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weaning difficulties in critical care

Yuichiro Ono, Makiko Morifusa, Satoru Ikeda, Chika Kunishige, Yoshiki Tohma
Case: A 61-year-old man was diagnosed with severe chest trauma after a car accident and had had difficulty in weaning from a ventilator because of flail chest and dilated cardiomyopathy. On the 17th day in the intensive care unit, he received i.v. acetazolamide to increase urine output. One hour after the injection, he suddenly developed severe hypoxia. Chest radiography revealed a butterfly shadow. He received other diuretics and a vasodilator, which seemed slowly to resolve the respiratory failure...
July 2017: Acute Medicine & Surgery
D Schädler, L Kaiser, B Malchow, T Becher, G Elke, I Frerichs, T Küchler, N Weiler
BACKGROUND: It is unknown whether health related quality of life measured in German patients one year after mechanical ventilation in the intensive care unit is impaired or not. OBJECTIVES: The aim of this study was to assess health related quality of life one year after inclusion into a randomized controlled trial for weaning from mechanical ventilation with the help of a questionnaire that has never been used in critically ill patients and to investigate whether health related quality of life scores differ between the study population and a general German population...
April 2017: Der Anaesthesist
Angela Amigoni, Maria Cristina Mondardini, Ilaria Vittadello, Federico Zaglia, Emanuele Rossetti, Francesca Vitale, Stefania Ferrario, Fabio Savron, Giancarlo Coffaro, Luca Brugnaro, Roberta Amato, Andrea Wolfler, Linda S Franck
OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome...
February 2017: Pediatric Critical Care Medicine
Min-Shan Chung, Chi-Chin Huang, Shu-Ling Yeh, Yueh-E Lin, Lun-Hui Ho, Shu-Ching Chen
BACKGROUND: Prolonged of use mechanical ventilators results in respiratory muscle atrophy and difficulties in weaning, which increase mortality rates and psychlogical distress. While pulmonary rehabilitation has been shown to improve respiratory muscle strength, the effects of this intervention in critical-care patients who use mechanical ventilation remain uncertain. PURPOSE: The present paper uses a systematic review of the literature to evaluate the effects of pulmonary rehabilitation on the rate of ventilator weaning and on the physical performance of ventilator patients receiving critical care...
June 2016: Hu Li za Zhi the Journal of Nursing
Hussam K Hamadah, Mohamed S Kabbani, Mahmoud Elbarbary, Omar Hijazi, Ghassan Shaath, Sameh Ismail, Ammar M H Qadi, Hayan AlTaweel, Abdulraouf Jijeh
Introduction The use of ultrasound for assessing diaphragmatic dysfunction after paediatric cardiac surgery may be under-utilised. This study aimed to evaluate the role of bedside ultrasound performed by an intensivist to diagnose diaphragmatic dysfunction and the need for plication after paediatric cardiac surgery. METHODS: We carried out a retrospective cohort study on prospectively collected data of postoperative children admitted to the paediatric cardiac ICU during 2013. Diaphragmatic dysfunction was suspected based on difficulties in weaning from positive pressure ventilation or chest X-ray findings...
April 2017: Cardiology in the Young
Corinne Taniguchi, Elivane S Victor, Talita Pieri, Renata Henn, Carolina Santana, Erica Giovanetti, Cilene Saghabi, Karina Timenetsky, Raquel Caserta Eid, Eliezer Silva, Gustavo F J Matos, Guilherme P P Schettino, Carmen S V Barbas
INTRODUCTION: A recent meta-analysis showed that weaning with SmartCare™ (Dräger, Lübeck, Germany) significantly decreased weaning time in critically ill patients. However, its utility compared with respiratory physiotherapist-protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCare™ would be as effective as respiratory physiotherapy-driven weaning in critically ill patients. METHODS: Adult critically ill patients mechanically ventilated for more than 24 hours in the adult intensive care unit of the Albert Einstein Hospital, São Paulo, Brazil, were randomly assigned to be weaned either by progressive discontinuation of pressure support ventilation (PSV) with SmartCare™...
2015: Critical Care: the Official Journal of the Critical Care Forum
Lin Pu, Bo Zhu, Li Jiang, Bin Du, Xi Zhu, Ang Li, Gang Li, Zhongjie He, Wei Chen, Penglin Ma, Jianguo Jia, Yuan Xu, Jianxin Zhou, Long Qin, Qingyuan Zhan, Wenxiong Li, Qi Jiang, Meiping Wang, Ran Lou, XiuMing Xi
PURPOSE: A proposal was made at the International Consensus Conference to classify weaning of patients in intensive care units from mechanical ventilation into simple, difficult, and prolonged weaning groups based on the difficulty and length of the weaning process. The objective of the present study was to determine the incidence and outcome of weaning according to these new categories. METHODS: We examined the weaning of patients in intensive care units from mechanical ventilation in a prospective multicenter cohort study...
August 2015: Journal of Critical Care
Lijing Jia, Hongliang Li, Yu Bai, Xi Zhu
OBJECTIVE: To investigate the value of drug intervention for difficult weaning from mechanical ventilation. METHODS: A prospective single-blind randomized controlled trial was conducted. 120 patients with difficult weaning from mechanical ventilation encountered in Department of Critical Care Medicine of Peking University Third Hospital from January 2008 to December 2013 were included, and the patients were divided into treatment group and control group according to random number table, with 60 cases in each group...
December 2014: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Faith Eliason, Christopher Harden, Indrani Mukherjee
Critical Care Student/Resident Case Report Posters IIISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Organizing pneumonia (OP) is a reported complication of patients with H1N1 infection, typically after the interval development of acute respiratory distress syndrome (ARDS). Our patient, with recent history of H1N1 infection, was diagnosed as having OP by surgical lung biopsy (SLB) without the presence of pathologic features suggestive of ARDS...
October 1, 2014: Chest
Chunkui Zhou, Limin Wu, Fengming Ni, Wei Ji, Jiang Wu, Hongliang Zhang
Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles, respectively. Clinically, they manifest as limb and respiratory muscle weakness. Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation. Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event...
January 1, 2014: Neural Regeneration Research
Huawei Huang, Li Jiang, Ling Shen, Guobin Zhang, Bo Zhu, Jiajia Cheng, Xiuming Xi
BACKGROUND: Sleep deprivation is common in critically ill patients in intensive care units (ICU). It can result in delirium, difficulty weaning, repeated nosocomial infections, prolonged ICU length of stay and increased ICU mortality. Melatonin, a physiological sleep regulator, is well known to benefit sleep quality in certain people, but evidence for the effectiveness in ICU sleep disturbance is limited. METHODS/DESIGN: This study has a prospective, randomized, double-blind, controlled, parallel-group design...
August 18, 2014: Trials
Jiachun Feng, Xinmei Jiang, Shaokuan Fang
A 40- year-old Male was admitted to the first hospital of Jilin University with the complaint of 4 days of fever and headache and aggravation of weakness in his lower extremities accompanied with dysuria and disturbance of consciousness for one day. He had tachycardia, tachypnea and elevated white blood cell counts. General status of the patient got better day by day, while weakness and pain in his lower extremities had developed and gradually quadriplegia arose. When intensive care unit history, weaning difficulty from mechanical ventilator, clinical manifestations in intensive care unit associated with SIRS, symmetrical paresis pronounced in distal lower extremities, absence of deep tendon reflexes, evidence of distal sensory impairment, presence of electrophysiologic results indicating axonal sensorimotor polyneuropathy and muscle and nerve biopsy results were taken into consideration, he was diagnosed as critical illness polyneuropathy...
May 2014: Pakistan Journal of Medical Sciences Quarterly
Ayhan Yaman, Tanıl Kendirli, Çağlar Ödek, Cem Karadeniz, Tayfun Uçar, Gülnur Göllü, Zeynep Eyileten, Erdal İnce
For many decades, the primary treatment of acute respiratory failure has been mechanical ventilation. Intubation and mechanical ventilation carry complications such as upper respiratory system trauma, barotrauma, volutrauma, oxytrauma, atelectrauma, and nosocomial infection, and they increase mortality. Noninvasive mechanical ventilation (NIMV) applied to a specially selected group of patients has more advantages than invasive ventilation, especially the decreased number of complications. We present a three-year-old girl who had prolonged invasive mechanical ventilation (IMV) and weaning failure due to severe tracheal bleeding after Fontan operation...
January 2014: Turkish Journal of Pediatrics
Katalin Varga, Zsófia Varga, Gábor Fritúz
This case report describes the way psychological support based on positive suggestions (PSBPS) was added to the traditional somatic treatment of an acute pancreatitis 36-year-old male patient. Psychological support based on positive suggestions (PSBPS) is a new adjunct therapeutic tool focused on applying suggestive techniques in medical settings. The suggestive techniques usually applied with critically ill patients are based on a number of pre-prepared scripts like future orientation, reframing, positivity, supporting autonomy, etc...
December 2013: Interventional Medicine & Applied Science
Kurien Koshy, Douglas W Zochodne
Patients admitted to intensive care units (ICUs) suffer from a wide range of neurological disorders. Some develop within the ICU rendering weakness and difficulty in weaning patients from ventilator support. ICUAW, or ICU acquired weakness, is a broad term that includes several more specific neuromuscular problems. After exclusion of other causes of weakness, ICUAW includes critical illness polyneuropathy (CIP), first described by Charles Bolton, critical illness myopathy (CIM), and disorders of neuromuscular junction transmission...
2013: Handbook of Clinical Neurology
Andreas Perren, Laurent Brochard
BACKGROUND: In anaesthetized patients scheduled for surgery, tracheal intubation is performed with the expectation of subsequent smooth extubation. In critically ill patients, separation from the ventilator is often gradual and the time chosen for extubation may be either delayed or premature. Thus, weaning is challenging, represents a large part of the ventilation period and concerns all mechanically ventilated patients surviving their stay. DEFINITIONS AND MANAGEMENT: Weaning may be stratified in three groups according to its difficulty and duration...
November 2013: Intensive Care Medicine
Amit Kumar Mahajan, Philip Verhoef, Shruti B Patel, Gordon Carr, Douglas Kyle Hogarth
BACKGROUND: Bronchopleural fistulas (BPF) are conditions associated with prolonged hospital course, high morbidity, and possibly increased mortality. The presence of BPFs in critically ill patients may cause difficulty in ventilation and increased oxygen requirements. Intrabronchial valves (Spiration IBV) serve as a noninvasive therapeutic option for the closure of BPFs. METHODS: This report is a retrospective description of 3 patients transferred to our medical intensive care unit (ICU) with BPFs and persistent air leaks (PAL)...
April 2012: Journal of Bronchology & Interventional Pulmonology
O O Adekola, O O Soriyan, I Meka, O N Akanmu, S Olanipekun, T A A Oshodi
BACKGROUND: Electrolytes and acid-base disorders are common challenges seen in the intensive care unit (ICU) resulting in difficulty in weaning patients off the ventilator, prolonged admission periods, preventable cardiac arrhythmias and cardiac arrest. These require prompt lab results most of which are done serially, ideally a point of care test (POCT), as most central hospital lab result's turnaround time (TAT) sometimes might not meet up with the urgency of clinical decision making in the ICU...
April 2012: Nigerian Quarterly Journal of Hospital Medicine
Louise Rose, Ian M Fraser
BACKGROUND: Growing numbers of critically ill patients require prolonged mechanical ventilation and experience difficulty with weaning. Specialized centres may facilitate weaning through focused interprofessional expertise with an emphasis on rehabilitation. OBJECTIVE: To characterize the population of a specialized prolonged-ventilation weaning centre (PWC) in Ontario, and to report weaning, mobility, discharge and survival outcomes. METHODS: Data from consecutively admitted patients were retrospectively extracted from electronic and paper medical records by research staff and verified by the primary investigator...
May 2012: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Raquel Wanzuita, Luiz F Poli-de-Figueiredo, Felipe Pfuetzenreiter, Alexandre Biasi Cavalcanti, Glauco Adrieno Westphal
INTRODUCTION: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. METHODS: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil...
December 12, 2012: Critical Care: the Official Journal of the Critical Care Forum
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