Articles: mechanical-ventilation.
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Minerva anestesiologica · May 2023
Meta AnalysisEarly versus late tracheostomy for traumatic brain injury: a systematic review and meta-analysis.
Tracheostomy is the most frequent bedside surgical procedure performed on patients with traumatic brain injury who require mechanical ventilation. To compare the effects of early tracheostomy vs. late tracheostomy on the duration of mechanical ventilation in patients with traumatic brain injury, we carried out a systematic review and meta-analysis. ⋯ The findings from this meta-analysis suggest that early tracheostomy in severe TBI patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.
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Acta Anaesthesiol Scand · May 2023
ReviewMechanical Ventilation Post-Bilateral Lung Transplantation: A Scoping Review.
Evidence from lung protective ventilation (LPV) in the acute respiratory distress syndrome has commonly been applied to guide periprocedural ventilation in lung transplantation. However, this approach may not adequately consider the distinctive features of respiratory failure and allograft physiology in the lung transplant recipient. This scoping review was conducted to systematically map the research describing ventilation and relevant physiological parameters post-bilateral lung transplantation with the aim to identify any associations with patient outcomes and gaps in the current knowledge base. ⋯ This review has identified a significant knowledge gap that indicates uncertainty regarding the safest ventilation practice in lung transplant recipients. The risk may be greatest in patients with established high-grade primary graft dysfunction and undersized allografts, and these factors may define a sub-group that warrants further investigation.
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Meta Analysis
Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression.
Stroke patients requiring mechanical ventilation often have a poor prognosis. The optimal timing of tracheostomy and its impact on mortality in stroke patients remains uncertain. We performed a systematic review and meta-analysis of tracheostomy timing and its association with reported all-cause overall mortality. Secondary outcomes were the effect of tracheostomy timing on neurological outcome (modified Rankin Scale, mRS), hospital length of stay (LOS), and intensive care unit (ICU) LOS. ⋯ In this meta-analysis of over 17,000 critically ill stroke patients, the timing of tracheostomy was not associated with mortality, neurological outcomes, or ICU/hospital LOS.
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Curr Opin Anaesthesiol · Apr 2023
ReviewA review of the utility of high-frequency oscillatory ventilation in burn and trauma ICU patients.
The purpose was to examine the utility of high-frequency oscillatory ventilation (HFOV) in trauma and burn ICU patients who require mechanical ventilation, and provide recommendations on its use. ⋯ Although some studies have shown promise and improved outcomes associated with HFOV, we recommend its use as a rescue modality for patients who have failed conventional ventilation.
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Recent studies have focused on identifying optimal targets and strategies of mechanical ventilation in patients with acute brain injury (ABI). The present review will summarize these findings and provide practical guidance to titrate ventilatory settings at the bedside, with a focus on managing potential brain-lung conflicts. ⋯ Although direct data to guide mechanical ventilation in brain-injured patients is accumulating, the current evidence base remains limited. Ventilatory considerations in this population should be extrapolated from high-quality evidence in patients without brain injury - keeping in mind relevant effects on intracranial pressure and cerebral perfusion in patients with ABI and individualizing the chosen strategy to manage brain-lung conflicts where necessary.