ABSTRACT
Objective@#There is limited clarity concerning the risk of dementia after pneumonia with intensive care unit (ICU) stay. We conducted a nationwide cohort study, which aimed to investigate the impact of dementia after pneumonia with and without intensive care unit admission. @*Methods@#Data was obtained from Taiwan’s National Health Insurance Research Database between 2000 and 2015. A total of 7,473 patients were identified as having pneumonia required ICU stay, along with 22,419 controls matched by sex and age. After adjusting for confounding factors, multivariate Cox regression model analysis was used to compare the risk of developing dementia during the 15-years follow-up period. @*Results@#The enrolled pneumonia patients with ICU admission had a dementia rate of 9.89%. Pneumonia patients without ICU admission had a dementia rate of 9.21%. The multivariate Cox regression model analysis revealed that the patients with ICU stay had the higher risk of dementia, with a crude hazard ratio of 3.371 (95% confidence interval, 3.093–3.675; p<0.001). @*Conclusion@#This study indicated that pneumonia with ICU stay is associated with an increased risk of dementia. A 3-fold risk of dementia was observed in patients admitted to the ICU compared to the control group.
ABSTRACT
Thoracotomy is a common procedure. However, thoracotomy leads to lung atelectasis and deteriorates pulmonary gas exchange in operated side. Therefore, different positions with operated side lowermost or uppermost may lead to different gas exchange after thoracotomy. Besides, PEEP [positive end-expiratory pressure] influence lung atelectasis and should influence gas exchange. The purpose of this study was to determine the physiological changes in different positions after thoracotomy. In addition, we also studied the influence of PEEP to positional effects after thoracotomy. There were eight pigs in each group. Group I received left thoracotomy with zero end-expiratory pressure [ZEEP], and group II with PEEP; group III received right thoracotomy with ZEEP and group IV with PEEP. We changed positions to supine, LLD [left lateral decubitus] and RLD [right lateral decubitus] in random order after thoracotomy. PaO[2] was decreased after thoracotomy and higher in RLD after left thoracotomy and in LLD after right thoracotomy. PaO[2] in groups II and IV was higher than in groups I and III if with the same position. In group I and III, PaCO[2] was increased after thoracotomy and was higher in LLD after left thoracotomy and in RLD after right thoracotomy. In groups II and IV, there were no PaCO[2] changes in different positions after thoracotomy. Lung compliance [Crs] was decreased after thoracotomy in groups I and III and highest in RLD after left thoracotomy and in LLD after right thoracotomy. In groups II and IV, there were no changes in Crs regardless of the different positions. There were significant changes with regards to pulmonary gas exchange, hemodynamics and Crs after thoracotomy. The best position was non-operated lung lowermost Applying PEEP attenuates the positional effects