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Titolo:
Predictors of successful extubation in neurosurgical patients
Autore:
Namen, AM; Ely, EW; Tatter, SB; Case, LD; Lucia, MA; Smith, A; Landry, S; Wilson, JA; Glazier, SS; Branch, CL; Kelly, DL; Bowton, DL; Haponik, EF;
Indirizzi:
Wake Forest Univ, Baptist Med Ctr, Dept Internal Med, Sect Pulm Crit Care,Winston Salem, NC 27157 USA Wake Forest Univ Winston Salem NC USA 27157 e,Winston Salem, NC 27157 USA Wake Forest Univ, Baptist Med Ctr, Dept Publ Hlth Sci, Winston Salem, NC 27157 USA Wake Forest Univ Winston Salem NC USA 27157 , Winston Salem, NC 27157 USA Wake Forest Univ, Baptist Med Ctr, Dept Neurosurg, Winston Salem, NC 27157USA Wake Forest Univ Winston Salem NC USA 27157 g, Winston Salem, NC 27157USA Wake Forest Univ, Baptist Med Ctr, Dept Anesthesiol, Winston Salem, NC 27157 USA Wake Forest Univ Winston Salem NC USA 27157 , Winston Salem, NC 27157 USA Vanderbilt Univ, Sch Med, Div Allergy Pulm & Crit Care Med, Nashville, TN 37212 USA Vanderbilt Univ Nashville TN USA 37212 Care Med, Nashville, TN 37212 USA Johns Hopkins Univ, Sch Med, Div Pulm & Crit Care Med, Baltimore, MD USA Johns Hopkins Univ Baltimore MD USA m & Crit Care Med, Baltimore, MD USA
Titolo Testata:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
fascicolo: 3, volume: 163, anno: 2001,
pagine: 658 - 664
SICI:
1073-449X(200103)163:3<658:POSEIN>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
VENTILATOR-ASSOCIATED PNEUMONIA; MECHANICAL VENTILATION; RISK-FACTORS; WEANING PATIENTS; INTENSIVE-CARE; CRITERIA; PRESSURE; SCALE; REINTUBATION; PROTOCOL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Namen, AM Wake Forest Univ, Sch Med, Sect Pulm Crit Care Med, Med Ctr Blvd, Winston Salem, NC 27157 USA Wake Forest Univ Med Ctr Blvd Winston Salem NC USA 27157 157 USA
Citazione:
A.M. Namen et al., "Predictors of successful extubation in neurosurgical patients", AM J R CRIT, 163(3), 2001, pp. 658-664

Abstract

A respiratory therapist-driven weaning protocol incorporating daily screens, spontaneous breathing trials (SBT), and prompts to caregivers has been associated with superior outcomes in mechanically ventilated medical patients. To determine the effectiveness of this approach in neurosurgical (NSY) patients, we conducted a randomized controlled trial involving 100 patients over a 14-mo period. All had daily screens of weaning parameters. if these were passed, a 2-h SET was performed in the Intervention group. Study physicians communicated positive SET results, and the decision to extubate was made by the primary NSY team. Patients in the Intervention (n = 49) and Control (n = 51) groups had similar demographic characteristics, illness severity, and neurologic injuries. Among all patients, 87 (45 in the Control and 42 in the Intervention group) passed at least one daily screen. Forty (82%)patients in the Intervention group passed SBT, but a median of 2 d passed before attempted extubation, primarily because of concerns about the patient's sensorium (84%). Of 167 successful SBT, 126 (75%) did not lead to attempted extubation on the same day. The median time of mechanical ventilation was 6 d in both study groups, and there were no differences in outcomes. Overall complications included death (36%), reintubation (16%), and pneumonia(9%). Tracheostomies were created in 29% of patients. Multivariate analysis showed that Glasgow Coma Scale (GCS) score (p < 0.0001) and partial pressure of arterial oxygen/fraction of inspired oxygen ratio (p < 0.0001) were associated with extubation success. The odds of successful extubation increased by 39% with each CCS score increment. A CCS score greater than or equal to 8 at extubation was associated with success in 75% of cases, versus 33% for a GCS store < 8 (p < 0.0001). implementation of a weaning protocol based on traditional respiratory physiologic parameters had practical limitations in NSY patients, owing to concerns about neurologic impairment. Whether protocols combining respiratory parameters with neurologic measures lead to superior outcomes in this population requires further investigation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 24/09/20 alle ore 00:55:22