Positive end-expiratory pressure improves oxygenation inducing ventral-to-dorsal tidal ventilation redistribution: an electrical impedance tomography study (original) (raw)
CHEST Journal, 2012
ABSTRACT SESSION TYPE: Physiology/PFTs/ Rehabilitation IPRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PMPURPOSE: Respiratory failure requiring mechanical ventilation is an uncommon event during pregnancy. Physiologic changes of pregnancy and concerns for fetal wellbeing complicate the use of Mechanical Ventilation. The purpose of this study was to describe clinical characteristics of obstetric patients requiring Mechanical Ventilation, and their maternal and perinatal outcomes.METHODS: Observational retrospective study of all obstetric patients admitted to the Intensive Care Unit (ICU) at Rafael Calvo Maternity Hospital in Cartagena (Colombia), requiring Mechanical Ventilation for >24 hours between September, 2005 and December, 2011. Records were reviewed for demographic, diagnosis on admission and throughout stay, medical history, length of stay, perinatal and maternal mortality and ventilatory parameters.RESULTS: There were 750 ICU admissions during pregnancy or up to 6 weeks from the conclusion of pregnancy during the study period. A total of 131 (17.4 %) of patients required ventilatory support (32 during pregnancy), for a total of 822 ventilation days. The mortality rate was 23.6% (31 deaths) in Mechanical Ventilation patients. APACHE II was 8 (IQR 6-12) in non-ventilated patients and 14 (IQR 10-21) in ventilated patients (P<0.001). The median age was 24.3 years (SD±6.6). The median duration on mechanical ventilation was 3 days (IQR 1-6). Mean length of stay in ICU was 11.02 days (SD± 8.4). The most common diagnoses on admission were obstetric hemorrhage (36.2%) and gestational hypertensive disorders (29.8%). Volume-cycled was the most frequently used mode of ventilation (67/115 patients), with a mean tidal volume of 449.07mL (SD±90.7), and a mean Positive End-Expiratory Pressure (PEEP) of 7 cmH2O(SD± 2.4). Perinatal mortality (stillbirths and miscarriages) in ventilated mothers was 24.4%, and 15.4% in non-ventilated obstetric ICU patients (P<0.001).CONCLUSIONS: Maternal severity and perinatal mortality are significantly elevated in obstetric patients requiring mechanical ventilation.CLINICAL IMPLICATIONS: Given the elevated risk of mortality in obstetric patients requiring mechanical ventilation, aggressive therapeutic measures should be instituted.DISCLOSURE: The following authors have nothing to disclose: Jose Rojas-Suarez, Carmelo Dueñas, Angel Paternina, Jezid Miranda, Eliana Castillo, Ghada BourjeilyNo Product/Research Disclosure InformationUniversidad de Cartagena, Cartagena, Colombia.
Neurocritical care, 2013
Purpose To identify factors associated with decisions to withdraw life-sustaining therapies in patients with severe traumatic brain injury (TBI). Materials and Methods We conducted a 2-year multicenter retrospective cohort study (2005–2006) in mechanically ventilated patients aged 16 years and older admitted to the intensive care units (ICUs) of six Canadian level I trauma centers following severe TBI. One hundred and twenty charts were randomly selected at each center (n = 720). Data on ICU management strategies, patients’ clinical condition, surgical procedures, diagnostic imaging, and decision to withdraw life-sustaining therapies were collected. The association of factors pertaining to the injury, interventions, and management strategies with decisions to withdraw life-sustaining therapies was evaluated among non-survivors. Results Among the 228 non-survivors, 160 died following withdrawal of life-sustaining therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7 (±21.7) years old. Brain herniation was more often reported in patients who died following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91, 95 % confidence interval [CI] 1.16–7.30, p = 0.02) compared to those who died due to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18, 95 % CI 0.06–0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02–0.68, p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02–0.43, p < 0.01) were less often associated with death following withdrawal of life-sustaining therapies than death from other causes. Conclusions Death following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.