Resp Care
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Multicenter Study Comparative Study
Comparison of 2 correction methods for absolute values of esophageal pressure in subjects with acute hypoxemic respiratory failure, mechanically ventilated in the ICU.
A recent trial showed that setting PEEP according to end-expiratory transpulmonary pressure (P(pl,ee)) in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) might improve patient outcome. P(pl,ee) was obtained by subtracting the absolute value of esophageal pressure (P(es)) from airway pressure an invariant value of 5 cm H(2)O. The goal of the present study was to compare 2 methods for correcting absolute P(es) values in terms of resulting P(pl,ee) and recommended PEEP. ⋯ Referring absolute P(es) values to Vr rather than to an invariant value would be better adapted to a patient's physiological background. Further studies are required to determine whether this correction method might improve patient outcome.
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Randomized Controlled Trial
Different tracheotomy tube diameters influence diaphragmatic effort and indices of weanability in difficult to wean patients.
To determine the effects of different tracheotomy tube sizes on diaphragm effort and weanability indices. ⋯ In tracheotomized difficult to wean subjects the decrease of the tracheotomy tube size was associated with an increased PTP(di), f/V(T), and TT(di), that were otherwise normal, using a higher diameter. The in vitro study showed that the resistances increased similarly for tracheotomy tube and endotracheal tube, decreasing the diameter and increasing the flows.
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Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. The aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. ⋯ Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial surgery.
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To determine the utility of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) levels in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) samples from patients who underwent bronchoscopy for a clinical suspicion of ventilator-associated pneumonia (VAP), to categorize patients as VAP positive and VAP negative, when compared to quantitative culture results of BALF. ⋯ EBC and BALF sTREM-1 levels did not effectively categorize patients as VAP positive or VAP negative when using direct bronchoscopic quantitative culture samples as the comparison standard.