Manzo PE, De La Cruz LJ, Huerta AS, Mayo MRF

Language: Spanish
References: 46
Page: 188-193
PDF size: 135.05 Kb.

ABSTRACT

We analyzed a total of 143 patients that admitted to the Unit of Critical Care, and they were included to the study 50 patients, of those which assemble the approaches of inclusion 27 patients with a 52.5 ± 21.3 year-old Global age. Nine was male sex: 33.33%, with an age of 64.88 ± 20.94 years old and 18 of the female sex: 66.66% with an age of 46.27 ± 19.05 years old. Diagnostic main: Diabetes Mellitus 10 (37.1%); Myocardial Infarction 4 (14.8%) abdominal Sepsis 3 (11.1%), Hypovolemia Shock 3 (11.1%), Severe Pneumonia 2 (7.40%), Politrauma: 2 (7.40%) Others: 3(11.1%).
The group of having excluded of the study was 23 patients: with a 56 ± 16 year-old global age. Sixteen of the female sex 69.56%, Age: 57.066 ± 13.66 years old, 7 of the Male sex: 30.43%, 77.85 ± 11.49 years old.
Statistical analysis: The analysis will be carried out the determination of the mode, standard deviation, sensibility, specificity, and the analysis through the methods nonparametric, square chi test
Resulted: Sensibility: 90% and specificity: 84%
Conclusion: The F/Vt index is a method protocolized for withdrawal Mechanical Ventilation that is of narrow surveillance for the medical personnel and non medical that it provides us satisfactory results.

REFERENCES

1. Cook DJ, Meade MO, Guyatt GH et al, for the McMaster Evidence-Based Practice Center. Weaning from mechanical ventilation. Agency for Healthcare Research and Quality (Contract No. 290-97-0017, Task order number 2), 2000.

2. Cook DJ, Walter SD, Cook RJ et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433-439.

3. Ely EW, Baker AM, Evans GW et al. The cost of respiratory care in mechanically ventilated patients with chronic obstructive pulmonary disease. Crit Care Med 2000;28:408-413.

4. Ely EW, Baker AM, Evans GW et al. The prognostic significance of passing a daily screen of weaning parameters. Intensive Care Med 1999;25:581-587.

5. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-192.

6. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-493.

7. Esteban A, Alia I, Gordo F et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997;156: 459-465.

8. Hall JB, Wood LD. Liberation of the patient from mechanical ventilation. JAMA 1987;257:1621-1628.

9. Esteban A, Frutos F, Tobin MJ et al. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 1995;332:345-350.

10. Ely EW, Baker AM, Dunagan DP et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335: 1864-1869.

11. Brock WA, Nolan K, Nolan T. Pragmatic science: accelerating the improvement of critical care. New Horizons 1998;6(1):61-68.

12. Clemmer TP, Spuhler VJ. Developing and gaining acceptance for patient care protocols. New Horizons 1998;6 (1):12-19.

13. Kollef MH, Horst HM, Prang L et al. Reducing the duration of mechanical ventilation: three examples of change in the intensive care unit. New Horizons 1998;6(1):52-60.

14. Alexander E, Weingarten S, Mohsenifar Z. Clinical strategies to reduce utilization of chest physiotherapy without compromising patient care. Chest 1996;110:430-432.

15. Browning JA, Kaiser DL, Durbin CG. The effect of guidelines on the appropriate use of ABG analysis in the intensive care unit. Respir Care 1989;34:269-276.

16. Hart SK, Dubbs W, Gil A et al. The effects of therapist evaluation of orders and interaction with physicians on the appropriateness of respiratory care. Respir Care 1989;34:185-190.

17. Komara J, Stoller JK. The impact of a postoperative oxygen therapy protocol on use of pulse oximetry and oxygen therapy. Respir Care 1995;40:1125-1129.

18. Stoller JK, Mascha EJ, Kester L et al. Randomized controlled trial of physician-directed versus respiratory therapy consult service-directed respiratory care to adult non-ICU inpatients. Am J Respir Crit Care Med 1998; 158:1068-1075.

19. Stoller JK, Skibinski CI, Giles DK et al. Physician-ordered use of a respiratory therapy consult service: results of a prospective observational study. Chest 1996;110:422-429.

20. Stoller JK. The rationale for respiratory care protocols: an update. Respir Care 1998;43:719-723.

21. Fridkin SK, Pear SM, Williamson TH et al. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17:150-158.

22. Archibald LK, Manning ML, Bell LM et al. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis 1997;16:1045-1048.

23. Thorens JB, Kaelin RM, Jolliet P et al. Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 1995;23:1807-1815.

24. Brochard L, Rauss A, Benito S et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.

25. Stoller JK. Why therapist-driven protocols? Respir Care 1994;39:706-708.

26. Kollef MH, Shapiro SD, Silver P et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997;25:567-574.

27. Saura P, Blanch L, Mestre J et al. Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 1996;22:1052-1056.

28. Wood G, MacLeod B, Moffatt S. Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol. Respir Care 1995;40:219-224.

29. Horst HM, Mouro D, Hall-Jenssens RA et al. Decrease in ventilation time with a standardized weaning process. Arch Surg 1998;133:483-488.

30. Brook AD, Ahrens TS, Schaiff R et al. Effect of a nursing implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999;27:2609-2615.

31. Kress JP, Pohlman AS, O’Connor MF et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342: 1471-1477.

32. Ely EW, Bennett PA, Bowton DL et al. Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999;159: 439-446.

33. Chatila W, Jacob B, Guaglionone D et al. The unassisted respiratory rate-tidal volume ratio accurately predicts weaning outcome. Am J Med 1996; 101:61-67.

34. Krieger BP, Ershowsky P, Becker DA et al. Evaluation of conventional criteria for predicting successful weaning from mechanical ventilatory support in elderly patients. Crit Care Med 1989;17:858-861.

35. Esteban A, Alia I, Tobin M et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 1999;159:512-518.

36. Nava S, Ambrosino N, Clini E et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized controlled trial. Ann Intern Med 1998;128:721-728.

37. Girault C, Daudenthun I, Chevron V et al. Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure. Am J Respir Crit Care Med 1999;160:86-92.

38. Vallverdu I, Calaf N, Subirana M et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial of patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1999; 158:1855-1862.

39. Torres A, Gatell JM, Aznar E. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995; 152:137-141.

40. Chevron V, Menard J, Richard J et al. Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med 1998;26:1049-1053.

41. Burrowes P, Wallace C, Davies JM et al. Pulmonary edema as a radiologic manifestation of venous air embolism secondary to dental implant surgery. Chest 1992; 101:561-562.

42. Wood KE, Flaten AL, Reedy JS et al. Use of a daily wean screen and weaning protocol for mechanically ventilated patients in a multidisciplinary tertiary critical care unit [abstract]. Crit Care Med 1999;27:A94.

43. Listello D, Sessler C. Unplanned extubation: clinical predictors for reintubation. Chest 1994;105:1496-1503.

44. Tindol GA Jr., DiBenedetto RJ, Kosciuk L. Unplanned extubations. Chest 1994;105:1804-1807.

45. Boulain T. Unplanned extubations in the adult intensive care unit: a prospective multicenter study; Association des Reanimateurs du Centre-Ouest. Am J Respir Crit Care Med 1998;157:1131-1137.

46. Betbese AJ, Perez M, Rialp G et al. A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 1998; 26:1180-1186.