RESUMO
OBJECTIVE: As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming approaches could be readily identified. We conducted an exploratory retrospective observational database study of routinely recorded mechanical ventilation parameters between January 1, 2010 and December 31, 2016 from 12 intensive care units. Mode epoch count proportions were examined using Chi squared and Fisher exact tests as appropriate on an inter-unit basis with outlier detection for two test cases via post hoc pairwise analyses of a binomial regression model. RESULTS: Final analysis included 559,734 mode epoch values. Significant heterogeneity was demonstrated between individual units (P < 0.05 for all comparisons). One unit demonstrated heightened utilization of high-frequency oscillatory ventilation, and three units demonstrated frequent synchronized intermittent mandatory ventilation utilization. Assist control ventilation was the most commonly recorded mode (51%), followed by adaptive support ventilation (23.1%). Volume-controlled modes were about twice as common as pressure-controlled modes (64.4% versus 35.6%). Our methodology provides a means by which to characterize the epidemiology of mechanical ventilation approaches and identify nonconforming practices. The observed variability warrants further clinical study about contributors and the impact on relevant outcomes.
Assuntos
Centros Médicos Acadêmicos , Unidades de Terapia Intensiva , Respiração Artificial , Desmame do Respirador , Humanos , Estudos Retrospectivos , UniversidadesAssuntos
Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/prevenção & controle , Pneumopatias/prevenção & controle , Respiração Artificial/métodos , Humanos , Complicações Pós-Operatórias/prevenção & controle , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/prevenção & controleAssuntos
Doença Cardíaca Carcinoide/tratamento farmacológico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Azul de Metileno/administração & dosagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Vasoplegia/tratamento farmacológico , Idoso , Doença Cardíaca Carcinoide/complicações , Doença Cardíaca Carcinoide/diagnóstico , Quimioterapia Adjuvante/métodos , Humanos , Masculino , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/etiologia , Vasoplegia/diagnóstico , Vasoplegia/etiologiaRESUMO
Severe pulmonary embolism often leads to right ventricular failure after surgical embolectomy secondary to ischaemia reperfusion injury and acute lung injury (ALI). Acute right ventricular dysfunction is traditionally treated with inotropes and vasopressors to maintain cardiac output and coronary perfusion as well as selective pulmonary vasodilators to provide right ventricular afterload reduction. We report the first case of utilisation of methylene (MB) in a patient with acute right ventricular failure and vasoplegic shock after surgical pulmonary embolectomy.
Assuntos
Embolectomia , Inibidores Enzimáticos/administração & dosagem , Azul de Metileno/administração & dosagem , Vasoplegia/tratamento farmacológico , Disfunção Ventricular Direita/tratamento farmacológico , Idoso , Quimioterapia Adjuvante/métodos , Humanos , Masculino , Embolia Pulmonar/cirurgia , Vasoplegia/etiologia , Disfunção Ventricular Direita/etiologiaRESUMO
Objective. Vancomycin is administered widely to patients undergoing cardiac surgery as prophylaxis against resistant Gram-positive sternal wound and venous donor site infections. The purpose of this study was to determine the efficacy of a standardized prebypass and postbypass dosing regimen of vancomycin by assessing plasma concentrations in the immediate postoperative period and postoperative surgical site infections (SSIs). Design. Retrospective cohort study. Setting . Cardiothoracic surgical intensive care unit in a tertiary care academic medical center. Methods. A total of 34 consecutive adult patients who had undergone cardiac surgery with cardiopulmonary bypass (CPB) were analyzed retrospectively. Each patient received 1000 mg of vancomycin administered over 1 hour around the time of induction of anesthesia and 500 mg after discontinuation of CPB. Trough vancomycin levels were sampled in the intensive care unit 12 hours after the last dose given in the operating room. Along with patient characteristics, postoperative readmission rates and SSIs were recorded for 1 year after surgery. Results. The nadir serum vancomycin level before the next dose was 9.3 ± 4.5 µg/mL (mean ± standard deviation). One superficial SSI was noted. Readmission rate for SSIs was 2.94%. Conclusion . Vancomycin concentrations in the serum were greater than the minimum inhibitory concentration for most staphylococci ranging from 4 to 19.3 µg/mL producing acceptable therapeutic serum concentrations and low rate of infectious complications. Thus postbypass dosing is acceptable in vancomycin cardiac surgical prophylaxis.
Assuntos
Antibacterianos/uso terapêutico , Ponte Cardiopulmonar/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/uso terapêutico , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/sangue , Antibioticoprofilaxia/métodos , Estudos de Coortes , Unidades de Cuidados Coronarianos , Feminino , Seguimentos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Infecções Estafilocócicas/prevenção & controle , Vancomicina/sangueAssuntos
Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Procedimentos Cirúrgicos Cardiovasculares/tendências , Ecocardiografia Doppler em Cores/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Insuficiência da Valva Tricúspide/mortalidadeRESUMO
Postoperative lung injury is a common, although decreasing, complication of cardiac surgery. This article discusses various means to prevent and minimize postoperative lung injury. These include lung-protective strategies, pharmacologic strategies, and mechanical ventilation.