Respiratory care
-
Postextubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of adult subjects was based on quality assurance data including standardized surveillance screening criteria and a volume-based cuff leak test (CLT) to evaluate PES risk among predominantly surgical-trauma and neurotrauma subjects. Data characterizing PES subjects also were collected. ⋯ Among predominantly surgical-trauma and neurotrauma subjects with a CLT, leak volume of ≥ 110 mL was associated with a PES risk of ∼6%, whereas the risk of PES was 7 times greater when the leak volume was < 110 mL.
-
Intermittent mandatory ventilation (IMV) is one kind of breath sequence used to classify a mode of ventilation. IMV is defined as the ability for spontaneous breaths (patient triggered and patient cycled) to exist between mandatory breaths (machine triggered or machine cycled). Over the course of more than a century, IMV has evolved into 4 distinct varieties, each with its own advantages and disadvantages in serving the goals of mechanical ventilation (ie, safety, comfort, and liberation). ⋯ Also included is a brief overview of the background information required for a proper perspective of the purpose and design of the innovations. Understanding these different forms of IMV is essential to recognizing the similarities and differences among many dozens of different modes of ventilation. This recognition is important for clinical application, education of caregivers, and research in mechanical ventilation.
-
Review Controlled Clinical Trial
Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review.
Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation. ⋯ The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.
-
Observational Study
Oxygen Desaturation and Persistence of Symptoms during Activities of Daily Living in Patients following Hospital Discharge for COVID-19.
COVID-19 can cause respiratory and multisystemic impairments, which lead to impaired activities of daily living (ADL). Telemonitoring after discharge from the hospital may help identify the persistence of such limitations during ADLs simulations. The aim of this study was to compare SpO2 , fatigue, and dyspnea through telemonitoring during a battery of 4 ADLs in patients following hospital discharge for COVID-19. ⋯ SpO2 was similar among the ADLs but walking triggered desaturation in a larger number of subjects. The subjects presented with mild-to-intense fatigue and dyspnea during ADLs 30 d after discharge after hospitalization for COVID-19 regardless of desaturation status, which demonstrated that the persistence of symptoms is independent of hypoxemia during exercise.
-
Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. ⋯ Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.