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Weaning from mechanical ventilation

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https://www.readbyqxmd.com/read/28936698/recommendations-for-mechanical-ventilation-of-critically-ill-children-from-the-paediatric-mechanical-ventilation-consensus-conference-pemvecc
#1
Martin C J Kneyber, Daniele de Luca, Edoardo Calderini, Pierre-Henri Jarreau, Etienne Javouhey, Jesus Lopez-Herce, Jürg Hammer, Duncan Macrae, Dick G Markhorst, Alberto Medina, Marti Pons-Odena, Fabrizio Racca, Gerhard Wolf, Paolo Biban, Joe Brierley, Peter C Rimensberger
PURPOSE: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. METHODS: The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28932567/respiratory-support-with-venovenous-extracorporeal-membrane-oxygenation-during-stent-placement-for-the-palliation-of-critical-airway-obstruction-case-series-analysis
#2
Jung-Hoon Park, Ji Hoon Shin, Kun Yung Kim, Ju Yong Lim, Pyeong Hwa Kim, Jiaywei Tsauo, Min Tae Kim, Ho-Young Song
BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions. METHODS: We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28914722/factors-associated-with-pediatric-ventilator-associated-conditions-in-six-u-s-hospitals-a-nested-case-control-study
#3
Noelle M Cocoros, Gregory Priebe, James E Gray, Philip Toltzis, Gitte Y Larsen, Latania K Logan, Susan Coffin, Julia S Sammons, Kathleen Deakins, Kelly Horan, Matthew Lakoma, Jessica Young, Michael Burton, Michael Klompas, Grace M Lee
OBJECTIVES: A newly proposed surveillance definition for ventilator-associated conditions among neonatal and pediatric patients has been associated with increased morbidity and mortality among ventilated patients in cardiac ICU, neonatal ICU, and PICU. This study aimed to identify potential risk factors associated with pediatric ventilator-associated conditions. DESIGN: Retrospective cohort. SETTING: Six U.S. hospitals PATIENTS:: Children less than or equal to 18 years old ventilated for greater than or equal to 1 day...
September 13, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28905112/extracorporeal-membrane-oxygenation-in-spina-bifida-and-h1n1-induced-acute-respiratory-distress-syndrome
#4
Oliver Jansen, Oliver Kamp, Christian Waydhas, Valentin Rausch, Thomas Armin Schildhauer, Justus Strauch, Dirk Buchwald, Uwe Hamsen
Acute respiratory distress syndrome (ARDS) is characterized as an acute hypoxemic and/or hypercapnic respiratory failure seen in critically ill patients and is still, although decreased over the past few years, associated with high mortality. Furthermore, ARDS may be a life-threatening complication of H1N1 pneumonia. We report on a 45-year-old spina bifida patient with confirmed H1N1 influenza virus infection causing acute respiratory failure, who was successfully weaned from 42-day veno-venous extracorporeal membrane oxygenation (vv-ECMO) treatment with an excellent outcome...
September 13, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28904980/enterovirus-human-rhinovirus-a-rare-cause-of-acute-respiratory-distress-syndrome
#5
Parita Soni, Anand Rai, Nidhi Aggarwal, Stephan Kamholz, Taek Yoon, Yizhak Kupfer
A 22-year-old Asian woman presented with respiratory distress, cough, and wheezing for 1 week. Prior history included asthma and Turner syndrome. On presentation to the emergency department, the patient was hypotensive, tachycardic, tachypneic, with an oxyhemoglobin saturation in the mid 80% range while breathing ambient air. Chest radiograph revealed pulmonary vascular congestion and a left lower lobe infiltrate. Endotracheal intubation, mechanical ventilation, and vasopressors were initiated. Empiric therapy for community-acquired pneumonia was administered utilizing broad-spectrum intravenous antibiotics...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28904810/nasal-high-flow-treatment-in-preterm-infants
#6
REVIEW
Calum T Roberts, Kate A Hodgson
Nasal High Flow (HF) is a mode of 'non-invasive' respiratory support for preterm infants, with several potential modes of action, including generation of distending airway pressure, washout of the nasopharyngeal dead space, reduction of work of breathing, and heating and humidification of inspired gas. HF has several potential advantages over continuous positive airway pressure (CPAP), the most commonly applied form of non-invasive support, such as reduced nasal trauma, ease of use, and infant comfort, which has led to its rapid adoption into neonatal care...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/28904477/studying-the-power-of-the-integrative-weaning-index-in-predicting-the-success-rate-of-the-spontaneous-breathing-trial-in-patients-under-mechanical-ventilation
#7
Sahar Ebrahimabadi, Ahmad Bagheri Moghadam, Mohammadali Vakili, Mahnaz Modanloo, Homeira Khoddam
BACKGROUND AND AIMS: The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to determine the power of the integrative weaning index (IWI) in predicting the success rate of the spontaneous breathing trial (SBT) in patients under mechanical ventilation. MATERIALS AND METHODS: In this prospective study, 105 patients undergoing mechanical ventilation for over 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥25), the success rate of the SBT was predicted...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28900041/predicting-extubation-outcome-by-cough-peak-flow-measured-using-a-built-in-ventilator-flow-meter
#8
Florent Gobert, Hodane Yonis, Romain Tapponnier, Raul Fernandez, Marie-Aude Labaune, Jean-François Burle, Jack Barbier, Bernard Vincent, Maria Cleyet, Jean-Christophe Richard, Claude Guérin
BACKGROUND: Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS: This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (VT) in the preceding inspiration...
September 12, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28893673/extracorporeal-membrane-oxygenation-ecmo-as-salvage-treatment-for-pulmonary-echinococcus-granulosus-infection-with-acute-cyst-rupture
#9
Sören L Becker, Sebastian Fähndrich, Franziska C Trudzinski, Barbara Gärtner, Frank Langer, Torben K Becker, Robert Bals, Philipp M Lepper, Christian Lensch
Extracorporeal membrane oxygenation (ECMO) has been successfully used for the treatment of patients with respiratory failure due to severe infections. Though rare, parasites can also cause severe pulmonary disease. Tapeworms of the genus Echinococcus give rise to the development of cystic structures in the liver, lungs and other organs. Acute cyst rupture leads to potentially life-threatening infection, and affected patients may deteriorate rapidly. We describe the case of a young woman from Bulgaria who was admitted to hospital with severe dyspnoea, progressive chest pain and haemoptysis...
September 8, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28892951/outcomes-of-mechanically-ventilated-critically-ill-geriatric-patients-in-intensive-care-unit
#10
Vivek Aggarwal, Rajeshwar Singh, Jung Bahadur Singh, Jps Bawa, Nimish Gaur, Sandeep Kumar, I V Nagesh
INTRODUCTION: Increase in life expectancy across the globe has led to rise in geriatric population. Geriatric population is now living longer and healthier. This rise in geriatric population has also led to increase in the geriatric ailments leading to increased number of geriatric patients requiring intensive care including mechanical ventilation. Data on outcomes of geriatric patients requiring mechanical ventilation from India is scarce. AIM: To study the profile and outcome of geriatric patients more than equal to 60 years requiring mechanical ventilation in Intensive Care Unit (ICU)...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28877705/loxapine-to-control-agitation-during-weaning-from-mechanical-ventilation
#11
Stéphane Gaudry, Benjamin Sztrymf, Romain Sonneville, Bruno Megarbane, Guillaume Van Der Meersch, Dominique Vodovar, Yves Cohen, Jean-Damien Ricard, David Hajage, Laurence Salomon, Didier Dreyfuss
BACKGROUND: Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients. METHODS: We performed a multicentre, double-blind, placebo-controlled, parallel group, randomised trial. Patients who were potential candidates for weaning but exhibited agitation (Richmond Agitation-Sedation Scale score ≥ 2) after sedation withdrawal were randomly assigned to receive either loxapine or placebo...
September 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#12
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28826983/impact-of-a-stay-in-the-intensive-care-unit-on-the-preparation-of-advance-directives-descriptive-exploratory-qualitative-study
#13
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. METHODS: Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD...
August 4, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28820027/atelectasis-after-airway-extubation-during-veno-arterial-extracorporeal-membrane-oxygenation-support
#14
Hong Wang, Ming Jia, Bin Mao, Xiaotong Hou
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is used in cardiopulmonary failure patients to provide temporary assisted circulation. Usually, prolonged intubation and invasive mechanical ventilation are required in patients with ECMO support. We report on two cases of patients who had no pre-existing injuries of the affected lung, underwent VA ECMO support after open-heart surgery and received airway extubation (AE) or awake ECMO with the recovery of left ventricular ejection fraction. Atelectasis happened after AE and non-invasive positive pressure ventilation attenuated the atelectasis of one patient...
September 2017: Perfusion
https://www.readbyqxmd.com/read/28808576/-awake-ecco2r-superseded-intubation-in-a-near-fatal-asthma-attack
#15
Thomas-Michael Schneider, Tibor Bence, Franz Brettner
BACKGROUND: Near-fatal asthma attacks are life threatening events that often require mechanical ventilation. Extracorporeal carbon dioxide removal (ECCO2R) is, beside extracorporeal membrane oxygenation (ECMO), a well-established rescue option whenever ventilation gets to its limits. But there seems to be very rare experience with those techniques in avoiding mechanical ventilation in severe asthma attacks. CASE PRESENTATION: A 67-year-old man with a near-fatal asthma attack deteriorated under non-invasive ventilation conditions...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28807037/selepressin-a-novel-selective-vasopressin-v1a-agonist-is-an-effective-substitute-for-norepinephrine-in-a-phase-iia-randomized-placebo-controlled-trial-in-septic-shock-patients
#16
James A Russell, Jean-Louis Vincent, Anne Louise Kjølbye, Håkan Olsson, Allan Blemings, Herbert Spapen, Peder Carl, Pierre-Francois Laterre, Lars Grundemar
BACKGROUND: Vasopressin is widely used for vasopressor support in septic shock patients, but experimental evidence suggests that selective V1A agonists are superior. The initial pharmacodynamic effects, pharmacokinetics, and safety of selepressin, a novel V1A-selective vasopressin analogue, was examined in a phase IIa trial in septic shock patients. METHODS: This was a randomized, double-blind, placebo-controlled multicenter trial in 53 patients in early septic shock (aged ≥18 years, fluid resuscitation, requiring vasopressor support) who received selepressin 1...
August 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28799698/retrospective-evaluation-of-cats-with-elapid-snake-envenomation-associated-neurotoxicity-requiring-mechanical-ventilation-12-cases-2005-2014
#17
Hui Mei Ong, Kylie Kelers, Dez Hughes, Manuel Boller
OBJECTIVE: To retrospectively determine the population and outcome characteristics of a cohort of Australian elapid snake envenomed cats requiring mechanical ventilation (MV). DESIGN: Retrospective observational study (2005-2014). SETTING: Academic veterinary emergency and critical care service. ANIMALS: Twelve cats undergoing MV for elapid snake envenomation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The medical records were searched to identify cats requiring MV as part of treatment for elapid snake envenomation...
September 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28797619/mechanical-ventilation-weaning-protocol-improves-medical-adherence-and-results
#18
Luís Guilherme Alegretti Borges, Augusto Savi, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Marcio Luiz Ferreira De Camillis, Ricardo Wickert, Sérgio Fernando Monteiro Brodt, Túlio Frederico Tonietto, Ricardo Cremonese, Leonardo Silveira da Silva, Fernanda Gehm, Eubrando Silvestre Oliveira, Jose Herve Diel Barth, Juçara Gasparetto Macari, Cíntia Dias de Barros, Sílvia Regina Rios Vieira
INTRODUCTION: Implementation of a weaning protocol is related to better patient prognosis. However, new approaches may take several years to become the standard of care in daily practice. We conducted a prospective cohort study to investigate the effectiveness of a multifaceted strategy to implement a protocol to wean patients from mechanical ventilation (MV) and to evaluate the weaning success rate as well as practitioner adherence to the protocol. METHODS: We investigated all consecutive MV-dependent subjects admitted to a medical-surgical intensive care unit (ICU) for >24h over 7years...
July 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28794867/rapid-onset-of-amiodarone-induced-pulmonary-toxicity-after-lung-lobe-resection-a-case-report-and-review-of-recent-literature
#19
Heiko Baumann, Phillip Fichtenkamm, Thomas Schneider, Jürgen Biscoping, Michael Henrich
Amiodarone-induced pulmonary toxicity (APT) is a severe side effect that can lead to lung fibrosis or fatal respiratory failure. Usually APT occurs during long term therapy after administration of prolonged loading doses or high cumulative doses. We present the case of a 58 year old woman who underwent thoracic surgery with lobe resection. She developed atrial fibrillation with hemodynamic-instability on the first post-operative day. We initiated amiodarone therapy and four days later she developed respiratory failure...
September 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28794694/quality-indicators-in-intensive-care-medicine-for-germany-third-edition-2017
#20
REVIEW
Oliver Kumpf, Jan-Peter Braun, Alexander Brinkmann, Hanswerner Bause, Martin Bellgardt, Frank Bloos, Rolf Dubb, Clemens Greim, Arnold Kaltwasser, Gernot Marx, Reimer Riessen, Claudia Spies, Jörg Weimann, Gabriele Wöbker, Elke Muhl, Christian Waydhas
Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed...
2017: German Medical Science: GMS E-journal
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