This study was performed to identify the physiological and psychological variables related to successful weaning from a mechanical ventilator. The subjects of this study were 22 patients who received mechanical ventilation therapy for more than 3 days in intensive care units. Before the weaning trial, baseline data for following physiologic variables were obtained: spontaneous respiration rate, blood pressure, pulse rate, PaO2, PaCO2, PEEP, static compliance, minute ventilation, tidal volume, rapid shallow breathing index(f/VT), SaO2, PaO2/FiO2 and mean arterial pressure. During spontaneous breathing, physiologic and psychologic variables such as vital signs, ABG, perspiration, chest retraction, paradoxical respiration, dyspnea, anxiety, confidence and efficacy were measured. Successful weaning was defined as sustaining spontaneous respiration over 24 hours after extubation. Weaning failure was defined as the development of more than one of following signs: (1) hypoxemia, (2) CO2 retention or (3) perspiration, tachypnea, chest retraction, tachycardia, arrhythmia, hypotension or hypertension. Subjects (N=18) who successfully weaned from mechanical ventilator were compared with subjects (N=4) who failed. The results are as follows; Eighteen percents of the subjects failed during the weaning trial. Most subjects in the failed group were mechanically ventilated for long-time. This result shows that the success of weaning is more difficult in long-term ventilation patients. In the baseline data that was measured before weaning trial, the mean score of PaO2 in the successfully weaned group was 121mmHg. This is significantly higher than the mean score of PaO2 in the failed group(95mmHg). However, the scores of pH, tidal volume, f/VT, pulse rates, blood pressure, mean airway pressure, SaO2, and PaCO2 were similar between the two groups. Specially the scores of f/VT index as a predominant predictor for successful weaning were not significant (f/VT=44.4) and (f/VT=47). During spontaneous breathing, the scores of dyspnea and anxiety level in the successfully weaned group were less than those of the failed group. On the contrary, the scores of confidence and efficacy in the successful group were greater than those of the failed group. In conclusion, the baseline data that were measured before weaning trial were similar between the both groups, therefore future studies are needed to focus on searching other variables besides physiological parameters related to weaning outcome.
The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities.
The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit.
The mean age was 62.24 (± 17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(± 2.94) and they had on average 4.01(± 1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio= 1.14) and leg swelling (odds ratio= 6.05) were significant predictors of deep vein thrombosis.
Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.