Tag: ventilation

Upvote Story 8
This book describes the techniques, strategies, and drugs that have been demonstrated by multicenter randomized trials to influence survival in critically ill patients, defined as those who have acute failure of at least one organ, due to either a pathological condition or a medical intervention, and require intensive care treatment. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide,... Read More | Comment
Upvote Story 11
Fundamental concepts of respiratory physiology and the day-to-day duties of a respiratory care professional. Utilizing the wide degree of topics covered, including airway management, understanding ventilator waveforms, and addressing critical care issues, readers have the best resource available for understanding mechanical ventilation and its clinical application. Enhancing the learning experience are valuable illustrations of concepts and equipment, highlighted key points, and self-assessment questions in NRBC... Read More | Comment
Upvote Story 5
In light of emerging data from clinical trials, the place of high-frequency oscillatory ventilation (HFOV) in the management of acute respiratory distress syndrome (ARDS) is uncertain. Although not first-line, HFOV remains a tool in the armamentarium of the intensivist managing the patient with severe ARDS and refractory hypoxemia. A refinement in the approach to delivering HFOV is warranted, with more attention paid to its adverse... Read More | Comment
Upvote Story 8
As expected, higher levels of BLS training correlated with better cardiopulmonary resuscitation (CPR) quality. However, this study showed that ventilations and hands-on time were the components of CPR that were most affected by the level of training. Self-assessments of CPR ability correlated well to actual test performance and may have a role in probing CPR skills in students. The results may be important for BLS... Read More | Comment
Upvote Story 5
This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the non-inferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Although this study failed to demonstrate non-inferiority of sham cricoid pressure to cricoid pressure the data does not show any hint that cricoid pressure is the better approach.... Read More | Comment
Upvote Story 5
Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung-protective ventilation reduces ventilator-associated complications including acute respiratory distress syndrome (ARDS). Additionally, it is believed that ventilatory-associated lung injury can occur early after the... Read More | Comment
Upvote Story 5
A few years ago, I received report that a patient was ready to be weaned from the ventilator. He had no respiratory need for mechanical ventilation, and every time the medical team attempted to wean sedation to extubate, the patient “went crazy.” As I assumed care on the night shift, I looked into the eyes of this intubated 67-year-old male patient. I asked him gently... Read More | Comment
Upvote Story 4
Use of initial tidal volumes less than 8 ml/kg PBW is common at hospitals participating in the NHLBI PETAL Network. After considering the size and budgetary requirement for a cluster-randomized trial of LTVV vs. usual care in acute respiratory failure (ARF), the PETAL network deemed the proposed trial infeasible. A rapid observational study and simulations to model anticipated power may help better design trials. We... Read More | Comment
Upvote Story 6
In awake morbidly obese volunteers, an increase in the FRC is observed when spontaneous ventilation at zero inspiratory pressure is switched to positive pressure. Compared with S positioning, the BC position had no measurable impact on the FRC. The RT position resulted in an optimal functional residual capacity (FRC). Using a prospective crossover randomized trial design, obese subjects underwent, in a randomized order, a combination... Read More | Comment
Upvote Story 10
The use of digestive and oral decontaminants in patients in the intensive care unit (ICU) who are mechanically ventilated and who have moderate to high antibiotic resistance is not associated with a reduction in ICU-acquired bloodstream infections caused by multidrug-resistant gram-negative bacteria. According to the results of a randomized clinical trial conducted by investigators in the Netherlands and published in the Journal of the American... Read More | Comment
Upvote Story 5
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction although mortality could be reduced from formerly ∼80% to 40–50%. In addition to percutaneous coronary intervention or coronary artery bypass grafting, catecholamines, fluids, intraaortic balloon pumping (IABP), and also active assist devices are widely used for CS management. However, there is only limited evidence for any of the above... Read More | Comment
Upvote Story 8
This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive mechanical ventilation or high-flow nasal oxygen therapy to support patients, with regular audit of re-intubation rates. The beneficial secondary outcomes demonstrated in this trial, such as reduced antibiotic use, reduced sedation requirement and reduced... Read More | Comment
Upvote Story 4
As little as 30 minutes of exposure to anesthetic and sedative agents may adversely affect the developing brain. Safe, humane management of critically ill infants requires the use of sedative agents, often for prolonged periods. Infants with respiratory diagnoses having non-invasive ventilation without sedation (Group C) or intubation and ventilation with sedation (Group S) were identified by chart review. It is not possible to randomise... Read More | Comment
Upvote Story 7
Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Among 364 randomized patients (mean age, 63.1 [SD, 14.8] years; 50.5% male), 319 were evaluable for the primary effectiveness outcome (41 died before liberation, 2 withdrew, and 2 were discharged with ongoing ventilation). The median time to liberation... Read More | Comment
Upvote Story 14
With a full-color design and concise, easy-to-read chapters, Critical Care Medicine: The Essentials and a Bit More covers the core elements of critical care, with a unique focus on the pathophysiology underlying clinical disorders and how pathophysiologic concerns affect treatment options. There is much here that’s new: brand-new content, expanded discussions, and more graphical elements than ever before. Chapters follow a consistent structural template, with... Read More | Comment