Articles: mechanical-ventilation.
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Curr Opin Crit Care · Feb 2025
ReviewHow to prevent and how to treat dyspnea in critically ill patients undergoing invasive mechanical ventilation.
To summarize current data regarding the prevalence, risk factors, consequences, assessment and treatment of dyspnea in critically ill patients receiving invasive mechanical ventilation. ⋯ As opposed to pain, dyspnea has often been overlooked in terms of detection and management, resulting in its significant underestimation in daily practice. When it is diagnosed, dyspnea can be relieved through straightforward interventions, such as adjusting ventilator settings. Assessing dyspnea in patients undergoing invasive mechanically ventilated may be challenging, especially in noncommunicative patients (RRBS). Implementing a systematic dyspnea assessment in routine, akin to pain, could serve as a first step to reduce RRBS and prevent potential severe psychological consequences. In addition to pharmacological treatments like opioids, a promising approach is to modulate both the sensory (air on the face, trigeminal nerve stimulation) and the affective (relaxing music, hypnosis, directed empathy) components of dyspnea.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewAwake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts.
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. ⋯ Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.
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Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and management of various respiratory conditions and lung perfusion. Its application may be especially beneficial for critically ill mechanically ventilated patients. ⋯ This report is the result of a four-day expert meeting where we aimed to promote the consistent and reliable use of EIT, facilitating its integration into both clinical practice and research, focusing on the adult intensive care patient. We discuss the state-of-the-art regarding EIT acquisition and processing, applications during controlled ventilation and spontaneous breathing, ventilation-perfusion assessment, and novel future directions.
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Extubation is a crucial step in the weaning process of critically ill mechanically ventilated patients. Some patients may develop postextubation respiratory failure that may lead to the need for re-intubation, which is associated with increased morbidity and mortality. This review comprehensively explores postextubation respiratory support strategies, focusing on the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and noninvasive ventilation (NIV) in reducing re-intubation rates among various patient populations. ⋯ NIV, alternatively, appears to provide substantial advantages in reducing the rates of re-intubation and respiratory failure, especially in patients with obesity and patients with hypercapnia. Therefore, the indiscriminate application of these support strategies without consideration of individual patient characteristics may not improve outcomes, highlighting the need for careful patient selection and tailored therapeutic strategies based on specific risk factors and clinical conditions. By aligning postextubation respiratory support strategies with patient-specific needs, we may improve the success rates of extubation, enhance overall recovery, and reduce the burden of reintubations in the intensive care setting.
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Review
Predictors of weaning failure in ventilated intensive care patients: a systematic evidence map.
Ventilator weaning is of great importance for intensive care patients in order to avoid complications caused by prolonged ventilation. However, not all patients succeed in weaning immediately. Their spontaneous breathing may be insufficient, resulting in extubation failure and the subsequent need for reintubation. To identify patients at high risk for weaning failure, a variety of potential predictors has already been examined in individual studies and meta-analyses over the last decades. However, an overview of all the predictors investigated is missing. ⋯ Predictors for weaning failure are widely researched. To date, 145 predictors have been investigated with varying intensity in 140 studies that are in line with the current weaning definition. It is no longer just individual predictors that are investigated, but more comprehensive assessments, indices and machine learning models in the last decade. Future research should be conducted in line with international weaning definitions and further investigate poorly researched predictors. Registration, Protocol: https://doi.org/10.17605/OSF.IO/2KDYU.