Articles: mechanical-ventilation.
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Exhaled breath contains an extensive reservoir of biomolecules. The collection of exhaled breath is noninvasive and low risk. ⋯ An overview of breath collection methods in both individuals who are spontaneously breathing and those receiving mechanical ventilation is outlined. We also highlight the challenges in exhaled breath testing and areas for future research.
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Case Reports
Contribution of electrical impedance tomography to personalize positive end-expiratory pressure under ECCO2R.
Extracorporeal Carbon Dioxide Removal (ECCO2R) is used in acute respiratory distress syndrome (ARDS) patients to facilitate lung-protective ventilatory strategies. Electrical Impedance Tomography (EIT) allows individual, non-invasive, real-time, bedside, radiation-free imaging of the lungs, providing global and regional dynamic lung analyses. To provide new insights for future ECCO2R research in ARDS, we propose a potential application of EIT to personalize End-Expiratory Pressure (PEEP) following each reduction in tidal volume (VT), as demonstrated in an illustrative case. ⋯ Inappropriately set PEEP levels can lead to alveolar collapse or overdistension, potentially negating the benefits of VT reduction. EIT facilitates real-time monitoring of derecruitment associated with VT reduction, guiding physicians in determining the optimal PEEP value after each decrease in tidal volume. This original description of using EIT under ECCO2R to adjust PEEP at a level compromising between recruitability and overdistention could be a crucial element for future research on ECCO2R.
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Observational Study
One-year survival of aneurysmal subarachnoid hemorrhage after airplane transatlantic transfer - a monocenter retrospective study.
Aneurysmal subarachnoid hemorrhage (aSAH) is preferentially treated by prompt endovascular coiling, which is not available in Guadeloupe. Subsequently, patients are transferred to Paris, France mainland, by commercial airplane (6751 km flight) after being managed according to guidelines. This study describes the characteristics, management and outcomes related to these patients. ⋯ When necessary, transatlantic air transfer of patients with suspected aSAH after management according to local guidelines seems feasible and safe.
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Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients.
Pre-clinical studies suggest that dyssynchronous diaphragm contractions during mechanical ventilation may cause acute diaphragm dysfunction. We aimed to describe the variability in diaphragm contractile loading conditions during mechanical ventilation and to establish whether dyssynchronous diaphragm contractions are associated with the development of impaired diaphragm dysfunction. ⋯ Dyssynchronous diaphragm contractions may impair diaphragm function during mechanical ventilation.