Articles: mechanical-ventilation.
-
Closed suction catheters are commonly used with pressurized metered-dose inhalers (pMDIs) in ventilator-dependent patients receiving bronchodilator therapy. Although heated/humidified circuits result in a decrease in drug delivery, no studies have investigated the impact of a closed suction catheter with a pMDI on aerosol delivery during mechanical ventilation. We sought to quantify aerosol delivery with a variety of closed suction catheters and pMDI adapters in a simulated ventilator-dependent adult lung model with and without exhaled humidity. ⋯ Closed suction catheter, pMDI spacer/adapters, and exhalation conditions have an impact on drug delivery during simulated adult mechanical ventilation. Aerosol delivery without exhaled humidity appears to report unrealistically high values in comparison to the more accurate values with simulated exhalation humidity.
-
Critical care medicine · Sep 2018
Observational StudyBenzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect.
Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for time-varying covariates such as mechanical ventilation and opiates, and evaluate the association between dosage of benzodiazepines and subsequent delirium. ⋯ Benzodiazepines are an independent and modifiable risk factor for development of delirium in critically ill children, even after carefully controlling for time-dependent covariates, with a dose-response effect. This temporal relationship suggests causality between benzodiazepine exposure and pediatric delirium and supports limiting the use of benzodiazepines in critically ill children.
-
Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. ⋯ Despite general acceptance of low Vt and limited Pplat, high driving pressure, low PEEP and low use of adjunctive measures may still be a concern in mainland China, especially in patients with severe ARDS.