post hoc tests showed significant differences in 28-day survival rates (log-rank (Mantel–Cox), 184.7; p < 0.001). In conclusion, during the first 72 h of mechanical ventilation, patients with hypoxia with fluctuating driving airway pressure have elevated central venous pressure and worse outcomes.

Delirium in a Tertiary Pediatric Cardiac Intensive Care Unit: Risk Factors and Outcomes

2021 ◽  
pp. 088506662110668
Author(s):  
Andrew M. Koth ◽  
Titus Chan ◽  
Yuen Lie Tjoeng ◽  
R. Scott Watson ◽  
Leslie A. Dervan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Objective Delirium is an increasingly recognized hospital complication associated with poorer outcomes in critically ill children. We aimed to evaluate risk factors for screening positive for delirium in children admitted to a pediatric cardiac intensive care unit (CICU) and to examine the association between duration of positive screening and in-hospital outcomes. Study design Retrospective cohort study in a single-center quaternary pediatric hospital CICU evaluating children admitted from March 2014-October 2016 and screened for delirium using the Cornell Assessment of Pediatric Delirium. Statistical analysis used multivariable logistic and linear regression. Results Among 942 patients with screening data (98% of all admissions), 67% of patients screened positive for delirium. On univariate analysis, screening positive was associated with younger age, single ventricle anatomy, duration of mechanical ventilation, continuous renal replacement therapy, extracorporeal life support, and surgical complexity, as well as higher average total daily doses of benzodiazepines, opioids, and dexmedetomidine. On multivariable analysis, screening positive for delirium was independently associated with age <2 years, duration of mechanical ventilation, and greater than the median daily doses of benzodiazepine and opioid. In addition to these factors, duration of screening positive was also independently associated with higher STAT category (3-5) or medical admission, organ failure, acute kidney injury (AKI), and higher dexmedetomidine exposure. Duration of positive delirium screening was associated with both increased CICU and hospital length of stay (each additional day of positive screening was associated with a 3% longer CICU stay [95% CI = 1%-6%] and 2% longer hospital stay [95% CI = 0%-4%]). Conclusions Screening positive for delirium is common in the pediatric CICU and is independently associated with prolonged intensive care unit (ICU) and hospital stay. Longer duration of mechanical ventilation and higher sedative doses are independent risk factors for screening positive for delirium. Efforts aimed at reducing these exposures may decrease the burden of delirium in this population.

scholarly journals Incidence and Operative Factors Associated With Discretional Postoperative Mechanical Ventilation After General Surgery

2018 ◽  
Vol 126 (2) ◽  
pp. 489-494 ◽  
Author(s):  
Juliet J. Ray ◽  
Meredith Degnan ◽  
Krishnamurti A. Rao ◽  
Jonathan P. Meizoso ◽  
Charles A. Karcutskie ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
General Surgery ◽  
Factors Associated ◽  
Postoperative Mechanical Ventilation

scholarly journals A Prospective Observational Study of Hypomagnesemia in Critically Ill Paediatric Patients

2020 ◽  
Vol 40 (2) ◽  
pp. 67-71
Author(s):  
Channanayaka Chandrashekhar ◽  
Reshmi Pillai ◽  
Prajwala Hassan Vasudev ◽  
Tirin Babu ◽  
George Mathew Panachiyil
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Serum Magnesium ◽  
Length Of Hospital Stay ◽  
Inotropic Support ◽  
Respiratory Support ◽  
Common Finding ◽  
Critically Ill Children

Introduction: Magnesium deficiency, a common finding in critically ill patients, is associated with increased need for respiratory support, increased duration of ICU stay and mortality. The primary objective of our study is to assess the prevalence of hypomagnesaemia in critically ill children (requiring inotropic support, respiratory support, and fluid resuscitation) on admission in the Paediatric Intensive Care Unit (PICU). The secondary objective is to evaluate its relationship with the length of hospital stay and mortality. Methods: This prospective observational study was conducted in the PICU of a tertiary care hospital. In this study, serum magnesium levels at admission were measured along with other laboratory tests, after informed consent. Serum magnesium levels were assayed in our laboratory. The normal range of serum magnesium in our lab is 1.7-2.7 mg/dl. During admission in PICU, there was follow-up for ionotrope administration, need for mechanical ventilation, APACHE II score, PICU length of stay and mortality. Results: In this study, 350 critically ill children requiring hemodynamic / respiratory support were chosen. However, 83 children were excluded from study as they were discharged against medical advice. The prevalence of hypomagnesemia in this study was 43.4%. There was no significant association between hypomagnesemia, duration of hospital stay and mortality. Conclusion: Hypomagnesaemia is a common finding in critically ill paediatric patients, however there is no significant association noted in regards to length of hospital stay, duration of mechanical ventilation, inotropic support and mortality.

scholarly journals Effect of treatment applied in sepsis on intensive care unit and hospital stay: how effective are albumin/steroid/vasopressor agents?

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Selda Kayaalti ◽  
Ömer Kayaalti
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Vasopressor Agents ◽  
Increasing Risk

Abstract Background The incidence and prevalence of sepsis have increased in recent years and it is the most common cause of intensive care admission. The aim of this study was to determine the effects of albumin, steroid, and vasopressor agents and other possible factors on the duration of intensive care unit and hospital stay in sepsis patients. Open access data set obtained from Tohoku Sepsis Registry database was used. Four hundred sixty-two patients admitted to intensive care unit with the diagnosis of sepsis were divided into four groups according to their intensive care unit (≤ 5 or > 5 days) and hospital length of stay (≤ 24 or > 24 days). Demographic data, vital signs, laboratory values, mechanical ventilation requirement, and treatment protocols such as albumin, steroid, and vasopressor agent use were used in the evaluation of the groups. Results The use of albumin (odds ratio [OR] = 3.76 [95% confidence interval (CI), 2.16–6.56]; p < 0.001), steroids (OR = 2.85 [95% CI, 1.67–4.86]; p < 0.001), and vasopressor agents (OR = 3.56 [95% CI, 2.42–5.24]; p < 0.001) were associated with an increasing risk of prolonged intensive care unit length of stay. Also, it was found that the use of albumin (OR = 3.43 [95% CI, 2.00–5.89]; p < 0.001), steroids (OR = 2.81 [95% CI, 1.66–4.78]; p < 0.001), and vasopressor agents (OR = 4.47 [95% CI, 3.02–6.62]; p < 0.001) were associated with an increasing risk of prolonged hospital length of stay. In addition, prognostic scoring systems, body temperature, mean arterial pressure, pH, PaO2/FiO2 ratio, and mechanical ventilation requirement in the first 24 h were also found to be associated with length of stay in intensive care unit and hospital. There was a significant relationship between platelet count, creatinine, Na, lactic acid, and time between diagnosis of sepsis and source control and intensive care unit length of stay, and between hematocrit and C-reactive protein and hospital length of stay. Conclusions The use of albumin, steroid, and vasopressor agents has been found to be significantly correlated with both intensive care unit and hospital length of stay. Further studies are needed to determine in what order or at what dosage these agents will be administered in sepsis treatment.

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