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Extubation Readiness in Critically Ill Stroke Patients

Published on Aug 1, 2019in Stroke6.046
· DOI :10.1161/STROKEAHA.118.024643
Sonja Suntrup-Krueger7
Estimated H-index: 7
,
Sarah Schmidt1
Estimated H-index: 1
+ 6 AuthorsRainer Dziewas34
Estimated H-index: 34
Abstract
Background and Purpose— Predicting safe extubation represents a clinical challenge in acute stroke patients. Classical respiratory weaning criteria have not proven reliable. Concerning the paramoun...
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  • Citations (2)
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References0
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#1Rainer DziewasH-Index: 34
#2Rebecca StellatoH-Index: 1
Last. Bettina PfauslerH-Index: 1
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Summary Background Dysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this group of patients. We aimed to replicate and extend this single-centre experience. Methods We did a prospective, single-blind, randomised controlled trial across nine sites (seven acute care hospitals, two rehabilitation facilities) in Germany, Austria, and Italy. Patients with rece...
13 CitationsSource
#1Thomas MarianH-Index: 4
#2Martin W. Dünser (Johannes Kepler University of Linz)H-Index: 9
Last. Rainer DziewasH-Index: 34
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#1Martin Christensen (QUT: Queensland University of Technology)H-Index: 14
#2Michaela TraplH-Index: 1
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#1Joerg C. SchefoldH-Index: 26
#2David H. BergerH-Index: 53
Last. Jukka TakalaH-Index: 54
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OBJECTIVES Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS ICU of a tertiary care academic center. PATIENTS One thousand three-hundred four admissions o...
17 CitationsSource
#1Karim AsehnouneH-Index: 33
#2Philippe SeguinH-Index: 29
Last. Blanloeil YH-Index: 6
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Background:Patients with brain injury are at high risk of extubation failure.Methods:We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with bra
13 CitationsSource
#1Corinna SteidlH-Index: 2
#2Julian BoeselH-Index: 1
Last. Rainer DziewasH-Index: 34
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Background: Both delayed and premature extubation increase complication rate, the need for tracheostomy (TT), the duration of intensive care unit stay, and mortal
12 CitationsSource
#1Victoria A. McCredie (Sunnybrook Health Sciences Centre)H-Index: 7
#2Aziz S. Alali (Sunnybrook Health Sciences Centre)H-Index: 2
Last. Avery B. Nathens (Sunnybrook Health Sciences Centre)H-Index: 60
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Background The optimal timing of tracheostomy placement in acutely brain-injured patients, who generally require endotracheal intubation for airway protection rather than respiratory failure, remains uncertain. We systematically reviewed trials comparing early tracheostomy to late tracheostomy or prolonged intubation in these patients.
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#1Susan E. Langmore S E (BU: Boston University)H-Index: 33
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#1Thomas GodetH-Index: 10
#2Russell ChabanneH-Index: 8
Last. Jean-Michel ConstantinH-Index: 35
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Background:The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients.Methods:One hundred and forty brain-injured patie
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#1Vasileios-Arsenios Lioutas (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 9
#2Khalid A. Hanafy (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 13
Last. Sandeep Kumar (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 20
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Abstract Background Acute ischemic stroke (AIS) patients often undergo intubation and mechanical ventilation (MV). Prolonged intubation and MV have disadvantages and complications. Conventional extubation criteria based only on respiratory parameters are insufficient to guide extubation practices in stroke patients where capacity for airway protection is a major concern. Objective To identify clinical and neuroanatomical markers of successful extubation in AIS patients requiring MV. Methods Retr...
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#1Chiara Robba (UniGe: University of Genoa)H-Index: 3
#2Giulia Bonatti (UniGe: University of Genoa)H-Index: 1
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Most patients with ischaemic stroke are managed on the ward or in specialty stroke units, but a significant number requires higher-acuity care and, consequently, admission to the intensive care unit. Mechanical ventilation is frequently performed in these patients due to swallowing dysfunction and airway or respiratory system compromise. Experimental studies have focused on stroke-induced immunosuppression and brain-lung crosstalk, leading to increased pulmonary damage and inflammation, as well ...
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Besides the traditional indices such as biochemistry, arterial blood gas, rapid shallow breathing index (RSBI), acute physiology and chronic health evaluation (APACHE) II score, this study suggests a data science framework for extubation prediction in the surgical intensive care unit (SICU) and investigates the value of the information our prediction model provides. A data science framework including variable selection (e.g., multivariate adaptive regression splines, stepwise logistic regression...
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#1Ritvij BowryH-Index: 7
#2Ahmad Riad Ramadan (HFHS: Henry Ford Health System)
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