Dataset Information

Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China

ABSTRACT:

Background

Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.

Methods

The clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. PMV was defined as a mechanical ventilation length of more than 24?h. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.

Results

Out of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24?h. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO2/FiO2 (OR=0.989, PConclusions Estimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03524-4.

SUBMITTER: Zhao H

PROVIDER: S-EPMC7796589 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectivesChildren with an immunocompromised condition and requiring invasive mechanical ventilation have high risk of death. Such patients are commonly transitioned to rescue modes of nonconventional ventilation, including airway pressure release ventilation and high-frequency oscillatory ventilation, for acute respiratory distress syndrome refractory to conventional ventilation. Our aim was to describe our experience with airway pressure release ventilation and high-frequency oscillatory ventilation in children with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation and to identify factors associated with survival.DesignRetrospective cohort study.SettingTertiary care, university-affiliated PICU.PatientsSixty pediatric patients with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation.InterventionsNone.Measurements and main resultsDemographic data, ventilator settings, arterial blood gases, oxygenation index, and PaO(2)/FIO(2) were recorded before transition to either mode of nonconventional ventilation and at predetermined intervals after transition for up to 5 days. Mortality in the entire cohort was 63% and did not differ between patients transitioned to airway pressure release ventilation and high-frequency oscillatory ventilation. For both airway pressure release ventilation and high-frequency oscillatory ventilation, improvements in oxygenation index and PaO(2)/FIO(2) at 24 hours expressed as a fraction of pretransition values (oxygenation index(24)/oxygenation index(pre) and PaO(2)/FIO(224)/PaO(2)/FIO(2pre)) reliably discriminated nonsurvivors from survivors, with receiver operating characteristic areas under the curves between 0.89 and 0.95 (p for all curves < 0.001). Sensitivity-specificity analysis suggested that less than 15% reduction in oxygenation index (90% sensitive, 75% specific) or less than 90% increase in PaO(2)/FIO(2) (80% sensitive, 94% specific) 24 hours after transition to airway pressure release ventilation were the optimal cutoffs to identify nonsurvivors. The comparable values 24 hours after transition to high-frequency oscillatory ventilation were less than 5% reduction in oxygenation index (100% sensitive, 83% specific) or less than 80% increase in PaO(2)/FIO(2) (91% sensitive, 89% specific) to identify nonsurvivors.ConclusionsIn this single-center retrospective study of pediatric patients with an immunocompromised condition and acute respiratory distress syndrome failing conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation, improved oxygenation at 24 hours expressed as PaO(2)/FIO(224)/PaO(2)/FIO(2pre) or oxygenation index(24)/oxygenation indexpre reliably discriminates nonsurvivors from survivors. These findings should be prospectively verified.

Project description:BackgroundSpecialization in medical professions is considered a challenging and intensive period due to the number and sequence of duty hours. Considering the effect of duty hours on residents, both physically and mentally, several models have been created over the years to address this complexity. The two main model schools aim to decrease the duty hour length and night shift (i.e., night float, NF) frequency. In recent years, duty hours have become a source of disagreement and frustration among the medical community, both residents and attendings. A possible change in the duty hour structure may affect residents in terms of several parameters, such as patient safety, the well-being of the physician and the degree of training of the resident.Purpose(1) To investigate medical residents' perspectives on their duty hours utilizing online questionnaires on their effect on the work environment and (2) to assess residents' preferences in relation to the suggested shortened shift and NF models.MethodsQuestionnaires were emailed to all residents (main residents and fellows) at an Israeli tertiary medical center between March 2020 and April 2020. Questions were scored from 1 (disagree) to 5 (fully agree).ResultsTwo hundred and sixty residents (227 main residents, 43 fellows) participated in the study (40% female). The score for the degree of balance between work and personal life was low (0.9±1.99). The shortened shift model was perceived by the residents as more compatible with a balanced lifestyle than the NF model (3.77 ± 1.20 and 3.14 ± 1.26, respectively, P < 0.0001). Neither model was considered to risk impairing professional training (2.33 ± 1.45 and 2.47 ± 1.25, respectively, P = 0.12). Overall, 74% of the residents were not willing to lower their income if the decision were made to change models, and 56% were not willing to increase the number of shifts.ConclusionsThere is agreement among residents that shortening shift hours to 16 h would have a positive effect on the balance between personal life and work. In the eyes of residents, the change would not impair their training during residency.

Project description:BackgroundSurgical stabilization of rib fractures (SSRF) should be performed early after injury. Factors that influence timing remain unknown. Our objective was to identify inherent variables that allow for early identification and treatment. We hypothesized that certain demographic, injury, and logistical factors are associated with SSRF <24 hours from admission.MethodsRetrospective review from an urban level 1 trauma center (10/2010-8/2019). Patients were grouped as SSRF <24 hours from admission vs. ≥24 hours. Demographics, transfer from an outside hospital (OSH), timing documentation, injury descriptors, surgeon on-call, and operative surgeon were collected. SSRF for chronic non-union was excluded.ResultsData from 173 patients were analyzed. Eighty-five patients (49%) were in the <24 hours group and 88 (51%) were in the ≥24 hours group. Baseline demographics were similar between groups. Injury severity was significantly higher in the late group: increased Injury Severity Score (ISS; 16.5 vs. 21.0, P<0.01), lower Glasgow Coma Scale (GCS; 15 vs. 14, P<0.01), more rib fractures (7 vs. 9, P=0.01), and increased incidence of face (6% vs. 16%, P=0.03), spine (22% vs. 47%, P<0.01), and pelvis fractures (8% vs. 25%, P<0.01). Patients admitted on a Wednesday were more likely to undergo early SSRF as compared to other days of the week (P=0.01) There was also a shorter time from the decision to perform SSRF to the actual operation in the early group, as compared to the late group (13 vs. 44 hours, P<0.01). Fifty (28.9%) SSRF cases were performed by the on-call surgeon; this percentage did not differ in the early vs. late group (33% vs. 25%, P=0.25). Patients needing pelvic fixation were more likely to be in the late group. Patients transferred from an OSH for SSRF were more likely to be in the early group (29% vs. 10%, P<0.01). Finally, likelihood of early surgery increased with increasing study year.ConclusionsApproximately one-half of SSRF cases were performed within 24 hours of admission. Factors that influence surgery within 24 hours of admission appear related to overall injury severity and systems issues, including day of admission, transfer from another facility, additional urgent pelvic surgery, and institutional experience with SSRF. Surgeon availability did not drive this disparity.