Journal Reading :

Characteristics and
Outcomes in Adult Patients
Receiving Mechanical
Ventilation

Jasreena Kaur S.
11-2013-165

Introduction

Information about the mortality of the patients

requiring mechanical ventilation is important
allows for better counselling of patients and
their families
The multivariate analysis showed that factors
independently associated with an increased
mortality rate were age, multiorgan system
failure,human immunodeficiency virus
infection,chronic liver disease and cancer


Objective of the study :
To determine the survival and the relative
importance of many factors influencing survival
of mechanicallly ventilated patients such as
baseline characteristics,ventilatory settings, and
organ failure developing over the course of the
mechanical ventilation

Methods

Study Design
Prospective cohort study of consecutive adult
patients admitted to 361 ICUs in 20 countries
and who received mechanical ventilation for
more than 12 hours
The following data was collected :
age,sex,weight,simplified acute physiology
score II (SAPS II) at the time of admission,
chronic functional status,indication for the
initiation of mechanical ventilation,and
modality of ventilatory support.


The following event were assesed daily (maximum 28 days)
-need for tracheal intubation in patients receiving noninvasive
mechanical ventilation
-ARDS
-Barotrauma
-pneumonia
-sepsis
-renal failure
-hepatic failure
-coagulopathy
Duration of mechanical ventilation was defined as the elapsed from
the initiation of ventilatory support to the onset of weaning.


Statistical Analysis
All variants were grouped in 3 categories
1.Factors present at start of the mechanical
ventilation
2.Factors related to patient management
3.Events occuring over the course of mechanical
ventilation

Results

Mechanical ventilation was delivered through

an orophareangal tube in 89 % , a
nasotracheal tube in 4.1 % ,a facial mask in
4.9 %, and a tracheostomy in 2.0 % patients.
85 % patients with COPD received non
invasive ventilation and 25.9 % subsequently
required tracheal intubation
Of the 148 patients with ARF who received non
invasive ventilation, 54 (36.5 %)subsequently
required tracheal intubation


A total of 5199 weaning attempts were undertaken in
3640 patients (70.2 %) using the following methods
-once daily (77.8 %)
-multiple weaning (14.0%)
-gradual reduction of pressure support (20.7%)
-gradual reduction of synchronized intermittent
mandatory ventilation (8.5%)
-gradual reduction in the simultaneous use of
synchronized intermittent mandatory ventilation and
pressure support (21.8%)

Patients experienced the following during mechanical

ventilation:
-ARDS (4.0%)
-Barotrauma (3.0%)
-pneumonia (9.8%)
-sepsis (9.7 %)
-shock (22.1 %)
-renal failure ( 18.7 %)
-hepatic failure (6.3%)
-coagulopathy (10.6)
-respiratory acidosis (5.6%)
-metabolic acidosis (6.0%)

Comment

Survival in patients with respiratory failure

who required mechanical ventilation for more
than 12 hours was 69% and depended not
only on factors present when initiating
mechanical ventilation but mainly on the :
-developmental of complications
-changes in monitored variables
-patient management during the subsequent
course


Mortality is not independently associated with
the patients sex.
Hospital mortality of 28% in patients with
COPD receiving mechanical ventilation due to
an acute excacerbation of their disease
Patients receiving mechanical ventilation due
to an acute decompessation of COPD had
significantly lower mortality rate than patients
receiving mechanical ventilation because of
ARF and other etiologies.


In the present studies , survival was 23 %
lower in patients who developed ARDS in 48
hours after the the start of mechanical
ventilation than in patients who had it when
the ventilation was instituted.
The only factors independently associated
with the descreased survival were :
-coma,ARDS and sepsis
The only factor independently associated with
the increased survival rate was postoperative
state.

Summary

Both factors at baseline and complications of

critical illness over time influence the outcome
of patients receiving mechanical ventilation.
Future controlled trials of ventilator strategies
evaluating mortality need to take into account
not only variables evident at the time of
randomization but also developments that
occur later in the course of mechanical
ventilation.

Thank You