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liberation from mechanical ventilation

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https://www.readbyqxmd.com/read/28774204/apache-ii-score-cannot-predict-successful-weaning-from-prolonged-mechanical-ventilation
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/28367339/bronchopleural-fistula-resolution-with-endobronchial-valve-placement-and-liberation-from-mechanical-ventilation-in-acute-respiratory-distress-syndrome-a-case-series
#10
Haris Kalatoudis, Meena Nikhil, Fuad Zeid, Yousef Shweihat
Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28355597/endobronchial-valve-used-as-salvage-therapy-in-a-mechanically-ventilated-patient-with-intractable-life-threatening-haemoptysis
#11
Usha Lalla, Brian W Allwood, Soumitra Sinha Roy, Elvis M Irusen, Coenraad F N Koegelenberg
Treatment options for intractable life-threatening haemoptysis in mechanically ventilated patients with structural lung disease who do not respond to bronchial artery embolisation (BAE) and who are deemed unfit for surgery are limited. A 26-year-old HIV-positive male with a poorly preserved CD4 count and active pulmonary tuberculosis was intubated and mechanically ventilated for persistent life-threatening haemoptysis. Two attempts at BAE failed, and life-threatening haemoptysis recurred daily for 14 days despite antituberculous therapy...
2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28351903/diaphragm-muscle-thinning-in-subjects-receiving-mechanical-ventilation-and-its-effect-on-extubation
#12
Horiana B Grosu, David E Ost, Young Im Lee, Juhee Song, Liang Li, Edward Eden, Keith Rose
BACKGROUND: Diaphragm muscle weakness and atrophy are consequences of prolonged mechanical ventilation. Our purpose was to determine whether thickness of the diaphragm (TDI) changes over time after intubation and whether the degree of change affects clinical outcome. METHODS: For this prospective, longitudinal observational study, we identified subjects who required mechanical ventilation and measured their TDI by ultrasonography. TDI was measured at baseline and repeated 72 h later and then weekly until the subject was either liberated from mechanical ventilation, was referred for tracheostomy, or died...
March 28, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28338483/prevalence-and-impact-on-weaning-of-pleural-effusion-at-the-time-of-liberation-from-mechanical-ventilation-a-multicenter-prospective-observational-study
#13
MULTICENTER STUDY
Martin Dres, Damien Roux, Tài Pham, Alexandra Beurton, Jean-Damien Ricard, Muriel Fartoukh, Alexandre Demoule
BACKGROUND: Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown. METHODS: In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h...
June 2017: Anesthesiology
https://www.readbyqxmd.com/read/28288543/renal-function-weaning-and-survival-in-patients-with-ventilator-dependent-respiratory-failure
#14
Debapriya Datta, Raymond J Foley, Rong Wu, James Grady, Paul Scalise
BACKGROUND: Acute kidney injury in acute critical illness has been associated with poor weaning and survival outcomes. The relation between renal dysfunction as defined by creatinine clearance (CrCl) and weaning from prolonged mechanical ventilation (PMV) is not known. The objective of this study was to determine the relation of measured CrCl to weaning and survival in patients on PMV. METHODS: We retrospectively studied 167 patients on PMV admitted to a long-term acute care facility for weaning over a 3-year period...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28288027/cumulative-probability-and-time-to-reintubation-in-u-s-icus
#15
Andrea N Miltiades, Hayley B Gershengorn, May Hua, Andrew A Kramer, Guohua Li, Hannah Wunsch
OBJECTIVE: Reintubation after liberation from mechanical ventilation is viewed as an adverse event in ICUs. We sought to describe the frequency of reintubations across U.S. ICUs and to propose a standard, appropriate time cutoff for reporting of reintubation events. DESIGN AND SETTING: We conducted a cohort study using data from the Project IMPACT database of 185 diverse ICUs in the United States. PATIENTS: We included patients who received mechanical ventilation and excluded patients who received a tracheostomy, had a do-not-resuscitate order placed, or died prior to first extubation...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28284296/oxygen-therapeutics-and-mechanical-ventilation-advances
#16
REVIEW
Brian Weiss, Lewis J Kaplan
Advances in intensive care unit (ICU) therapeutics are plentiful and rooted in technological enhancements as well as recognition of patient care priorities. A plethora of new devices and modes are available for use to enhance patient safety and support liberation from mechanical ventilation while preserving oxygenation and carbon dioxide clearance. Increased penetrance of closed loop systems is one means to reduce care variation in appropriate populations. The intelligent design of the ICU space needs to integrate the footprint of that device and the data streaming from it into a coherent whole that supports patient, family, and caregivers...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28220822/pulmonary-outcomes-following-specialized-respiratory-management-for-acute-cervical-spinal-cord-injury-a-retrospective-analysis
#17
E C Zakrasek, J L Nielson, J J Kosarchuk, J D Crew, A R Ferguson, S L McKenna
STUDY DESIGN: Retrospective analysis. OBJECTIVES: To identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation. SETTING: United States regional spinal cord injury (SCI) treatment center. METHODS: Retrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1-C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place...
June 2017: Spinal Cord
https://www.readbyqxmd.com/read/28170290/durability-of-weaning-success-for-liberation-from-invasive-mechanical-ventilation-an-analysis-of-a-nationwide-database
#18
Sheng-Yuan Ruan, Nai-Chi Teng, Huey-Dong Wu, Shu-Ling Tsai, Cheng-Yi Wang, Chin-Pyng Wu, Chong-Jen Yu, Likwang Chen
No abstract text is available yet for this article.
February 7, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28029806/liberation-from-mechanical-ventilation-in-critically-ill-adults-an-official-ats-accp-clinical-practice-guideline
#19
Eddy Fan, Bishoy Zakhary, Andre Amaral, Jessica McCannon, Timothy D Girard, Peter E Morris, Jonathon D Truwit, Kevin C Wilson, Carey C Thomson
No abstract text is available yet for this article.
March 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27875282/metabolic-requirement-of-septic-shock-patients-before-and-after-liberation-from-mechanical-ventilation
#20
Peggy Siu-Pik Lee, Kar Lung Lee, James A Betts, Kin Ip Law
OBJECTIVES: This study identified the difference in energy expenditure and substrate utilization of patients during and upon liberation from mechanical ventilation. METHODS: Patients under intensive care who were diagnosed with septic shock and dependent on mechanical ventilation were recruited. Indirect calorimetry measurements were performed during and upon liberation from mechanical ventilation. RESULTS: Thirty-five patients were recruited (20 men and 15 women; mean age, 69 ± 10 years)...
October 3, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
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