Re-engineering ventilatory support to decrease days and improve resource utilization
| Autor: | Orlando C. Kirton, C. Bryan DeHaven, Judith Hudson-Civetta, Joseph P. Morgan, Jimmy Windsor, Joseph M. Civetta |
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| Rok vydání: | 1996 |
| Předmět: |
Artificial ventilation
Adult Male Resuscitation Time Factors Respiratory rate medicine.medical_treatment Cost-Benefit Analysis Work of breathing Medicine Humans Prospective Studies Re engineering Tidal volume Work of Breathing Ventilators Mechanical business.industry Middle Aged Respiration Artificial Anesthesia Rapid shallow breathing index Breathing Surgery business Ventilator Weaning Research Article |
| Zdroj: | Annals of surgery. 224(3) |
| ISSN: | 0003-4932 |
| Popis: | Objective The objective of this study was to describe the development of a cost-effective ventilatory strategy using a portable microprocessor-controlled respiratory monitor (Bicore CP-100 ; Allied Healthcare Products, Riverside, CA). Summary Background Data Until recently, clinicians have had to accept the uncertainties of clinical judgment, which unfortunately, often biased the patient to a prolonged ventilatory course to avoid extubation failures, necessitating reintubation. Methods Over a 4-year period, the authors attempted to re-engineer the process of ventilatory support based on measured work of breathing (WOB),including physiologic (WOB phys ), imposed (WOB imp ) and total (WOB Tot ). Results The authors made 90 determinations of WOB in 31 patients. The coefficient of determination (r 2 ) of WOB Tot , with the breathing frequency was 0.35, with tidal volume was 0.10, and with the rapid shallow breathing index (f/V τ ) was 0.23 ; therefore, the authors discarded them as reliable inferences. Of 27 patients ventilated for >2 days with satisfactory blood gases, but with breathing frequency > 30 breaths/minute, 6 had WOB Tot < 0.8 J/L and were extubated successfully. In 21 patients, WOB Tot was elevated to 1.6 ± 0.83 J/L, WOB imp was 1.1 ± 0.64 J/L, approximately twice the WOB phys (0.5 ± 0.26 J/L), a normal value. Extubation was successful in 20 of those 21 patients. This approach was extended to the spontaneous breathing pre-extubation trial. In addition, the ventilator was adjusted so that the patient sustained a WOB Tot of 0.6 to 1 J/L during the ventilatory support. This evolution was tracked for 18 months in a series of 838 trauma intensive care unit patients. Average duration of ventilation decreased from 8.2 to 4.2 days (49% ; p < 0.01). This translated into approximately 2400 decreased ventilator days per year. Conclusion Objective measurement to guide the adequacy of ventilatory support and interpret apparent clinical weaning failures decreased total ventilatory time by 50%, permitting extubation in nearly 20% of patients previously considered failures. |
| Databáze: | OpenAIRE |
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