Articles: mechanical-ventilation.
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Recent findings suggest that using alveolar PCO2 (PACO2 ) estimated by volumetric capnography in the Bohr equation instead of PaCO2 (Enghoff modification) could be appropriate for the calculation of physiological dead space to tidal volume ratio (VD/VT Bohr and VD/VT Enghoff, respectively). We aimed to describe the relationship between these 2 measurements in mechanically ventilated children and their significance in cases of ARDS. ⋯ This study suggests that VD/VT Bohr and VD/VT Enghoff are not different when there is no hypoxemia (PaO2 /FIO2 > 300) except in the case of status asthmaticus. In subjects with a low PaO2 /FIO2 , the method to measure VD/VT must be reported, and results cannot be easily compared if the measurement methods are not the same.
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Med Klin Intensivmed Notfmed · Apr 2017
Observational StudyCytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit.
The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. ⋯ There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.
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Am. J. Respir. Crit. Care Med. · Mar 2017
Multicenter Study Observational StudyEpidemiology of Weaning Outcome According to a New Definition. The WIND Study.
The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. ⋯ A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.
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To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults. ⋯ Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness.