APACHE II score predicts mortality in patients requiring prolonged ventilation in a weaning center

  BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature. Objective: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon. METHODS: This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU). RESULTS: Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study. CONCLUSIONS: It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.  BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature. Objective: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon. METHODS: This was a retrospective cohort design conducted at a tertiary care cardiovascular intensive care unit at an academic medical centre. All patients who underwent VV-ECMO from 2009 to 2014 were included in the study except for those who had been decannulated for withdrawal of care. Complication rates from decannulation were compared between patients who were decannulated by surgeons in the operating room and those decannulated by intensivists in the intensive care unit (ICU). RESULTS: Twenty-eight patients were included in this study, of whom twenty-three patients (82%) were decannulated by intensivists, board certified in Critical Care Medicine through the American Board of Anesthesiology, while five (18%) the patients were decannulated by a surgeon. There was no significant difference in the complications rates between the surgeons (0) and intensivists (1) (P = 1.00). There were no major complications requiring operative intervention associated with decannulation identified in this study. CONCLUSIONS: It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs

A single-centre 7-year experience with weaning from mechanical ventilation

Background: Weaning from mechanical ventilation is a growing and challenging issue in modern intensive care medicine. We aimed to describe a 7-year experience in mechanical ventilation weaning of a single centre in Germany. Methods: We retrospectively analysed data regarding 403 patients admitted between 2007 and 2013 with difficult or prolonged mechanical ventilation weaning. Results: There were 261 men (64.8%) in the population. The median age was 72 (IQR 63; 77) years. The underlying reasons for ventilator dependence comprised: post-operative respiratory failure (56.3%), exacerbation of chronic obstructive pulmonary disease (14.4%) and pneumonia (7.4%). A tracheostomy was performed about 9 (IQR 7; 14) days after the last attempt of a spontaneous breathing trial, usually with the percutaneous method (89.3%). The median length of stay was 28 (IQR 20; 41) days. Sixty-five (16.1%) patients died. Among the survivors, complete ventilator independence was achieved in 316 (78.4%) subjects while 94 (29.7%) of them required a tracheal tube on discharge. The vast majority of patients were discharged to rehabilitation clinics (56.1%). All of the analysed parameters did not statistically significantly differ between consecutive years in the investigated period. Conclusion: Our initial results of mechanical ventilation weaning are encouraging, repeatable in subsequent years of observation and consistent with the literature data. Assessing the predictors of successful mechanical ventilation weaning requires further research.Background: Weaning from mechanical ventilation is a growing and challenging issue in modern intensive care medicine. We aimed to describe a 7-year experience in mechanical ventilation weaning of a single centre in Germany. Methods: We retrospectively analysed data regarding 403 patients admitted between 2007 and 2013 with difficult or prolonged mechanical ventilation weaning. Results: There were 261 men (64.8%) in the population. The median age was 72 (IQR 63; 77) years. The underlying reasons for ventilator dependence comprised: post-operative respiratory failure (56.3%), exacerbation of chronic obstructive pulmonary disease (14.4%) and pneumonia (7.4%). A tracheostomy was performed about 9 (IQR 7; 14) days after the last attempt of a spontaneous breathing trial, usually with the percutaneous method (89.3%). The median length of stay was 28 (IQR 20; 41) days. Sixty-five (16.1%) patients died. Among the survivors, complete ventilator independence was achieved in 316 (78.4%) subjects while 94 (29.7%) of them required a tracheal tube on discharge. The vast majority of patients were discharged to rehabilitation clinics (56.1%). All of the analysed parameters did not statistically significantly differ between consecutive years in the investigated period. Conclusion: Our initial results of mechanical ventilation weaning are encouraging, repeatable in subsequent years of observation and consistent with the literature data. Assessing the predictors of successful mechanical ventilation weaning requires further research