scholarly journals Exercise testing of patients after a period of prolonged mechanical ventilation

2004 ◽  
Vol 60 (2) ◽  
Author(s):  
R. Roos ◽  
H. Van Aswegen ◽  
C. J. Eales ◽  
P. J. Becker
Keyword(s):  
Mechanical Ventilation ◽  
Exercise Test ◽  
Statistical Tests ◽  
Prolonged Mechanical Ventilation ◽  
Correlation Study ◽  
Perceived Effort ◽  
Kaplan Meier ◽  
Functional Exercise ◽  
Lost To Follow Up

In this study, physical recovery of patients who received prolonged mechanical ventilation (PMV) was assessed with a six-phase functional exercise test after the period of ventilation. A prospective correlation study using a consecutive sampling method was carried out over a six-month period. Thirty-one patients were tested but five were lost to follow-up Statistical tests included the Pearson’s correlation coefficient, student’s paired t-test and Kaplan-Meier survival estimate. Subjective perceived effort changed significantly from phase to phase in the exercise test and over time (p < 0.00) Heart rate and respiratory rate responses indicated increased cardio-respiratory effort during the test. No correlation existed between subjective perceived

scholarly journals Perceived effort of funtional activities after a period of mechanical ventilation

2002 ◽  
Vol 58 (4) ◽  
Author(s):  
R. Roos ◽  
H. Van Aswegen ◽  
C. J. Eales
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Exercise Testing ◽  
Exercise Test ◽  
Perceived Exertion ◽  
Rating Of Perceived Exertion ◽  
Subjective Rating ◽  
Borg Scale ◽  
Perceived Effort ◽  
Functional Exercise

A case report to assess exercise testing post-mechanical ventilation, using functional activities while monitoring changes in the physiological parameters and subjective rating of perceived exertion.  The case report subject was able to use the Modified Borg Scale to report  her perception of perceived exertion during functional exercise testing.  An increase in heart rate, respiratory rate and Modified Borg Scale rating was noted on progression through the exercise test.  Difficulty was experienced with subject follow-up due to discharged from hospital as soon as the patient was considered to be medically stable.  The subject was unable to complete the functional exercise test before discharge.

scholarly journals Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

2021 ◽  
Author(s):  
Hayato Taniguchi ◽  
Aimi Ohya ◽  
Hidehiro Yamagata ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Prolonged Mechanical Ventilation ◽  
X Rays ◽  
C Reactive Protein ◽  
Time Points ◽  
Reactive Protein ◽  
Bedside Test ◽  
Successful Extubation

Abstract Background: Some patients with severe coronavirus disease (COVID-19) who present with fibrosis on computed tomography (CT) require prolonged mechanical ventilation (PMV). Lung ultrasound (LUS), a rapid, bedside test, has been reported to have findings consistent with those of CT. Thus, this study aimed to assess whether serial LUS scores could predict PMV or successful extubation in severe COVID-19 patients.Methods: LUS was performed for 20 consecutive severe COVID-19 patients at three time points: admission (day 1), after 48 h (day 3), and seventh-day follow-up (day 7). We compared the LUS score with the results of chest X-rays and laboratory tests at three time points. Moreover, we assessed LUS score to determine the inter-rater reliability (IRR) of the results among examiners.Results: While there were no significant differences in mortality in each PMV and successful extubation groups, there were significant differences in LUS scores on day 3 and day 7; XP score on day 7; and P/F ratio on day 7 in the PMV group (p<0.05). There were significant differences in LUS scores on days 3 and 7, C-reactive protein (CRP) levels on day 7, and P/F ratio on day 7 in the successful extubation group (p<0.05). The areas under the curves (AUCs) of LUS score on days 3 and 7, XP score on day 7, and P/F ratio were 0.88, 0.98, 0.77, and 0.80, respectively in the PMV group; and the AUCs of LUS score on days 3 and 7, CRP levels on day 7, and P/F ratio 0.79, 0.90, 0.82, and 0.79, respectively, in the successful extubation group. Variations in serial LUS scores exhibited significant differences between the groups. The serial LUS score on day 7 was higher than that on day 1 in the PMV group but lower in the successful extubation group (p<0.05). However, there was slight IRR agreement in the LUS score changes on days 1 to 7 (κ= 0.15 [95% CI: 0-0.31]). Conclusions: The serial LUS score of severe COVID-19 patients could predicted PMV and successful extubation. To overcome IRR disagreement, the automatic ultrasound judgement, such as deep learning, would be needed.

Autologous Transplantation in De Novo Non-Promyelocytic Acute Myeloid Leukemia (AML) Patients in First Complete Remission (CR1) with Peripheral Blood Stem Cell (PBSC) Collection Following Consolidation with High-Dose Cytarabine and Etoposide: A Single Institution Experience

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4461-4461
Author(s):  
Eugene Choi ◽  
Lingyi Chen ◽  
Srikanth Nagalla ◽  
Vamshi Kaveti ◽  
Regina Mullaney ◽  
...  
Keyword(s):  
De Novo ◽  
Disease Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Kaplan Meier ◽  
Cd34 Cells ◽  
High Dose Cytarabine ◽  
Lost To Follow Up ◽  
Disease Free

Abstract INTRODUCTION: Autologous PBSC transplant is an important yet evolving treatment modality for patients with AML. However, the ideal mobilization regimen from which to collect PBSC remains in question. Previous reports have indicated that highdose cytarabine with etoposide is both safe and effective in terms of successful PBSC procurement, subsequent engraftment, and disease outcome. METHODS: At our institution from 1994 to 2007, 38 consecutive patients with de novo non-promyelocytic AML in first complete remission following conventional induction chemotherapy were consolidated with high-dose cytarabine (2000mg/m2 IV q12h × 8 doses, days 1–4) and etoposide (40mg/kg IV over 96h) followed by G-CSF 5 mg/kg subcutaneously starting d14 until completion of PBSC collection. Patients underwent myeloablative therapy with busulfan (1mg/kg po q6h × 16 doses, days –7 to -4) and etoposide (60 mg/kg IV over 10h, day -3) with PBSC infusion occurring on day 0 with daily G-CSF 5 mg/kg. Data regarding stem cell yield, engraftment and patient outcome was collected retrospectively. RESULTS: The average patient age was 44 years (range 19–70). Following consolidation, at least 2×106 CD34 cells/kg were isolated from all 38 patients with a median of 9.4×106 (range 2.2–43) CD34 cells/kg over a mean of 4 collections (range 1–11). Overall, 36 of 38 (95%) remained in CR and went onto PBSC transplant (one died from infectious complications during consolidation, one relapsed before transplant). The median number of stem cells infused was 8.8×106 CD 34 cells/kg (range 2.2–47). All 36 patients engrafted with the mean number of days to neutrophil recovery (ANC&gt;500) being 11 (range 8–17) and the mean number of days to platelet recovery (&gt;20,000) being 12 (range 8–19). Disease-free outcomes in patients undergoing PBSC transplant while in CR1 are presented in Figure 1. The 3y overall survival in all pts was 66%, and 56% at 5y. For good-risk cytogenetic patients, 3y OS was 78% and the 5y OS was 75%. For intermediate-risk cytogenetic patients, OS was 47% and 36% at 3y and 5y respectively. Three patients with poor cytogenetics were autulogously transplanted. One patient relapsed at day 111 and expired at day 450. The second patient remains in CR at day 246. The third patient relapsed at day 104 and expired at day 322. CONCLUSION: In patients with de novo non-promyelocytic AML in CR1, consolidation with high-dose cytarabine plus etoposide is safe and provides excellent yield of PBSCs upon growth factor accelerated hematological recovery. Subsequent engraftment after autologous transplanation is rapid. Our outcomes support the viability of this regimen in patients with good and intermediate-risk cytogenetics. Figure 1: Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up. Figure 1:. Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up.

scholarly journals Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110107
Author(s):  
Jaclyn Daigneault ◽  
Heather White ◽  
Alexandra Dube ◽  
Qiming Shi ◽  
Jean-Marc Gauguet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Prolonged Mechanical Ventilation ◽  
Ultrasound Screening ◽  
Initial Screening ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Grade Ii

Very preterm infants are at risk for germinal matrix hemorrhage- intraventricular hemorrhage (GH-IVH). Severe GH-IVH may cause death or severe neurodevelopmental disability while mild GH-IVH is considered a static, non-progressive disease. This retrospective study aimed to determine if infants with no GH-IVH or mild GH-IVH on initial screening head ultrasound (HUS) advanced to severe GH-IVH. A total of 353 eligible infants with birth gestational age ≤32 0/7 weeks who received a HUS during hospitalization were identified. Of the 343 (97%) infants who had mild GH-IVH (grade II or less) on initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days. Therefore, premature infants who have no GH-IVH or mild GH-IVH on initial routine screening HUS without other risk factors may not require follow-up HUSs. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.

scholarly journals Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation

2020 ◽  
pp. 1-10
Author(s):  
A Takhar ◽  
C Tornari ◽  
N Amin ◽  
D Wyncoll ◽  
S Tricklebank ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Multidisciplinary Approach ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Interquartile Range ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation

Abstract Objectives Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT–anaesthetics department led tracheostomy team. Method A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. Results Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13–20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23–40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7–16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. Conclusion Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.

scholarly journals CLINICAL RESPONSE OF A BRAND OF ARTEMETHER- LUMEFANTRINE IN CHILDREN BELOW FIVE YEARS OLD

2021 ◽  
Vol 19 (1) ◽  
pp. 123-132
Author(s):  
JOHN EDJOPHE ARUTE ◽  
VALENTINE UCHE ODILI ◽  
EMMANUEL AGBAMU ◽  
WINIFRED AITALEGBE OJIEABU
Keyword(s):  
Clinical Response ◽  
Falciparum Malaria ◽  
Failure Rate ◽  
Health Concern ◽  
Major Health ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
Lost To Follow Up ◽  
Parasitological Response

Malaria is a major health concern in children aged less than five years old, globally. In Nigeria, it was estimated that 300,000 children die annually from malaria. Thus, this study aims to evaluate the clinical response of a brand of arthemether-lumefantrine (AL) for clearing parasitaemia in children aged less than five years old. This was a prospective study of the clinical and parasitological responses to the treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria using a popular dispersible brand of AL 20/120 mg. A hundred participants within 6–59 months with P. falciparum malaria were enrolled in the study and participants who could not complete the follow-ups were excluded. The drug was administered to participants following same dosage regimen on days 0, 1, 2 and followed-up on days 3, 7, 14, 21 and 28 in which the participants were assessed clinically and parasitologically. Data was analysed using MS-Excel 2010 and SPSS version 18. Kaplan-Meier survival analysis was used to assess clinical outcomes. The study showed that 73 participants completed the 28 days follow-up while 27 participants were lost to follow-up. Clinical outcome revealed no early treatment failure (ETF), one late clinical failure (LCF), 10 parasitological failures and 62 adequate clinical and parasitological response (ACPF). Clinical response was 84.9%, cumulative success and failure rate was 93.6% and 6.4%, respectively, on day 28. The clinical response of AL was efficacious. The failure rate of 6.4% could likely be as a result of reinfection within the period of follow-up.

scholarly journals Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19

2020 ◽  
Author(s):  
Edward Needham ◽  
Virginia Newcombe ◽  
Andrew Michell ◽  
Rachel Thornton ◽  
Andrew Grainger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Significant Proportion ◽  
Neurological Deficits ◽  
Mononeuritis Multiplex ◽  
Critical Illness Neuromyopathy

AbstractThe prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.

scholarly journals On clinical trial fragility due to patients lost to follow up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin R. Baer ◽  
Stephen E. Fremes ◽  
Mario Gaudino ◽  
Mary Charlson ◽  
Martin T. Wells
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Intermediate State ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Fragility Index ◽  
Lost To Follow Up ◽  
Statistical Results

Abstract Background Clinical trials routinely have patients lost to follow up. We propose a methodology to understand their possible effect on the results of statistical tests by altering the concept of the fragility index to treat the outcomes of observed patients as fixed but incorporate the potential outcomes of patients lost to follow up as random and subject to modification. Methods We reanalyse the statistical results of three clinical trials on coronary artery bypass grafting (CABG) to study the possible effect of patients lost to follow up on the treatment effect statistical significance. To do so, we introduce the LTFU-aware fragility indices as a measure of the robustness of a clinical trial’s statistical results with respect to patients lost to follow up. Results The analyses illustrate that clinical trials can either be completely robust to the outcomes of patients lost to follow up, extremely sensitive to the outcomes of patients lost to follow up, or in an intermediate state. When a clinical trial is in an intermediate state, the LTFU-aware fragility indices provide an interpretable measure to quantify the degree of fragility or robustness. Conclusions The LTFU-aware fragility indices allow researchers to rigorously explore the outcomes of patients who are lost to follow up, when their data is the appropriate kind. The LTFU-aware fragility indices are sensitivity measures in a way that the original fragility index is not.

Comparison of chemoradiotherapy (CRT) and chemotherapy (CT) in patients with a locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: Final results of the international phase III LAP 07 study.

2013 ◽  
Vol 31 (18_suppl) ◽  
pp. LBA4003-LBA4003 ◽  
Author(s):  
Pascal Hammel ◽  
Florence Huguet ◽  
Jean-Luc Van Laethem ◽  
David Goldstein ◽  
Bengt Glimelius ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Final Analysis ◽  
Primary Objective ◽  
Phase Iii ◽  
Progression Rate ◽  
Kaplan Meier ◽  
Lost To Follow Up

LBA4003 Background: CRT in patients with LAPC controlled after induction CT could be superior to continuing CT (Huguet, JCO 2007). The role of erlotinib is unknown. We aimed to define the role of 1) CRT after disease control with gemcitabine, 2) erlotinib in LAPC. Methods: LAPC PS 0-2 patients were first randomized to gemcitabine alone or plus erlotinib 100 mg/d for 4 months (R1, stratification: center, PS). Patients with controlled disease were then randomized to 2 additional months of CT (Arm 1) or CRT (Arm 2) 54 Gy and capecitabine 1600 mg/m2/d (R2, stratification: center, initial arm). Patients receiving erlotinib at R1 had maintenance with this drug after protocol completion. Quality control for radiotherapy included dummy runs and assessment of treated patients. Primary objective: overall survival (OS) in R2 patients. Secondary objectives: role of erlotinib on OS (R1), tolerance, predictive markers, and circulating tumor cells. Taking into account a 30% progression rate between R1 and R2, and 5% lost to follow-up, 722 patients were required to observe 392 deaths to show a median OS increase from 9 to 12 m (HR=0.75) in the CRT arm (2 sided α=5% and β=20%) with planned interim analyses using alpha spending function and O’Brien Fleming boundaries (to reject H0 or H1). Kaplan-Meier, log rank and univariate Cox tests were used. Results: From 442 pts included for R1, 269 pts reached R2 (arm1:136; arm 2:133). Main baseline characteristics in arms 1/2: female 44%/56%, mean age 63/62, head tumor 65%/62%, PS 0 56%/48%. After a median follow-up of 36 m, 221 deaths had occurred allowing the planned interim analysis (information fraction 56.4%). OS in R2 pts was 16.5 m [15.5-18.5] and 15.3 m [13.9–17.3] in arms 1 and 2, respectively (HR=1.03 [0.79-1.34], p=0.83). IDMC has confirmed that the futility boundary for the hypothesis of CRT superiority was crossed and considered this as the final analysis of the study. Conclusions: Administering CRT is not superior to continuing CT in patients with controlled LAPC after 4 months of CT. Clinical trial information: NCT00634725.

Effect of concomitant proton pump inhibitor (PPI) on effectiveness of tyrosine kinase inhibitor (TKI) in patients with metastatic renal cell carcinoma (mRCC).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 608-608
Author(s):  
Trang H. Au ◽  
Erin B. Bailey ◽  
Shiven B. Patel ◽  
Srinivas Kiran Tantravahi ◽  
Neeraj Agarwal ◽  
...  
Keyword(s):  
Kinase Inhibitor ◽  
Small Sample Size ◽  
Small Sample ◽  
Kaplan Meier ◽  
Observational Cohort ◽  
Retrospective Study Design ◽  
Tki Treatment ◽  
Lost To Follow Up ◽  
Tki Discontinuation

608 Background: PPIs may reduce TKI bioavailability resulting in reduced efficacy, shortened time on TKI treatment, and disease progression. Axitinib, sorafenib, and pazopanib exhibit pH-dependent solubility. Esomeprazole reduced the AUC and Cmax of pazopanib by 40%, but there was no significant interaction for sorafenib with omeprazole or axitinib with rabeprazole. In real world practice, the effect of PPIs as a class on the efficacy of TKIs as a class in mRCC has not been reported. Methods: This observational cohort study evaluated adult patients treated with a TKI for mRCC. Time on TKI treatment was defined as TKI initiation date to date of discontinuation, change in therapy, lost to follow-up, or death. We performed a treatment line analysis. Time on TKI treatment was compared between patients with and without concurrent PPI (Kaplan-Meier, log-rank). Results: Analysis included 128 treatment lines, including 49 TKI with PPI and 79 TKI with no PPI treatment lines. TKIs included sunitinib, pazopanib, sorafenib, and axitinib. PPIs included omeprazole, lansoprazole, esomeprazole, pantoprazole, and rabeprazole. The three most common TKI/PPI combinations involved omeprazole with sunitinib (26), pazopanib (13), and axitinib (3). No difference in time on TKI treatment with PPI (median 8.7 months) and with no PPI (median 7.0 months, p = 0.41) was observed. In pazopanib treatment lines, no difference in time on treatment was observed in those treated with omeprazole or esomeprazole (n = 14, median 4.8 months) compared to those without PPI (n = 18, median 1.7 months, p = 0.22). Conclusions: Among the TKI/PPI combinations evaluated, there was no difference in time to TKI discontinuation with or without concurrent PPI. This suggests that concurrent PPI does not affect time to discontinuation of TKI. Study limitations include the small sample size, limited number of TKI/PPI combinations, and retrospective study design. A larger study is needed to validate these findings.

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