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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Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern. ⋯ In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.
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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.