Articles: intensive-care-units.
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Critical care medicine · May 2023
Observational StudyOccurrence Rate and Outcomes of Weaning Groups According to a Refined Weaning Classification: A Retrospective Observational Study.
The weaning according to a new definition (WIND) classification groups mechanically ventilated (MV) patients into "short weaning," "difficult weaning," "prolonged weaning," and "no weaning." The aims of the study were: 1) to describe the weaning group distribution, 2) to evaluate if "short weaning" patients can be divided into groups with distinct characteristics and outcomes depending on the MV duration, and 3) to study 1-year outcomes related to weaning groups. ⋯ The high proportion of "short weaning" patients in this mainly surgical ICU population could be divided into two groups with distinct characteristics. This refined WIND classification allowed to enhance prognostication, also beyond hospitalization, highlighting the need to further optimize the weaning process.
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Among all surgical specialties, vascular surgery has the greatest proportion of patients with unplanned admissions to the intensive care unit postoperatively. Therefore, current clinical pathways for the postoperative management of vascular surgery patients may need to be revised. We aimed to compare the prevalence of postoperative deterioration in the high and standard risk cohorts of patients through several markers: medical emergency team activations and unplanned intensive care unit admissions. ⋯ In addition, surgical outcome risk tool 5% or greater risk patients were approximately five times more likely to experience a medical emergency team activation than their surgical outcome risk tool less than 5% risk counterparts (relative risk 5.15, 95% confidence interval 3.37-7.86). Our findings highlight the need for a revision of the inpatient journey for surgical outcome risk tool 5% or greater risk vascular patients, given their increased rates of unfavourable postoperative outcomes such as unplanned intensive care unit admission and medical emergency team activation. Ideally this can be addressed through appropriate postoperative triage, thus allowing this vulnerable population group early access to higher acuity care.