Articles: mechanical-ventilation.
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Anaesth Intensive Care · May 2017
A snapshot of the oxygenation of mechanically ventilated patients in one Australian intensive care unit.
Hyperoxaemia in patients undergoing mechanical ventilation (MV) has been found to be an independent predictor of worse outcome and in-hospital mortality in some conditions. Data suggests that a fraction of inspired oxygen (FiO2) of 0.4 or lower may produce hyperoxaemia although it is commonly accepted without adjustment in ventilator settings. The primary aim of this study was to observe current practice at one Australian tertiary intensive care unit (ICU) with regard to prescription and titration of oxygen (O2) in patients undergoing MV, in particular whether they received higher FiO2 than required according to arterial blood gas (ABG) results, and whether there was FiO2 titration as a response to initial ABG results during the 12 hours following. ⋯ Oxygen titration (up or down) occurred in 31% of patients. Morning ABGs were taken at a time suggested by ICU guidelines, and on review of these measures, the mean FiO2 was lower than that purported to create toxicity. Subsequently, almost one-third of the cohort had their FiO2 titrated, however there was a floor effect whereby 39%-43% of the cohort received an FiO2 of 0.3.
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Arch Phys Med Rehabil · May 2017
Observational StudyEarly Mobilization Reduces Duration of Mechanical Ventilation and Intensive Care Unit Stay in Patients With Acute Respiratory Failure.
To evaluate the effects of a quality improvement program to introduce early mobilization on the outcomes of patients with mechanical ventilation (MV) in the intensive care unit (ICU). ⋯ The introduction of early mobilization for patients with MV in the ICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient's family can work together to improve the patient's clinical outcomes.
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Many in vitro models report higher inhaled dose with dry versus heated humidity. Heat-and-moisture exchangers (HMEs) provide passive humidity in ventilator-dependent patients but act as a barrier to aerosol. The HMEs designed to allow aerosol delivery (HME-ADs) have not been well described. The purpose of this study is to determine the impact on aerosol deposition of HME-ADs with and without active exhaled humidity in a simulated ventilator-dependent adult model. ⋯ In this model simulating active exhaled humidity, aerosol drug delivery was lower and more consistent with both control and the HME-ADs than with the standard nonhumidified model. Further studies are needed to determine whether greater deposition in a dry model is an artifact of the model that does not simulate exhaled humidity.
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To determine the epidemiology of bleeding in critically ill children. ⋯ Our findings suggest that bleeding complicates critical illness in children.
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Randomized Controlled Trial Multicenter Study Comparative Study
Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial.
Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. ⋯ To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs.