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Ventilator mini bible

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12 papers 25 to 100 followers
By Jason Mann No BS pulmonary critical care fellow
Lei Guo, Weiwei Wang, Nana Zhao, Libo Guo, Chunjie Chi, Wei Hou, Anqi Wu, Hongshuang Tong, Yue Wang, Changsong Wang, Enyou Li
BACKGROUND: It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies...
July 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
Jarrod M Mosier, Cameron Hypes, Raj Joshi, Sage Whitmore, Sairam Parthasarathy, Charles B Cairns
Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%...
November 2015: Annals of Emergency Medicine
Felipe Saddy, Yuda Sutherasan, Patricia R M Rocco, Paolo Pelosi
Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist-control ventilation, pressure assist-control ventilation, pressure support ventilation (PSV), airway pressure release ventilation (APRV), APRV with PSV, proportional assist ventilation (PAV), noisy ventilation, and neurally adjusted ventilatory assistance (NAVA)...
August 2014: Seminars in Respiratory and Critical Care Medicine
Dean R Hess
Lung-protective ventilator strategies are considered standard practice in the care of patients with the acute respiratory distress syndrome (ARDS). To minimize ventilator-induced lung injury, attention is directed at avoidance of alveolar overdistention and cyclical opening and closing. The lowest possible plateau pressure and tidal volume (V(T)) should be selected. A reasonable target V(T) in all mechanically ventilated patients is 6 mL/kg. A topic of much controversy is the optimal setting of positive end-expiratory pressure (PEEP)...
August 2014: Seminars in Respiratory and Critical Care Medicine
Francisco José Parrilla, Indalecio Morán, Ferran Roche-Campo, Jordi Mancebo
Chronic obstructive pulmonary disease (COPD) is characterized by expiratory flow limitation (EFL) due to progressive airflow obstruction. The various mechanisms that cause EFL are central to understanding the physiopathology of COPD. At the end of expiration, dynamic inflation may occur due to incomplete emptying the lungs. This "extra" volume increases the alveolar pressure at the end of the expiration, resulting in auto-positive end-expiratory pressure (PEEP) or PEEPi. Acute exacerbations of COPD may result in increased airway resistance and inspiratory effort, further leading to dynamic hyperinflation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Thomas Strøm, Palle Toft
Traditionally, critically ill patients undergoing mechanical ventilation (MV) have received sedation. Over the last decade, randomized controlled trials have questioned continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol reduces length of MV compared with standard strategy with sedation. Furthermore, daily interruption of sedation reduces length of MV, intensive care unit (ICU), and hospital length of stay (LOS). A larger scale trial with daily interruption of sedation has confirmed these findings and furthermore showed a reduction in 1-year mortality with the use of daily interruption of sedation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Gianluigi Li Bassi, Miquel Ferrer, Joan Daniel Marti, Talitha Comaru, Antoni Torres
Ventilator-associated pneumonia (VAP) is an iatrogenic pulmonary infection that develops in tracheally intubated patients on mechanical ventilation for at least 48 hours. VAP is the nosocomial infection with the greatest impact on patient outcomes and health care costs. Endogenous colonization by aerobic gram-negative pathogens, that is, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus play a pivotal role in the pathogenesis of VAP. Several preventive strategies have shown efficacy in decreasing VAP incidence and are often implemented altogether as a prevention bundle...
August 2014: Seminars in Respiratory and Critical Care Medicine
Pierpaolo Terragni, Chiara Faggiano, Erica L Martin, V Marco Ranieri
Airway access for mechanical ventilation (MV) can be provided either by orotracheal intubation (OTI) or tracheostomy tube. During episodes of acute respiratory failure, patients are commonly ventilated through an orotracheal tube that represents an easy and rapid initial placement of the airway device. OTI avoids acute surgical complications such as bleeding, nerve and posterior tracheal wall injury, and late complications such as wound infection and tracheal lumen stenosis that may emerge due to tracheostomy tube placement...
August 2014: Seminars in Respiratory and Critical Care Medicine
Laurent Brochard, Jean-Claude Lefebvre, Ricardo Luiz Cordioli, Evangelia Akoumianaki, Jean-Christophe M Richard
Noninvasive ventilation (NIV) has an established efficacy to improve gas exchange and reduce the work of breathing in patients with hypoxemic acute respiratory failure. The clinical efficacy in terms of meaningful outcome is less clear and depends very much on patient selection and assessment of the risks of the technique. The potential risks include an insufficient reduction of the oxygen consumption of the respiratory muscles in case of shock, an excessive increase in tidal volume in case of lung injury, and a risk of delayed or emergent intubation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Miquel Ferrer, Jacobo Sellares, Antoni Torres
Patients with chronic airflow obstruction and difficult or prolonged weaning are at increased risk for prolonged invasive mechanical ventilation (IMV). Several randomized controlled trials mainly conducted in patients who had pre-existing lung disease have shown that the use of noninvasive ventilation (NIV) to advance extubation in patients with difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates, and improved survival. Patients in these studies were hemodynamically stable, with a normal level of consciousness, no fever, and a preserved cough reflex...
August 2014: Seminars in Respiratory and Critical Care Medicine
V Fanelli, A Costamagna, V Marco Ranieri
Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO(2) removal (ECCO(2)R) techniques have increasingly been applied in patients with severe acute lung injury refractory to conventional mechanical ventilatory support. The objectives of this article are to review current concepts of extracorporeal life support techniques (ECMO and ECCO(2)R systems) and provide the rationale for their application in patients with acute respiratory distress syndrome, chronic obstruction pulmonary disease, and as adjunctive therapy for bridging patients to lung transplantation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Hameeda Shaikh, Daniel Morales, Franco Laghi
For many critically ill patients admitted to an intensive care unit, the insertion of an endotracheal tube and the initiation of mechanical ventilation (MV) can be lifesaving procedures. Subsequent patient care often requires intensivists to manage the complex interaction of multiple failing organ systems. The shift in the intensivists' focus toward the discontinuation of MV can thus occur late in the course of critical illness. The dangers of MV, however, make it imperative to wean patients at the earliest possible time...
August 2014: Seminars in Respiratory and Critical Care Medicine
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