Articles: mechanical-ventilation.
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We aimed to investigate the association between noninvasive ventilation (NIV) initiated in the emergency department and patient outcomes for those requiring invasive mechanical ventilation so that we could understand the effect of extended NIV use (ie, > 4 h) prior to invasive mechanical ventilation on patient outcomes. ⋯ Although any exposure to NIV prior to invasive mechanical ventilation did not appear to affect morbidity and mortality, extended NIV use prior to invasive mechanical ventilation was associated with worse patient outcomes, suggesting a need for additional study to better understand the ramifications of duration of NIV use prior to failure on outcomes. Given this early timeframe for intervention, future studies should be collaborations between the emergency department and ICU.
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Automatic cuff pressure (Pcuff) control devices for artificial airways are available, yet there are no standards or data to support their use. We hypothesized that airway pressure oscillations during mechanical ventilation are transmitted to Pcuff; and that the change in mean Pcuff (ΔPcuff) is zero during mechanical ventilation with controlled or uncontrolled Pcuff. ⋯ Automatic devices do not regulate ventilatory pressure oscillations, but they do control mean Pcuff and keep ΔPcuff well below a clinically important threshold. The large ΔPcuff seen with uncontrolled Pcuff warrants periodic monitoring. Further studies are needed to determine the source of ΔPcuff and the physiologic effects of Pcuff oscillations during mechanical ventilation.
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To identify potential predictors for invasive and non-invasive mechanical ventilation in coronavirus disease 2019 (COVID-19) patients. ⋯ Glucocorticoid, increased neutrophil and LDH were predictive indicators for IMV, whereas glucocorticoid, increased neutrophil and PCT were predictive indicators for NIMV. In addition, the above-mentioned mediators had the most predictive meaning for mechanical ventilation when combined.The reviews of this paper are available via the supplemental material section.
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Acute medicine & surgery · Jan 2020
Utility of a prediction model for delirium in intensive care unit patients (PRE-DELIRIC) in mechanically ventilated patients with sepsis.
Delirium frequently develops in patients with sepsis during their intensive care unit (ICU) stay, which is associated with increased morbidity and mortality. A prediction model for delirium in patients in ICU, PRE-DELIRIC, has been utilized in overall ICU patients, but its utility is uncertain among patients with sepsis. This study aims to examine the utility of PRE-DELIRIC to predict delirium in mechanically ventilated patients with sepsis. ⋯ The PRE-DELIRIC model could not predict delirium in mechanically ventilated patients with sepsis.
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Frontiers in medicine · Jan 2020
Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study.
Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. ⋯ Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.