Early Versus Late Tracheostomy in Outcome of Patients Admitted in Neurosurgical Intensive Care Unit

Background: Tracheostomy is a commonly performed procedure in neurosurgical Intensive Care Units (ICU) performed to secure airway, aid in pulmonary toileting, and minimize ventilator-associated pneumonia (VAP) in cases requiring prolonged mechanical ventilation. Although early tracheostomy has been advocated rampantly in recent days, its benefit over late tracheostomy and the timing itself has been very controversial. In this study, we tried to study the effect of timing of tracheostomy in the outcome of patients in our ICU. Materials and methods: This is a retrospective study carried out over a period of one and a half years in a tertiary care center in western Nepal. Early tracheostomy was defined as those done within 4 days of endotracheal intubation and late were those done thereafter. Outcomes were studied in terms of length of ICU stay, hospital stay, mechanical ventilation, duration of tracheostomy in situ, VAP and mortality and complication over 90 days. Statistical analysis was done using SPSS 20.0. Results: There were 67 cases included in the study, out of which 27(40.3%) underwent early and 40 (59.7%) underwent late tracheostomy. The Mean duration of ICU stay, tracheostomy in situ duration, mechanical ventilation duration, and VAP were the parameters showing a significant difference between the two groups. There were 13 (19.4%) cases having complications in our series of which 6 (9%) of cases were from the early tracheostomy group and 7 (10.4%) of the cases were from the late tracheostomy group (p=0.63). Conclusion: Early tracheostomy is beneficial in a neurosurgical patient in terms of a decrease in ICU stay, duration of mechanical ventilation, duration of tracheostomy in situ, and VAP.

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Impact of Permissive Hypoxia and Hyperoxia Avoidance on Clinical Outcomes in Septic Patients Receiving Mechanical Ventilation: A Retrospective Single-Center Study

BioMed Research International ◽

10.1155/2021/7332027 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Kota Nishimoto ◽

Takeshi Umegaki ◽

Sayaka Ohira ◽

Takehiro Soeda ◽

Natsuki Anada ◽

...

Keyword(s):

Mechanical Ventilation ◽

University Hospital ◽

Icu Mortality ◽

Respiratory Dysfunction ◽

Mechanically Ventilated ◽

Icu Stay ◽

Ventilation Duration ◽

Mechanical Ventilation Duration ◽

Before And After ◽

Clinical Records

Background. Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients. Methods. In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO2: ≥96%) to more conservative targets with permissive hypoxia (SpO2: 88-92% or PaO2: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for Pa O 2 > 110 mmHg ). Patients were divided into a prechange group (April 2015 to March 2017; n = 83 ) and a postchange group (April 2017 to March 2019; n = 130 ). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO2/FiO2 ratios. Results. The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; P = 0.31 ) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; P = 0.01 ) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; P = 0.02 ). Conclusions. Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.

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Outcome Difference in Neurosurgical Patients Based on Timing of Tracheostomy and Ventilator Associated Pneumonia

Nepal Journal of Neuroscience ◽

10.3126/njn.v15i1.20022 ◽

2018 ◽

Vol 15 (1) ◽

pp. 19-22

Author(s):

Pratyush Shrestha ◽

Subash Lohani ◽

Sunita Shrestha ◽

Upendra P Devkota

Keyword(s):

Hospital Stay ◽

Tracheostomy Tube ◽

Length Of Hospital Stay ◽

Ventilator Associated Pneumonia ◽

Early Tracheostomy ◽

Icu Stay ◽

Neurosurgical Patients ◽

Significant Difference ◽

Length Of Icu Stay

Background and Objective: Tracheostomy in neurosurgical patients has been shown in various studies to lower the length of ICU stay and the length of hospital stay by decreasing the incidence of ventilator associated pneumonia. In this regard, we wanted to evaluate the outcome of neurosurgical ICU patients based on timing of tracheostomy and ventilator associated pneumonia.Methods: This is a retrospective single centre study performed over a period of two and a half years. Early tracheostomy was defi ned as those done three days of intubation or earlier and late as those done then after. Statistical analysis was done using SPSS.Results: There were 56 patients over the study period of which 18 patients underwent early tracheostomy and 38 patients underwent late tracheostomy. There was no statistically significant difference between the two groups with regards to the length of ICU stay, the length of hospital stay or the length of tracheostomy tube in situ. But based on tracheal aspirate culture positivity, length of tracheostomy tube in situ was signifi cantly longer in those with positive bacterial cultures.Early tracheostomy does not improve neurosurgical outcome while documented pneumonia prolongs the length of tracheostomy tube in situ.Nepal Journal of Neuroscience 15:19-22, 2018

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Relationship between Intracranial Pressure Monitoring and Outcomes in Severe Traumatic Brain Injury Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x1103900610 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1043-1050 ◽

Cited By ~ 22

Author(s):

S. Haddad ◽

A. S. Aldawood ◽

A. Alferayan ◽

N. A. Russell ◽

H. M. Tamim ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Intracranial Pressure ◽

Hospital Mortality ◽

Icp Monitoring ◽

Icu Mortality ◽

Ventilation Duration ◽

Mechanical Ventilation Duration ◽

Significant Difference ◽

Severe Tbi

Intracranial pressure (ICP) monitoring is recommended in patients with a severe traumatic brain injury (TBI) and an abnormal computed tomography (CT) scan. However, there is contradicting evidence about whether ICP monitoring improves outcome. The purpose of this study was to examine the relationship between ICP monitoring and outcomes in patients with severe TBI. From February 2001 to December 2008, a total of 477 consecutive adult (>18 years) patients with severe TBI were included retrospectively in the study. Patients who underwent ICP monitoring (n=52) were compared with those who did not (n=425). The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, mechanical ventilation duration, the need for tracheostomy, and ICU and hospital length of stay (LOS). After adjustment for multiple potential confounding factors, ICP monitoring was not associated with significant difference in hospital or ICU mortality (odds ratio [OR]=1.71, 95% confidence interval [CI]=0.79 to 3.70, P=0.17; OR=1.01, 95% CI=0.41 to 2.45, P=0.99, respectively). ICP monitoring was associated with a significant increase in mechanical ventilation duration (coefficient=5.66, 95% CI=3.45 to 7.88, P <0.0001), need for tracheostomy (OR=2.02, 95% CI=1.02 to 4.03, P=0.04), and ICU LOS (coefficient=5.62, 95% CI=3.27 to 7.98, P <0.0001), with no significant difference in hospital LOS (coefficient=8.32, 95% CI=-82.6 to 99.25, P=0.86). Stratified by the Glasgow Coma Scale score, ICP monitoring was associated with a significant increase in hospital mortality in the group of patients with Glasgow Coma Scale 7 to 8 (adjusted OR=12.89, 95% CI=3.14 to 52.95, P=0.0004). In patients with severe TBI, ICP monitoring was not associated with reduced hospital mortality, however, with a significant increase in mechanical ventilation duration, need for tracheostomy, and ICU LOS.

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

Journal of Critical Care ◽

10.1016/j.jcrc.2008.07.001 ◽

2009 ◽

Vol 24 (3) ◽

pp. 435-440 ◽

Cited By ~ 39

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

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Risk factors of frailty and death or only frailty after intensive care in non-frail elderly patients: a prospective non-interventional study

Journal of Intensive Care ◽

10.1186/s40560-019-0403-3 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Yoann Launey ◽

Hervé Jacquet ◽

Matthieu Arnouat ◽

Chloe Rousseau ◽

Nicolas Nesseler ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Risk Factor ◽

Intensive Care ◽

Elderly Patients ◽

Interventional Study ◽

Old Patients ◽

Ventilation Duration ◽

Frail Patients ◽

Mechanical Ventilation Duration

Abstract Background Frailty status is recognized as an important parameter in critically ill elderly patients, but nothing is known about outcomes in non-frail patients regarding the development of frailty or frailty and death after intensive care. The aim of this study was to determine risk factors for frailty and death or only frailty 6 months after intensive care unit (ICU) admission in non-frail patients ≥ 65 years. Methods A prospective non-interventional study performed in an academic ICU from February 2015 to February 2016 included non-frail ≥ 65-year-old patients hospitalized for > 24 h in the ICU. Frailty was assessed by calculating the frailty index (FI) at admission and 6 months later. Patients who remained non-frail (FI < 0.2) were compared to patients who presented frailty (FI ≥ 0.2) and those who presented frailty and death at 6 months. Results Among 974 admissions, 136 patients were eligible for the study and 88 patients were analysed at 6 months (non-frail n = 34, frail n = 29, death n = 25). Multivariable analysis showed that mechanical ventilation duration was an independent risk factor for frailty/death at 6 months (per day of mechanical ventilation, odds ratio [OR] = 1.11; 95% confidence interval [CI] 1.04–1.19, p = 0.002). When excluding patients who died, mechanical ventilation duration remained the sole risk factor for frailty at 6 months (OR = 1.19; 95% CI 1.07–1.33, p = 0.001). Conclusion Mechanical ventilation duration was the sole predictive factor of frailty and death or only frailty 6 months after ICU hospitalization in initially non-frail patients.

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Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

10.20944/preprints202104.0330.v2 ◽

2021 ◽

Author(s):

Apinya Koontalay ◽

Wanich Suksatan ◽

Jonaid M Sadang ◽

Kantapong Prabsangob

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Nutritional Status ◽

Nutritional Factors ◽

Factors Influencing ◽

Ventilation Duration ◽

Mechanical Ventilation Duration ◽

Critical Patients ◽

The Impact

Objective: This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. Patients and Methods: The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. Results: As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. Conclusion: The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

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A study of dysnatremia in patients admitted in medical intensive care unit of a tertiary care teaching hospital

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210267 ◽

2021 ◽

Vol 8 (2) ◽

pp. 220

Author(s):

Mantavya Patel ◽

Sanjay Kumar Paliwal ◽

Syed Javed

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Female Ratio ◽

Survival Status ◽

Icu Stay ◽

Significant Difference ◽

Male Female Ratio ◽

Medical Intensive Care

Background: Both dysnatremia at admission and that acquired in the intensive care unit (ICU) have been shown to have a direct influence on prognosis. The present was planned to study dysnatremia in adult patients admitting in medical intensive care unit (MICU).Methods: The present prospective observational study was conducted on patients admitted in medical ICU over a period of 1 year who developed dysnatremia during ICU stay. Patient’s age, sex, diagnosis at the time of diagnosis, comorbidities, serum sodium levels, risk factors, length of ICU stay, and survival status were noted.Results: Out of total 798 patients during the study period; 207 (25.94%) were found to have hypernatremia and 87 (10.9%) were hyponatremic. In hypernatremic group male/ female ratio was 125/82 and it was 50/37 in hyponatremic group. The mean ICU stay was significantly more in hypernatremic patients (4.76±3.57) compared to hyponatremic group (4.06±2.80). (p˂0.05) Mortality in both hypernatremic patients and hyponatremic patients was found significantly more in hypervolemic group which was 84.38% and 53.84% respectively. (p˂0.05)Conclusions: This study concluded that nowadays hypernatremia is more common with longer ICU stay. In both hypernatremia and hyponatremia mortality was found similar without any significant difference.

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Paradox of Predictors in Critically ill COVID-19 Patients: Outcome of a COVID-dedicated Intensive Care Unit

10.1101/2021.04.23.21256009 ◽

2021 ◽

Author(s):

Morshed Nasir ◽

Rawshan Ara Perveen ◽

Rumana Nazneen ◽

Tahmina Zahan ◽

Sonia Nasreen Ahmad ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Tertiary Care ◽

Predictive Biomarkers ◽

Nasopharyngeal Swab ◽

Treatment Schedule ◽

Care Hospital ◽

Icu Stay ◽

Significant Difference

Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.

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Effect of Nurse-Led Goal-Directed Lung Physical Therapy on the Prognosis of Pneumonia in Sepsis Patients in the ICU: A Prospective Cohort Study

Journal of Intensive Care Medicine ◽

10.1177/0885066620987200 ◽

2021 ◽

pp. 088506662098720

Author(s):

Jianhua Sun ◽

Wen Han ◽

Na Cui ◽

Qi Li ◽

Hao Wang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Physical Therapy ◽

Confidence Interval ◽

Odds Ratio ◽

Phase 1 ◽

Phase 2 ◽

Icu Mortality ◽

Icu Stay ◽

Ventilation Duration ◽

Mechanical Ventilation Duration

Background: Pneumonia poses a significant burden on healthcare systems. However, few studies have focused on nurse-led goal-directed lung physical therapy (GDLPT) for pneumonia in sepsis patients in the intensive care unit (ICU). Objectives: This study aimed to investigate the effects of nurse-led GDLPT on the prognosis of pneumonia in sepsis patients in the ICU. Methods: We performed a prospective 2-phase (before-and-after) study over 3 years. After an observational phase (phase 1, n = 188), we designed, implemented, and evaluated a nurse-led GDLPT protocol (phase 2, n = 359) for pneumonia in sepsis patients in the ICU. The primary outcome was 28-day mortality. Results: We evaluated 742 critically ill patients with sepsis from January 2017 to January 2020. Among the 742 sepsis patients, 609 were diagnosed with pneumonia and 547 who met the inclusion criteria were enrolled in the study. Compared with patients in phase 1, patients in phase 2 had significantly shorter mechanical ventilation duration (5 [4, 6] days vs. 5 [4, 8] days, p = 0.037), shorter ICU stay (9 [4, 16] days vs. 9 [6, 20] days, p = 0.010), lower ICU mortality (15.0% [54/359] vs. 25.5% [48/188], p = 0.003), and lower 28-day mortality (16.7% [60/359] vs. 27.1% ([51/188], p = 0.004). Multivariate logistic regression analysis revealed that nurse-led GDLPT (odds ratio 0.540, 95% confidence interval 0.345–0.846, p = 0.007), clinical pulmonary infection score (odds ratio 1.111, 95% confidence interval 1.012–1.221, p = 0.028), and ventilation day (OR 1.160, 95% CI, 1.058–1.240, p<0.001)were independent predictors of 28-day mortality for pneumonia in sepsis patients, and that nurse-led GDLPT was a protective factor. Conclusions: Nurse-led GDLPT improved the outcomes of pneumonia in sepsis patients, and was particularly associated with shortened mechanical ventilation duration and ICU stay, and reduced ICU mortality and 28-day mortality.

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