Duration of Mechanical Ventilation in an Adult Intensive Care Unit After Introduction of Sedation and Pain Scales
Teresa A. WilliamsSuzanne MartinGavin LeslieLinda P ThomasTimothy LeenSheralee TamaliunasK. Y. LeeGeoffrey Dobb
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Background Sedation and analgesia scales promote a less-distressing experience in the intensive care unit and minimize complications for patients receiving mechanical ventilation. Objectives To evaluate outcomes before and after introduction of scales for sedation and analgesia in a general intensive care unit. Method A before-and-after design was used to evaluate introduction of the Richmond Agitation-Sedation Scale and the Behavioral Pain Scale for patients receiving mechanical ventilation. Data were collected for 6 months before and 6 months after training in and introduction of the scales. Results A total of 769 patients received mechanical ventilation for at least 6 hours (369 patients before and 400 patients after implementation). Age, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and diagnostic groups were similar in the 2 groups, but the after group had more men than did the before group. Duration of mechanical ventilation did not change significantly after the scales were introduced (median, 24 vs 28 hours). For patients who received mechanical ventilation for 96 hours or longer (24%), mechanical ventilation lasted longer after implementation of the scales (P =.03). Length of stay in the intensive care unit was similar in the 2 groups (P = .18), but patients received sedatives for longer after implementation (P=.01). By logistic regression analysis, APACHE II score (P <.001) and diagnostic group (P <.001) were independent predictors of mechanical ventilation lasting 96 hours or longer. Conclusion Sedation and analgesia scales did not reduce duration of ventilation in an Australian intensive care unit.Cite
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Investigation of the Relationship Between Oral Lesions and Early Pneumonia Associated with Mechanical Ventilation in Patients Undergoing Mechanical Ventilation in Intensive Care Unit
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Critically ill patients undergoing mechanical ventilation have traditionally been deeply sedated. In the latest decade growing evidence supports less sedation as being beneficial for the patients. A daily interruption of sedation has been shown to reduce the length of mechanical ventilation and the length of stay in the intensive care unit. Recently it has been shown that a strategy with no sedation of critically ill patients undergoing mechanical ventilation reduced the time patients received mechanical ventilation and reduced the length of both intensive care and hospital stay.
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Factors associated with survival in patients undergoing invasive mechanical ventilation in an intensive care unit in Colombia Objective: To determine the clinical characteristics and outcomes of critically ill patients who required invasive mechanical ventilation in an intensive care unit of a high-complexity hospital in Colombia. Methods: This was a retrospective follow-up study of a cohort of adult patients who required invasive mechanical ventilation in an intensive care unit. Sociodemographic, clinical, and pharmacological variables were identified. Using Cox regression, variables associated with survival and complications were identified. Results: A total of 357 patients were analyzed. They had an average age of 64.8±18.9 years, and 52.9% were male. The most frequent diagnoses were sepsis/septic shock (38.4%) and trauma (17.4%). The main factors associated with shorter survival were advanced age (HR:0.97, 95%CI:0.96–0.99), a diagnosis of septic shock (HR:0.29; 95%CI:0.18–0.48) or diabetes mellitus at admission (HR:0.57; 95%CI:0.33–0.98), suffering from a healthcare-associated infection (HR: HR:0.51; 95%CI:0.33–0.80), and the need for vasopressors (HR:0.36; 95%CI:0.22–0.59). The administration of systemic corticosteroids was associated with a higher probability of survival (HR:1.93; 95%CI:1.15–3.25). Conclusions: The use of systemic corticosteroids was associated with a greater probability of survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit. The identification of the variables associated with a higher risk of dying should allow care protocols to be improved, thereby extending the life expectancy of these patients.
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To quantify the mean daily cost of intensive care, identify key factors associated with increased cost, and determine the incremental cost of mechanical ventilation during a day in the intensive care unit.Retrospective cohort analysis using data from NDCHealth's Hospital Patient Level Database.A total of 253 geographically diverse U.S. hospitals.The study included 51,009 patients >/=18 yrs of age admitted to an intensive care unit between October 1, 2002, and December 31, 2002.None.Days of intensive care and mechanical ventilation were identified using billing data, and daily costs were calculated as the sum of daily charges multiplied by hospital-specific cost-to-charge ratios. Cost data are presented as mean (+/-sd). Incremental daily cost of mechanical ventilation was calculated using log-linear regression, adjusting for patient and hospital characteristics. Approximately 36% of identified patients were mechanically ventilated at some point during their intensive care unit stay. Mechanically ventilated patients were older (63.5 yrs vs. 61.7 yrs, p < .0001) and more likely to be male (56.1% vs. 51.8%, p < 0.0001), compared with patients who were not mechanically ventilated, and required mechanical ventilation for a mean duration of 5.6 days +/- 9.6. Mean intensive care unit cost and length of stay were 31,574 +/- 42,570 dollars and 14.4 days +/- 15.8 for patients requiring mechanical ventilation and 12,931 +/- 20,569 dollars and 8.5 days +/- 10.5 for those not requiring mechanical ventilation. Daily costs were greatest on intensive care unit day 1 (mechanical ventilation, 10,794 dollars; no mechanical ventilation, 6,667 dollars), decreased on day 2 (mechanical ventilation:, 4,796 dollars; no mechanical ventilation, 3,496 dollars), and became stable after day 3 (mechanical ventilation, 3,968 dollars; no mechanical ventilation, 3,184 dollars). Adjusting for patient and hospital characteristics, the mean incremental cost of mechanical ventilation in intensive care unit patients was 1,522 dollars per day (p < .001).Intensive care unit costs are highest during the first 2 days of admission, stabilizing at a lower level thereafter. Mechanical ventilation is associated with significantly higher daily costs for patients receiving treatment in the intensive care unit throughout their entire intensive care unit stay. Interventions that result in reduced intensive care unit length of stay and/or duration of mechanical ventilation could lead to substantial reductions in total inpatient cost.
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The most recent edition of the Acute Physiology and Chronic Health Evaluation provides a prediction of intensive care unit length of stay in addition to the probability of hospital mortality. Intensive care length of stay is an important determinant of intensive care costs and may be an important indicator of quality of care. Data were collected from 22 Scottish intensive care units over a 2‐year period to allow comparison of actual intensive care unit length of stay with that predicted by the Acute Physiology and Chronic Health Evaluation III system. Correlation between actual and predicted stay for individual patients was poor. However, performance of the model for patients, grouped either by predicted length of stay or by intensive care unit, indicated that the model stratified patient groups appropriately while demonstrating a consistent bias. Length of stay in Scottish intensive care units was found to be consistently lower than that predicted by a model which is based on intensive care practice in the USA. Variations in severity of illness in intensive care unit populations cannot readily explain differences in intensive care unit length of stay. The availability of a model capable of predicting length of intensive care stay, based on data reflecting practice in the UK, would compliment current methods of assessing effectiveness of intensive care.
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Sedation is often necessary to optimize care for critically ill children requiring mechanical ventilation. If too light or too deep, however, sedation can cause significant adverse reactions, making it important to assess the degree of sedation and maintain its optimal level. We evaluated the efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. We compared 12 month data in 21 patients (intervention group), for whom we used the pediatric intensive care unit (PICU) sedation protocol of Asan Medical Center (Seoul, Korea) and the COMFORT scale to maintain optimal sedation, with the data in 20 patients (control group) assessed before using the sedation protocol and the COMPORT scale. Compared with the control group, the intervention group showed significant decreases in the total usage of sedatives and analgesics, the duration of mechanical ventilation (11.0 days vs. 12.5 days) and PICU stay (15.0 days vs. 19.5 days), and the development of withdrawal symptoms (1 case vs. 7 cases). The total duration of sedation (8.0 days vs. 11.5 days) also tended to decrease. These findings suggest that application of protocol-based sedation with the COMPORT scale may benefit children requiring mechanical ventilation.
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It is aimed to contribute to the literature on Covid 19, a new disease, by examining the mechanical ventilation support, mortality and factors affecting them during the follow-up of patients infected with Covid 19 in the intensive care unit. The clinical course of covid 19 infected patients who were hospitalized in the intensive care unit between March 30 and October 30, 2020, such as length of stay, additional diseases, mechanical ventilation support and mortality rates, were analyzed retrospectively and compared. 66 of 100 patients included in the study required invasive mechanical ventilation, 34 of them did not. The probability of having two or more comorbidities was significantly higher in patients requiring invasive mechanical ventilation (P:0,007). The motrality rate was 64% among all patients. Advanced age and additional systemic diseases increase mortality in patients infected with Covid19 treated in intensive care. We believe that patients of advanced age and 2 and above with additional systemic diseases need more invasive mechanical ventilation support and that adequate clinical improvement cannot always be achieved with high flow nasal oxigenation (HFNO) and invasive mechanical ventilation (IMV) support applications in these patients.
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The purpose of the study was to reveal the predictors of more than 24-hour intensive care unit stay for patients activated early (up to 5 hours) after surgery under extracorporeal circulation and to explore the possibilities of predicting the prolongation of postoperative intensive care in the clinical situation under examination. The protocols of anesthetic maintenance, early activation, and postoperative intensive care were analyzed in 83 patients (50 males and 33 females) aged 31 to 82 years, who had been operated on under extracorporeal circulation for various cardiosurgical diseases. The multiple regression analysis showed that the significant predictors of more prolonged intensive care after early activation were the level of arterial lactatemia (p = 0.0021), the dosages of adrenaline and/or noradrenaline (p = 0.0048), age (p = 0.0051), and female sex (p = 0.0142). It was shown that the multiple regression analysis could approximately predict the duration of intensive care after early activation. The predicted and actual durations of intensive care in patients with an intensive care unit stay length of more than 24 hours coincided in 52% of cases. In patients with an intensive care unit stay length of less than 24 hours, the estimated and actual durations of intensive care were in agreement in 92% of cases. It is concluded that it is expedient to take into account the results of the performed analysis in choosing the optimum postoperative management policy in cardiosurgical patients who are to undergo early activation.
Extracorporeal circulation
Extracorporeal
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