Articles: mechanical-ventilation.
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Pediatric pulmonology · Jul 2017
Effect of ventilator mode on patient-ventilator synchrony and work of breathing in neonatal pigs.
Patient-ventilator asynchrony can result in increased work of breathing (WOB) and need for increased sedation, as well as respiratory muscle fatigue and prolonged mechanical ventilation. Different ventilator modes may result in varying degrees of asynchrony and WOB. ⋯ Asynchrony and WOB are highest with SIMV/VC plus PS. If SIMV is utilized, SIMV/PRVC plus a PS that optimizes tidal volume may be preferable. PRVC has the least asynchrony and WOB in the injured lung.
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Early mobilization protocols have been successfully implemented to improve function in critically ill patients; however, no study has focused on the oncology population. ⋯ Early mobilization appears feasible in addressing the cognitive and functional needs of oncology patients in the 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.