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Physiological and Psychosocial Predictors of Ventilator Weaning Outcomes among Intensive Care Units

مجال مشروع البحث–الرئيسي: العلوم الطبية والصحية
مجال مشروع البحث–الثانوي: الامراض المزمنة
المؤسسة العلمية: الجامعة الأردنية
المحافظة: عمان
قيمة الدعم: JD7525.2
سنة الدعم: 2015
حالة المشروع: منتهي مع النشر
البحث منشور: (1) Abdalrahim, M. S., Khalil, A. A., Alramly, M., Alshlool, K. N., Abed, M. A., & Moser, D. K. (2020). Pre-existing chronic kidney disease and acute kidney injury among critically ill patients. Heart & Lung, 49(5), 626-629. (2) Alramly, M. K., Abdalrahim, M. S., & Khalil, A. (2020). Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study. Nutrition and Health, 26(3), 225-229.
ملخص عن مشروع البحث: 1. Background:The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. Objectives: To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. Methods:A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission. Results:Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02–1.05;(P<0.001) and AKI (1.68; 95% CI 1.12–2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0–1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. Conclusion: Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality. https://www.sciencedirect.com/science/article/abs/pii/S0147956320301473 2. Background: Nutritional status has been proven to be associated with poor outcomes in mechanically ventilated patients in intensive care units (ICU). Nutritional assessment has been assessed using different tools. Few data are available on the validity of the modified Nutrition Risk Assessment Tool for Critically Ill (mNUTRIC) score in ICU patients receiving mechanical ventilation (MV). Aim: This study aimed to assess prognostic performance of the mNUTRIC score for discriminative abilities for 30-day mortality and prolonged MV. Methods: This was a multi-centre retrospective study that included 737 mechanically ventilated patients using secondary data analysis. Data were collected on variables required to calculate mNUTRIC score. Patients with a mNUTRIC score ≥5 were considered at nutritional risk. Predictive performance of the mNUTRIC was assessed for discriminative abilities for Acute Physiology and Chronic Health Evaluation II at baseline, mortality in 42 days of follow-up and outcomes related to MV. Results: A total of 737 patients on MV met the inclusion criteria. The majority (57.1%) of patients were male. The mean age of the participants was 62.1±18 years. Of all patients, 482 (58%) were at high nutritional risk (mNUTRIC score ≥5). Median ventilator days were 3 (±7.2) days and 72 (±174) hours. The overall mortality rate was 78.8% (n=652), and weaning failure was 79.8% (n=660). Conclusions: This study showed new evidence on the validity of the mNUTRIC as a tool for assessing nutritional risk in an ICU population in Jordan. The mNUTRIC score obtained from the current retrospective data suggests that the use of the tool can truly identify and diagnose critically ill patients with malnutrition. https://journals.sagepub.com/doi/abs/10.1177/0260106020923832