Articles: mechanical-ventilation.
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The rationale for the use of recruitment maneuvers (RMs) in acute respiratory distress syndrome (ARDS) is to promote alveolar recruitment, leading to an increased end-expiratory lung volume and thus decreased ventilator-induced lung injury (VILI). RMs consists of a transient increase in transpulmonary pressure that can re-open previously collapsed alveoli. RMs represents a physiological response to lung aggression in different conditions by re-opening the collapsed part of the lung and decreasing lung oedema. ⋯ Knowledge of physiological determinants is crucial to selecting good levels of pressure and time required to perform an efficient and well-tolerated RM. Identifying ARDS patients who may benefit from RMs is a major issue, depending essentially on the amount of recruitable lung involved. In any case, however, RMs should be done at the early phase of ARDS.
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High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for infants with respiratory failure. We sought to identify parameters that were associated with successful application of HFJV in patients with hypercapnic respiratory failure. ⋯ We identified that lower postmenstrual age, improvements in capillary PCO2 and pH at 1 h, and a reduction of FIO2 were associated with good response to HFJV. These data may help to identify patients who are likely to benefit from HFJV in the neonatal intensive care unit.
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Nurs Manag (Harrow) · Jun 2017
Ambulation of patients who are mechanically ventilated: nurses' views.
Aims Equipment and skills in intensive care have advanced dramatically, and early rehabilitation and ambulation for patients in intensive care units (ICUs) are part of their journey to recovery. The aim of this study is to understand better nurses' perspectives on ambulating mechanically ventilated patients, and to determine why this is not a routine part of ICU patient care. Method Interpretative phenomenological analysis was used to extract data from semi-structured interviews. ⋯ The study also found that education and training programmes could increase staff confidence and consequently result in routine ambulation of mechanically ventilated patients. Conclusion The study identified that nursing staff are aware of the benefits of ambulation for patients in ICUs, but the personal satisfaction gained from undertaking this activity does not outweigh the anxiety it causes. This is compounded by the organisational culture of ICUs; for example, the hierarchical pyramid of leadership, which dictates that consultants decide when patients are ready to ambulate.
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Veno-venous extracorporeal membrane oxygenation (ECMO) is being more commonly used in patients with acute respiratory distress syndrome (ARDS) due to potentially reversible illnesses. Survival from ARDS using ECMO has been reported even in patients with AIDS. However, the indications for ECMO for ARDS due to immune reconstitution inflammatory syndrome (IRIS) in patients with AIDS are unknown. ⋯ This patient's clinical course suggests two important messages. First, ECMO is a reasonable option for the treatment of patients with ARDS even in a patient with AIDS. Second, ECMO may be effective for the treatment of patients with IRIS.
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Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicrobial therapy for VAP. ⋯ Antimicrobial treatment based on Gram stain results may restrict the administration of broad-spectrum antimicrobial agents without increasing the risk of treatment failure.