Articles: mechanical-ventilation.
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COVID-19 resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic of respiratory failure previously unencountered. Early in the pandemic, concentrated infections in high-density population cities threatened to overwhelm health systems, and ventilator shortages were predicted. An early proposed solution was the use of shared ventilation, or the use of a single ventilator to support ≥ 2 patients. ⋯ Prior to 2020, there were 7 publications on this topic. A year later, more than 40 publications have addressed the technical details for shared ventilation, clinical experience with shared ventilation, as well as the numerous limitations and ethics of the technique. This is a review of the literature regarding shared ventilation from peer-reviewed articles published in 2020.
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Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes. Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation. Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. ⋯ Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23). Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation.
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The COVID-19 pandemic has led to an increased demand for mechanical ventilators and concerns of a ventilator shortage. Several groups have advocated for 1 ventilator to ventilate 2 or more patients in the event of such a shortage. However, differences in patient lung mechanics could make sharing a ventilator detrimental to both patients. Our previous study indicated failure to ventilate in 67% of simulations. The safety problems that must be solved include individual control of tidal volume (VT), individual measurement of VT, individualization of PEEP settings, and individual PEEP measurement. The purpose of this study was to evaluate potential solutions developed at our institution. ⋯ The results of this simulation-based study indicate that devices for individual control and display of VT and PEEP are effective in extending the usability and potential patient safety of multiplex ventilation.
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Randomized Controlled Trial
Pulmonary volume-feedback and ventilatory pattern after bilateral lung transplantation using neurally adjusted ventilatory assist ventilation.
Bilateral lung transplantation results in pulmonary vagal denervation, which potentially alters respiratory drive, volume-feedback, and ventilatory pattern. We hypothesised that Neurally Adjusted Ventilatory Assist (NAVA) ventilation, which is driven by diaphragm electrical activity (EAdi), would reveal whether vagally mediated pulmonary-volume feedback is preserved in the early phases after bilateral lung transplantation. ⋯ NCT03367221.
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Randomized Controlled Trial
The effect of reconnection to mechanical ventilation for 1 hour after spontaneous breathing trial on reintubation among patients ventilated for more than 12 hours: A randomized clinical trial.
The resting of the respiratory musculature after undergoing the spontaneous breathing trial (SBT) to prevent extubation failures in critically ill patients needs to be studied further. ⋯ Reconnection to MV after a successful SBT, compared with DE, did not result in a statistically significant reduction in the risk of reintubation in mechanically ventilated patients. Subgroup exploratory findings suggest that the strategy may benefit patients who were ventilated for more than 72 h, which should be confirmed in further studies.