Articles: mechanical-ventilation.
-
Intensive care medicine · Jun 2020
Review Meta AnalysisDiagnosis of ventilator-associated pneumonia in critically ill adult patients-a systematic review and meta-analysis.
The accuracy of the signs and tests that clinicians use to diagnose ventilator-associated pneumonia (VAP) and initiate antibiotic treatment has not been well characterized. We sought to characterize and compare the accuracy of physical examination, chest radiography, endotracheal aspirate (ETA), bronchoscopic sampling cultures (protected specimen brush [PSB] and bronchoalveolar lavage [BAL]), and CPIS > 6 to diagnose VAP. We searched six databases from inception through September 2019 and selected English-language studies investigating accuracy of any of the above tests for VAP diagnosis. ⋯ CPIS > 6 had a sensitivity of 73.8% (95% CI 50.6-88.5) and specificity of 66.4% (95% CI 43.9-83.3). Classic clinical indicators had poor accuracy for diagnosis of VAP. Reliance upon these indicators in isolation may result in misdiagnosis and potentially unnecessary antimicrobial use.
-
Journal of critical care · Apr 2020
Meta AnalysisKetamine sedation in mechanically ventilated patients: A systematic review and meta-analysis.
Ketamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients. ⋯ The data regarding ketamine use in mechanically ventilated patients is limited in terms of quantity, methodological quality, and demonstrated clinical benefit. Ketamine may play a role as a sedative-sparing agent, but may be associated with harm. High-quality studies are needed before widespread adoption of ketamine earlier in the sedation pathway.
-
The combination of general anaesthesia with low tidal volume and moderate-to-high PEEP reduces post-operative pulmonary complications in the general surgical population.
pearl -
Atelectasis during general anaesthesia increases with age up to 50 years and BMI up to 30 kg/m2, but appears curiously limited beyond this.
pearl -
Meta Analysis
Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis.
Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition. ⋯ There is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).