Articles: mechanical-ventilation.
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Multicenter Study
Frontal QRS/T angle can predict mortality in COVID-19 patients.
The frontal QRS-T (fQRS) angle has been investigated in the general population, including healthy people and patients with heart failure. The fQRS angle can predict mortality due to myocarditis, ischaemic and non-ischaemic cardiomyopathies, idiopathic dilated cardiomyopathy, and chronic heart failure in the general population. Moreover, no studies to date have investigated fQRS angle in coronavirus disease 2019 (COVID-19) patients. Thus, the purpose of this retrospective multicentre study was to evaluate the fQRS angle of COVID-19 patients to predict in-hospital mortality and the need for mechanical ventilation. ⋯ In conclusion, a wide fQRS angle >90° was a predictor of in-hospital mortality and associated with the need for mechanical ventilation among COVID-19 patients.
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J Clin Monit Comput · Aug 2022
Observational StudyAssessment of different computing methods of inspiratory transpulmonary pressure in patients with multiple mechanical problems.
While plateau airway pressure alone is an unreliable estimate of lung overdistension inspiratory transpulmonary pressure (PL) is an important parameter to reflect it in patients with ARDS and there is no concensus about which computation method should be used to calculate it. Recent studies suggest that different formulas may lead to different tidal volume and PEEP settings. The aim of this study is to compare 3 different inspiratory PL measurement method; direct measurement (PLD), elastance derived (PLE) and release derived (PLR) methods in patients with multiple mechanical abnormalities. 34 patients were included in this prospective observational study. ⋯ There was a good aggreement and there was no bias between the measurements in Bland-Altman analysis. The estimated bias was similar between the PLD and PLE (- 3.12 ± 11 cmH2O) and PLE and PLR (3.9 ± 10.9 cmH2O) measurements. Our results suggest that standardization of calculation method of inspiratory PL is necessary before using it routinely to estimate alveolar overdistension.
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Critical care nurse · Aug 2022
Case ReportsImpact of COVID-19 on Patient-Provider Communication in Critical Care: Case Reports.
Communication impairment during mechanical ventilation and prolonged critical illness is extremely frustrating and frightening for patients and increases the risk for miscommunication, misinterpretation, and poor outcomes. The COVID-19 pandemic amplified patient communication impairment in intensive care units. This article presents 3 case examples from the experience of a team of hospital-based speech-language pathologists providing augmentative and alternative communication support resources and services to intensive care unit patients treated for COVID-19 during the first wave of the pandemic. Cases were selected to illustrate the protracted and complex in-hospital and rehabilitative recovery of critically ill patients with COVID-19, necessitating creative problem-solving and nursing collaborations with speech-language pathologists to support patient-provider communication. ⋯ Evaluation by augmentative and alternative communication specialists and progressive intervention from speech-language pathologists in collaboration with intensive care unit nurses can greatly improve patient-provider communication during treatment for and recovery from COVID-19 and other prolonged critical illnesses.
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Randomized Controlled Trial
Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals.
Inspiratory muscle training (IMT) strategies can reduce ICU length of stay and optimize recovery in critically ill patients. Our objective was to compare IMT combined with spontaneous breathing with T-piece in tracheostomized subjects. ⋯ IMT modalities in this trial had no significant impacts on weaning time or successful weaning rates.