Post-graduate theses
Current Record: 17 of 6542
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| Identifier |
000463537 |
| Title |
Η χρήση του μη επεμβατικού μηχανικού αερισμού σε ασθενείς με αναπνευστική ανεπάρκεια μετά την αποσωλήνωση στη ΜΕΘ |
| Alternative Title |
The use of NIMV in critically ill patients with post extubation respiratory failure |
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Author
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Βόμβα, Αρετή
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Thesis advisor
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Βαπορίδη, Αικατερίνη
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Reviewer
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Κονδύλη, Ευμορφία
Ακουμιανάκη, Ευαγγελία
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| Abstract |
BACKROUND
The use of Non-Invasive Mechanical Ventilation (NIMV) has been widely studied and a proven tool to avoid endotracheal intubation in critically ill patients with respiratory failure, thanks to the provision of positive pressure oxygen therapy.
Respiratory failure might occur in patients’ post-extubation either as a complication of prolonged endotracheal intubation or as an inability of the respiratory muscles for effective spontaneous breathing. In these conditions, the necessity to treat underlying pathology is immediate while the need for possible invasive respiratory support increases as well as mortality rates.
Despite the proven therapeutic use of NIMV in respiratory failure, its effectiveness in cases of developing respiratory failure post-extubation remains controversial.
OBJECTIVE
In the ICU, NIMV is used both to prevent and treat respiratory failure post-extubation. The use of NIMV in the treatment of patients with respiratory failure post-extubation is not recommended, but the relevant data are not considered sufficient. The purpose of this study was to examine the outcome of patients who received NIMV post-extubation
METHODS
Design: 5-year retrospective data analysis (2017-2022)
Study population: Patients who received invasive mechanical ventilation and were extubated
Measurements: Data were sought from the electronic system of the PAGNI general ICU (CSS) including parameters such as ABGs before and after intubation, ABGs post-extubation and during NIMV application, data on patient’s history and medication administered
RESULTS
1507 patients were extubated. 251 of them received NIMV, 122 for prophylactic and 139 for therapeutic cause. Post extubation, patients received NIMV either therapeutically, prophylactically, or neither of them, and ICU mortality was 16%, 8%, and 20% respectively, with no significant differences in demographics. The re-intubation rate at 48 hours was 32%, 69%, 3% respectively. The presence of certain risk factors for extubation failure (age >65 years, comorbidities) was not associated with an increased rate of re-intubation, nor was found any correlation in prophylactic use of NIMV and a reduction in re-intubation rate.
The therapeutic use of NIMV was mainly intended for hypoxic respiratory failure treatment post-extubation, being successful in 68% and with no difference in mortality rate when compared to patients directly re-intubated (20%, p=0.6). Factors associated with re-intubation were the need for Esmolol administration, continuous NIMV>12 hours, and failure to improve oxygenation after the application of NIMV. Two patients experienced major complications in the re-intubation process and survived. Avoiding re-intubation was associated with shorter ICU length of stay.
CONCLUSION
The use of NIMV was found to be effective and safe in treating respiratory failure developed post-extubation.
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| Language |
Greek |
| Issue date |
2024-04-17 |
| Collection
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School/Department--School of Medicine--Department of Medicine--Post-graduate theses
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Type of Work--Post-graduate theses
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| Permanent Link |
https://elocus.lib.uoc.gr//dlib/6/b/2/metadata-dlib-1713246704-21988-3877.tkl
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| Views |
2 |
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