Articles: mechanical-ventilation.
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Mechanical ventilation is a life-support therapy that can be associated with respiratory muscle dysfunction that may perturb the weaning process. The timed inspiratory effort (TIE) index is a recently proposed weaning index that has been reported to be effective in predicting successful weaning. We sought to analyze the respiratory muscle groups involved with the TIE index measurement utilizing the surface electromyography (sEMG). ⋯ Subjects succeeding in a weaning trial had higher muscle strength, confirmed in the pooled and the individual sEMG analysis. A vigorous diaphragm with low fatigue potential seems essential for successful weaning; the sternocleidomastoid may also be of importance in this regard.
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Obesity is an important risk factor for major complications, morbidity and mortality related to intubation procedures and ventilation in the intensive care unit (ICU). The fall in functional residual capacity promotes airway closure and atelectasis formation. This narrative review presents the impact of obesity on the respiratory system and the key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity. ⋯ Prone positioning is a therapeutic choice in severe ARDS patients with obesity. Prophylactic NIV should be considered after extubation to prevent re-intubation. If obesity increases mortality and risk of ICU admission in the overall population, the impact of obesity on ICU mortality is less clear and several confounding factors have to be taken into account regarding the "obesity ICU paradox".
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Journal of critical care · Dec 2020
Observational StudyAssessment of electrical impedance tomography to set optimal positive end-expiratory pressure for veno-venous ECMO-treated severe ARDS patients.
Ultra-protective ventilation with low tidal volume is used in severe acute respiratory distress syndrome (ARDS) patients under extracorporeal membrane oxygenation (ECMO). However, the optimal positive end-expiratory pressure (PEEP) is unknown. The aim of our study was to assess electrical impedance tomography's (EIT) ability to choose the best PEEP for these patients. ⋯ Ultra-protective ventilation with low tidal volume is used in severe acute respiratory distress syndrome patients under extracorporeal membrane oxygenation (ECMO), but the optimal positive end-expiratory pressure is unknown. This trial shows that electrical impedance tomography may be an interesting non-invasive bedside tool to provide real-time monitoring of PEEP impact in severe ARDS patients under ECMO. The Pulmovista® electrical impedance tomography was provided by Dräger (Lübeck, Germany) during the study period. Dräger had no role in the study design, collection, analysis and interpretation of the data, writing the article, or the decision to submit the article for publication.
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Intensive care medicine · Dec 2020
Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
To investigate whether COVID-19-ARDS differs from all-cause ARDS. ⋯ COVID-19-ARDS is a subset of ARDS characterized overall by higher compliance and lung gas volume for a given PaO2/FiO2, at least when considered within the timeframe of our study.
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Elucidate how the degree of ventilator-induced lung injury due to atelectrauma that is produced in the injured lung during mechanical ventilation is determined by both the timing and magnitude of the airway pressure profile. ⋯ Low-Vt and airway pressure release ventilation represent markedly different strategies for the avoidance of ventilator-induced lung injury, primarily involving the manipulation of positive end-expiratory pressure and , respectively. can be based on exhalation flow values, which may provide a patient-specific approach to protective ventilation.