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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/27842756/evolving-concepts-in-mechanical-ventilation
#1
EDITORIAL
Neil MacIntyre
No abstract text is available yet for this article.
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842755/extracorporeal-gas-exchange-the-expanding-role-of-extracorporeal-support-in-respiratory-failure
#2
REVIEW
Nikunj Bhatt, Erik Osborn
The use of extracorporeal support is expanding quickly in adult respiratory failure. Extracorporeal gas exchange is an accepted rescue therapy for severe acute respiratory distress syndrome (ARDS) in select patients. Extracorporeal carbon dioxide removal is also being investigated as a preventative, preemptive, and management platform in patients with respiratory failure other than severe ARDS. The non-ARDS patient population is much larger, so the potential for rapid growth is high. This article hopes to inform decisions about the use of extracorporeal support by increasing understanding concerning the past and present practice of extracorporeal gas exchange...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842754/long-term-mechanical-ventilation
#3
REVIEW
Sarina Sahetya, Sarah Allgood, Peter C Gay, Noah Lechtzin
Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842753/the-changing-role-for-tracheostomy-in-patients-requiring-mechanical-ventilation
#4
REVIEW
Kamran Mahmood, Momen M Wahidi
Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842752/management-of-sedation-and-paralysis
#5
REVIEW
Michael A Fierro, Raquel R Bartz
Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Deep sedation plus muscle relaxants may be required to treat PVD or to reduce oxygen consumption and carbon dioxide production...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842751/noninvasive-ventilation
#6
REVIEW
Giuseppe Bello, Gennaro De Pascale, Massimo Antonelli
Noninvasive ventilation (NIV) has assumed a prominent role in the treatment of patients with both hypoxemic and hypercapnic acute respiratory failure (ARF). The main theoretic advantages of NIV include avoiding side effects and complications associated with endotracheal intubation, improving patient comfort, and preserving airway defense mechanisms. Factors that affect the success of NIV in patients with ARF are clinicians' expertise, selection of patient, choice of interface, selection of ventilator setting, proper monitoring, and patient motivation...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842750/ventilatory-management-of-the-noninjured-lung
#7
REVIEW
David L Bowton, Louis Keith Scott
This article reviews aspects of mechanical ventilation in patients without lung injury, patients in the perioperative period, and those with neurologic injury or disease including spinal cord injury. Specific emphasis is placed on ventilator strategies, including timing and indications for tracheostomy. Lung protective ventilation, using low tidal volumes and modest levels of positive end-expiratory pressure, should be the default consideration in all patients requiring mechanical ventilatory support. The exception may be the patient with high cervical spinal cord injuries who requires mechanical ventilatory support...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842749/mechanical-ventilator-discontinuation-process
#8
REVIEW
Lingye Chen, Daniel Gilstrap, Christopher E Cox
The goal of this article is to discuss approaches to discontinuing invasive mechanical ventilation in a general intensive care unit (ICU) population. It considers approaches in which the clinician expects patient survival, as well as those that do not. Additionally, approaches to acute and chronic critical illness are included.
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842748/preventing-ventilator-associated-infections
#9
REVIEW
Avani Mehta, Rajesh Bhagat
Mechanical ventilator use is fraught with risk of complications. Ventilator-associated pneumonia (VAP) is a common complication that prolongs stays on the ventilator and increases mortality and costs. The Centers for Disease Control and Prevention recommend the use of the term, ventilator-associated event. Prevention and/or interruption of cycle of inflammation, colonization of respiratory tract, and ventilator-associated tracheobronchitis are key to managing VAP. Modifying risk factors using a ventilator bundle is considered standard of care...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842747/patient-ventilator-interactions
#10
REVIEW
Daniel Gilstrap, John Davies
Ventilatory muscle fatigue is a reversible loss of the ability to generate force or velocity of contraction in response to increased elastic and resistive loads. Mechanical ventilation should provide support without imposing additional loads from the ventilator (dys-synchrony). Interactive breaths optimize this relationship but require that patient effort and the ventilator response be synchronous during breath initiation, flow delivery, and termination. Proper delivery considers all 3 phases and uses clinical data, ventilator graphics, and sometimes a trial-and-error approach to optimize patient-ventilator interactions...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842746/managing-respiratory-failure-in-obstructive-lung-disease
#11
REVIEW
Stephen P Bergin, Craig R Rackley
Exacerbations of obstructive lung disease are common causes of acute respiratory failure. Short-acting bronchodilators and systemic glucocorticoids are the foundation of pharmacologic management. For patients requiring ventilator support, use of noninvasive ventilation reduces the risk of mortality and progression to invasive mechanical ventilation. Challenges associated with invasive ventilation include ventilator dyssynchrony, air trapping, and dynamic hyperinflation. Careful monitoring and adjustment of ventilatory support parameters helps to optimize the patient-ventilator interaction and minimizes the risk of associated morbidity...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842745/managing-acute-lung-injury
#12
REVIEW
Gregory A Schmidt
The foundation of mechanical ventilation for acute respiratory distress syndrome involves limiting lung overdistention by using small tidal volumes or transpulmonary pressures. Potential for additional lung recruitment with higher positive end-expiratory pressure (PEEP) should be assessed. When stress index indicates tidal recruitment-derecruitment, PEEP is increased to higher values. Alternatively, a high PEEP table is used in all patients. When these conventional approaches are insufficient to sustain acceptable gas exchange, rescue is attempted using extracorporeal therapies, airway pressure-release ventilation, inhaled vasodilators, or high-frequency oscillatory ventilation...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842744/ventilator-induced-lung-injury
#13
REVIEW
Jeremy R Beitler, Atul Malhotra, B Taylor Thompson
Prevention of ventilator-induced lung injury (VILI) can attenuate multiorgan failure and improve survival in at-risk patients. Clinically significant VILI occurs from volutrauma, barotrauma, atelectrauma, biotrauma, and shear strain. Differences in regional mechanics are important in VILI pathogenesis. Several interventions are available to protect against VILI. However, most patients at risk of lung injury do not develop VILI. VILI occurs most readily in patients with concomitant physiologic insults. VILI prevention strategies must balance risk of lung injury with untoward side effects from the preventive effort, and may be most effective when targeted to subsets of patients at increased risk...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842743/assessing-respiratory-system-mechanical-function
#14
REVIEW
Ruben D Restrepo, Diana M Serrato, Rodrigo Adasme
The main goals of assessing respiratory system mechanical function are to evaluate the lung function through a variety of methods and to detect early signs of abnormalities that could affect the patient's outcomes. In ventilated patients, it has become increasingly important to recognize whether respiratory function has improved or deteriorated, whether the ventilator settings match the patient's demand, and whether the selection of ventilator parameters follows a lung-protective strategy. Ventilator graphics, esophageal pressure, intra-abdominal pressure, and electric impedance tomography are some of the best-known monitoring tools to obtain measurements and adequately evaluate the respiratory system mechanical function...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842742/design-features-of-modern-mechanical-ventilators
#15
REVIEW
Neil MacIntyre
A positive-pressure breath ideally should provide a VT that is adequate for gas exchange and appropriate muscle unloading while minimizing any risk for injury or discomfort. The latest generation of ventilators uses sophisticated feedback systems to sculpt positive-pressure breaths according to patient effort and respiratory system mechanics. Currently, however, these new control strategies are not totally closed-loop systems. This is because the automatic input variables remain limited, some clinician settings are still required, and the specific features of the perfect breath design still are not entirely clear...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27514604/rare-lung-diseases-occasionally-the-horse-has-stripes
#16
EDITORIAL
Robert M Kotloff, Francis X McCormack
No abstract text is available yet for this article.
September 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27514603/benign-metastasizing-leiomyoma
#17
REVIEW
Gustavo Pacheco-Rodriguez, Angelo M Taveira-DaSilva, Joel Moss
Benign metastasizing leiomyoma (BML) is a rare and poorly characterized disease affecting primarily premenopausal women. Asymptomatic patients are often diagnosed incidentally by radiographs or other lung-imaging procedures performed for other indications, and the diagnosis is eventually confirmed by biopsy. Patients with BML are usually treated pharmacologically with antiestrogen therapies or surgically with oophorectomy or hysterectomy. Antiestrogen therapy is typically efficacious and, in general, most patients have a favorable prognosis...
September 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27514602/diffuse-idiopathic-pulmonary-neuroendocrine-cell-hyperplasia-and-neuroendocrine-hyperplasia-of-infancy
#18
REVIEW
Laurie L Carr, Jeffrey A Kern, Gail H Deutsch
Although incidental reactive pulmonary neuroendocrine cell hyperplasia (PNECH) is seen on biopsy specimens in adults with chronic lung disease, disorders characterized by marked PNECH are rare. Primary hyperplasia of neuroendocrine cells in the lung and obstructive lung disease related to remodeling or physiologic constriction of small airways define diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH) in the adult and neuroendocrine cell hyperplasia of infancy (NEHI) in children. DIPENCH and NEHI share a similar physiology, typical imaging appearance, and increased neuroendocrine cells on biopsy...
September 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27514601/immunoglobulin-g4-related-disease-and-the-lung
#19
REVIEW
Jay H Ryu, Eunhee S Yi
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease with protean manifestations involving virtually any organ in the body. At initial clinical presentation, 1 or multiple organs may be involved. Initial descriptions focused on pancreatic disease. It has, however, become clear that IgG4-RD can cause an immune-mediated fibroinflammatory process, commonly manifesting as mass-like lesions, in various regions of the body including the thorax where any compartment can be involved. This pathologic process is characterized by infiltration of IgG4+ plasma cells and a propensity to fibrosis leading to organ dysfunction which can be prevented by early diagnosis and corticosteroid therapy...
September 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27514600/hyper-ige-syndromes-and-the-lung
#20
REVIEW
Alexandra F Freeman, Kenneth N Olivier
Elevated serum IgE has many etiologies including parasitic infection, allergy and asthma, malignancy, and immune dysregulation. The hyper-IgE syndromes caused by mutations in STAT3, DOCK8, and PGM3 are monogenic primary immunodeficiencies associated with high IgE, eczema, and recurrent infections. These primary immunodeficiencies are associated with recurrent pneumonias leading to bronchiectasis; however, each has unique features and genetic diagnosis is essential in guiding therapy, discussing family planning, and defining prognosis...
September 2016: Clinics in Chest Medicine
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