FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3023112859> ?p ?o ?g. }

• W3023112859 endingPage "1463" @default.
• W3023112859 startingPage "1456" @default.
• W3023112859 abstract "BackgroundPalliative ventilator withdrawal (PVW) in the ICU is a common occurrence.Research QuestionThe goal of this study was to measure the rate of severe tachypnea as a proxy for dyspnea and to identify characteristics associated with episodes of tachypnea.Study Design and MethodsThis study assessed a retrospective cohort of ICU patients from 2008 to 2012 mechanically ventilated at a single academic medical center who underwent PVW. The primary outcome of at least one episode of severe tachypnea (respiratory rate > 30 breaths/min) within 6 h after PVW was measured by using detailed physiologic and medical record data. Multivariable logistic regression was used to examine the association between patient and treatment characteristics with the occurrence of a severe episode of tachypnea post extubation.ResultsAmong 822 patients undergoing PVW, 19% and 30% had an episode of severe tachypnea during the 1-h and 6-h postextubation period, respectively. Within 1 h postextubation, patients with the following characteristics were more likely to experience tachypnea: no pre-extubation opiates (adjusted OR [aOR], 2.08; 95% CI, 1.03-4.19), lung injury (aOR, 3.33; 95% CI, 2.19-5.04), Glasgow Coma Scale score > 8 (aOR, 2.21; 95% CI, 1.30-3.77), and no postextubation opiates (aOR, 1.90; 95% CI, 1.19-3.00).InterpretationUp to one-third of ICU patients undergoing PVW experience severe tachypnea. Administration of pre-extubation opiates (anticipatory dosing) represents a key modifiable factor that may reduce poor symptom control. Palliative ventilator withdrawal (PVW) in the ICU is a common occurrence. The goal of this study was to measure the rate of severe tachypnea as a proxy for dyspnea and to identify characteristics associated with episodes of tachypnea. This study assessed a retrospective cohort of ICU patients from 2008 to 2012 mechanically ventilated at a single academic medical center who underwent PVW. The primary outcome of at least one episode of severe tachypnea (respiratory rate > 30 breaths/min) within 6 h after PVW was measured by using detailed physiologic and medical record data. Multivariable logistic regression was used to examine the association between patient and treatment characteristics with the occurrence of a severe episode of tachypnea post extubation. Among 822 patients undergoing PVW, 19% and 30% had an episode of severe tachypnea during the 1-h and 6-h postextubation period, respectively. Within 1 h postextubation, patients with the following characteristics were more likely to experience tachypnea: no pre-extubation opiates (adjusted OR [aOR], 2.08; 95% CI, 1.03-4.19), lung injury (aOR, 3.33; 95% CI, 2.19-5.04), Glasgow Coma Scale score > 8 (aOR, 2.21; 95% CI, 1.30-3.77), and no postextubation opiates (aOR, 1.90; 95% CI, 1.19-3.00). Up to one-third of ICU patients undergoing PVW experience severe tachypnea. Administration of pre-extubation opiates (anticipatory dosing) represents a key modifiable factor that may reduce poor symptom control. FOR EDITORIAL COMMENT, SEE PAGE 1317Nearly 25% of deaths in the United States occur in ICUs.1Angus D.C. Barnato A.E. Linde-Zwirble W.T. et al.Use of intensive care at the end of life in the United States: an epidemiologic study.Crit Care Med. 2004; 32: 638-643Crossref PubMed Scopus (858) Google Scholar,2Khandelwal N. Benkeser D. Coe N.B. Engelberg R.A. Teno J.M. Curtis J.R. Patterns of cost for patients dying in the intensive care unit and implications for cost savings of palliative care interventions.J Palliat Med. 2016; 19: 1171-1178Crossref PubMed Scopus (37) Google Scholar The majority of deaths in the ICU reflect a transition from curative to comfort-focused care through a process of palliative ventilator withdrawal (PVW).3Cook D. Rocker G. Dying with dignity in the intensive care unit.N Engl J Med. 2014; 370: 2506-2514Crossref PubMed Scopus (194) Google Scholar Numerous professional societies and patient groups have advocated for improved management of ventilated ICU patients transitioning to palliative care.4Carlet J. Thijs L.G. Antonelli M. et al.Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003.Intensive Care Med. 2004; 30: 770-784Crossref PubMed Scopus (394) Google Scholar, 5Holloway R.G. Arnold R.M. Creutzfeldt C.J. et al.Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 1887-1916Crossref PubMed Scopus (190) Google Scholar, 6Lanken P.N. Terry P.B. Delisser H.M. et al.An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses.Am J Respir Crit Care Med. 2008; 177: 912-927Crossref PubMed Scopus (564) Google Scholar, 7Salinas J. Sprinkhuizen S.M. Ackerson T. et al.An international standard set of patient-centered outcome measures after stroke.Stroke. 2016; 47: 180-186Crossref PubMed Scopus (143) Google Scholar, 8Steinhauser K.E. Christakis N.A. Clipp E.C. McNeilly M. McIntyre L. Tulsky J.A. Factors considered important at the end of life by patients, family, physicians, and other care providers.JAMA. 2000; 284: 2476-2482Crossref PubMed Scopus (1889) Google Scholar, 9Teno J.M. Clarridge B.R. Casey V. et al.Family perspectives on end-of-life care at the last place of care.JAMA. 2004; 291: 88-93Crossref PubMed Scopus (1207) Google Scholar, 10Truog R.D. Campbell M.L. Curtis J.R. et al.Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine.Crit Care Med. 2008; 36: 953-963Crossref PubMed Scopus (739) Google Scholar Research conducted over the past 15 years has informed several aspects of palliative care in the ICU setting, particularly how to improve communication and family-centered care.10Truog R.D. Campbell M.L. Curtis J.R. et al.Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine.Crit Care Med. 2008; 36: 953-963Crossref PubMed Scopus (739) Google Scholar, 11Carson S.S. Cox C.E. Wallenstein S. et al.Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial.JAMA. 2016; 316: 51-62Crossref PubMed Scopus (199) Google Scholar, 12Creutzfeldt C.J. Hanna M.G. Cheever C.S. et al.Palliative care needs assessment in the neuro-ICU: effect on family.Neurocritical Care. 2017; 27: 163-172Crossref PubMed Scopus (11) Google Scholar, 13A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). The SUPPORT Principal Investigators.JAMA. 1995; 274 ([published correction appears in JAMA. 1996;275(16):1232]): 1591-1598Crossref PubMed Google Scholar, 14Lautrette A. Darmon M. Megarbane B. et al.A communication strategy and brochure for relatives of patients dying in the ICU.N Engl J Med. 2007; 356: 469-478Crossref PubMed Scopus (888) Google Scholar, 15Nelson J.E. Curtis J.R. Mulkerin C. et al.Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board.Crit Care Med. 2013; 41: 2318-2327Crossref PubMed Scopus (140) Google Scholar, 16Sullivan A.M. Rock L.K. Gadmer N.M. Norwich D.E. Schwartzstein R.M. The impact of resident training on communication with families in the intensive care unit. Resident and family outcomes.Ann Am Thorac Soc. 2016; 13: 512-521Crossref PubMed Scopus (27) Google Scholar, 17Aslakson R.A. Reinke L.F. Cox C. Kross E.K. Benzo R.P. Curtis J.R. Developing a research agenda for integrating palliative care into critical care and pulmonary practice to improve patient and family outcomes.J Palliat Med. 2017; 20: 329-343Crossref PubMed Scopus (28) Google Scholar, 18Davidson J.E. Aslakson R.A. Long A.C. et al.Guidelines for family-centered care in the neonatal, pediatric, and adult ICU.Crit Care Med. 2017; 45: 103-128Crossref PubMed Scopus (696) Google Scholar, 19Curtis J.R. Downey L. Engelberg R.A. The importance and challenge of measuring family experience with end-of-life care in the ICU.Intensive Care Med. 2016; 42: 1179-1181Crossref PubMed Scopus (7) Google Scholar, 20Curtis J.R. Treece P.D. Nielsen E.L. et al.Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care.Am J Respir Crit Care Med. 2016; 193: 154-162Crossref PubMed Scopus (211) Google Scholar, 21Seaman J.B. Arnold R.M. Scheunemann L.P. White D.B. An integrated framework for effective and efficient communication with families in the adult intensive care unit.Ann Am Thorac Soc. 2017; 14: 1015-1020Crossref PubMed Scopus (32) Google Scholar, 22White D.B. Ernecoff N. Buddadhumaruk P. et al.Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients.JAMA. 2016; 315: 2086-2094Crossref PubMed Scopus (125) Google Scholar, 23White D.B. Cua S.M. Walk R. et al.Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness.Am J Crit Care. 2012; 21: 396-409Crossref PubMed Scopus (68) Google Scholar, 24Zier L.S. Burack J.H. Micco G. Chipman A.K. Frank J.A. White D.B. Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar, 25White D.B. Engelberg R.A. Wenrich M.D. Lo B. Curtis J.R. The language of prognostication in intensive care units.Med Decis Making. 2010; 30: 76-83Crossref PubMed Scopus (70) Google Scholar, 26Engelberg R.A. Downey L. Wenrich M.D. et al.Measuring the quality of end-of-life care.J Pain Symptom Manage. 2010; 39: 951-971Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 27Curtis J.R. Engelberg R.A. Wenrich M.D. et al.Studying communication about end-of-life care during the ICU family conference: development of a framework.J Crit Care. 2002; 17: 147-160Crossref PubMed Scopus (172) Google Scholar In contrast, relatively little research has focused on the process of PVW. The practice therefore varies widely across ICUs,28Abarshi E.A. Papavasiliou E.S. Preston N. Brown J. Payne S. Euro I. The complexity of nurses' attitudes and practice of sedation at the end of life: a systematic literature review.J Pain Symptom Manage. 2014; 47: 915-925.e911Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 29Brinkkemper T. van Norel A.M. Szadek K.M. Loer S.A. Zuurmond W.W. Perez R.S. The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: a systematic review.Palliat Med. 2013; 27: 54-67Crossref PubMed Scopus (40) Google Scholar, 30Mayer S.A. Kossoff S.B. Withdrawal of life support in the neurological intensive care unit.Neurology. 1999; 52: 1602-1609Crossref PubMed Google Scholar, 31Papavasiliou E.S. Brearley S.G. Seymour J.E. Brown J. Payne S.A. Euro I. From sedation to continuous sedation until death: how has the conceptual basis of sedation in end-of-life care changed over time?.J Pain Symptom Manage. 2013; 46: 691-706Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 32van Beinum A. Hornby L. Ward R. Ramsay T. Dhanani S. Variations in the operational process of withdrawal of life-sustaining therapy.Crit Care Med. 2015; 43: e450-e457Crossref PubMed Scopus (7) Google Scholar, 33Robert R. Le Gouge A. Kentish-Barnes N. et al.Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).Intensive Care Med. 2017; 43 ([published correction appears in Intensive Care Med. 2017;43(12):1942-1943]): 1793-1807Crossref PubMed Scopus (43) Google Scholar, 34Campbell M.L. How to withdraw mechanical ventilation: a systematic review.AACN Adv Crit Care. 2007; 18: 397-403Crossref PubMed Scopus (51) Google Scholar and little is known about factors associated with better symptom control among terminally ill patients undergoing this procedure. FOR EDITORIAL COMMENT, SEE PAGE 1317 Patients undergoing PVW who are able to report symptoms describe the sensation of breathlessness or dyspnea as the most distressing symptom they experienced.10Truog R.D. Campbell M.L. Curtis J.R. et al.Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine.Crit Care Med. 2008; 36: 953-963Crossref PubMed Scopus (739) Google Scholar,35Campbell M.L. Dyspnea prevalence, trajectories, and measurement in critical care and at life’s end.Curr Opin Support Palliat Care. 2012; 6: 168-171Crossref PubMed Scopus (19) Google Scholar, 36Campbell M.L. Bizek K.S. Thill M. Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study.Crit Care Med. 1999; 27: 73-77Crossref PubMed Scopus (85) Google Scholar, 37Puntillo K. Nelson J.E. Weissman D. et al.Palliative care in the ICU: relief of pain, dyspnea, and thirst—a report from the IPAL-ICU advisory board.Intensive Care Med. 2014; 40: 235-248Crossref PubMed Scopus (108) Google Scholar Unfortunately, there are few data to guide the clinical approach to minimizing respiratory distress during PVW. Although evidence suggests lower rates of respiratory distress with gradual reduction of ventilator support (terminal weaning) vs immediate extubation,33Robert R. Le Gouge A. Kentish-Barnes N. et al.Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).Intensive Care Med. 2017; 43 ([published correction appears in Intensive Care Med. 2017;43(12):1942-1943]): 1793-1807Crossref PubMed Scopus (43) Google Scholar it is unknown whether administering analgesia/sedation pre-extubation (anticipatory dosing)38Billings J.A. Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation.Crit Care Med. 2012; 40: 625-630Crossref PubMed Scopus (49) Google Scholar,39Delaney J.W. Downar J. How is life support withdrawn in intensive care units: a narrative review.J Crit Care. 2016; : 12-18Crossref PubMed Scopus (8) Google Scholar relieves distress more effectively than giving these drugs only in response to observed symptoms.40Truog R.D. Cist A.F. Brackett S.E. et al.Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine.Crit Care Med. 2001; 29: 2332-2348Crossref PubMed Scopus (368) Google Scholar,41Truog R.D. Brock D.W. White D.B. Should patients receive general anesthesia prior to extubation at the end of life?.Crit Care Med. 2012; 40: 631-633Crossref PubMed Scopus (31) Google Scholar Assessing physical discomfort among patients undergoing PVW is challenging. A study of terminally ill ICU patients found that 50% were unable to communicate and 20% to 30% were comatose.42Smedira N.G. Evans B.H. Grais L.S. et al.Witholding and withdrawal of life support from the critically ill.N Engl J Med. 1990; 322: 309-315Crossref PubMed Scopus (432) Google Scholar Empirical evidence suggests that many patients deemed comatose retain the ability to experience the sensation of respiratory distress.43Campbell M.L. Respiratory distress: a model of responses and behaviors to an asphyxial threat for patients who are unable to self-report.Heart Lung. 2008; 37: 54-60Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar Moreover, a study of 104 ICU patients, most with neurologic injuries, found that 40% of patients deemed comatose by highly trained physicians actually displayed clinical signs of consciousness.44Schnakers C. Vanhaudenhuyse A. Giacino J. et al.Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.BMC Neurol. 2009; 9: 35Crossref PubMed Scopus (857) Google Scholar Taken together, the current report leverages the Medical Information Mart for Intensive Care III (MIMIC-III) database45Johnson A.E. Pollard T.J. Shen L. et al.MIMIC-III, a freely accessible critical care database.Sci Data. 2016; 3: 160035Crossref PubMed Scopus (3107) Google Scholar to better examine severe tachypnea in a cohort of ICU patients undergoing PVW. MIMIC is a rich dataset that collects detailed physiologic and clinical data from patients cared for in the seven ICUs at Beth Israel Deaconess Medical Center. The main objectives of the study were to describe the prevalence and identify modifiable factors associated with the occurrence of severe tachypnea among patients who underwent PVW through development of multivariable prediction models. Data were ascertained from the MIMIC-III,45Johnson A.E. Pollard T.J. Shen L. et al.MIMIC-III, a freely accessible critical care database.Sci Data. 2016; 3: 160035Crossref PubMed Scopus (3107) Google Scholar a publicly available dataset managed by the Laboratory for Computational Physiology at the Massachusetts Institute of Technology,46MIMIC-III Critical Care Database.https://mimic.physionet.org/about/mimic/Date accessed: September 1, 2018Google Scholar which includes data from seven medical, surgical, and subspecialty ICUs at the Beth Israel Deaconess Medical Center. Data from January 1, 2008, to December 31, 2012, were used for this study. MIMIC-III contains de-identified, high-resolution physiologic and treatment data, including chart notes, continuous telemetry data and vital signs, nursing assessments, and the complete electronic health record.45Johnson A.E. Pollard T.J. Shen L. et al.MIMIC-III, a freely accessible critical care database.Sci Data. 2016; 3: 160035Crossref PubMed Scopus (3107) Google Scholar The study received exempt status by the Institutional Review Board at Beth Israel Deaconess Medical Center. Subjects who were mechanically ventilated and underwent PVW were identified from MIMIC-III based on the following eligibility criteria: (1) age ≥ 18 years; (2) mechanical ventilation followed by extubation; (3) comfort measures only (CMO) documented in an order or physician note prior to ventilator withdrawal (CMO order indicates all therapies are directed toward comfort but does not specify particular treatment approaches); and (4) death within 24 h of extubation. Sample size was determined by convenience sample of all data available for analysis. Patient-level variables were extracted from the dataset as potentially associated with tachypnea or treatment of dyspnea based on prior literature26Engelberg R.A. Downey L. Wenrich M.D. et al.Measuring the quality of end-of-life care.J Pain Symptom Manage. 2010; 39: 951-971Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar,28Abarshi E.A. Papavasiliou E.S. Preston N. Brown J. Payne S. Euro I. The complexity of nurses' attitudes and practice of sedation at the end of life: a systematic literature review.J Pain Symptom Manage. 2014; 47: 915-925.e911Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar,32van Beinum A. Hornby L. Ward R. Ramsay T. Dhanani S. Variations in the operational process of withdrawal of life-sustaining therapy.Crit Care Med. 2015; 43: e450-e457Crossref PubMed Scopus (7) Google Scholar, 33Robert R. Le Gouge A. Kentish-Barnes N. et al.Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).Intensive Care Med. 2017; 43 ([published correction appears in Intensive Care Med. 2017;43(12):1942-1943]): 1793-1807Crossref PubMed Scopus (43) Google Scholar, 34Campbell M.L. How to withdraw mechanical ventilation: a systematic review.AACN Adv Crit Care. 2007; 18: 397-403Crossref PubMed Scopus (51) Google Scholar, 35Campbell M.L. Dyspnea prevalence, trajectories, and measurement in critical care and at life’s end.Curr Opin Support Palliat Care. 2012; 6: 168-171Crossref PubMed Scopus (19) Google Scholar,40Truog R.D. Cist A.F. Brackett S.E. et al.Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine.Crit Care Med. 2001; 29: 2332-2348Crossref PubMed Scopus (368) Google Scholar,47Soffler M.I. Rose A. Hayes M.M. Banzett R. Schwartzstein R.M. Treatment of acute dyspnea with morphine to avert respiratory failure.Ann Am Thorac Soc. 2017; 14: 584-588Crossref PubMed Scopus (10) Google Scholar, 48Binks A.P. Desjardin S. Riker R. ICU clinicians underestimate breathing discomfort in ventilated subjects.Respir Care. 2017; 62: 150-155Crossref PubMed Scopus (26) Google Scholar, 49Cottereau A. Robert R. le Gouge A. et al.ICU physicians' and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study.Intensive Care Med. 2016; 42: 1248-1257Crossref PubMed Scopus (17) Google Scholar, 50Campbell M.L. Yarandi H.N. Mendez M.A. Two-group trial of a terminal ventilator withdrawal algorithm: pilot testing.J Palliat Med. 2015; 18: 781-785Crossref PubMed Scopus (19) Google Scholar, 51Deschepper R. Laureys S. Hachimi-Idrissi S. Poelaert J. Distelmans W. Bilsen J. Palliative sedation: why we should be more concerned about the risks that patients experience an uncomfortable death.Pain. 2013; 154: 1505-1508Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 52Sanders R.D. Tononi G. Laureys S. Sleigh J.W. Unresponsiveness does not equal unconsciousness.Anesthesiology. 2012; 116: 946-959Crossref PubMed Scopus (279) Google Scholar, 53Parshall M.B. Schwartzstein R.M. Adams L. et al.An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.Am J Respir Crit Care Med. 2012; 185: 435-452Crossref PubMed Scopus (1100) Google Scholar, 54Willms D.C. Brewer J.A. Survey of respiratory therapists’ attitudes and concerns regarding terminal extubation.Respir Care. 2005; 50: 1046-1049PubMed Google Scholar, 55Curtis J.R. Interventions to improve care during withdrawal of life-sustaining treatments.J Palliative Med. 2005; 8: 116-131Crossref Scopus (26) Google Scholar, 56O'Mahony S. McHugh M. Zallman L. Selwyn P. Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service.J Pain Symptom Manage. 2003; 26: 954-961Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 57Cook D. Rocker G. Marshall J. et al.Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit.N Engl J Med. 2003; 349: 1123-1132Crossref PubMed Scopus (349) Google Scholar, 58Hawryluck L.A. Harvey W.R. Lemieux-Charles L. Singer P.A. Consensus guidelines on analgesia and sedation in dying intensive care unit patients.BMC Med Ethics. 2002; 3: E3Crossref PubMed Google Scholar and clinical experience. These variables included: demographic characteristics, insurance status, Glasgow Coma Scale (GCS) score (a score > 8 indicates lack of severe coma),59Teasdale G. Jennett B. Assessment of coma and impaired consciousness: a practical scale.Lancet. 1974; 2: 81-84Abstract PubMed Scopus (9534) Google Scholar the number of ventilator days (dichotomized at the median of 48 h), and Sequential Organ Failure Assessment (SOFA)60Vincent J.L. de Mendonca A. Cantraine F. et al.Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study.Crit Care Med. 1998; 26: 1793-1800Crossref PubMed Scopus (2374) Google Scholar score (dichotomized at the median > 8) and its components (eg, Pao2/Fio2 ratio most proximal to extubation).61Knaus W.A. Draper E.A. Wagner D.P. Zimmerman J.E. APACHE II: a severity of disease classification system.Crit Care Med. 1985; 13: 818-829Crossref PubMed Scopus (13393) Google Scholar A binary variable was created indicating the presence of reduced diffusion capacity of lung Pao2/Fio2 < 200, a marker of ARDS. Anticipatory dosing with opioids was defined as the administration (by any route, bolus, or increase in continuous infusion rate) of morphine, fentanyl, or hydromorphone within 1 h pre-extubation.38Billings J.A. Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation.Crit Care Med. 2012; 40: 625-630Crossref PubMed Scopus (49) Google Scholar,41Truog R.D. Brock D.W. White D.B. Should patients receive general anesthesia prior to extubation at the end of life?.Crit Care Med. 2012; 40: 631-633Crossref PubMed Scopus (31) Google Scholar,62Mazer M.A. Alligood C.M. Wu Q. The infusion of opioids during terminal withdrawal of mechanical ventilation in the medical intensive care unit.J Pain Symptom Manage. 2011; 42: 44-51Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Fentanyl and hydromorphone were converted to morphine-equivalent doses, and a binary variable was created indicating whether opiates were administered within 60 min prior to extubation. Postextubation opiate administration was indicated by variables created in a similar fashion (morphine and morphine-equivalent doses of fentanyl and hydromorphone) at 1 h and 6 h postextubation, respectively. Variables indicating benzodiazepine (midazolam, lorazepam, and diazepam) and propofol administration were created at the time points of within 60 min prior to and 60 min following extubation. Primary and secondary ICU diagnoses were extracted from the electronic health record. Primary neurologic diagnosis was defined by the presence of any International Classification of Diseases, Tenth Revision, code for ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, status epilepticus, anoxic brain injury, cerebral edema, brain herniation/compression, hydrocephalus, or brain mass.63van Drimmelen-Krabbe J.J. Bradley W.G. Orgogozo J.M. Sartorius N. The application of the International Statistical Classification of Diseases to neurology: ICD-10.J Neurol Sci. 1998; 161: 2-9Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Physiologic measures such as heart rate, respiratory rate, and other vital signs were obtained from telemetry data for up to 6 h post-extubation or death. All telemetry data are validated by a patient’s ICU nurse, with inaccurate values corrected or removed as part of routine clinical documentation. ICU type (eg, medical, surgical, subspecialty) was also extracted. The primary outcome of interest was severe tachypnea following PVW. The American Thoracic Society defines dyspnea as the “subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”53Parshall M.B. Schwartzstein R.M. Adams L. et al.An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.Am J Respir Crit Care Med. 2012; 185: 435-452Crossref PubMed Scopus (1100) Google Scholar Dyspnea is therefore not uniformly assessed, and although tachypnea is not equivalent to dyspnea, it is a measurable objective sign that correlates with breathlessness in controlled settings.64Simon P.M. Schwartzstein R.M. Weiss J.W. et al.Distinguishable sensations of breathlessness induced in normal volunteers.Am Rev Respir Dis. 1989; 140: 1021-1027Crossref PubMed Scopus (219) Google Scholar,65Banzett R.B. Pedersen S.H. Schwartzstein R.M. Lansing R.W. The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort.Am J Respir Crit Care Med. 2008; 177: 1384-1390Crossref PubMed Scopus (177) Google Scholar We used a respiratory rate of > 30 breaths/min (validated from telemetry) to define severe tachypnea,66McGee S. Evidence-Based Physical Diagnosis.3rd ed. Elsevier, New York, NY2012: 145-155Crossref Google Scholar which was measured up to 1 h and until 6 h from the time of extubation or death. Frequencies were used to describe all variables. Bivariate analyses using logistic regression measured the association of individual independent variables and the occurrence of a severe tachypnea episode measured at two time points: within 1 h and 6 h postextubation (outcomes). The following patient characteristics (described in the Data Elements section) were included as independent variables: demographic information, GCS score > 8, mechanical ventilation > 48 h prior to PVW, SOFA score > 8, Pao2/Fio2 ratio < 200, anticipatory dosing with opiates, pre-extubation and postextubation benzodiazepine and propofol use, opiate dosing within 1 h and 6 h postextubation, non-neurologic primary diagnosis, and ICU type. The process for selection of variables was as follows: independent variables associated with the outcomes at P < .20 in these unadjusted analyses were included in a multivariable logistic regression model for the outcome at 1 h and 6 h, controlling for time at risk (patient survival time). Repeated episodes of severe tachypnea within the same patient, and patients who died, were censored from the analysis of population at risk. Complete case analysis was used for missing data. ORs with 95% CIs were generated from these analyses. A Cox proportional hazards model described time to tachypnea event, and Kaplan-Meier time-to-event curves were generated comparing patients receiving and not receiving anticipatory dosing of opiates. Analyses were performed by using R version 3.6.2 (R Foundation for Statistical Computing) and Stata version 13 (StataCorp) software packages. Among the 17,692 patients in the MIMIC-III database during the years 2008 to 2012, there were 1,251 patients undergoing PVW. The analytical sample consisted of 822 patients with complete CMO and postextubation respiratory rate data available for analysis; 248 of these patients (30%) experienced at least one episode of severe tachypnea following PVW. Median age was 73 yea" @default.
• W3023112859 created "2020-05-13" @default.
• W3023112859 creator A5000597528 @default.
• W3023112859 creator A5031401755 @default.
• W3023112859 creator A5036684117 @default.
• W3023112859 creator A5046251307 @default.
• W3023112859 creator A5051833274 @default.
• W3023112859 creator A5070034048 @default.
• W3023112859 creator A5079984972 @default.
• W3023112859 creator A5089086037 @default.
• W3023112859 date "2020-10-01" @default.
• W3023112859 modified "2023-10-03" @default.
• W3023112859 title "Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation" @default.
• W3023112859 cites W1558599585 @default.
• W3023112859 cites W1563613436 @default.
• W3023112859 cites W1603121691 @default.
• W3023112859 cites W1757329641 @default.
• W3023112859 cites W1829337408 @default.
• W3023112859 cites W1847706259 @default.
• W3023112859 cites W1968923393 @default.
• W3023112859 cites W1974571142 @default.
• W3023112859 cites W1990673433 @default.
• W3023112859 cites W1991864206 @default.
• W3023112859 cites W2003775456 @default.
• W3023112859 cites W2009552025 @default.
• W3023112859 cites W2012404050 @default.
• W3023112859 cites W2013516713 @default.
• W3023112859 cites W2020191261 @default.
• W3023112859 cites W2031184972 @default.
• W3023112859 cites W2032504730 @default.
• W3023112859 cites W2035099993 @default.
• W3023112859 cites W2037445092 @default.
• W3023112859 cites W2037474741 @default.
• W3023112859 cites W2041741066 @default.
• W3023112859 cites W2043202680 @default.
• W3023112859 cites W2045228479 @default.
• W3023112859 cites W2045932891 @default.
• W3023112859 cites W2046174927 @default.
• W3023112859 cites W2050264738 @default.
• W3023112859 cites W2053302108 @default.
• W3023112859 cites W2059193009 @default.
• W3023112859 cites W2059471040 @default.
• W3023112859 cites W2061664312 @default.
• W3023112859 cites W2073859061 @default.
• W3023112859 cites W2074546317 @default.
• W3023112859 cites W2085285941 @default.
• W3023112859 cites W2095250018 @default.
• W3023112859 cites W2116965226 @default.
• W3023112859 cites W2120711353 @default.
• W3023112859 cites W2125130977 @default.
• W3023112859 cites W2126086977 @default.
• W3023112859 cites W2128195581 @default.
• W3023112859 cites W2130868065 @default.
• W3023112859 cites W2131800241 @default.
• W3023112859 cites W2131807433 @default.
• W3023112859 cites W2134387356 @default.
• W3023112859 cites W2137249080 @default.
• W3023112859 cites W2152325645 @default.
• W3023112859 cites W2168722963 @default.
• W3023112859 cites W2177727633 @default.
• W3023112859 cites W2317498994 @default.
• W3023112859 cites W2321840258 @default.
• W3023112859 cites W2327535022 @default.
• W3023112859 cites W2328288740 @default.
• W3023112859 cites W2333247239 @default.
• W3023112859 cites W2335020000 @default.
• W3023112859 cites W2338509351 @default.
• W3023112859 cites W2345956474 @default.
• W3023112859 cites W2396881363 @default.
• W3023112859 cites W2407608263 @default.
• W3023112859 cites W2462215746 @default.
• W3023112859 cites W2503390110 @default.
• W3023112859 cites W2560860516 @default.
• W3023112859 cites W2567172426 @default.
• W3023112859 cites W2594712960 @default.
• W3023112859 cites W2599557759 @default.
• W3023112859 cites W2605222242 @default.
• W3023112859 cites W2734885549 @default.
• W3023112859 cites W2747226248 @default.
• W3023112859 cites W4237872303 @default.
• W3023112859 cites W4251279442 @default.
• W3023112859 cites W4293242440 @default.
• W3023112859 doi "https://doi.org/10.1016/j.chest.2020.04.027" @default.
• W3023112859 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7545486" @default.
• W3023112859 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/32360728" @default.
• W3023112859 hasPublicationYear "2020" @default.
• W3023112859 type Work @default.
• W3023112859 sameAs 3023112859 @default.
• W3023112859 citedByCount "8" @default.
• W3023112859 countsByYear W30231128592020 @default.
• W3023112859 countsByYear W30231128592022 @default.
• W3023112859 countsByYear W30231128592023 @default.
• W3023112859 crossrefType "journal-article" @default.
• W3023112859 hasAuthorship W3023112859A5000597528 @default.
• W3023112859 hasAuthorship W3023112859A5031401755 @default.
• W3023112859 hasAuthorship W3023112859A5036684117 @default.
• W3023112859 hasAuthorship W3023112859A5046251307 @default.
• W3023112859 hasAuthorship W3023112859A5051833274 @default.

• next