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Spontaneous breathing trials

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https://www.readbyqxmd.com/read/28316317/direct-two-minute-unassisted-breathing-evaluation-dtube-is-an-attractive-alternative-to-longer-spontaneous-breathing-trials-a-prospective-observational-study
#1
Matthew B Bloom, Jonathan Lu, Tri Tran, Marko Bukur, Rex Chung, Eric J Ley, Nicolas Melo, Ali Salim, Daniel R Margulies
We sought to identify a simple bedside method to predict successful extubation outcomes that might be used during rounds. We hypothesized that a direct 2-minute unassisted breathing evaluation (DTUBE) could replace a longer spontaneous breathing trial (SBT). Data were prospectively collected on all patients endotracheally intubated for >48 hours nearing extubation in a tertiary center's mixed trauma/surgical intensive care unit from August 2012 to August 2013. The SBT was performed for at least 30 minutes at 40 per cent FiO2, PEEP 5, and PS 8...
March 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28294957/regional-ventilation-redistribution-measured-by-electrical-impedance-tomography-during-spontaneous-breathing-trial-with-automatic-tube-compensation
#2
Yeong-Long Hsu, Ai-Jia Tien, Mei-Yun Chang, Hao-Tai Chang, Knut Moeller, Inez Frerichs, Zhanqi Zhao
Automatic tube compensation (ATC) was developed to overcome the flow resistance of endotracheal tube and decrease the imposed work of breathing. Although ATC is used as an evidence-based strategy to predict successful weaning from assisted ventilation, the changes in regional ventilation distribution induced by this technique are not known. We hypothesized that continuous positive airway pressure plus ATC (CPAP+100%ATC) could reactivate the respiratory muscles in patients with prolonged mechanical ventilation (PMV) more effectively than volume assist-control mandatory ventilation (ACMV)...
March 15, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28272202/effects-of-combined-epidural-and-general-anesthesia-on-intraoperative-hemodynamic-responses-postoperative-cellular-immunity-and-prognosis-in-patients-with-gallbladder-cancer-a-randomized-controlled-trial
#3
Jun Zhu, Xue-Rong Zhang, Hu Yang
BACKGROUND: This study is supposed to investigate the effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer (GBC). METHODS: One hundred forty-four GBC patients were selected and randomly divided into the general anesthesia (GA) group and the combined epidural-general anesthesia (CEGA) group. Before anesthesia induction (t0), at intubation (t1), at the beginning of surgery (t2), 5 minutes after pneumoperitoneum (t3), at the end of surgery (t4), after recovery of spontaneous breathing (t5), after regaining consciousness (t6), and after extubation (t7), the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the depth of anesthesia (bispectral index [BIS]) were detected...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28267947/ambu%C3%A2-auragain%C3%A2-versus-lma-supreme%C3%A2-second-seal%C3%A2-a-randomised-controlled-trial-comparing-oropharyngeal-leak-pressures-and-gastric-drain-functionality-in-spontaneously-breathing-patients
#4
I I Shariffuddin, W H Teoh, Ebk Tang, Nhm Hashim, P S Loh
Newer second generation supraglottic airway devices may perform differently in vivo due to material and design modifications. We compared performance characteristics of the Ambu® AuraGain™ and LMA Supreme™ Second Seal™ in 100 spontaneously breathing anaesthetised patients in this randomised controlled study. We studied oropharyngeal leak pressures (OLP) (primary outcome) and secondarily, ease of insertion, success rates, haemodynamic response, time to insertion, and complications of usage. We found no significant difference in OLP between the AuraGain versus the LMA Supreme, mean (standard deviation, SD) 24...
March 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28246308/use-of-cough-peak-flow-measured-by-a-ventilator-to-predict-re-intubation-when-a-spirometer-is-unavailable
#5
Bai Linfu, Jun Duan
BACKGROUND: A ventilator includes the function to measure flow velocity. We aimed to compare the predictive accuracy for re-intubation diagnosed by cough peak flow (CPF) measured by a spirometer and a ventilator. METHODS: Endotracheally intubated subjects who passed a spontaneous breathing trial were enrolled. Before extubation, CPF was measured by a spirometer and a ventilator, respectively. Re-intubation was recorded at 72 h after extubation. RESULTS: A total of 126 subjects were enrolled...
February 28, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28236395/nursing-strategies-for-effective-weaning-of-the-critically-ill-mechanically-ventilated-patient
#6
REVIEW
Darian Ward, Paul Fulbrook
The risks imposed by mechanical ventilation can be mitigated by nurses' use of strategies that promote early but appropriate reduction of ventilatory support and timely extubation. Weaning from mechanical ventilation is confounded by the multiple impacts of critical illness on the body's systems. Effective weaning strategies that combine several interventions that optimize weaning readiness and assess readiness to wean, and use a weaning protocol in association with spontaneous breathing trials, are likely to reduce the requirement for mechanical ventilatory support in a timely manner...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28219811/stress-echocardiography-in-patients-who-experienced-mechanical-ventilation-weaning-failure
#7
Manuel Ruiz-Bailén, Jesús Cobo-Molinos, Ana Castillo-Rivera, María Dolores Pola-Gallego-de-Guzmán, Antonio Cárdenas-Cruz, Antonio Martínez-Amat, María Sevilla-Martínez, Clara Hernández-Caballero
INTRODUCTION: Critically ill patients may suffer varying degrees of temporary myocardial dysfunction during respiratory weaning that could play an important role in weaning failure. OBJECTIVES: In this study, we tried to assess the existence of temporary diastolic dysfunction during respiratory weaning. METHODS: Inclusion period is from 2006 to 2015. In this study, we included 181 ventilated patients with cardiogenic shock that were being weaned from mechanical ventilation...
January 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28215134/drainage-of-pleural-effusion-improves-diaphragmatic-function-in-mechanically-ventilated-patients
#8
Michele Umbrello, Giovanni Mistraletti, Andrea Galimberti, Ilaria R Piva, Ottavia Cozzi, Paolo Formenti
BACKGROUND: Pleural effusion adversely affects the pressuregenerating capacity of the diaphragm. It uncouples the lung and chest wall, which may result in diaphragmatic dysfunction. Information on the effects of effusion drainage on diaphragmatic function is limited, but several studies report relief of dyspnoea after drainage, which was attributed to improved diaphragmatic mechanics, even if this issue was never formally addressed. OBJECTIVE: To investigate the effect of drainage of unilateral pleural effusion on diaphragmatic function...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28212205/spontaneous-breathing-during-extracorporeal-membrane-oxygenation-in-acute-respiratory-failure
#9
Stefania Crotti, Nicola Bottino, Giulia Maria Ruggeri, Elena Spinelli, Daniela Tubiolo, Alfredo Lissoni, Alessandro Protti, Luciano Gattinoni
BACKGROUND: We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membrane oxygenation and the interactions between artificial and native lungs in patients bridged to lung transplant or with acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome. METHODS: The clinical course of a total of 48 patients was analyzed. Twenty-three of 48 patients were enrolled in the prospective study (nine bridged to lung transplant, six COPD, and eight acute respiratory distress syndrome)...
April 2017: Anesthesiology
https://www.readbyqxmd.com/read/28198753/mechanical-ventilation-weaning-practices-and-decision-making-in-european-picus
#10
Lyvonne N Tume, Martin C J Kneyber, Bronagh Blackwood, Louise Rose
OBJECTIVES: This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. DESIGN: Cross-sectional electronic survey...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28181336/impact-of-high-concentrations-of-sevoflurane-on-laryngeal-reflex-responses
#11
Thomas O Erb, Britta S von Ungern-Sternberg, Jens Moll, Franz J Frei
BACKGROUND: Exaggerated defensive upper airway reflexes, particularly laryngospasm, may cause hypoxemic damage, especially in children. General clinical experience suggests that laryngeal reflex responses are more common under light levels of anesthesia, and previous clinical studies have shown an inverse correlation between laryngeal responsiveness and depth of hypnosis. However, this seems to be less obvious in children anesthetized with sevoflurane. The aim of this study was to assess the impact of high concentrations of sevoflurane on laryngeal and respiratory reflex responses in spontaneously breathing children...
February 8, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28157394/how-well-prepared-are-medical-and-nursing-students-to-identify-common-hazards-in-the-icu
#12
Alison S Clay, Saumil M Chudgar, Kathleen M Turner, Jacqueline Vaughn, Nancy W Knudsen, Jeanne M Farnan, Vineet M Arora, Margory A Molloy
RATIONALE: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. While the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare students adequately for this role. OBJECTIVES: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified...
February 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28152280/surfactant-administration-via-a-thin-endotracheal-catheter-during-spontaneous-breathing-in-preterm-infants
#13
REVIEW
Wanliang Wu, Yan Shi, Fengxia Li, Zhuoyu Wen, Hongli Liu
To systematically review the clinical outcomes of surfactant administration via a thin endotracheal catheter during spontaneous breathing compared with conventional administration involving tracheal intubation, mechanical ventilation (MV), and tracheal extubation, in preterm infants. PubMed, EMBASE, and the Cochrane Library were searched to identify relevant clinical trials. Data were analyzed using the Cochrane Collaboration methods. Primary outcome measures included the incidence of MV and bronchopulmonary dysplasia (BPD)...
February 2, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28151886/impact-of-fiber-optic-laryngoscopy-on-the-weaning-process-from-mechanical-ventilation-in-high-risk-patients-for-postextubation-stridor
#14
Malcolm Lemyze, Emmanuelle Durville, Mehdi Meddour, Marie Jonard, Johanna Temime, Stéphanie Barailler, Didier Thevenin, Jihad Mallat
The objective of this study was to assess the impact of fiber-optic laryngoscopy (FOL) on the weaning process from mechanical ventilation in critically ill patients with a positive cuff leak test (CLT) as compared with the current recommended strategy based on corticosteroids.In this prospective observational pilot study conducted over a 1-year period in a 15-bed ICU, CLT was systematically performed before extubation in all intubated patients having passed a spontaneous breathing trial (SBT). After the endotracheal tube cuff was deflated, cuff leak volume (CLVol) was assessed during assisted controlled ventilation...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28144686/-new-technical-developments-for-inhaled-sedation
#15
A Meiser, H Bomberg, T Volk, H V Groesdonk
The circle system has been in use for more than 100 years, whereas the first clinical application of an anaesthetic reflector was reported just 15 years ago. In the circle system, all breathing gas is rebreathed after carbon dioxide absorption. A reflector, on the other hand, with the breathing gas flowing to and fro, specifically retains the anaesthetic during expiration and resupplies it during the next inspiration. A high reflection efficiency (number of molecules resupplied/number of molecules exhaled, RE 80-90%) decreases consumption...
January 31, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28080976/respiratory-modulation-of-startle-eye-blink-a-new-approach-to-assess-afferent-signals-from-the-respiratory-system
#16
André Schulz, Thomas M Schilling, Claus Vögele, Mauro F Larra, Hartmut Schächinger
Current approaches to assess interoception of respiratory functions cannot differentiate between the physiological basis of interoception, i.e. visceral-afferent signal processing, and the psychological process of attention focusing. Furthermore, they typically involve invasive procedures, e.g. induction of respiratory occlusions or the inhalation of CO2-enriched air. The aim of this study was to test the capacity of startle methodology to reflect respiratory-related afferent signal processing, independent of invasive procedures...
November 19, 2016: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
https://www.readbyqxmd.com/read/28079564/an-anesthesiologist-s-perspective-on-the-history-of-basic-airway-management-the-artisanal-anesthetic-era-1846-to-1904
#17
Adrian A Matioc
This second installment of the history of basic airway management covers the early-artisanal-years of anesthesia from 1846 to 1904. Anesthesia was invented and practiced as a supporting specialty in the context of great surgical and medical advances. The current-day anesthesia provider tends to equate the history of airway management with the history of intubation, but for the first 58 yr after the introduction of ether anesthesia, airway management was provided by basic airway techniques with or without the use of a face mask...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28074804/outcome-of-four-pretreatment-regimes-on-hemodynamics-during-electroconvulsive-therapy-a-double-blind-randomized-controlled-crossover-trial
#18
RANDOMIZED CONTROLLED TRIAL
Devangi Ashutosh Parikh, Sanchita Nitin Garg, Naina Parag Dalvi, Priyanka Pradip Surana, Deepa Sannakki, Bharati Anil Tendolkar
CONTEXT: Electroconvulsive therapy (ECT) is associated with tachycardia and hypertension. AIMS: The aim of this study was to compare two doses of dexmedetomidine, esmolol, and lignocaine with respect to hemodynamics, seizure duration, emergence agitation (EA), and recovery profile. METHODOLOGY: Thirty patients undergoing ECT were assigned to each of the following pretreatment regimes over the course of five ECT sessions in a randomized crossover design: Group D1 (dexmedetomidine 1 μg/kg), Group D0...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28067942/body-positioning-for-spontaneously-breathing-preterm-infants-with-apnoea
#19
REVIEW
Rami A Ballout, Jann P Foster, Lara A Kahale, Lina Badr
BACKGROUND: It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea. OBJECTIVES: To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups...
January 9, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28063121/monitoring-of-electrical-activity-of-the-diaphragm-shows-failure-of-t-piece-trial-earlier-than-protocol-based-parameters-in-prolonged-weaning-in-non-communicative-neurological-patients
#20
Oliver Trapp, Mascha Fiedler, Michael Hartwich, Martin Schorl, Armin Kalenka
BACKGROUND: The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion...
January 6, 2017: Neurocritical Care
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