Tag: oxygenation

Upvote Story 11
There were both similarities and differences in tracheal intubation practice and outcomes across international PICUs. Fewer adverse tracheal intubation–associated events were reported from International versus North American PICUs. International PICUs used cuffed endotracheal tube less often and had higher proportion of endotracheal tube change. Adverse tracheal intubation–associated events and desaturation occurrence (oxygen saturation < 80%) were evaluated. A total of 1,134 and 9,376 TIs from... 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 5
Multi-system organ failure is ubiquitous but treatable with adequate hemodynamic support. Neurologic recovery was prolonged requiring delayed prognostication. Immediate 24/7 availability of surgical and medical specialty expertise was required to achieve 48% functionally intact survival. Of 100 appropriately transported patients, 83 achieved CICU admission. 40/83 (48%) discharged functionally intact. Multi-system organ failure occurred in all patients. Cardiac, pulmonary, renal, and liver injury improved within 3-4... Read More | Comment
Upvote Story 4
Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by... Read More | Comment
Upvote Story 10
The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique. Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to... Read More | Comment
Upvote Story 5
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
Upvote Story 10
Vasopressors are used in sepsis when hypotension is assumed to be mainly due to a decreased arterial tone. However, the appropriate time to initiate vasopressors is not clearly defined, and fluid administration is most often prioritized with potential risks of fluid overload and persistent hypotension, all events associated with increased mortality. We thus need relevant easy-to-obtain markers of decreased arterial tone to appropriately initiate a... Read More | Comment
Upvote Story 5
Prevalence of HIT among patients under VA‑ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA‑ECMO without HIT. In addition, HIT was ultimately ruled out in one‑third of patients with clinical suspicion of HIT and positive anti‑PF4/heparin antibodies. A total of 5797 patients under VA‑ECMO were... Read More | Comment
Upvote Story 3
Improvements in acute respiratory distress syndrome (ARDS) outcomes in adults have been achieved along-side demonstration of the superiority of low-tidal volume ventilation, the relative advantage of a restrictive fluid strategy and the characterization of the main effectors of ventilator-induced lung injury. The heterogeneity of the group of patients defined as “ARDS” on pragmatic criteria is widely recognized. “Lumping” together patients with different ages, etiologies, time... Read More | Comment
Upvote Story 7
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
Upvote Story 5
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
Upvote Story 6
Emergency physicians (EPs) are experts in emergent airway management and thus must be confident managing mechanical ventilation. Hospital-wide bed shortages mean that EPs will be managing admitted patients for longer periods of time, and if you work in a hospital without intensivist coverage you must be the ventilator expert. A recent study suggests implementing a ventilator protocol in the emergency department can improve mortality in... Read More | Comment
Upvote Story 9
The American Society of Anesthesiologists (ASA) difficult airway algorithm recommends that if initial attempts at tracheal intubation after the induction of general anesthesia are unsuccessful, the practitioner should “consider the advisability of awakening the patient”. With respect to the use of muscle relaxants, “awakening” is assumed to mean return to an unparalyzed state that permits life-sustaining spontaneous ventilation (hereafter referred to as functional recovery). The... Read More | Comment
Upvote Story 5
This is the first extracorporeal cardiopulmonary resuscitation report to examine changes in Functional Status Scale from admission (baseline) to discharge as a measure of overall functional outcome. Half of surviving patients (19/38) had new morbidity, while 68% (26/38) had favorable outcomes. Lactate levels, duration of cardiopulmonary resuscitation, and duration of extracorporeal membrane oxygenation were not found to be risk factors for the development of new... Read More | Comment
Upvote Story 4
Several studies nowadays prove the physiological benefits of neurally adjusted ventilatory assist, as opposed to the conventional modes of partial support. Whether these advantages translate into improvement of clinical outcomes remains to be determined. Compared with pressure support, neurally adjusted ventilatory assist has been shown to improve patient–ventilator interaction and synchrony in patients with the most challenging respiratory system mechanics, such as very low compliance... Read More | Comment