Using a Collaborative Weaning Plan to Decrease Duration of Mechanical Ventilation and Length of Stay in the Intensive Care Unit for Patients Receiving Long-Term Ventilation

2002 ◽  
Vol 11 (2) ◽  
pp. 132-140 ◽  
Author(s):  
Elizabeth Henneman ◽  
Kathleen Dracup ◽  
Tomas Ganz ◽  
Orna Molayeme ◽  
Christopher B. Cooper
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Cost ◽  
Outcome Variable ◽  
Collaborative Management ◽  
Flow Sheet ◽  
Long Term Ventilation

• Background Patients requiring mechanical ventilation for prolonged periods typically are sicker and have more comorbid illnesses than do patients who can be weaned more rapidly. As a result, the weaning process is often complex, requiring shared decision making by a skilled, multidisciplinary team. Unfortunately, many of the structures used in critical care units to plan and evaluate care do not lend themselves to collaborative management of patients. • Objective To evaluate the effect of a collaborative weaning plan on outcomes, including duration of mechanical ventilation, for patients treated with mechanical ventilation for 7 days or more. • Methods A collaborative weaning plan (weaning board and flow sheet) was introduced into the medical intensive care unit at the University of California Los Angeles, Medical Center. A historical design was used to compare outcomes before and after the plan was used. The primary outcome variable was duration of mechanical ventilation. Other outcomes studied included length of stay in the unit, cost, prevalence of complications (ie, reventilation, readmission to the intensive care unit), and mortality rate. • Results The collaborative weaning plan decreased duration of ventilation by 4.9 days (P = .02) and decreased median length of stay in the unit by 4.5 days (P = .004). The median cost per stay in the unit decreased from $50 462 to $37 330 (P = .004). The prevalence of complications did not differ significantly between groups. • Conclusions Collaborative structures (eg, weaning boards, flow sheets) are useful in decreasing duration of mechanical ventilation for patients receiving long-term ventilation.

scholarly journals Global Muscle Strength But Not Grip Strength Predicts Mortality and Length of Stay in a General Population in a Surgical Intensive Care Unit

2012 ◽  
Vol 92 (12) ◽  
pp. 1546-1555 ◽  
Author(s):  
Jeanette J. Lee ◽  
Karen Waak ◽  
Martina Grosse-Sundrup ◽  
Feifei Xue ◽  
Jarone Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Manual Muscle Testing ◽  
Surgical Intensive Care Unit ◽  
Muscle Testing

Background Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design This investigation was a prospective, observational study. Methods One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles=3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.

The impact of time to tracheostomy on mechanical ventilation duration, length of stay, and mortality in intensive care unit patients

2009 ◽  
Vol 24 (3) ◽  
pp. 435-440 ◽  
Author(s):  
Yaseen M. Arabi ◽  
Jamal A. Alhashemi ◽  
Hani M. Tamim ◽  
Andres Esteban ◽  
Samir H. Haddad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
The Impact

The Future of Intensive Care Unit Sedation: A Report of Continuous Infusion Ketamine as an Alternative Sedative Agent

2016 ◽  
Vol 30 (5) ◽  
pp. 576-581 ◽  
Author(s):  
Scott T. Benken ◽  
Alexandra Goncharenko
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Ventilator Weaning ◽  
Long Term Effects ◽  
Alternative Agent ◽  
Epidural Hemorrhage ◽  
Icu Sedation

This report describes a patient case utilizing a nontraditional sedative, continuous infusion ketamine, as an alternative agent for intensive care unit (ICU) sedation. A 27-year-old female presented for neurosurgical management of a coup contrecoup injury, left temporal fracture, epidural hemorrhage (EDH), and temporal contusion leading to sustained mechanical ventilation. The patient experienced profound agitation during mechanical ventilation and developed adverse effects with all traditional sedatives: benzodiazepines, dexmedetomidine, opioids, and propofol. Ketamine was titrated to effect and eliminated the need for other agents. This led to successful ventilator weaning, extubation, and transition of care. Given the unique side effect profile of ketamine, it is imperative that information is disseminated on potential utilization of this agent. More information is needed regarding dosing, monitoring, and long-term effects of utilizing ketamine as a continuous ICU sedative, but given the analgesia, anesthesia, and cardiopulmonary stability, future utilization of this medication for this indication seems promising.

scholarly journals The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Seyhan Pala Cifci ◽  
Yasemin Urcan Tapan ◽  
Bengu Turemis Erkul ◽  
Yusuf Savran ◽  
Bilgin Comert
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
High Flow Oxygen ◽  
The Impact

Objective. Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. Materials and Methods. One hundred and eighty-seven patients who met inclusion criteria, treated in Dokuz Eylul University Medical Intensive Care Unit between January 1, 2016, and October 31, 2018, were examined retrospectively. These patients’ demographic data, oxygen saturation (SpO2) values for the first 24 hours, APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, whether they needed intubation, if they did how many days they got ventilated, length of stay in intensive care unit and hospital, maximum PaO2 values of the first day, oxygen treatment method of the first 24 hours, and the rates of mortality were recorded. Results. Hyperoxemia was determined in 62 of 187 patients who were not treated with invasive mechanic ventilation in the first 24 hours of admission. Upon further investigation of the relation between comorbid situations and hyperoxia, hyperoxia frequency in patients with COPD was detected to be statistically low (16% vs. 35%, p<0.008). Hospital mortality was significantly high (51.6% vs. 35.2%, p<0.04) in patients with hyperoxia. When the types of oxygen support therapies were investigated, hyperoxia frequency was found higher in patients treated with supplemental oxygen (nasal cannula, oronasal mask, high flow oxygen therapy) than patients treated with NIMV (44.2% vs. 25.5%, p<0.008). After exclusion of 56 patients who were intubated and treated with invasive mechanical ventilation after the first 24 hours, hyperoxemia was determined in 46 of 131 patients. Mortality in patients with hyperoxemia who were not treated with invasive mechanical ventilation during hospital stay was statistically higher when compared to normoxemic patients (41.3% vs 15.3%, p<0.001). Conclusion. We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.

Use of flexible intermediate and intensive care to reduce multiple transfers of patients

1999 ◽  
Vol 8 (3) ◽  
pp. 170-179 ◽  
Author(s):  
E Besserman ◽  
D Teres ◽  
A Logan ◽  
M Brennan ◽  
S Cleaves ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Noninvasive Ventilation ◽  
Cost Savings ◽  
Median Number ◽  
Nursing Unit ◽  
Teaching Community ◽  
Intermediate Unit

OBJECTIVE: To test an alternative flexible approach to traditional fixed intermediate and intensive care to minimize transfers of patients. METHODS: Patients admitted to a 28-bed nursing unit with intermediate care potential and a 12-bed intensive care unit at a 300-bed teaching community hospital were studied. The group included 524 patients with a discharge diagnosis code for mechanical ventilation. During eight 3-week cycles, 1073 transfers of patients were tabulated. A plan-do-study-act method was used to improve weaning from mechanical ventilation and reduce the number of inappropriate days in intensive care. Admissions and transfers to the 2 units for all patients during the eight 3-week cycles were compared over time. Length of stay and mortality were noted for all patients treated with conventional and noninvasive ventilation. RESULTS: Direct admissions to the flexible intermediate unit increased with no overall change in admissions to the intensive care unit. Fewer patients needed conventional ventilation, and more in both units were treated with noninvasive ventilation. The median number of transfers per patient treated with mechanical ventilation decreased from 1.94 to 1.20. Length of stay and mortality also decreased among such patients. Some cost savings were attributable to the decrease in the number of transfers. Transfers out of the hospital directly from the intensive care unit increased from 2.24% to 4.43%. CONCLUSIONS: In a community teaching hospital, flexible care policies decreased the number of in-hospital transfers of patients treated with mechanical ventilation.

scholarly journals Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia

2017 ◽  
Vol 218 (2) ◽  
pp. 179-188 ◽  
Author(s):  
Vikki G Nolan ◽  
Sandra R Arnold ◽  
Anna M Bramley ◽  
Krow Ampofo ◽  
Derek J Williams ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Bacterial Infections ◽  
Clinical Characteristics ◽  
Community Acquired Pneumonia ◽  
Virus Infections ◽  
Oxygen Supplementation

Abstract Background Recognition that coinfections are common in children with community-acquired pneumonia (CAP) is increasing, but gaps remain in our understanding of their frequency and importance. Methods We analyzed data from 2219 children hospitalized with CAP and compared demographic and clinical characteristics and outcomes between groups with viruses alone, bacteria alone, or coinfections. We also assessed the frequency of selected pairings of codetected pathogens and their clinical characteristics. Results A total of 576 children (26%) had a coinfection. Children with only virus detected were younger, more likely to be black, and more likely to have comorbidities such as asthma, compared with children infected with typical bacteria alone. Children with virus-bacterium coinfections had a higher frequency of leukocytosis, consolidation on chest radiography, parapneumonic effusions, intensive care unit admission, and need for mechanical ventilation and an increased length of stay, compared with children infected with viruses alone. Virus-virus coinfections were generally comparable to single-virus infections, with the exception of the need for oxygen supplementation, which was higher during the first 24 hours of hospitalization in some virus-virus pairings. Conclusions Coinfections occurred in 26% of children hospitalized for CAP. Children with typical bacterial infections, alone or complicated by a viral infection, have worse outcomes than children infected with a virus alone.

Tracheostomy trends in paediatric intensive care

2020 ◽  
pp. archdischild-2020-319396
Author(s):  
Jason Powell ◽  
Hannah L Buckley ◽  
Rachel Agbeko ◽  
Malcolm Brodlie ◽  
Steven Powell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Incidence Rate ◽  
Paediatric Intensive Care Unit ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Great Variability ◽  
Paediatric Intensive Care ◽  
Long Term Ventilation

Paediatric tracheostomy is most commonly performed in children on the paediatric intensive care unit (PICU) to facilitate long-term ventilation. We sought to identify trends in UK tracheostomy practice in PICUs. Data were analysed from 250 261 admissions, including 4409 children tracheostomised between 2003 and 2017. The incidence of tracheostomy in 2017 was approximately half that in 2003 (incidence rate ratio=0.48, 95% CI 0.40 to 0.57). The percentage of patients tracheostomised during a PICU admission, as a proportion of all admissions, was 2.44% (n=319) in 2003 and reduced to 0.97% (n=180) in 2017. Nevertheless, we identified great variability in practice between different PICUs with tracheostomy rates between 0.0% and 4.0% of all admissions. Risk-adjusted PICU mortality was comparable between tracheostomised children and all admissions to PICU.

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