Tag: ventilator

Upvote Story 5
A score derived from ventilator settings may help clinicians predict the timing of ventilator liberation in patients requiring prolonged mechanical ventilation. Of 372 patients, 72% were liberated from mechanical ventilation. The ventilator independence score measured on the day after tracheostomy placement had an area under the receiver operating characteristic curve value of 0.71 (95% CI, 0.65–0.76) for differentiating patients who were liberated within the next... Read More | Comment
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We developed a computerized algorithm that accurately detects three types of ventilator dyssynchrony. Double-triggered and flow-limited breaths are associated with the frequent delivery of tidal volumes of greater than 10 mL/kg. Although ventilator dyssynchrony is reduced by deep sedation, potentially deleterious tidal volumes may still be delivered. However, neuromuscular blockade effectively eliminates ventilator dyssynchrony. A total of 4.26 million breaths were recorded from 62 ventilated patients.... Read More | Comment
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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
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The treatment of choice for a pneumothorax is a chest tube, and when the small pig-tail catheter doesn’t do the job, the answer is to replace it with a larger bore – right? Not so fast. The exact mechanism of REPE is not clear. The current theory is that lung expansion leads to increased vascular permeability. Rapid inflow of blood to atelectatic lung segments results... Read More | Comment
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This book discusses mechanical ventilation in emergency settings, covering the management of patients from the time of intubation until transfer to the ICU. It provides an introduction to key concepts of physiology pertinent to mechanical ventilation as well as a review of the core evidence-based principles of ventilation. The text highlights the management of mechanical ventilation for critically ill patients with several conditions commonly encountered... Read More | Comment
Upvote Story 11
Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. Although evidence is limited, results suggest that most communication methods may be effective in improving patient–healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an... 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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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 13
Synchrony between the patient and the ventilator is defined as the appropriate interaction between the two, where the ventilator recognizes patient’s effort and provides support for breathing at the right time—that is, inspiratory and expiratory times matches with patients’ times (patient’s neural time equals to ventilator times). In our humble opinion, the mismatch between the patient and the ventilator occurs because we set the ventilator... Read More | Comment
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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
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Patients with PARDS managed with lower PEEP relative to FiO2 than recommended by the ARDSNet model had higher mortality. Clinical trials targeting PEEP management in PARDS are needed. This was a multicenter, retrospective analysis of patients with pediatric acute respiratory distress syndrome (PARDS) managed without a formal PEEP/FiO2 protocol. Four distinct datasets were combined for analysis. Read More | Comment
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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
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The goal of this book is to provide the most up to date information on mechanical ventilation based on current research, evidence based practice and my experiences as a flight paramedic and educator. A comprehensive look at ventilator management strategies as it relates to emergency medicine, and pre-hospital transport in both EMS and HEMS industries. The book is written in a conversational format and will... Read More | Comment
Upvote Story 8
Approximately 50 percent of all patients receiving mechanical ventilator support develop ventilator-associated pneumonia (VAP). Researchers at Massachusetts General Hospital (MGH) have developed an automated system for identifying patients at risk for complications associated with the use of mechanical ventilators. The new system uses an algorithm that has been shown to be 100 percent accurate in identifying at-risk patients when provided with necessary data, according to... Read More | Comment
Upvote Story 20
Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols – written or computerized – attempts to early identify patients who are able to breathe spontaneously and to hasten extubation, resulting in better outcomes. Nevertheless, individualized care is needed in the most vulnerable patients, trying to prompt weaning without exposing patients to unnecessary risks. The results... Read More | Comment