Articles: 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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J. Cardiothorac. Vasc. Anesth. · Jul 2021
Association Between Early Tracheostomy and Delirium in Older Adults in the United States.
Early tracheostomy (fewer than eight days after intubation) is associated with shorter length of stay in the intensive care unit and shorter duration of mechanical ventilation. Studies assessing the association between early tracheostomy and incidence of delirium, however, are lacking. This investigation sought to fill this gap. ⋯ Early tracheostomy was associated significantly with lower odds of delirium among all patients studied. This association held true across medical and nonsurgical subgroups.
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Unplanned extubation (UE) is a preventable adverse event and may lead to additional complications such as cardiovascular resuscitation or respiratory compromise in a critically ill neonate during an emergent re-intubation. A quality improvement project to reduce unplanned endotracheal tube dislodgement would reduce these morbidities. We aimed to reduce UEs in the NICU to 1 UE/100 ventilator days by October 2018. ⋯ Development of a quality improvement project by a multidisciplinary taskforce, along with several PDSA cycles including education and staff awareness, reduced the UE rate by 84% in a level 4 NICU. Ongoing surveillance, education, and review of UE cases will be key to maintaining UE events at a goal of 1 UE/100 ventilator days.
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J. Cardiothorac. Vasc. Anesth. · Jul 2021
Observational StudyDiaphragm Thickening During Venoarterial Extracorporeal Membrane Oxygenation Weaning: An Observational Prospective Study.
The respiratory workload, according to the diaphragm thickening fraction (TF) during sweep gas flow (SGF), decrease during weaning from venoarterial extracorporeal membrane oxygenation (VA ECMO) was evaluated for the present study. ⋯ Diaphragm TF was related to the SGF of the venoarterial ECMO settings and LVEF at the time of weaning.
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Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an "awake approach," may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach.