Biomedical subjects

P J Scalise

Publications and source records attributed to P J Scalise.

4 recordsLinked to original sources

PubMed2005

Weaning from long-term mechanical ventilation.

As many as 5% of patients who need mechanical ventilation will require prolonged mechanical ventilation (PMV). The cost of their care and its associated morbidity is alarming; however, good outcomes can be achieved when their care is specialized and delivered in a programmatic manner. In this article, we review some of the common and potentially reversible reasons why patients fail successfully liberation from mechanical ventilation. We examine the outcomes of patients requiring PMV and present evidence that supports the development of specialized units where patients can be cohorted and may produce better outcomes than would be likely if these patients remained in the ICU.

Acute Kidney Injury↗

PubMed1998

COPD and other diseases in chronically ventilated patients in a prolonged respiratory care unit: a retrospective 20-year survival study.

OBJECTIVES: To evaluate the long-term prognosis of ventilator-dependent patients. DESIGN: Retrospective study. SETTING: A prolonged respiratory care unit (PRCU). The PRCU provides comprehensive medical, nursing, and respiratory care to tracheostomized, ventilator-dependent adult patients who had failed all attempts at weaning. Because of their medical complexity, these patients could not be discharged to a lower level of care. PATIENTS: Of the 293 patients admitted to the PRCU over a 20-year period beginning January 1, 1977, 145 had respiratory failure from COPD, 22 from spinal cord disease or trauma, 34 from primary CNS disease, 50 from primary neuromuscular disease, and 16 from chest wall disease. Twenty-six patients were not classifiable into the above categories. MEASUREMENTS: Demographics, diagnoses, and survival data were reviewed. The survival of patients with COPD was compared with the other diagnosis categories using the Cox proportional hazards model. RESULTS: The median survival for the entire group was 9 months; younger age and female gender were both predictive of longer survival (both, p < 0.001). The median survival of those with COPD (5 months) was significantly shorter than that of patients with spinal cord disease (47 months), neuromuscular disease (17 months), and chest wall disease (27 months) (all, p < 0.01). These differences in survival were present even with inclusion of gender and age in the model as covariates. The survival of patients with CNS disease was not significantly different from survival of patients with COPD. CONCLUSION: Chronically ventilated patients with respiratory failure from COPD have a significantly worse prognosis than patients with respiratory failure from other causes.

Adult↗

PubMed1997

A regional weaning center for patients requiring mechanical ventilation: an 18-month experience.

This report reviews the outcomes of patients on mechanical ventilation admitted to a new regional weaning center. We reviewed the records of 47 patients admitted to the weaning center over an 18-month period. All patients had a tracheostomy, were ventilator dependent, and considered difficult to wean by their referring physician. The mean days of ventilator dependence prior to transfer to our facility was 86 days, with a range of 21 to 332 days. Patients were admitted to a 12-bed weaning unit at our chronic disease and rehabilitation hospital and assessed by a multi-disciplinary team of physicians, nurses, and therapists. Thirty patients were successfully weaned from prolonged mechanical ventilation and subsequently discharged from our unit. These data indicate that the majority of difficult to wean patients admitted to our regional weaning center were successfully liberated from prolonged mechanical ventilation.

Aged↗

PubMed1995

Severe hypothermia in the elderly.

Hypothermia is not an uncommon clinical problem in the geriatric population. Several factors place elderly individuals at risk, including their reduced ability to sense and react to cold and their underlying medical conditions and medications. Successful detection and treatment of these patients involve an awareness of these risk factors and the characteristic physiology of the elderly, as well as an appreciation of the often controversial aspects of hypothermia management. Elderly victims of severe hypothermia have a particularly grave prognosis. We present one of the oldest reported survivors of severe hypothermia, and discuss some unique aspects of his presentation.

Aged↗