Factors Associated with Mechanical Ventilation in Sepsis Patients
Researchers who analyzed ten years of data from the University of Michigan Medical Center electronic health data warehouse have identified several risk factors for mechanical ventilation among patients with sepsis. Their study showed —
- 3,891 of 28,747 eligible patients, or 5%, required mechanical ventilation within 30 days after sepsis onset.
- Among that group, 52.6% required mechanical ventilation within 24 hours of diagnosis, 11.3% from one to two days, 8.0% from two to three days, and 28.1% from three to 30 days.
- Patients requiring mechanical ventilation had higher baseline illness severity and a higher prevalence of 27 of the 35 comorbidities on the Elixhauser Comorbidity Index.
- Mechanical ventilation patients had a higher in-hospital mortality rate than patients who did not require mechanical ventilation, 21% vs. 7%.
- Further analysis revealed that of the patients who received mechanical ventilation before but not after sepsis onset, only 35 (4% of 822) died prior to hospital discharge.
- Factors that were independently associated with an increased likelihood that mechanical ventilation would be needed included race, systemic inflammatory response syndrome score, Sequential Organ Failure Assessment (SOFA) score, and congestive heart failure.
- Risks decreased with time for the SOFA score and congestive heart failure, and varied with time for four comorbidities and three culture results.
“Requiring mechanical ventilation is often a pivotal point for patients with sepsis, and their risk of respiratory failure may vary with time,” said study author Robert Freundlich, MD, MS, MSCI, from Vanderbilt University Medical Center. “Identifying patients at high risk and implementing targeted interventions in a timely manner has the potential to significantly improve outcomes.”
The study was published by the American Journal of Critical Care. Read More
A Downside to Removing Race Corrections from Spirometry Results
In the face of mounting evidence about care disparities caused by race corrected spirometry results, the American Thoracic Society now recommends against the practice.
A new study out of Michigan Medicine suggests the recommendation could hurt African-Americans being considered for lung cancer surgery.
The investigators arrived at that conclusion after presenting cardiothoracic surgeons with hypothetical cases for African-American patients, some of which included race corrected spirometry and others of which did not. Results showed the removal of race correction caused a significant reduction in the estimation of lung function among African-Americans, leading the surgeons to be less likely to recommend lung cancer resection.
“The removal of race correction for African-American patients has the potential to change who surgeons consider to be candidates for surgical intervention and what type of surgery may be performed,” said study author Sidra Bonner, MD, PHF, MS. “The change in pulmonary function test numbers could lead surgeons to believe that patients are at a higher risk for post-operative complications or mortality than they actually are.
Dr. Bonner goes on to note that while it is important to remove race correction from spirometry results, it is also important to realize how that removal may impact medical vs. surgical decision-making. “For African-Americans with lung cancer being evaluated for surgery, this may exacerbate existing disparities in lung cancer care,” she said.
She believes surgeons need to educate themselves about the impact and surgical societies need to provide new recommendations governing surgical candidacy for lung cancer resection.
The study was funded by the NIH T32 Institutional Multidisciplinary Research Training Program in Lung Disease. Read More
E-Cigarettes Lead to Smoking Cessation in Large Study
E-cigarettes have been touted for their ability to help people quit smoking, but studies have called that premise into question.
Now researchers from the Medical University of South Carolina add to the debate with a new study that found e-cigarettes do indeed lead people to abstain from traditional cigarettes.
In an attempt to mimic real life situations, the study, which was conducted over four years in 11 U.S. cities and is thought to be the largest such study to date, involved smokers who did and did not state a desire to quit smoking. All the participants were given e-cigarettes and told it was up to them whether they used them or not. A control group received no e-cigarettes.
The investigators found people in the e-cigarette group were more likely to report a complete cessation of traditional cigarette smoking and they were also more likely to report they had cut back on the number of traditional cigarettes they smoked.
Participants in the e-cigarette group reduced their number of quit attempts as well, which the researchers found significant because many people need multiple quit attempts to quit smoking.
While study author Matthew Carpenter, PhD, notes that e-cigarettes are “not a panacea for smoking cessation” he believes these findings suggest they have promise.
“It’s rarely the case that you’re proven correct for almost everything that you predicted,” he said. “Here, it was one effect after another: No matter how we looked at it, those who got the e-cigarette product demonstrated greater abstinence and reduced harm as compared to those who didn’t get it.”
The investigators have now received funding to study e-cigarettes as a stop smoking aid among people who have already tried and failed to quit using two different FDA-approved stop smoking methods.
The study was published by eClinical Medicine. Read More
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