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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Management and outcome of mechanically ventilated neurologic patients
Critical Care Medicine, Volume 39, No. 6, Year 2011
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Description
Objective: To describe and compare characteristics, ventilatory practices, and associated outcomes among mechanically ventilated patients with different types of brain injury and between neurologic and nonneurologic patients. Design: Secondary analysis of a prospective, observational, and multicenter study on mechanical ventilation. Setting: Three hundred forty-nine intensive care units from 23 countries. Patients: We included 552 mechanically ventilated neurologic patients (362 patients with stroke and 190 patients with brain trauma). For comparison we used a control group of 4,030 mixed patients who were ventilated for nonneurologic reasons. Interventions: None. Measurements and Main Results: We collected demographics, ventilatory settings, organ failures, and complications arising during ventilation and outcomes. Multivariate logistic regression analysis was performed with intensive care unit mortality as the dependent variable. At admission, a Glasgow Coma Scale score ≤8 was observed in 68% of the stroke, 77% of the brain trauma, and 29% of the nonneurologic patients. Modes of ventilation and use of a lung-protective strategy within the first week of mechanical ventilation were similar between groups. In comparison with nonneurologic patients, patients with neurologic disease developed fewer complications over the course of mechanical ventilation with the exception of a higher rate of ventilator-associated pneumonia in the brain trauma cohort. Neurologic patients showed higher rates of tracheotomy and longer duration of mechanical ventilation. Mortality in the intensive care unit was significantly (p < .001) higher in patients with stroke (45%) than in brain trauma (29%) and nonneurologic disease (30%). Factors associated with mortality were: stroke (in comparison to brain trauma), Glasgow Coma Scale score on day 1, and severity at admission in the intensive care unit. Conclusions: In our study, one of every five mechanically ventilated patients received this therapy as a result of a neurologic disease. This cohort of patients showed a higher mortality rate than nonneurologic patients despite a lower incidence of extracerebral organ dysfunction. Copyright © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Authors & Co-Authors
Pelosi, Paolo P.
Italy, Genoa
Università Degli Studi Di Genova
Ferguson, Niall D.
Canada, Toronto
Mount Sinai Hospital of University of Toronto
Frutos-Vivar, Fernando
Spain, Getafe
Hospital Universitario de Getafe
Anzueto, Antonio R.
United States, San Antonio
University of Texas Health Science Center at San Antonio
Putensen, Christian
Germany, Bonn
Universität Bonn
Raymondos, Konstantinos
Germany, Hannover
Hannover Medical School
Apezteguía, Carlos J.
Argentina, Buenos Aires
Hospital Nacional Professor Dr. Alejandro Posadas
Desmery, Pablo M.
Argentina, Buenos Aires
Sanatorio Mitre
Hurtado, Javier L.
Uruguay, Montevideo
Hospital de Clinicas Dr. Manuel Quintela
Abrouk, Fekri
Unknown Affiliation
Elizalde, José J.
Mexico
American British Cowdray Medical Center
Tomicic F, Vinko
Chile, Santiago
Clínica Las Lilas
Çakar, Nahit
Turkey, Istanbul
İstanbul Tıp Fakültesi
González, Marco A.
Colombia, Medellin
Universidad Pontificia Bolivariana
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Abdulaziz Medical City - Riyadh
Moreno, Rui Paulo
Portugal, Lisbon
Hospital de Santo António Dos Capuchos
Esteban, Andrés
Spain, Getafe
Hospital Universitario de Getafe
Statistics
Citations: 177
Authors: 17
Affiliations: 15
Identifiers
Doi:
10.1097/CCM.0b013e31821209a8
ISSN:
00903493
e-ISSN:
15300293
Research Areas
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative