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Longitudinal Changes in Patient-Ventilator Asynchronies and Respiratory System Mechanics Before and After Tracheostomy

التفاصيل البيبلوغرافية
العنوان:	Longitudinal Changes in Patient-Ventilator Asynchronies and Respiratory System Mechanics Before and After Tracheostomy
المؤلفون:	Umberto Lucangelo, Paolo Pelosi, José Aquino-Esperanza, Lluís Blanch, Rafael Fernandez, Enrico Lena, Jaume Montanya, Candelaria de Haro, Josefina López-Aguilar, Rudys Magrans, Leonardo Sarlabous, Robert M. Kacmarek, Neus López, Montserrat Rué
المساهمون:	Lena, Enrico, Aquino-Esperanza, José, López-Aguilar, Josefina, Magrans, Rudy, de Haro, Candelaria, Sarlabous, Leonardo, López, Neu, Montanyà, Jaume, Rué, Montserrat, M Kacmarek, Robert, Lucangelo, Umberto, Fernández, Rafael, Pelosi, Paolo, Blanch, Lluís
المصدر:	Respir Care
بيانات النشر:	Daedalus Enterprises Inc., 2021.
سنة النشر:	2021
مصطلحات موضوعية:	Pulmonary and Respiratory Medicine, Adult, medicine.medical_treatment, Ventilators, Pilot Projects, Respiratory physiology, Critical Care and Intensive Care Medicine, Air trapping, Airway resistance, Tracheostomy, Medicine, Humans, Pilot Project, Prospective Studies, Respiratory system, Prospective cohort study, Lung, Respiration, Artificial, Respiratory Mechanics, Ventilators, Mechanical, Original Research, Mechanical ventilation, Respiratory Mechanic, business.industry, Respiration, Repeated measures design, General Medicine, Mechanical, Prospective Studie, Editorial, Respiratory failure, Anesthesia, Artificial, medicine.symptom, business, Human
الوصف:	BACKGROUND: This was a pilot study to analyze the effects of tracheostomy on patient-ventilator asynchronies and respiratory system mechanics. Data were extracted from an ongoing prospective, real-world database that stores continuous output from ventilators and bedside monitors. Twenty adult subjects were on mechanical ventilation and were tracheostomized during an ICU stay: 55% were admitted to the ICU for respiratory failure and 35% for neurologic conditions; the median duration of mechanical ventilation before tracheostomy was 12 d; and the median duration of mechanical ventilation was 16 d. METHODS: We compared patient-ventilator asynchronies (the overall asynchrony index and the rates of specific asynchronies) and respiratory system mechanics (respiratory-system compliance and airway resistance) during the 24 h before tracheostomy versus the 24 h after tracheostomy. We analyzed possible differences in these variables among the subjects who underwent surgical versus percutaneous tracheostomy. To compare longitudinal changes in the variables, we used linear mixed-effects models for repeated measures along time in different observation periods. A total of 920 h of mechanical ventilation were analyzed. RESULTS: Respiratory mechanics and asynchronies did not differ significantly between the 24-h periods before and after tracheostomy: compliance of the respiratory system median (IQR) (47.9 [41.3 – 54.6] mL/cm H(2)O vs 47.6 [40.9 – 54.3] mL/cm H(2)O; P = .94), airway resistance (9.3 [7.5 – 11.1] cm H(2)O/L/s vs 7.0 [5.2 – 8.8] cm H(2)O/L/s; P = .07), asynchrony index (2.0% [1.1 – 3.6%] vs 4.1% [2.3 – 7.6%]; P = .09), ineffective expiratory efforts (0.9% [0.4 – 1.8%] vs 2.2% [1.0 – 4.4%]; P = .08), double cycling (0.5% [0.3 – 1.0%] vs 0.9% [0.5 – 1.9%]; P = .24), and percentage of air trapping (7.6% [4.2 – 13.8%] vs 10.6% [5.9 – 19.2%]; P = .43). No differences in respiratory mechanics or patient-ventilator asynchronies were observed between percutaneous and surgical procedures. CONCLUSIONS: Tracheostomy did not affect patient-ventilator asynchronies or respiratory mechanics within 24 h before and after the procedure
وصف الملف:	ELETTRONICO
اللغة:	English
الوصول الحر:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fb03c3b7dd00352e4866b080f92b9f49Test https://europepmc.org/articles/PMC9993883Test/
حقوق:	OPEN
رقم الانضمام:	edsair.doi.dedup.....fb03c3b7dd00352e4866b080f92b9f49
قاعدة البيانات:	OpenAIRE

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Data were extracted from an ongoing prospective, real-world database that stores continuous output from ventilators and bedside monitors. Twenty adult subjects were on mechanical ventilation and were tracheostomized during an ICU stay: 55% were admitted to the ICU for respiratory failure and 35% for neurologic conditions; the median duration of mechanical ventilation before tracheostomy was 12 d; and the median duration of mechanical ventilation was 16 d. METHODS: We compared patient-ventilator asynchronies (the overall asynchrony index and the rates of specific asynchronies) and respiratory system mechanics (respiratory-system compliance and airway resistance) during the 24 h before tracheostomy versus the 24 h after tracheostomy. We analyzed possible differences in these variables among the subjects who underwent surgical versus percutaneous tracheostomy. To compare longitudinal changes in the variables, we used linear mixed-effects models for repeated measures along time in different observation periods. A total of 920 h of mechanical ventilation were analyzed. RESULTS: Respiratory mechanics and asynchronies did not differ significantly between the 24-h periods before and after tracheostomy: compliance of the respiratory system median (IQR) (47.9 [41.3 – 54.6] mL/cm H(2)O vs 47.6 [40.9 – 54.3] mL/cm H(2)O; P = .94), airway resistance (9.3 [7.5 – 11.1] cm H(2)O/L/s vs 7.0 [5.2 – 8.8] cm H(2)O/L/s; P = .07), asynchrony index (2.0% [1.1 – 3.6%] vs 4.1% [2.3 – 7.6%]; P = .09), ineffective expiratory efforts (0.9% [0.4 – 1.8%] vs 2.2% [1.0 – 4.4%]; P = .08), double cycling (0.5% [0.3 – 1.0%] vs 0.9% [0.5 – 1.9%]; P = .24), and percentage of air trapping (7.6% [4.2 – 13.8%] vs 10.6% [5.9 – 19.2%]; P = .43). No differences in respiratory mechanics or patient-ventilator asynchronies were observed between percutaneous and surgical procedures. 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