دورية أكاديمية
A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project
| العنوان: | A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project |
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| المؤلفون: | Asehnoune, Karim, Mrozek, Ségolène, Perrigault, Pierre François, Seguin, Philippe, Dahyot-Fizelier, Claire, Lasocki, Sigismond, Pujol, Anne, Martin, Mathieu, Chabanne, Russel, Muller, Laurent, Hanouz, Jean Luc, Hammad, Emmanuelle, Rozec, Bertrand, Kerforne, Thomas, Ichai, Carole, Cinotti, Raphael, Geeraerts, Thomas, Elaroussi, Djillali, Pelosi, Paolo, Jaber, Samir, Dalichampt, Marie, Feuillet, Fanny, Sebille, Véronique, Roquilly, Antoine |
| المساهمون: | Asehnoune, Karim, Mrozek, Ségolène, Perrigault, Pierre Françoi, Seguin, Philippe, Dahyot-Fizelier, Claire, Lasocki, Sigismond, Pujol, Anne, Martin, Mathieu, Chabanne, Russel, Muller, Laurent, Hanouz, Jean Luc, Hammad, Emmanuelle, Rozec, Bertrand, Kerforne, Thoma, Ichai, Carole, Cinotti, Raphael, Geeraerts, Thoma, Elaroussi, Djillali, Pelosi, Paolo, Jaber, Samir, Dalichampt, Marie, Feuillet, Fanny, Sebille, Véronique, Roquilly, Antoine |
| بيانات النشر: | Springer Verlag |
| سنة النشر: | 2017 |
| المجموعة: | Università degli Studi di Genova: CINECA IRIS |
| مصطلحات موضوعية: | Airway extubation, Brain injurie, PEEP, Tidal volume, Ventilator weaning, Adult, Aged, Controlled Before-After Studie, Female, Glasgow Coma Scale, Human, Intensive Care Unit, Male, Middle Aged, Non-Randomized Controlled Trials as Topic, Positive-Pressure Respiration, Prospective Studie, Quality Improvement, Statistics, Nonparametric, Tomography, X-Ray Computed, Ventilator-Induced Lung Injury, Critical Care and Intensive Care Medicine |
| الوصف: | Purpose: We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. Methods: Prospective nationwide before–after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24h in 20 French intensive care units (ICUs) were included. The management of invasive ventilation in brain-injured patients admitted between 1 July 2013 and 31 October 2013 (4months) was monitored and analysed. After the baseline period (1 November 2013–31 December 2013), ventilator settings and decision to extubate were selected as targets to hasten weaning from invasive ventilation. During the intervention period, low tidal volume (≤7ml/kg), moderate positive end-expiratory pressure (PEEP, 6–8cm H 2 O) and an early extubation protocol were recommended. The primary endpoint was the number of days free of invasive ventilation at day 90. Comparisons were performed between the two periods and between the compliant and non-compliant groups. Results: A total of 744 patients from 20 ICUs were included (391 pre-intervention; 353 intervention). No difference in the number of invasive ventilation-free days at day 90 was observed between the two periods [71 (0–80) vs. 67 (0–80)days; P=0.746]. Compliance with the complete set of recommendations increased from 8 (2%) to 52 (15%) patients after the intervention (P<0.001). At day 90, the number of invasive ventilation-free days was higher in the 60 (8%) patients whose care complied with recommendations than in the 684 (92%) patients whose care deviated from recommendations [77 (66–82) and 71 (0–80)days, respectively; P=0.03]. The mortality rate was 10% in the compliant group and 26% in the non-compliant group (P=0.023). Both multivariate analysis [hazard ratio (HR)1.78, 95% confidence interval (95% CI) 1.41–2.26; P<0.001] and propensity score-adjusted analysis (HR2.25, 95% CI 1.56–3.26, P<0.001) revealed that compliance was an independent factor associated with the ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | ELETTRONICO |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/28315940; info:eu-repo/semantics/altIdentifier/wos/WOS:000404020100001; volume:43; firstpage:957; lastpage:970; numberofpages:14; journal:INTENSIVE CARE MEDICINE; http://hdl.handle.net/11567/945062Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85015679830 |
| DOI: | 10.1007/s00134-017-4764-6 |
| الإتاحة: | https://doi.org/10.1007/s00134-017-4764-6Test http://hdl.handle.net/11567/945062Test |
| حقوق: | info:eu-repo/semantics/closedAccess |
| رقم الانضمام: | edsbas.25FEB235 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1007/s00134-017-4764-6 |
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