Factors determining outcomes in adult patient undergoing mechanical ventilation: A "real-world" retrospective study in an Indian Intensive Care Unit

Characteristics and Outcomes of Mechanically Ventilated Patients at Adult ICU of Selected Public Hospitals in Addis Ababa, Ethiopia

Introduction

Objective

Methods

Results

Conclusion

New integrated weaning indices from mechanical ventilation: A derivation-validation observational multicenter study

Background

To develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices.

Methods

This retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT 01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes’ theorem to assess the probability of each test in predicting weaning.

Results

In the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87–0.99).

Conclusion

The new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.

The predictive ability of SAPS II, APACHE II, SAPS III, and APACHE IV to assess outcome and duration of mechanical ventilation in respiratory intensive care unit

Objectives:

The objective is to determine utility of SAPS II, APACHE II, SAPS III, and APACHE IV scoring system in assessing outcome in mechanically ventilated patients in respiratory intensive care unit and to predict duration of mechanical ventilation (MV).

Materials and Methods:

A prospective observational study where 83 mechanically ventilated patients were grouped into Group 1 (n₁ = 40, NIV) and Group 2 (n₂ = 43, Invasive ventilation) was conducted. SAPS II, APACHE II, SAPS III, and APACHE IV scores based predicted mortality (PM) were collected at day 1, and day 3. Outcomes (on day 7) were grouped into negative and positive. (NIV-negative outcome = Home NIV, intubation or death; positive outcome = NIV free. Invasive group-positive outcome = Extubation; negative outcome = Death). Binary logistic regression was applied to predict duration of MV (> or < 5 days).

Results:

The data were analyzed using SPSS version 17.0 trials comparisons of PM on day 1 with SAPS II (P < 0.05) and APACHE IV (P < 0.007) were significant predictors of clinical outcomes in Group 1 where as in Group 2, none of the system could predict significantly. On day 3, Group 1 analysis revealed SAPS II (P < 0.002), SAPS III (P < 0.03), and APACHE IV (P < 0.004) based PM as significant predictors of outcome. APACHE II (P < 0.05) and APACHE IV (P < 0.02) PM were significant in Group 2. On day 3, APACHE IV could significantly predict (P < 0.05) duration of MV (>5 or < 5) while A-a gradient (P < 0.09) predicted poorly in Group 1. In Group 2, APACHE IV was a poor predictor (P < 0.09). Two full logistic regression models were also formulated for both the groups.

Conclusion:

Study concludes that day 3 severity scores are more significant predictors of outcome and duration. APACHE IV scoring system was found more effective than other systems, not only significantly differentiating outcomes of MV but also predicting duration of NIV.

Optimizing respiratory management in resource-limited settings

PURPOSE OF REVIEW

This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.

RECENT FINDINGS

Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.

SUMMARY

The management of patients with acute respiratory failure in LMICs should focus on avoiding intubation where possible, improving the safety of mechanical ventilation and expediting weaning. Future directions should involve the development and trialing of robust and context-appropriate respiratory support technology.