Tag: ARF

Upvote Story 5
In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome. Six eligible studies were identified with a total of 564 participants. The synthesized data... Read More | Comment
Upvote Story 9
The majority of respondents reported targeting moderate to deep sedation following cannulation, with the use of sedative and opioid infusions. There is considerable variability surrounding early physical therapy and mobilization goals for patients with acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation. We analyzed responses from 209 respondents (53%), mostly from academic centers (63%); 41% respondents provide venovenous extracorporeal membrane oxygenation to adults... Read More | Comment
Upvote Story 6
In this study, antipsychotics were used to treat nearly half of all antipsychotic-naïve ICU patients and were prescribed at discharge to 24% of antipsychotic-treated patients. Treatment with an atypical antipsychotic greatly increased the odds of discharge with an antipsychotic prescription, a practice that should be examined carefully during medication reconciliation since these drugs carry “black box warnings” regarding long-term use. After excluding 18 patients due... Read More | Comment
Upvote Story 7
A large proportion of patients with do-not-intubate orders who received noninvasive ventilation survived to hospital discharge and at 1 year, with limited data showing no decrease in quality of life in survivors. Provision of noninvasive ventilation in a well-equipped hospital ward may be a viable alternative to the ICU for selected patients. Crucial questions regarding quality of life in survivors, quality of death in nonsurvivors,... Read More | Comment
Upvote Story 6
Randomized clinical trials (RCTs) are conducted to guide clinicians’ selection of therapies for individual patients. Currently, RCTs in critical care often report an overall mean effect and selected individual subgroups. Yet work in other fields suggests that such reporting practices can be improved. Specifically, this Critical Care Perspective reviews recent work on so-called “heterogeneity of treatment effect” (HTE) by baseline risk and extends that work... Read More | Comment
Upvote Story 8
Dr. Fraser, MD, speaks with Bruce A. Mueller, PharmD, FCCP, FASN, about his talk presented at the 47th Critical Care Congress in San Antonio, Texas, entitled “Artificial Kidney Meets Mechanical Lung: Comanaging the Patient with Renal and Respiratory Failure.” Dr. Mueller discusses the concepts of drug dosing during renal replacement therapy. Dr. Mueller is a Professor and Associate Dean at University of Michigan College of... Read More | Comment
Upvote Story 6
The introduction of early mobilization for patients with mechanical ventilation (MV) in the ICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient’s family can work together to improve the patient’s clinical outcomes. We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body... Read More | Comment
Upvote Story 22
It is indisputable from the biological and clinical perspectives that not all cases of sepsis are the same. On the contrary, most have great many differences, that is, different portals of entry, clinical manifestations, immunologic responses, and survival outcomes. Therefore, why is there a single definition for something as complex and diverse as sepsis? This is the antithesis of precision medicine. We propose that all... Read More | Comment
Upvote Story 6
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. A new analysis of the large, prospective Intensive Care Over Nations (ICON) database compares patients who underwent intubation early – within two days of ICU admission – to those who underwent intubation later. Results show that later intubation (after two days) was associated with a greater hazard of death... Read More | Comment
Upvote Story 4
Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of... Read More | Comment
Upvote Story 23
In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV). HFNC has an effect on intubation but not on mortality rates. Failure to identify ARF etiology is associated with higher rates of both intubation and mortality. This suggests that in addition to selecting the appropriate oxygenation device, clinicians should strive to identify the etiology of ARF. Read More | Comment
Upvote Story 14
Patients starting noninvasive ventilation (NIV) to treat acute respiratory failure are often unable to eat and therefore remain in the fasting state or receive nutritional support. Nearly three-fifths of patients receiving NIV fasted for the first 2 days. Lack of feeding or underfeeding was not associated with mortality. The optimal route of nutrition for these patients needs to be investigated. Read More | Comment
Upvote Story 13
High-flow nasal cannula, when set at 60 L/min, significantly reduces the indexes of respiratory effort in adult patients recovering from acute respiratory failure (ARF). This effect is associated with an improvement in respiratory mechanics. Four experimental conditions were evaluated: baseline with conventional oxygen therapy and high-flow nasal cannula at 20, 40, and 60 L/min. Read More | Comment
Upvote Story 6
The proportion of survivors of acute respiratory failure is growing; yet, many do not regain full function and require prolonged admission in an acute or post-acute care facility. Patients who require prolonged admission after acute respiratory failure have significantly lower physical functional performance than patients who return home. However, the rates of physical functional recovery between the two groups do not differ. The majority of... Read More | Comment
Upvote Story 8
There is heterogeneity among the outcomes evaluated in studies of survivors of acute respiratory failure (ARF). Patient, family and researcher groups supported inclusion of outcome domains that fit within the PICS framework. Patients and family members also supported many additional domains, emphasising the importance of including patients/family, along with researchers, in consensus processes to select core outcome domains for future research studies. Read More | Comment