ABSTRACT
PURPOSE: To develop a model to predict prolonged mechanical ventilation within 48 hours of its initiation. MATERIALS AND METHODS: In 282 general intensive care unit patients, multiple variables from the first 2 days on mechanical ventilation and their total ventilation duration were prospectively collected. Three models accounting for early deaths were developed using different analyses: (a) multinomial logistic regression to predict duration > 7 days vs duration ≤ 7 days alive vs duration ≤ 7 days death; (b) binary logistic regression to predict duration > 7 days for the entire cohort and for survivors only, separately; and (c) Cox regression to predict time to being free of mechanical ventilation alive. RESULTS: Positive end-expiratory pressure, postoperative state (negatively), and Sequential Organ Failure Assessment score were independently associated with prolonged mechanical ventilation. The multinomial regression model yielded an accuracy (95% confidence interval) of 60% (53%-64%). The binary regression models yielded accuracies of 67% (61%-72%) and 69% (63%-75%) for the entire cohort and for survivors, respectively. The Cox regression model showed an equivalent to area under the curve of 0.67 (0.62-0.71). CONCLUSIONS: Different predictive models of prolonged mechanical ventilation in general intensive care unit patients achieve a moderate level of overall accuracy, likely insufficient to assist in clinical decisions.
Subject(s)
Multiple Trauma/therapy , Postoperative Complications/therapy , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/therapy , Statistics as Topic , Adult , Aged , Cohort Studies , Critical Care , Decision Support Techniques , Female , Humans , Intensive Care Units , Male , Middle Aged , Organ Dysfunction Scores , Positive-Pressure Respiration , Prospective Studies , Survivors , Time Factors , Ventilator Weaning/statistics & numerical dataABSTRACT
Coccidioidomycosis is a pulmonary infection caused by the dimorphic fungi Coccidioides immitis and Coccidioidomycosis posadasii. This disease is endemic to the southwestern United States and has a predilection for immunocompromised patients. Diabetes mellitus has been shown to be a strong risk factor for acquiring this infection in these states. Most cases are asymptomatic or present with mild pulmonary symptoms. However, untreated pulmonary mycosis can lead to disseminated infection, most often involving meningitis, osteomyelitis, or skin and soft-tissue infections. When there is arthritis, the knee is the most common site of infection. We present a case of a 23-year-old male with longstanding, uncontrolled Type 1 diabetes mellitus who was found to have pulmonary coccidioidomycosis following diagnosis of coccidioidomycosis osteomyelitis of the knee.