Articles: mechanical-ventilation.
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Pediatr Crit Care Me · Dec 2022
Prolonged Mechanical Ventilation in Pediatric Trauma Patients in a Combat Zone.
It is well known that polytrauma can lead to acute lung injury. Respiratory failure has been previously observed in combat trauma, but not reported in children, who account for over 11% of bed days at deployed Military Treatment Facilities (MTFs) using significant resources. We seek to identify risk factors associated with prolonged mechanical ventilation (PMV) which is important in resource planning and allocation in austere environments. ⋯ In this analysis of factors associated with PMV in pediatric trauma patients in a combat zone, in addition to severe injury to skin and thorax, we found that administration of crystalloids, colloids, and platelets was independently associated with greater odds of PMV. Our findings will help inform resource planning and suggest potential resuscitation strategies for future studies.
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Respiratory therapists (RTs) play a crucial role in managing mechanically ventilated patients, such as addressing patient-ventilator asynchronies that may contribute to patient harm. Waveform analysis is integral to the evaluation of patient-ventilator asynchronies; despite this, no published studies have assessed the ability of practicing RTs to interpret ventilator waveform abnormalities. ⋯ RTs may benefit from additional training in ventilator waveform interpretation, especially early in their clinical training. More work is needed to determine the optimal length and content of a mechanical ventilation curriculum for RTs.
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Background: Growing numbers of acute critical illness survivors experience chronic critical illness (CCI) marked by prolonged dependence on life support, delirium, and/or disability. There is minimal recent data on treatment limitations in CCI. Objectives: To evaluate the natural history of changes in orders for life-sustaining treatment (OLST) in patients requiring prolonged mechanical ventilation. ⋯ The 86 patients who underwent at least one change in OLST were older, had longer admissions, were more likely to be deceased at hospital discharge, and were more likely to have received specialty palliative care. Thirty percent of OLST changes occurred in the last week of admission. Conclusions: OLST occur infrequently and late in patients with CCI.
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Mechanical insufflation-exsufflation (MI-E) has been proposed as a potential strategy to generate high expiratory flows and simulate cough in the critically ill. However, efficacy and safety of MI-E during invasive mechanical ventilation are still to be fully elucidated. This study in intubated and mechanically ventilated pigs aimed to evaluate the effects of 8 combinations of insufflation-exsufflation pressures during MI-E on mucus displacement, respiratory flows, as well as respiratory mechanics and hemodynamics. ⋯ MI-E appeared to be an efficient strategy to improve mucus displacement during invasive ventilation, particularly when set at +40/-70 cm H2O. No safety concerns were identified although a transient significant increase of transpulmonary pressure was observed.
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African health sciences · Dec 2022
The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients - a systematic review.
Several observational reports from different parts of the world have shown that systemic hypertension (hypertension) was the single commonest comorbid condition in hospitalized COVID-19 patients. Hypertension is also the most prevalent comorbidity reported among patients who developed severe disease, were admitted to Intensive Care Unit, needed mechanical ventilatory support, or who died on admission. The objective of this systematic review is to study the association between hypertension and specific clinical outcomes of COVID-19 disease which are- development of severe COVID-19 disease, need for admission in the intensive care unit (ICU) or critical care unit (CCU), need for mechanical ventilation or death. ⋯ Hypertension affects the clinical course and outcome of COVID-19 disease in many cohorts. Prospective studies are needed to further understand this relationship.