Impact of neurological problems on mechanical ventilation and ICU outcomes in the pulmonary ICU patients

Abstract

Neurological problems (NP) are frequently connected with different critical illnesses in intensive care unit (ICU) patients, and they may have an influence on ICU outcomes. The aim of this study is to examine the effects of NPs on ICU outcomes, especially in pulmonary ICU patients. his is a retrospective observational study comprising adult pulmonary critical care patients who were hospitalized between 2015 and 2019. Frequency of NPs at admission, their impact on mechanical ventilation (MV), ICU out comes, the rate of NP development during ICU stay, and risk factors for them were investigated. A total of 361 patients were included in the study, and 130 of them (36%) had NPs (Group 1). NIV requirement rate in patients with NPs was less than in those without NPs (group 2) and the requirement of MV was significantly more frequent in this group (37% & 19%, p<0.05). The duration of MV and sepsis rate were also  higher in Group 1 (19±27& 8±6 days, p: 0.003, p<0.05). NPs developing after ICU admission increased MV requirement 3 times as an independent risk factor. Risk factors for ICU acquired NPs were the existence of sepsis during admission (OR: 2.01, CI95%:1.02-4, p: 0.045) and longer MV durations before ICU admission (OR: 1.05, CI95%:1.004-41.103, p: 0.033). NPs were not independent risk factors for mortality (OR: 0.67, CI 95%: 0.37-1.240, p: 0.207). NPs did not increase mortality but more frequently caused MV requirement, more extubation failure, and longer ICU stay in this study population. Additionally, our data suggest that having sepsis during admission and a longer length of MV prior to admission may increase the neurological complication rate.