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weaning AND Ventilator AND tracheostomy AND elderly

Michael S Green, Johann J Mathew, Lia J Michos, Parmis Green, Mansoor M Aman
Introduction: An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF...
August 2017: Anesthesiology and Pain Medicine
Michele Vitacca, Mara Paneroni, Roberta Peroni, Luca Barbano, Valmira Dodaj, Giancarlo Piaggi, Fabio Vanoglio, Alberto Luisa, Amerigo Giordano, Piero Ceriana
BACKGROUND: The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease)...
December 2014: Respiratory Care
J Dermot Frengley, Giorgio R Sansone, Kunjan Shakya, Robert J Kaner
OBJECTIVES: To investigate effects of older age, comorbidities, and physiological measures on outcomes of elderly adults requiring prolonged mechanical ventilation (PMV). DESIGN: Retrospective cohort study. SETTING: Public long-term acute care hospital (LTACH) with an active program for ventilator weaning from PMV. PARTICIPANTS: Chronically seriously ill individuals with PMV aged 65 and older divided into six cohorts (65-69, 70-74, 75-79, 80-84, 85-89, ≥ 90) for comparative purposes (n = 540)...
January 2014: Journal of the American Geriatrics Society
Samária Ali Cader, Rodrigo Gomes de Souza Vale, Juracy Correa Castro, Silvia Corrêa Bacelar, Cintia Biehl, Maria Celeste Vega Gomes, Walter Eduardo Cabrer, Estélio Henrique Martin Dantas
QUESTIONS: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. INTERVENTION: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily...
2010: Journal of Physiotherapy
Keith S Naunheim, Douglas E Wood, Mark J Krasna, Malcolm M DeCamp, Mark E Ginsburg, Robert J McKenna, Gerard J Criner, Eric A Hoffman, Alice L Sternberg, Claude Deschamps
OBJECTIVE: We sought to identify predictors of operative mortality, pulmonary morbidity, and cardiovascular morbidity after lung volume reduction surgery. METHODS: Univariate and multivariate logistic regression analyses were performed. Candidate predictors included demographic characteristics, physical condition characteristics, pulmonary function measures, measures of the distribution of emphysema as determined by radiologists and by means of computerized analysis of chest computed tomographic scans, and measures of exercise capacity, dyspnea, and quality of life...
January 2006: Journal of Thoracic and Cardiovascular Surgery
Cheryl Crocker
Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weaning can be defined as the process of assisting patients to breathe spontaneously without mechanical ventilatory support [Am. J. Crit. Care 7 (1998) 1491. Weaning from mechanical ventilation is not about the method used but more about how that method is employed [Crit. Care Med. 27 (1999) 2331]. A review of the literature revealed that there was no one method of weaning that was superior, furthermore evidence suggests that the use of a protocol was more effective in reducing the duration of weaning [Dimensions Crit...
October 2002: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Barbara A Phelan, Dawn A Cooper, Prasama Sangkachand
Mechanical ventilation is a life-sustaining technology used with increasing frequency in the elderly population. Prolonged mechanical ventilation is associated with high morbidity, mortality, and poor functional status. Care of these complex patients requires a coordinated multidisciplinary approach to optimize outcome. To minimize mortality and morbidity and contain health care costs, it is essential to identify patients at high risk for prolonged ventilation and to implement early interventions to curtail functional decline...
February 2002: AACN Clinical Issues
N D Lawn, E F Wijdicks
Specific treatment has been shown to shorten the duration of mechanical ventilation in Guillain-Barré syndrome (GBS) and could obviate the need for tracheostomy in a significant proportion of patients. However, the factors predictive of prolonged ventilation are undetermined, and the timing and use of tracheostomy in patients with GBS have not been systematically studied. The medical records of 60 patients ventilated for GBS were reviewed. Only 13 patients (22%) could be weaned within 3 weeks. Patients ventilated longer were significantly older (P = 0...
August 1999: Muscle & Nerve
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