Articles: mechanical-ventilation.
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Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. ⋯ The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them. Lastly, a series of knowledge-based recommendations are proposed that can be helpful for the ventilator assisted management of ARDS at the patient bedside.
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Observational Study
Role of Integrated Pulmonary Index in Identifying Extubation Failure.
The integrated pulmonary index (IPI) utilizes an algorithm based on the measurement of end-tidal carbon dioxide, breathing frequency, heart rate, and oxygen saturation to provide an assessment of the patient's ventilatory status. This clinical trial was designed to determine whether lower IPI values were associated with extubation failure. ⋯ Declining IPI measurements postextubation are predictive of extubation failure. Further clinical trials are needed to assess the role of IPI in guiding interventions in extubated patients.
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Intensive care medicine · Dec 2017
Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).
The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives. ⋯ Compared to terminal weaning, immediate extubation was not associated with differences in psychological welfare of relatives when each method constituted standard practice in the ICU where it was applied. Patients had more airway obstruction and gasps with immediate extubation.
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Randomized Controlled Trial
Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.
Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. ⋯ PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV+VG. Therefore, PSV+VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.
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Journal of critical care · Dec 2017
Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit.
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. ⋯ In this large cohort of critically ill patients requiring intubation, intubation >2days after admission was associated with increased mortality later in the hospital course.