Outcomes of COVID-19 positive and COVID-19 negative adult patients who underwent tracheostomy for prolonged intubation in a COVID-19 referral center during the pandemic

Objective@#To compare outcomes of COVID-19 positive and COVID-19 negative patients who underwent tracheostomy for prolonged intubation in terms of weaning duration, length of ICU and hospital stay, overall and 30-day mortality, and explore risk factors for particular outcomes (mortality, 30-day mortality and weaning duration post tracheostomy). @*Methods@#Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Of 122 adult patients that underwent tracheotomy between March 30, 2020 and March 30, 2021; 76 adult patients underwent tracheostomy for prolonged intubation were analyzed.@*Results@#Open tracheotomy was performed on 122 adult patients. Seventy six (62.3%) due to prolonged intubation and 46 (37.7%) for airway prophylaxis. Among the former, the mean age was 58.46±16.81 and 54 (71.05%) patients were female, 22 (28.95%) tested COVID-19 positive and 54 (71.05%) tested negative. Mean APACHE II score was 16.62±6.78. Average days of intubation prior to tracheostomy was 29.14±17.66 days. No statistically significant difference in outcomes (weaning days, length of stay, days discharge from ICU and hospital, 30-day mortality, days to death) were noted between COVID19 positive and negative patients who underwent tracheostomy for prolonged intubation. Mortality rates post tracheostomy in this institution appear to be higher than existing literature. On multiple linear regression analysis, days of intubation prior to tracheostomy was associated with increased weaning time post-tracheostomy (OR: 0.35 CI:0.18-0.51 95% p = <.001). This implies that for every additional day of intubation prior to tracheostomy, weaning days increase by 0.35 of a day. @*Conclusion@#Outcomes of COVID-19 compared to non-COVID-19 patients undergoing tracheostomy for prolonged intubation do not seem to be significantly different which is consistent with existing literature.

Analysis of risk factors for prolonged mechanical ventilation in patients with sepsis after abdominal surgery / 中华危重病急救医学

Objective:To analyze the risk factors of prolonged mechanical ventilation (PMV) in patients with sepsis complicated by abdominal surgery, and to evaluate the predictive value of risk factors for PMV.Methods:A retrospective case-control study was conducted. The clinical data of patients with postoperative abdominal sepsis complicated with invasive mechanical ventilation who were admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 1, 2018 to December 31, 2020 were collected. The patients were divided into PMV group (duration of mechanical ventilation longer than 48 hours) and non-PMV group (duration of mechanical ventilation shorter than 48 hours) according to the duration of mechanical ventilation in ICU. The patient's gender, age, body mass index (BMI), underlying diseases, mean arterial pressure (MAP), complete blood count, blood biochemistry, arterial blood gas, cardiac function indicators, procalcitonin (PCT) at admission to the ICU, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and the sequential organ failure assessment (SOFA) scores in the first 24 hours of admission to the ICU, and other clinical information were recorded. Univariate and multivariate Logistic regression models were used to analyze the risk factors for PMV. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of related indicators for PMV.Results:A total of 195 patients with sepsis after abdominal surgery who received invasive mechanical ventilation were enrolled, including 127 males (65.1%) and 68 females (34.9%), with the median age of 65 (21, 93) years old. There were 91 patients (46.7%) in the non-PMV group and 104 patients (53.3%) in the PMV group. Univariate analysis showed that the APACHEⅡ score, SOFA score, cardiac troponin T (cTnT), N-terminal pro-B type natriuretic peptide (NT-proBNP) in the PMV group were significantly higher than those in the non-PMV group. Oxygenation index (PaO 2/FiO 2), total protein (TP) and prealbumin (PA) in the PMV group were all lower than those in the non-PMV group when admitted to ICU. In the PMV group, serum creatinine (SCr), blood urea nitrogen (BUN), cystatin C (Cys C) were significantly increased, prothrombin time (PT) was significantly prolonged, the proportion of patients with septic shock and hypertension were significantly increased as compared with those in the non-PMV group. Multivariate analysis showed that low PaO 2/FiO 2 at ICU admission [odds ratio ( OR) = 0.995, 95% confidence interval (95% CI) was 0.992-0.999, P = 0.010], high ln PCT ( OR = 1.301, 95% CI was 1.088-1.555, P = 0.004), high ln cTnT ( OR = 1.562, 95% CI was 1.079-2.261, P = 0.018) and septic shock ( OR = 4.967, 95% CI was 2.461-10.026, P = 0.000) were the independent risk factors for PMV in patients with sepsis after abdominal surgery. ROC curve analysis showed that the PaO 2/FiO 2, ln cTnT, ln PCT and septic shock had certain predictive value for PMV, the area under the ROC curve (AUC) of the four variables were 0.607, 0.638, 0.690 and 0.711, the sensitivity was 50.0%, 62.5%, 86.5% and 74.0%, and the specificity was 71.4%, 62.6%, 48.3% and 68.1%, respectively. The AUC for the joint prediction of the four variables was 0.803, with a sensitivity of 76.0% and a specificity of 78.0%. It suggested that the multivariate joint prediction of PMV was more accurate. Conclusions:Decreased PaO 2/FiO 2, increased PCT, increased cTnT and the occurrence of septic shock are independent risk factors for PMV in patients with sepsis complicated by abdominal surgery. The combination of above four indices was more accurate than one single variable in predicting PMV and had higher diagnostic value.

Clinical epidemiological investigation of children with prolonged mechanical ventilation in pediatric intensive care unit / 中国小儿急救医学

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.

A multi-center survey of medical staffs′ cognition and management of prolonged mechanical ventilation in pediatric intensive care unit / 中国小儿急救医学

Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

Transition of prolonged mechanical ventilation in children from PICU to family and humanistic care / 中国小儿急救医学

With the improvement of pediatric treatment level, the number of children with prolonged mechanical ventilation has increased rapidly.The transition of children from PICU to home mechanical ventilation is a very complex and arduous process that requires multi-faceted support and management.Long-term mechanically ventilated children and their families bear a huge social and psychological burden, and they need psychological support and humanistic care from the society.

Rehabilitation for prolonged mechanical ventilation in children / 中国小儿急救医学

Rehabilitation and multidisciplinary team management are very important to improve the prognosis of children with prolonged mechanical ventilation(PMV). The current status of rehabilitation intervention including physical therapy, neuromuscular electrical stimulation and inspiratory muscle training in adult patients with PMV were discussed, aiming to provide some evidence for the implementation of rehabilitation in children with PMV.

Nutritional support strategies for children receiving prolonged mechanical ventilation / 中国小儿急救医学

The number of children receiving prolonged mechanical ventilation has increased significantly in recent years.Nutritional support is very important to improve the prognosis of children on prolonged mechanical ventilation.But there is a lack of research, expert consensus or guidelines on nutritional support for children on prolonged mechanical ventilation now.This review summarized the process and strategy of nutrition support for children with prolonged mechanical ventilation based on the current research results.Multidisciplinary collaboration helps improve nutritional support outcomes.A large number of high-quality studies are needed to provide evidences to develop more rational and standardized nutritional support strategies.

Airway management and complications of prolonged mechanical ventilation in children / 中国小儿急救医学

Children with prolonged mechanical ventilation have complex conditions, high treatment cost of long-term stay in PICU, high nosocomial complications and mortality.Effective airway management and treatment of complications are essential to reduce ventilator-related pneumonia, prolong life, and reduce economic burden.This review aimed to summarize the updated studies to provide some evidences for children′s prolonged mechanical ventilation airway management and complications management.

The ventilator weaning strategies for prolonged mechanic ventilation in children / 中国小儿急救医学

The main reason for prolonged mechanic ventilation in children staying in PICU for a long time is that it cannot weaning.The reasons for prolonged mechanic ventilation are complex and diverse, and how to deal with it is a difficult problem faced by clinicians.This review summarized the etiology and weaning strategies of prolonged mechanic ventilation in children, so as to provide evidence for clinicians to deal with this problem.

The concept and research progress of long-term mechanical ventilation in children / 中国小儿急救医学

In recent years, the number of children with prolonged mechanical ventilation has increased rapidly, and they have been in intensive care units for a long time, resulting in a heavy disease burden and high mortality.Families and society are also paying more and more attention to this special group.The United States and Canada have issued a management consensus on mechanical ventilation for children at home, but the allocation of medical resources in China and other countries is very different, and the domestic family-centered management plan is still difficult at this stage.This review summarized the current status of long-term mechanical ventilation in children in China and other countries, and hoped to learn from foreign experience to help domestic children with long-term mechanical ventilation better.

Analysis of a Cohort of Decannulated Patients in a Critical Care Center for Chronically Ill Patients in Argentina

Objectives: To describe the characteristics of a cohort of decannulated patients admitted to a Neuro-rehabilitation and Critical Care Center and their condition upon discharge. The secondary objective was to analyze the existence of possible risk factors associated with referral of patients to a high complexity center. Materials and Method: Descriptive, cross-sectional, retrospective study in the Clínica de Neurorehabilitación Santa Catalina, Autonomous City of Buenos Aires, Argentina. Results: 87 patients were decannulated. 29 patients were admitted with IMVA and could be completely weaned. The median of TQT days was 35 days (IQR 22-68). 21% of decannulated patients were still hospitalized at the institution upon the end of the study. 53% were discharged home alive, whereas 23% had to be referred to a high complexity center. Two decannulated patients died while they were hospitalized. Some variables independently associated with referral to a high complexity center were found, the presence of a neurological history before ICU admission (OR [odds ratio] = 4.22, 95% CI [confidence interval] (1.03-10.5), p = 0.02) and ICU admission for respiratory causes (OR = 4.44, 95% CI (1.22-16.1), p = 0.02). Conclusion: Most decannulated patients were discharged home alive. Neurological history and respiratory disease as reasons for ICU admission could be risk factors to be referred to a high complexity center.

Ventilación mecánica prolongada en tiempos de pandemia / COVID-19 / Prolonged mechanical ventilation in pandemics times / COVID-19

The CoVID-19 pandemic may limit health resources in the hospital setting for the management of seriously ill patients, mainly adults; For this reason, strategies should be established from the pediatric field, which can consequently have an impact on the number of beds usually assigned to the child population. Of the patients who use prolonged mechanical ventilation, a significant number are managed at home, being considered to be at high risk of hospitalization and complications; on the other hand, there are some of them that remain institutionalized for clinical and / or social reasons. This article aims to provide guidelines for its safe handling both at home and in the pediatric services of our country, during times of pandemic CoVID - 19.

La pandemia de CoVID-19, puede limitar el recurso en salud en el escenario intrahospitalario para el manejo de pacientes graves, principalmente adultos; por lo cual se deben establecer estrategias desde el ámbito pediátrico, que pueden repercutir consecuentemente en los días camas destinados habitualmente a la población infantil. De los pacientes que emplean ventilación mecánica prolongada, un número importante es manejado en domicilio, siendo considerados de alto riesgo de hospitalización y complicaciones; por otro lado, existen algunos de ellos que permanecen institucionalizados por razones clínicas y/o sociales. Este artículo pretende entregar orientaciones para su manejo seguro, tanto en domicilio como en los servicios de pediatría de nuestro país, durante tiempos de pandemia CoVID ­ 19.

Predictive factors and interventions for prolonged mechanical ventilation after liver transplantation / 临床肝胆病杂志

Despite the great improvements in the techniques and perioperative management of liver transplantation in recent years, there are still several perioperative complications that may lead to the poor prognosis of recipients. Prolonged mechanical ventilation (PMV) is a common complication in the early stage after surgery and may result in a high incidence rate of postoperative complications, prolonged length of stay in the intensive care unit and hospital stay, and an increase in mortality rate. In recent years, many studies have reported PMV after liver transplantation, but no summarization and statistical analysis have been performed and there are still no effective measures to prevent PMV after liver transplantation. This article summarizes the influencing factors and interventions for PMV after liver transplantation, in order to provide valuable information for reducing the duration of mechanical ventilation after liver transplantation and improving the prognosis of liver transplantation recipients.

Predictive risk factors for prolonged mechanical ventilation after surgery for stanford type A acute aortic dissection / 中华胸心血管外科杂志

To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours (group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146. 8 ±78. 5)h and(21. 7 ±9. 5)h in group A and group B respectively. Overall inhospital mortality was 8. 6％ and 2. 3％. Multivariate logistic analysis showed that BMI(OR = 5. 956, 95％ CI: 2. 585 - 13. 723, P =0. 000), CPB time(OR =1. 108, 95％CI: 1. 052 -1. 166, P =0. 000), DHCA(OR =4. 562, 95％ CI: 1. 250 - 16. 640, P =0. 022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR =2. 625, 95％ CI: 1. 515 -4. 549, P =0. 001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.

Progress of risk factor evaluation for prolonged mechanical ventilation after cardiac surgery / 中国胸心血管外科临床杂志

@#Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.

Características epidemiológicas de los pacientes con enfermedad crítica crónica / Epidemiological characteristics of patients with chronic critical illness

Resumen ANTECEDENTES: la población de pacientes que requiere cuidados intensivos por tiempo prologado se ha incrementado en las últimas décadas dando lugar a una nueva población de pacientes con enfermedad crítica crónica. OBJETIVO: describir las características epidemiológicas de los pacientes con enfermedad crítica crónica atendidos en el Hospital Regional de Alta Especialidad de Oaxaca. MATERIAL Y MÉTODO: estudio ambispectivo, observacional y descriptivo que incluyó los pacientes ingresados entre el 1 de enero de 2012 al 31 de diciembre de 2015. Se definió a los pacientes con enfermedad crítica crónica como aquéllos con ventilación mecánica prolongada definida como más de 21 días de ventilación mecánica por más de 6 horas al día. Los pacientes fueron seguidos hasta su egreso hospitalario o defunción. RESULTADOS: se incluyeron 284 pacientes, la incidencia de enfermedad crítica crónica fue de 10%. En los pacientes con enfermedad crítica crónica la escala de APACHE II fue de 19.4±9.7 y sin enfermedad crítica crónica fue de 15.94±8.6 (p=0.044), mientras que la escala SOFA en los pacientes con y sin enfermedad crítica crónica fue de 8.7±2.6 y 7.01±4.4, respectivamente (p=0.007). La media de días de estancia en la unidad de cuidados intensivos (UCI) en los pacientes con y sin enfermedad crítica crónica fue de 17.1±9.2 y 8±4.8, respectivamente (p=0.0000). Los días de estancia hospitalaria fueron 45.9±19.7 y 18.3±12.4 en los pacientes con y sin enfermedad crítica crónica, respectivamente (p=0.0000). La mortalidad en la UCI fue de 18 y 28% en los pacientes con y sin enfermedad crítica crónica, respectivamente (p=0.0000). La mortalidad hospitalaria fue de 50 y 16% en los pacientes con y sin enfermedad crítica crónica, respectivamente (p=0.0000). Egresaron del hospital 32 y 56% de los pacientes con y sin enfermedad crítica crónica, respectivamente (p=0.0000). CONCLUSIONES: la incidencia de enfermedad crítica crónica en nuestro estudio fue similar a la reportada en la bibliografía. La severidad de la enfermedad aguda al ingreso de acuerdo con las escalas SOFA y APACHE se relaciona con la aparición de enfermedad crítica crónica. Los pacientes con enfermedad crítica crónica tuvieron mayor estancia en la UCI, mayores días de sedación, así como mayor estancia y mortalidad hospitalarias.

Abstract BACKGROUND: Population of patients requiring intensive care for prolonged time has increased in recent decades resulting in a new population of patients with chronic critical illness (CCI). OBJECTIVE: To describe the epidemiologic characteristics of patients with chronic critical illness assisted at Regional Hospital of High Specialty of Oaxaca, Mexico. MATERIAL AND METHOD: A retrospective, prospective, observa tional and descriptive study included patients admitted from January 1st, 2012 to December 31st, 2015. Patients with CCI were defined as those with prolonged mechanical ventilation defined as ≥21 days of ventilation for ≥6 hours/day. Patients were followed until hospital discharge or death. RESULTS: 284 patients were included; the incidence of CCI was 10%. In patients with CCI the APACHE II score was 19.4±9.7 and without CCI was 15.94±8.6 (p=0.044), while the SOFA scale in patients with CCI was 8.7±2.6 and without CCI 7.01±4.4 (p=0.007). Days of ICU stay were 17.1±9.2 for patients with CCI and 8±4.8 without CCI (p=0.0000). Days of hospital stay were 45.9±19.7 in patients with CCI and 18.3±12.4 in patients without CCI (p=0.0000). ICU mortality was 18% in patients with CCI and 28% in patients without CCI (p=0.0000). The hospital mortality was 50% in patients with CCI and 16% in patients without CCI (p=0.0000). Discharged from hospital were 32% of patients with CCI and 56% of patients without CCI (p=0.0000). CONCLUSIONS: The incidence of CCI in our study was similar to that reported in the literature. Severity of acute disease income according to APACHE and SOFA scales was related to the development of CCI. Patients with chronic critical illness had higher ICU stay, more days sedation, longer hospital stays and increased hospital mortality.

Características epidemiológicas de los pacientes con enfermedad crítica crónica. Un estudio observacional ambispectivo / Epidemiological characteristics of patients with chronic critical illness. An ambispective observational study / Características epidemiolológicas dos pacientes con doença crítica crónica. Um estudo observacional ambispectivo

Resumen: Introducción: La población de pacientes que requiere de cuidados intensivos por tiempo prolongado se ha incrementado en las últimas décadas, lo que ha dado lugar a una nueva población de individuos con enfermedad crítica crónica (ECC). El objetivo de este trabajo fue describir las características epidemiológicas de los sujetos con enfermedad crítica crónica en la Unidad de Cuidados Intensivos (UCI) del Hospital Regional de Alta Especialidad de Oaxaca. Material y métodos: Se realizó un estudio ambispectivo, observacional y descriptivo que incluyó a las personas ingresadas entre el 01 de enero de 2012 y el 31 de diciembre de 2015. Se definió a los pacientes con ECC como aquéllos con ventilación mecánica prolongada (más de 21 días de ventilación mecánica por más de seis horas al día). Los individuos fueron seguidos hasta su egreso hospitalario o defunción. Se excluyeron los sujetos con expedientes clínicos incompletos, edad menor de 16 años, enfermedades neuromusculares (síndrome de Guillain-Barre y miastenia gravis) y aquéllos sin ventilación mecánica o requerimiento menor a 48 horas. Resultados: Se incluyeron 284 pacientes; la incidencia de ECC fue de 9.8%. En los individuos con ECC, la escala de APACHE II fue 19.4 ± 9.7, y en aquéllos sin ECC, fue 15.94 ± 8.6 (p = 0.044). La escala SOFA en los sujetos con ECC fue de 8.7 ± 2.6, y aquéllos sin ECC, de 7.01 ± 4.4 (p = 0.007). Los días de estancia en la UCI fueron 17.1 ± 9.2 en las personas con ECC y 8 ± 4.8 días en aquéllas sin ECC (p = 0.0000). Los días de estancia hospitalaria fueron 45.9 ± 19.7 en los pacientes con ECC y 18.3 ± 12.4 en los individuos sin ECC (p = 0.0000). La mortalidad en la UCI fue de 17.8% en los sujetos con ECC y de 27.7% en las personas sin ECC (p = 0.0000). La mortalidad hospitalaria fue de 50% en los pacientes con ECC y de 16% en aquéllos sin ECC (p = 0.0000). Fueron egresados del hospital 32.2% de los individuos con ECC y 56.3% de los sujetos sin ECC (p = 0.0000). Conclusiones: La incidencia de ECC en nuestro estudio fue similar a la reportada en la literatura. La severidad de la enfermedad aguda al ingreso (de acuerdo con las escalas de SOFA y APACHE) estuvo relacionada con el desarrollo de ECC. Las personas con enfermedad crítica crónica tuvieron mayor estancia en la UCI, más días de sedación, así como una estancia hospitalaria más prolongada y una mortalidad hospitalaria aumentada.

Abstract: Introduction: The population of patients requiring intensive care for a prolonged time has increased in recent decades, resulting in a new population of individuals with chronic critical illness (CCI). The aim of this study was to describe the epidemiological characteristics of subjects with CCI in the ICU of the High Specialty Regional Hospital of Oaxaca. Material and methods: It was a retrospective and prospective, observational and descriptive study that included people admitted between January 1, 2012 and December 31, 2015. Patients with CCI were defined as those with prolonged mechanical ventilation (more than 21 days of ventilation for more than six hours/day). The individuals were followed until their hospital discharge or death. Subjects with incomplete medical records, under 16 years of age, neuromuscular diseases (Guillain-Barre syndrome and Myasthenia gravis) and those without mechanical ventilation or who required it for less than 48 hours were excluded. Results: Two-hundred eighty-four people were included; the incidence of CCI was 9.8%. In patients with CCI, the APACHE II score was 19.4 ± 9.7, and in those without CCI, it was 15.94 ± 8.6 (p = 0.044). The SOFA scale in individuals with CCI was 8.7 ± 2.6, and in those without CCI, 7.01 ± 4.4 (p = 0.007). The days of ICU stay were 17.1 ± 9.2 for subjects with CCI and 8 ± 4.8 for those without CCI (p = 0.0000). The days of hospital stay were 45.9 ± 19.7 in people with CCI and 18.3 ± 12.4 in patients without CCI (p = 0.0000). ICU mortality was 17.8% in individuals with CCI and 27.7% in subjects without CCI (p = 0.0000). The hospital mortality was 50% in people with CCI and 16% in those without CCI (p = 0.0000). Of those patients with CCI, 32.2% were discharged from hospital, compared to 56.3% of individuals without CCI (p = 0.0000). Conclusions: The incidence of CCI in our study was similar to that reported in the literature. The severity of acute disease upon admission, according to the APACHE and SOFA scales, was related to the development of CCI. Subjects with chronic critical illness had a longer ICU stay, more days on sedation and of hospital stay, and increased hospital mortality.

Resumo: Introdução: A população de pacientes que necessitam de cuidados intensivos por tempo prolongado tem aumentado nas últimas décadas, resultando em uma nova população de pacientes com doença crítica crônica (DCC). O objetivo deste estudo foi descrever as características epidemiológicas dos pacientes com a doença crônica crítica na UTI do Hospital Regional de Alta Especialidade de Oaxaca. Material e métodos: Estudo ambispectivo, observacional e descritivo que incluiu pacientes admitidos entre 1 de janeiro de 2012 a 31 de dezembro de 2015. Definiu-se os pacientes com DCC como aqueles com ventilação mecânica prolongada > 21 dias ventilação mecânica por > 6 horas por dia. Os pacientes foram acompanhados até a alta hospitalar ou morte. Foram excluídos pacientes com prontuários incompletos, idade inferior a 16 anos, as doenças neuromusculares (síndrome de Guillain Barré e Miastenia Gravis) e pacientes sem ventilação mecânica ou exigência ventilatória menor à 48 horas. Resultados: 284 pacientes foram incluídos no estudo, a incidência de DCC foi de 9.8%. Em pacientes com DCC a pontuação APACHE II foi de 19.4 + 9.7 e sem DCC foi 15.94 + 8.6 (p = 0.044), a escala SOFA em paciente com DCC foi de 8.7 + 2.6, e sem DCC 7.01 + 4.4 (p = 0.007). Os dias de permanência na UTI foram de 17.1 + 9.2 dias para os pacientes com DCC e 8 + 4.8 dias para os pacientes sem DCC (p = 0.0000). Os dias de permanência hospitalar foram de 45.9 + 19.7 dias para os pacientes com DCC e para os pacientes sem DCC 18.3 + 12.4 dias (p = 0.0000). A mortalidade na UTI foi de 17.8% nos pacientes com DCC e 27.7% nos pacientes sem DCC (p = 0.0000). A mortalidade hospitalar foi de 50% nos pacientes com DCC e 16% (p = 0.0000) nos pacientes sem DCC. 32.3% dos pacientes com DCC tiveram alta e 56.3% dos pacientes sem DCC (p = 0.0000). Conclusões: A incidência de DCC em nosso estudo foi semelhante ao relatado na literatura. A gravidade da doença aguda ao ingresso do paciente, de acordo com a pontuação APACHE e SOFA está relacionada com o desenvolvimento da DCC. Os pacientes com doença crítica crônica tiveram um maior tempo de permanência na UTI, mais dias de sedação, maior tempo de internação e maior mortalidade hospitalar.

Risk factors for prolonged mechanical ventilation in children with transposition of the great arteries and intact ventricular septum that underwent primary arterial switch operation / 中华实用儿科临床杂志

Objective To explore the risk factors for prolonged mechanical ventilation in children with trans-position of great arteries and intact ventricular septum who underwent arterial switch operation. Methods This study was a retrospective,single center study. One hundred and twenty patients with transposition of great arteries and intact ventricular septum who underwent primary arterial switch operation between January 2014 and December 2016 at Fuwai Hospital were eligible for this study. The data of patients from pediatric intensive care unit database and electronic medical records were collected. The data related to postoperative respiratory assist time were collected,including demo-graphic data,preoperative diagnosis,intraoperative data,and postoperative recovery data. The patients were divided into 2 groups according to ventilation time which were prolonged mechanical ventilation group(ventilation time > 72 hours) and non - prolonged mechanical ventilation group(ventilation time ≤72 hours). The data of 2 groups were analyzed by using single factor analysis,and the P≤0. 2 factors were processed into Logistic regression analysis. Results Ninety -six patients were enrolled including 22 patients in prolonged ventilation group and 74 patients in non - prolonged me-chanical ventilation group. No statistical significance was found in 2 groups in gender,age,weight,preoperative lactate, hemoglobin,use of prostaglandin E1,mechanical ventilation,cardiopulmonary time,aortic clamping time,the ratio of left ventricular pressure to right ventricular pressure,immediate postoperative plasma lactate,and vasoactive inotropic score. The weight and postoperative left atrial pressure were significantly different between 2 groups with P < 0. 2. Weight were (3. 5 ± 0. 9)kg in prolonged mechanical ventilation group and (3. 9 ± 1. 0)kg in non - prolonged mechanical ventila-tion group (P = 0. 117). Left atrial pressures were (7. 9 ± 1. 9)mmHg(1 mmHg = 0. 133 kPa)in prolonged mechani-cal ventilation group and (6. 7 ± 2. 0)mmHg in non - prolonged mechanical ventilation group(P = 0. 015). The weight and left atrial pressure were processed into Logistic regression analysis and the results revealed that high left atrial pres-sure was the risk factor for ventilation prolongation(OR = 1. 048,P = 0. 020). Respiratory assist time in prolonged and non - prolonged ventilation group was 112(80,194)h and 26(17,46)h,respectively;ICU time in prolonged and non - prolonged ventilation group was 10(1,14)d and 4(3,6)d,respectively;and all the differences were significant (all P = 0. 000). The number of death in each group was 1 with no significant difference(P = 0. 420). Conclusions High left atrial pressure is the risk factor for prolonged mechanical ventilation in children with transposition of great ar-teries and intact ventricular septum following primary arterial switch operation.

Desvinculación de la asistencia ventilatoria mecánica prolongada a las 72 horas de respiración espontánea

El objetivo del presente trabajo fue describir la población que ingresó en un centro de desvinculación de la ventilación mecánica y rehabilitación (CDVMR) en asistencia ventilatoria mecánica invasiva (AVMi), analizar su evolución y determinar los predictores de fracaso de la desvinculación de la AVMi. Se revisaron las historias clínicas de 763 pacientes que ingresaron en el servicio de Cuidados Respiratorios, en el período comprendido entre mayo 2005 y enero 2012, se seleccionaron 372 con traqueotomía y AVMi. Se analizaron diferentes variables como posibles predictores de desvinculación. La media de edad fue 69 años (DS 14.7), 57% fueron hombres. La mediana de días de internación en la unidad de terapia intensiva (UTI) fue de 33 (rango intercuartilo-RQ 26-46). El 86% de los ingresados a UTI fue por causa médica. Durante la internación en el CDVMR lograron desvincularse el 50%; mediana de días de desvinculación, 13 (RQ 5-38). La edad fue predictor de fracaso de desvinculación. Al estudiar a la subpoblación con desvinculación parcial, se sumó el antecedente de EPOC como predictor. Si bien un 25% de los pacientes falleció o requirió derivación a un centro de mayor complejidad antes de 2 semanas de internación, más de la mitad de los pacientes lograron ser desvinculados definitivamente de la AVMi; esto podría sustentar la atención de pacientes críticos crónicos en CDVMR en la Argentina, ya que los pacientes internados en estos centros tienen buena expectativa de desvinculación, a pesar de las altas chances de desarrollar complicaciones.

The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.

Ventilação mecânica domiciliar: uma realidade cada vez mais frequente / Mechanical ventilation home: an increasingly frequent reality

Desde que a ventilação mecânica foi difundida após a epidemia de poliomielite até os dias atuais com o avanço das estratégias diagnósticas e terapêuticas, houve significativo aumento na sobrevida dos pacientes criticamente enfermos. Este subgrupo de sobreviventes encontra-se em um estado cronicamente crítico e dentre outras disfunções e terapias de suporte, caracteriza-se pela necessidade de ventilação mecânica prolongada. Paralelo a este fato, o envelhecimento populacional eleva a chance de internações hospitalares com necessidade de assistência ventilatória invasiva. Nos dias de hoje, a ventilação mecânica domiciliar é uma realidade e tornou-se uma opção viável para pacientes com insuficiência respiratória crônica, também estimulada pelo crescimento da utilização de ventilação não invasiva com pressão positiva, o reconhecimento de diferentes tipos de pacientes que podem se beneficiar desta técnica e redução dos custos hospitalares através da desospitalização.Atualmente possuímos diversos tipos e modelos de ventiladores exclusivos para ventilação mecânica domiciliar, assim como interfaces e a escolha do dispositivo ideal para cada paciente pode ser uma tarefa árdua. Porém não pode ser esquecido que o objetivo principal da utilização da ventilação domiciliar deve ser o controle dos sintomas decorrentes da doença do paciente e consequente melhora da qualidade de vida...

Since mechanical ventilation was widespread after the polio epidemic to the present day with the advancement of diagnostic and therapeutic strategies, a significant increase in survival of critically ill patients. This subgroup of survivors is in a critical state and chronically various etiologies and therapies support, characterized by the need for prolonged mechanical ventilation. Parallel to this fact, population aging increases the chance of hospitalizations requiring invasive mechanical ventilation. Today, home mechanical ventilation is a reality and has become a viable option for patients with chronic respiratory insufficiency, also encouraged by the increasing use of noninvasive positive pressure ventilation, recognition of different types of patients who may benefit from this technique and reduced hospital costs through deinstitutionalization.We currently have various types and models of home mechanical ventilatiors, as well as interfaces and choosing the right device for each patient can be a chore. But it can not be forgotten that the main purpose of using home ventilation is to control the symptoms of the patient’s illness and consequent improvement in quality of life...