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The association between duration of mechanical ventilation and survival in post cardiac arrest patients.

心脏骤停后患者机械通气时间与生存率的相关性。

  • 影响因子:3.86
  • DOI:10.1016/j.resuscitation.2020.01.013
  • 作者列表:"Lundin A","Karlsson T","Herlitz J","Lundgren P","Rylander C
  • 发表时间:2020-01-28
Abstract

PURPOSE:To assess the association between the duration of mechanical ventilation during post resuscitation care and 30-day survival after cardiac arrest. METHODS:We conducted a retrospective observational study using data from two national registries. Comatose cardiac arrest patients admitted to general intensive care in Swedish hospitals between 2011 and 2016 were eligible. Based on the median duration of mechanical ventilation for patients who did not survive to hospital discharge, used as a proxy for the endurance of post resuscitation care, the hospitals were divided into four ordered groups for which association with 30-day survival was analyzed. RESULTS:In total, 5.113 patients in 56 hospitals were included. Median duration of mechanical ventilation for patients who did not survive to hospital discharge ranged from 17 hours in hospital group 1 to 51 hours in hospital group 4. After adjustment for baseline characteristics, 30-day survival in the entire cohort was positively and independently associated with ordered hospital group: (adjusted odds ratio (95%CI); 1.12 (1.02,1.23); p = 0.02). Thus, hospitals with a longer duration of mechanical ventilation among non-survivors had better survival rate among patients admitted to ICU after a cardiac arrest. However, in a secondary analysis restricted to patients with length of stay in the intensive care unit ≥ 48 hours, there was no significant association between 30-day survival and ordered hospital group. CONCLUSION:A tendency for longer duration of post resuscitation care in the ICU was associated with higher 30-day survival in comatose patients admitted to intensive care after cardiac arrest.

摘要

目的: 评估复苏后护理期间机械通气的持续时间与心脏骤停后 30 天存活率之间的关系。 方法: 我们使用来自两个国家登记处的数据进行了一项回顾性观察性研究。2016 和 2011年瑞典医院普通重症监护病房收治的昏迷心脏骤停患者有资格。根据未存活至出院的患者机械通气的中位持续时间,作为复苏后护理耐力的代表, 将医院分为四个有序组,分析其与 30 天生存率的相关性。 结果: 共纳入 56 家医院 5.113 例患者。未存活至出院患者的机械通气中位时间为住院 1 组 17 h ~ 住院 4 组 51 h。校正基线特征后,整个队列的 30 天生存率与有序医院组呈正相关和独立相关 :( 调整后的比值比 (95% CI)); 1.12 (1.02, 1.23);P = 0.02)。因此,在心搏骤停后入住 ICU 的患者中,非存活者机械通气时间较长的医院具有较好的生存率。然而,在仅限于重症监护室住院时间 ≥ 48 小时的患者的二次分析中,30 天生存率与有序住院组之间无显著相关性。 结论: 心脏骤停后入住重症监护病房的昏迷患者复苏后护理时间较长的趋势与较高的 30 天生存率相关。

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发表时间:2020-01-24
DOI:10.3390/ijerph17020656
作者列表:["Maria Kózka","Aurelia Sega","Katarzyna Wojnar-Gruszka","Agnieszka Tarnawska","Agnieszka Gniadek"]

METHODS:Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5&#8722;15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

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影响因子:2.87
发表时间:2020-01-28
来源期刊:Bioscience reports
DOI:10.1042/BSR20192435
作者列表:["Yu H","Luo J","Ni Y","Hu Y","Liu D","Wang M","Liang B","Liang Z"]

METHODS::Backgroud Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ration (OR) 1.141, 95% confident interval (CI) 1.022-1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008-1.249, P = 0.035, cutoff at 9.87mmol/L), dose of fentanyl (OR 3.010, 95%CI 1.100-8.237, P = 0.032, cutoff at 1.135mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062-7.252, P = 0.037) were independent risk factors for extubation failure. Conclusions In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87mmol/L, fentanyl usage > 1.135mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

翻译标题与摘要 下载文献
影响因子:3.86
发表时间:2020-01-28
来源期刊:Resuscitation
DOI:10.1016/j.resuscitation.2020.01.013
作者列表:["Lundin A","Karlsson T","Herlitz J","Lundgren P","Rylander C"]

METHODS:PURPOSE:To assess the association between the duration of mechanical ventilation during post resuscitation care and 30-day survival after cardiac arrest. METHODS:We conducted a retrospective observational study using data from two national registries. Comatose cardiac arrest patients admitted to general intensive care in Swedish hospitals between 2011 and 2016 were eligible. Based on the median duration of mechanical ventilation for patients who did not survive to hospital discharge, used as a proxy for the endurance of post resuscitation care, the hospitals were divided into four ordered groups for which association with 30-day survival was analyzed. RESULTS:In total, 5.113 patients in 56 hospitals were included. Median duration of mechanical ventilation for patients who did not survive to hospital discharge ranged from 17 hours in hospital group 1 to 51 hours in hospital group 4. After adjustment for baseline characteristics, 30-day survival in the entire cohort was positively and independently associated with ordered hospital group: (adjusted odds ratio (95%CI); 1.12 (1.02,1.23); p = 0.02). Thus, hospitals with a longer duration of mechanical ventilation among non-survivors had better survival rate among patients admitted to ICU after a cardiac arrest. However, in a secondary analysis restricted to patients with length of stay in the intensive care unit ≥ 48 hours, there was no significant association between 30-day survival and ordered hospital group. CONCLUSION:A tendency for longer duration of post resuscitation care in the ICU was associated with higher 30-day survival in comatose patients admitted to intensive care after cardiac arrest.

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