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liberation from mechanical ventilation

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https://www.readbyqxmd.com/read/29458319/proportional-assist-ventilation-versus-pressure-support-ventilation-in-weaning-ventilation-a-pilot-randomised-controlled-trial
#1
John Botha, Cameron Green, Ian Carney, Kavi Haji, Sachin Gupta, Ravindranath Tiruvoipati
OBJECTIVE: Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation. DESIGN: Prospective randomised controlled trial comparing PSV with PAV+. SETTING: University-affiliated, tertiary referral intensive care unit (ICU)...
March 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29413508/weaning-failure-and-respiratory-muscle-function-what-has-been-done-and-what-can-be-improved
#2
REVIEW
Paulo A F Magalhães, Carlos A Camillo, Daniel Langer, Lívia B Andrade, Maria do Carmo M B Duarte, Rik Gosselink
INTRODUCTION: Respiratory muscle dysfunction, being a common cause of weaning failure, is strongly associated with prolonged mechanical ventilation (MV) and prolonged stay in intensive care units. Inspiratory muscle training (IMT) has been described as an important contributor to the treatment of respiratory muscle dysfunction in critically ill patients. Its effectiveness is however yet controversial. OBJECTIVE: To discuss evidence for assessment of readiness and the effectiveness of interventions for liberation from MV, with special attention to the role of IMT...
January 2018: Respiratory Medicine
https://www.readbyqxmd.com/read/29364998/usefulness-of-radiological-signs-of-pulmonary-congestion-in-predicting-failed-spontaneous-breathing-trials
#3
Ana Carolina Peçanha Antonio, Cassiano Teixeira, Priscylla Souza Castro, Ana Paula Zanardo, Marcelo Basso Gazzana, Marli Knorst
Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU. All enrolled individuals met the eligibility criteria for liberation from mechanical ventilation. Tracheostomized subjects were excluded...
July 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29325841/single-center-experience-with-venovenous-ecmo-for-influenza-related-ards
#4
Jessica Buchner, Michael Mazzeffi, Zachary Kon, Jay Menaker, Lewis Rubinson, Gregory Bittle, Chetan Pasrija, Daniel Herr
OBJECTIVES: This study was designed to determine whether venovenous extracorporeal membrane oxygenation (VV ECMO) reduced mortality in patients with influenza-related acute respiratory distress syndrome (ARDS). DESIGN: A retrospective cohort study was performed. Baseline characteristics of participants were compared and Kaplan-Meier survival analysis was used to compare survival at last medical center follow-up. Cox proportional hazards modeling also was performed to test for univariate associations between salient variables and mortality...
September 22, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29314320/patient-agitation-and-its-management-in-adult-critical-care-a-systematic-review-and-narrative-synthesis
#5
REVIEW
Samantha Freeman, Janelle Yorke, Paul Dark
AIM: To critically review the evidence relating to the management of agitation within the Adult Critical Care Unit (ACCU) environment and identify any risks and benefits of current management strategies. BACKGROUND: Admission to an ACCU can be traumatic and potentially life altering for the patient. Patient agitation is common in ACCUs and is associated with the potential for harm. Despite inherent safety risks, there is a paucity of evidence-based guidance underpinning the care of agitation in patients with critical illness...
January 4, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29273362/the-risk-factors-of-venous-thromboembolism-in-massively-transfused-patients
#6
Navpreet K Dhillon, Eric J T Smith, Ara Ko, Megan Y Harada, Audrey R Yang, Kavita A Patel, Galinos Barmparas, Eric J Ley
BACKGROUND: Massive transfusion protocols (MTPs) are necessary for hemodynamically unstable trauma patients with active bleeding. Thrombotic events have been associated with blood transfusion; however, the risk factors for the development of venous thromboembolism (VTE) in trauma patients receiving MTP are unknown. METHODS: A retrospective review was conducted by reviewing the electronic medical records of all trauma patients admitted to a Level I trauma center who received MTP from 2011 to 2016...
February 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#7
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#8
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28974646/factors-associated-with-re-intubation-within-14-days-after-ventilator-liberation
#9
Chia-Chen Chu, Chin-Jung Liu, Suh-May Yen, Wen-Yu Chou, Pei-Tseng Kung, Yuh-Show Tsai, Wen-Chen Tsai
BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010...
December 2017: Respiratory Care
https://www.readbyqxmd.com/read/28948503/extubating-the-neurocritical-care-patient-a-spontaneous-breathing-trial-algorithmic-approach
#10
Naresh Mullaguri, Zalan Khan, Premkumar Nattanmai, Christopher R Newey
BACKGROUND: Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28930478/mechanical-ventilation-induced-diaphragm-atrophy-strongly-impacts-clinical-outcomes
#11
Ewan C Goligher, Martin Dres, Eddy Fan, Gordon D Rubenfeld, Damon C Scales, Margaret S Herridge, Stefannie Vorona, Michael C Sklar, Nuttapol Rittayamai, Ashley Lanys, Alistair Murray, Deborah Brace, Cristian Urrea, W Darlene Reid, George Tomlinson, Arthur S Slutsky, Brian P Kavanagh, Laurent J Brochard, Niall D Ferguson
Rationale Diaphragm dysfunction worsens outcomes in mechanically ventilated patients but the clinical impact of potentially preventable changes in diaphragm structure and function due to mechanical ventilation is unknown. Objectives To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation. Methods Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28774204/apache-ii-score-cannot-predict-successful-weaning-from-prolonged-mechanical-ventilation
#12
Anna Rojek-Jarmuła, Rainer Hombach, Łukasz J Krzych
At least 5% of all intensive care unit patients require prolonged respiratory support. Multiple factors have been suggested as possible predictors of successful respiratory weaning so far. We sought to verify whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) can predict freedom from prolonged mechanical ventilation (PMV) in patients treated in a regional weaning centre. The study group comprised 130 consecutive patients (age; median (interquartile range): 71 (62-77) years), hospitalized between 1 January 2012, and 31 December 2013...
August 2017: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/28770093/the-clinical-practice-guideline-for-the-management-of-ards-in-japan
#13
Satoru Hashimoto, Masamitsu Sanui, Moritoki Egi, Shinichiro Ohshimo, Junji Shiotsuka, Ryutaro Seo, Ryoma Tanaka, Yu Tanaka, Yasuhiro Norisue, Yoshiro Hayashi, Eishu Nango
BACKGROUND: The Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU. METHOD: The guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan)...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28768527/bilateral-blindness-secondary-to-optic-nerve-ischemia-from-severe-amlodipine-overdose-a-case-report
#14
Raymond Kao, Yves Landry, Genevieve Chick, Andrew Leung
BACKGROUND: Calcium channel blockers are commonly prescribed medications; calcium channel blocker overdose is becoming increasingly prevalent. The typical presentation of a calcium channel blocker overdose is hypotension and decreased level of consciousness. We describe a case of a calcium channel blocker overdose that led to bilateral cortical blindness, a presentation that has not previously been reported. CASE PRESENTATION: A 49-year-old white woman with known bilateral early optic atrophy presented to our hospital with hypotension and obtundation following a known ingestion of 150 mg of amlodipine...
August 3, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28649385/the-practice-of-tracheostomy-decannulation-a-systematic-review
#15
REVIEW
Ratender Kumar Singh, Sai Saran, Arvind K Baronia
Decannulation is an essential step towards liberating tracheostomized patients from mechanical ventilation. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. Presence of an intact sensorium coordinated swallowing and protective coughing are often the minimum requirements for a successful decannulation. Objective criteria for each of these may help better the clinical judgement of decannulation. In this systematic review on decannulation, we focus attention to this important aspect of tracheostomy care...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28622013/acetazolamide-use-in-severe-chronic-obstructive-pulmonary-disease-pros-and-cons
#16
Rosemary Adamson, Erik R Swenson
Acetazolamide is a carbonic anhydrase (CA) inhibitor sometimes used as a respiratory stimulant for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving oxygenation, reducing carbon dioxide retention, and aiding liberation from mechanical ventilation and/or attempting to correct a metabolic alkalosis. However, the net effect of CA inhibition is multifactorial and complex, because CA is inhibited in many tissues that may negatively affect the patient with lung disease. The full impact of acetazolamide and other CA inhibitors depends critically on dosing, age, and pulmonary, renal, hepatic, hematological, and respiratory muscle function and reserves...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28588895/evaluation-of-cough-peak-expiratory-flow-as-a-predictor-of-successful-mechanical-ventilation-discontinuation-a-narrative-review-of-the-literature
#17
REVIEW
Chuan Jiang, Antonio Esquinas, Bushra Mina
A crucial step in the transition from mechanical ventilation to extubation is the successful performance of a spontaneous breathing trial (SBT). The American College of Chest Physicians (ACCP) Guidelines recommend removal of the endotracheal tube upon successful completion of a SBT. However, this does not guarantee successful extubation as there remains a risk of re-intubation. Guidelines have outlined ventilator liberation protocols, selected use of non-invasive ventilation on extubation, early mobilization, and dynamic ventilator metrics to prevent and better predict extubation failure...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28497033/intrapulmonary-percussive-ventilation-as-an-airway-clearance-technique-during-venoarterial-extracorporeal-life-support-in-an-infant-with-pertussis
#18
Conrad Krawiec, Ken Ballinger, E Scott Halstead
Initiation of extracorporeal life support (ECLS) is often followed by complete opacification of pulmonary parenchyma and volume loss. The optimal mechanical ventilator management and lung recruitment strategy of a pediatric patient requiring extracorporeal membrane oxygenation is not known. We present a case of a 4-week old infant who developed a severe pertussis infection requiring ECLS. The severity of his illness and pertussis infection-associated intraluminal bronchiole obstruction made medical management challenging...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28413775/an-interesting-case-of-mycoplasma-pneumonia-associated-multisystem-involvement-and-diffuse-alveolar-hemorrhage
#19
Rashmi Mishra, Edison Cano, Sindhaghatta Venkatram, Gilda Diaz-Fuentes
Severe mycoplasma pneumonia is a rare entity with only 0.5-2% of cases having a fulminant course. We present a 74-year-old woman with hypertension, diabetes mellitus and remote history of marginal zone B-cell lymphoma admitted with abdominal pain and diarrhea of 1-2 days associated with body-aches, dyspnea, dry cough and weight loss for 2-3 weeks. On physical exam, she was febrile, tachypneic, tachycardic and hypoxic on room air. Chest examination revealed diffuse crackles and end-expiratory wheezes. Laboratory tests showed anemia, acute-on-chronic kidney injury and hyaline casts and epithelial cells in the urine analysis...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28383845/-surgical-fixation-in-flail-chest-a-local-first-encouraging-experience
#20
M Tonglet, Q Desiron, H Marechal, F Pitance, S Degesves
We report the case of a young woman who suffered from a severe traffic accident with major thoracic trauma consisting of hemopneumothorax and flail chest. At day 5 of mechanical ventilation, a surgical reduction and fixation of the fractured ribs were performed; the patient was liberated from mechanical ventilation the next day and discharged from the intensive care unit two days later. The success of this local first case incites us to further a similar approach in such challenging trauma cases.
July 2016: Revue Médicale de Liège
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