Tag: hypoxemia

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When used in intensive care units, video laryngoscopy did not improve the chances of successful intubation on the first try, compared with direct laryngoscopy, and was associated with a significantly higher risk of severe life-threatening complications, researchers reported. The view during video laryngoscopy can also create a cognitive blind spot: laryngoscopists may fail to abort a laryngoscopy attempt in a timely manner because they have... Read More | Comment
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The Advanced Ventilator Book is a companion to the best-selling The Ventilator Book and is written for clinicians who already have a solid foundation in the basics of mechanical ventilation. It goes beyond the ventilator itself to discuss strategies for severe hypoxemia and rescue maneuvers for refractory respiratory failure. Subjects covered in The Advanced Ventilator Book include: Optimal PEEP, Treatment of severe bronchospasm, Prone positioning,... Read More | Comment
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Prone position, inhaled nitric oxide, high frequency oscillation, extra corporeal life support. The mortality of severe acute respiratory distress syndrome (ARDS), defined with a PaO2/FiO2 ratio of 100 mmHg or less with at least 5 cm H2O of PEEP, still exceeds 40%. Furthermore, although it is true that more ARDS patients die from multi-organ failure than hypoxemia per se, an important subgroup of severe ARDS... Read More | Comment
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This free eBook presents emergent clinical situations and the core tasks required of healthcare professionals needing to recognize, navigate and safely manage them. It’s really about how to perform the ABCs while protecting yourself, the patient and others; attempting to establish therapeutic relationships; and respecting patients’ values and wishes. When first called upon to manage acutely ill patients, the healthcare team must initiate their ABCs... Read More | Comment
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Cognitive impairment (CI) is an important but an under-recognized extra-pulmonary feature of chronic obstructive pulmonary disease (COPD). It is related to the burden of disability, worse health outcomes and impaired self-management. Areas covered: CI includes deterioration of a wide range of cognitive functions, such as memory and various executive functions. Risk of hospitalization might be higher in patients with COPD compared to those without, with... Read More | Comment
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Since the description in the 1970s of external positive end-expiratory pressure for acute respiratory distress syndrome (ARDS), the optimum level of external positive end-expiratory pressure remains unresolved. In the 1990s, the lower inflection point, an inspiratory phenomenon on the low-flow pressure–volume curve, was defined as the point above which external positive end-expiratory pressure should be set to ensure full opening of the lung, e.g., open... Read More | Comment
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Hypoxemia should certainly be avoided, but the fact that the liberal administration of oxygen to patients in intensive care units and emergency rooms tends to increase morbidity and mortality implies the advisability of a conservative, normoxic oxygenation strategy. 13 prospective, randomized trials involving a total of 17 213 patients were analyzed. In patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and in ventilated... Read More | Comment
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Mr. Jackson is a 36-year-old man whom you are caring for in the intensive care unit (ICU). Before this hospitalization, he was healthy and took no medications. He has never smoked, and he drinks three or four beers every week. A week ago, a couple of coworkers in his office had respiratory illnesses, and a day later, he started having fever, chills, cough, and generalized... Read More | Comment
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For the identification of acute respiratory distress syndrome (ARDS) using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that... Read More | Comment
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The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups. I first started using it as a pediatric intensive care fellow, but had little knowledge of how it actually worked. I noticed a few years after using it successfully in children, mainly with severe bronchiolitis, that we... Read More | Comment
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Timely use of NIV in the ED may decrease the need for invasive ventilation and its associated complications. The appropriate device, interface and patient selection are, therefore, key components of NIV success. Once the decision is given to apply NIV, EP should decide on the mode (either CPAP or BPAP), the interface, and the circuit that is suitable for the ventilator. Continuous positive airway pressure... Read More | Comment
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Half the patients with acute respiratory distress syndrome (ARDS) had major comorbidities, which were associated with severe ARDS, multiple organ dysfunction, and day‑28 mortality. These findings do not support the exclusion of ARDS patients with severe comorbidities from randomized clinical trials. Trials in ARDS patients with whatever comorbidities are warranted. Among 4953 ARDS patients, 2545 (51.4%) had major comorbidities; the proportion with major comorbidities increased... Read More | Comment
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The published reductions in asynchrony and length of stay in the ICU with proportional assist ventilation (PAV ventilation by Medtronic) led to shorter time on ventilation, and reduced incidence of ventilator-associated pneumonia (VAP) and tracheostomy in this decision analytic model. Increased patient survival with PAV resulted in annual healthcare costs being accumulated over a longer period. This made it most likely that PAV is cost-saving... Read More | Comment
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High flow nasal oxygen is a novel device that actively humidifies and heats air to make flows of up to 60 liters a minutes tolerable. These incredibly high flows are important, because in order to provide 100% fiO2 to patients in respiratory distress, we must be able to match their minute ventilation. High flow nasal oxygen also offers the theoretical benefits of low levels of... Read More | Comment
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This blog post is the second part of a series of 3, on a recent lecture I was asked to give on Critical Care Updates: Resuscitation Sequence Intubation. This talk was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis... Read More | Comment