Articles: mechanical-ventilation.
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Although maintaining some amount of positive end-expiratory pressure (PEEP) seems essential, selecting and titrating a specific level for patients with ARDS remains challenging despite extensive research on the subject. Although an "open lung" approach to ventilation is popular and has some degree of biological plausibility, it is not without risk. ⋯ Here we present a pragmatic approach based on simple measurements available on all ventilators, focused on achieving balance between the potential risks and benefits of PEEP. Acknowledging "best PEEP" as an impossible goal, we aim for a straightforward method to achieve "better PEEP."
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Critical care nurse · Jun 2022
ReviewOral Microbes in Hospital-Acquired Pneumonia: Practice and Research Implications.
Hospital-acquired pneumonia accounts for 25% of all health care-associated infections and is classified as either ventilator-associated or non-ventilator-associated pneumonia. Hospital-acquired pneumonia most frequently results from aspiration of oropharyngeal secretions into the lungs. Although preventive measures for ventilator-associated pneumonia are well established, few preventive measures exist for the nonventilator type. ⋯ Findings reaffirm the importance of consistent oral care in hospitalized patients. In addition, practices should be different in patients receiving mechanical ventilation versus patients not receiving ventilation. Results may also provide knowledge to inform future preventive measures for pneumonia, particularly for nonventilator pneumonia.
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Critical care nurse · Jun 2022
ReviewRisk Stratification in Noninvasive Respiratory Support Failure: A Narrative Review.
The use of noninvasive respiratory support, including noninvasive ventilation and high-flow nasal cannula therapy, has increased over the years. Failure of noninvasive respiratory support, defined as the need for invasive mechanical ventilation, increases the mortality rate. ⋯ Future research opportunities include improving study design for risk stratification and implementing preventive strategies for patients requiring noninvasive respiratory support. Clinically, risk stratification can provide an opportunity to share knowledge and facilitate conversations with patients and families.
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Curr Opin Crit Care · Jun 2022
ReviewThe weaning from mechanical ventilation: a comprehensive ultrasound approach.
Due to heart, lung and diaphragm interactions during weaning from mechanical ventilation, an ultrasound integrated approach may be useful in the detection of dysfunctions potentially leading to weaning failure. In this review, we will summarize the most recent advances concerning the ultrasound applications relevant to the weaning from mechanical ventilation. ⋯ The present review summarizes the potential role of ultrasonography in the weaning process. A multimodal integrated approach allows the clinician to comprehend the pathophysiological processes of weaning failure.
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Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32-36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients. ⋯ We suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.