TAILIEUCHUNG - Báo cáo y học: "Impact of renal dysfunction on weaning from prolonged mechanical ventilation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Impact of renal dysfunction on weaning from prolonged mechanical ventilation. | Chao et al. Critical Care 1997 1 101 http c CRITICAL CARE RESEARCH Open Access Impact of renal dysfunction on weaning from prolonged mechanical ventilation David C Chao David J Scheinhorn Meg Stearn-Hassenpflug Abstract Background In the intensive care unit ICU setting the combination of mechanical ventilation and renal replacement therapy RRT has been associated with prolonged length of hospital stay high cost of care and poor outcome. We gathered outcome data on patients who had severe renal dysfunction on transfer to our regional weaning center RWC for attempted weaning from prolonged mechanical ventilation PMV . We screened the admission laboratory values of 1077 patients transferred to our RWC over an 8-year period. We reviewed the medical records of patients with serum creatinine mg dl. Results Sixty-three patients met screening criteria and 40 patients were on RRT at the time of transfer. Eighteen patients had begun chronic RRT at least 2 months prior to admission to the transferring hospital for their current illness. Twenty-two patients had RRT initiated at the transferring hospital. Ten patients had RRT initiated at the RWC eight patients had improvement or resolution of azotemia at our facility. RRT was withheld at patient family request in five patients with progressive renal failure. None of the 50 patients who received RRT recovered renal function during treatment at our RWC. Intermittent hemodialysis was the standard RRT at the RWC. Duration of mechanical ventilation prior to transfer to the RWC was days mean SD . Outcome of weaning attempts in the 63 patients was as follows 13 weaned 3 failed to wean and 84 died. These outcomes were significantly worse P than those in the 1014 patients whose admission serum creatinine was mg dl 58 weaned 15 failed to wean 27 died . The five patients in whom RRT was withheld were predominantly in progressive multisystem organ failure and were unlikely to have survived regardless of

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