Articles: mechanical-ventilation.
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Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. ⋯ Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.
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Am. J. Respir. Crit. Care Med. · Sep 2020
Observational StudyPulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging and Hematologic Observations.
Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology. Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia. Methods: Clinical, physiologic, and laboratory data were collated. ⋯ Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6). Conclusions: Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.
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To increase the understanding of the self-extubation phenomena, we assessed its rate in our medical ICU and aimed to identify the risk factors of self-extubation and the risk factors for re-intubation. ⋯ Results of our study showed that, in the era of reduced use of sedatives in the ICU, clinicians must be vigilant of the risk of self-extubation in the first 2 d of mechanical ventilation in patients who are agitated and with a longer endotracheal tube to carina distance on chest radiograph.
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Detection of diaphragmatic muscle activity during invasive ventilation may provide valuable information about patient-ventilator interactions. Transesophageal electromyography of the diaphragm ([Formula: see text]) is used in neurally adjusted ventilatory assist. This technique is invasive and can only be applied with one specific ventilator. Surface electromyography of the diaphragm ([Formula: see text]) is noninvasive and can potentially be applied with all types of ventilators. The primary objective of our study was to compare the ability of diaphragm activity detection between [Formula: see text] and [Formula: see text]. ⋯ Analysis of our results showed that [Formula: see text] was not reliable for breathing effort detection in subjects who were invasively ventilated compared with [Formula: see text]. In stable recordings, however, [Formula: see text] and [Formula: see text] had excellent temporal correlation and good agreement. With optimization of signal stability, [Formula: see text] may become a useful monitoring tool.
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In the modern era, many devices exist to support patients with respiratory insufficiency. There is currently no way to depict changes in the degree of support a patient is receiving over time. ⋯ Elements of respiratory support can be automatically extracted and transformed into a numerical RSS for visualization of respiratory course. The RSS provides a clear visual depiction of respiratory care over time, particularly in subjects with a complex ICU course. The score also allows for the automated adjudication of meaningful end points, including timing of extubation and incidence of nonprocedural re-intubation.