Articles: mechanical-ventilation.
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Randomized Controlled Trial
Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a randomized controlled study.
Current sedatives have different side effects in long-term sedation. The sequential use of midazolam and dexmedetomidine for prolonged sedation may have distinct advantages. We aimed to evaluate the efficacy and safety of the sequential use of midazolam and either dexmedetomidine or propofol, and the use of midazolam alone in selected critically ill, mechanically ventilated patients. ⋯ The sequential use of midazolam and dexmedetomidine was an effective and safe sedation strategy for long-term sedation and could provide clinically relevant benefits for selected critically ill, mechanically ventilated patients.
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J. Thorac. Cardiovasc. Surg. · May 2022
Randomized Controlled TrialSpontaneous versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomized trial.
Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS (MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely demonstrated. ⋯ SV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in selected patients undergoing blebectomy for primary spontaneous pneumothorax.
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Randomized Controlled Trial
Patient-Ventilator Synchrony in Neurally-Adjusted Ventilatory Assist and Variable Pressure Support Ventilation.
Neurally-adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony and reduces the risk of respiratory over-assistance. Variable pressure support ventilation (PSV) is a recently introduced mode of assisted ventilation that has also shown reduction in patient-ventilator asynchronies. We hypothesized that NAVA would reduce patient-ventilator asynchronies and inspiratory effort compared to variable PSV because breathing variability was intrinsically determined by the patient and not by the ventilator. This study aimed to evaluate patient-ventilator asynchronies and inspiratory effort pressure-time product (PTP) between NAVA and variable PSV in subjects with mild ARDS. ⋯ In this randomized controlled trial including subjects with mild ARDS, NAVA and variable PSV had comparable effects on patient-ventilator synchronies and PTP. However, variable PSV reduced the variability of VT and PS when compared with NAVA.
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Journal of critical care · Apr 2022
Randomized Controlled TrialFailure of non-sedation strategy in critically ill, mechanically ventilated patients - a retrospective, post-hoc analysis of the NONSEDA trial.
There is a growing awareness on minimizing sedation in ICUs. In the NONSEDA trial 700 critically ill patients were randomized to light sedation or non-sedation during mechanical ventilation. Approximately 40% of patients randomized to non-sedation needed sedation. The aim of this study is to obtain knowledge on patients, who experienced failure of non-sedation. ⋯ Patients with non-sedation success had better in-hospital outcomes, but mortality and long-term outcomes were not affected by success or failure of non-sedation.
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Critical care medicine · Feb 2022
Randomized Controlled TrialLung- and Diaphragm-Protective Ventilation by Titrating Inspiratory Support to Diaphragm Effort: A Randomized Clinical Trial.
Lung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes diaphragm atrophy, whereas excessive breathing effort induces diaphragm and lung injury. In a proof-of-concept study, we aimed to assess whether titration of inspiratory support based on diaphragm effort increases the time that patients have effort in a predefined "diaphragm-protective" range, without compromising lung-protective ventilation. ⋯ Titration of inspiratory support based on patient breathing effort greatly increased the time that patients had diaphragm effort in the predefined "diaphragm-protective" range without compromising tidal volumes and transpulmonary pressures. This study provides a strong rationale for further studies powered on patient-centered outcomes.