https://doi.org/10.4081/monaldi.2023.2506
Impact of neurological problems on mechanical ventilation and intensive care unit outcomes in pulmonary intensive care unit patients: a retrospective analysis of a single-center cohort
Submitted: December 9, 2022
Accepted: April 11, 2023
Published: April 19, 2023
Accepted: April 11, 2023
Abstract Views: 702
PDF: 256
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Neurological problems (NPs) are frequently connected with different critical illnesses in intensive care unit (ICU) patients, and they may influence ICU outcomes. This study aims to examine the effects of NPs on ICU outcomes, especially in pulmonary ICU patients. This is a retrospective observational study comprising adult pulmonary critical care patients who were hospitalized between 2015 and 2019. The frequency of NPs at admission, their impact on mechanical ventilation (MV), ICU outcomes, the rate of NP development during the ICU stay, and risk factors for them were investigated. A total of 361 patients were included in the study, and 130 of them (36%) had NPs (group 1). The noninvasive ventilation requirement rate in patients with NPs was less than in those without NPs (group 2), and the requirement of MV was significantly more frequent in this group (37% and 19%, p<0.05). The duration of MV (19±27 and 8±6 days, p=0.003) and sepsis rate (31% and 18%, p=0.005) were also higher in group 1. NPs developing after ICU admission increased the MV requirement 3 times as an independent risk factor. Risk factors for ICU-acquired NPs were the existence of sepsis during admission [odds ratio (OR): 2.01, confidence interval (CI) 95%: 1.02-4, p=0.045] and longer MV durations before ICU admission (OR: 1.05, CI 95%: 1.004-41.103, p=0.033). NPs were not independent risk factors for mortality (OR: 0.67, CI 95%: 0.37-1.240, p=0.207). NPs did not increase mortality but more frequently caused MV requirement, more extubation failure, and a longer ICU stay in this study population. Additionally, our data suggest that having sepsis during admission and a longer length of MV prior to admission may increase the neurological complication rate.
Gu M, Mei XL, Zhao YN. Sepsis and cerebral dysfunction: BBB damage, neuroinflammation, oxidative stress, apoptosis and autophagy as key mediators and the potential therapeutic approaches. Neurotox Res 2021;39:489-503.
Smith M, Meyfroidt G. Critical illness: the brain is always in the line of fire. Intensive Care Med 2017;43:870-3.
Barlas I, Oropello JM, Benjamin E. Neurologic complications in intensive care. Curr Opin Crit Care 2001;7:68-73.
Bleck TP, Smith MC, Pierre-Louis SJ, et al. Neurologic complications of critical medical illnesses. Crit Care Med 1993;21:98-103.
Khan BA, Perkins AJ, Gao S, et al. The confusion assessment method for the ICU-7 delirium severity scale: a novel delirium severity instrument for use in the ICU. Crit Care Med 2017;45:851-7.
Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest 2016;150:1129-40.
Symeonidou Z, Theodoraki K, Chalkias Athanasios A, et al. Critical illness polyneuropathy (CIP): a multicenter study on functional outcome. G Ital Med Lav Ergon 2019;41:58-64.
Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 2009;37:1649-54.
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181-247.
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;9:63:e61-111.
Johansen TE, Botto H, Cek M, et al. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system. Int J Antimicrob Agents 2011;38:64-70.
Park J, Kwon YS, Kim HA, et al. Clinical implications of neurological comorbidities and complications in ICU patients with COVID-19. J Clin Med 2021;10:2281.
Harde Y, Manimala Rao S, Sahoo J, et al. Detection of ventilator associated pneumonia, using clinical pulmonary infection score (CPIS) in critically ill neurological patients. J Anesthesiol Clin Sci 2013;2:20.
Jonkman AH, Jansen D, Heunks LM. Novel insights in ICU-acquired respiratory muscle dysfunction: implications for clinical care. Crit Care 2017;21:64.
Jung B, Vaschetto R, Jaber S. Ten tips to optimize weaning and extubation success in the critically ill. Intensive Care Med 2020;46:2461-3.
Asehnoune K, Seguin P, Lasocki S, et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology 2017;127:338-46.
Kifle N, Zewdu D, Abebe B, et al. Incidence of extubation failure and its predictors among adult patients in intensive care unit of low-resource setting: a prospective observational study. PLoS One 2022;17:e0277915.
Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015;350:h2538.
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
Krewulak KD, Stelfox HT, Leigh JP, et al. Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Crit Care Med 2018;46:2029-35.
Ayşe G, Nilda T, Suat T, et al. Stroke complications management in intensive care unit. Turk J Cerebrovasc Dis 2015;3:153-60.
Oddo M, Carrera E, Claassen J, et al. Continuous electroencephalography in the medical intensive care unit. Crit Care Med 2009;37:2051-6.
Warrior L, Bleck PT. Neurological emergencies in the intensive care unit. Clin Pulm Medi 2019;26:53-60.
Kelley RE, Kovacks AG. Mechanism of in-hospital cerebral ischemia. Stroke 1986;17:430-3.
Nadav L, Gur AY, Korczyn AD, Bornstein NM. Stroke in hospitalized patients: are there special risk factors? Cerebrovasc Dis 2002;13:127-31.
Stevens RD, Dowdy DW, Michaels RK, et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007;33:1876-91.
Ortega-Gutierrez S, Wolfe T, Pandya DJ, et al. Neurologic complications in non-neurological intensive care units. Neurologist 2009;15:254-67.
Ethics Approval
The study was approved by the ethics committee of Gazi University Medical Faculty (ethics committee approval number and date: 868, November 23, 2020).How to Cite
Çınar, Zeynep, Eda Macit Aydın, Nurgul Naurzvai, Ayshan Mammadova, Sümeyye Kodalak, Aygül Abbasova, and Gül Gürsel. 2023. “Impact of Neurological Problems on Mechanical Ventilation and Intensive Care Unit Outcomes in Pulmonary Intensive Care Unit Patients: A Retrospective Analysis of a Single-Center Cohort”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2506.
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