Articles: mechanical-ventilation.
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J Intensive Care Med · Jun 2016
Clinical TrialUltrasonography for Screening and Follow-Up of Diaphragmatic Dysfunction in the ICU: A Pilot Study.
Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials. ⋯ The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.
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To assess the safety of mechanical ventilation and effectiveness of extrinsic positive end-expiratory pressure (PEEP) (PEEPe) in improving peripheral oxygen saturation (SpO2) during direct microlaryngeal laser surgery; to assess the incidence, amount, and nature (dynamic hyperinflation or airflow obstruction) of ensuing intrinsic PEEP (PEEPi); and to find a surrogate PEEPi indicator. ⋯ During ventilation through small endotracheal tubes, PEEPi (mostly due to dynamic hyperinflation) is common. Hemodynamic complications, barotrauma, and O2 desaturation (reversible with PEEPe) are rare. Pawplateau provided by ventilators is useful in suspecting and monitoring the occurrence of PEEPi and allows detection of lung overdistension as PEEPe is applied.
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Patients requiring mechanical ventilation can have complications related to their underlying diseases and hospital-related events. It is possible that easily obtained information early in the course of mechanical ventilation can provide information about important outcomes. ⋯ Easily available information collected on day 2 of mechanical ventilation can help identify patients at risk for poor outcomes, including the duration of mechanical ventilation, the development of ventilator-associated complications and mortality. Prospective studies measuring peak pressures are needed to evaluate the utility of this simple measurement in the management of patients requiring mechanical ventilation.
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In emphysema airway resistance can exceed collateral airflow resistance, causing air to flow preferentially through collateral pathways. In severe emphysema ventilation through openings directly through the chest wall into the parenchyma (spiracles) could bypass airway obstruction and increase alveolar ventilation via transpleural expiration. During lung transplant operations, spiracles occasionally can occur inadvertently. ⋯ During transpleural spiracle ventilation, inspiratory tidal volumes (TV) were unchanged; however, expiration was entirely transpleural in two patients whereas the expired TV to the ventilator circuit was reduced to 25% of the inspired TV in one. At baseline, mean PCO2 was 61 ± 5 mm Hg, which decreased to a mean PCO2 of 49 ± 5 mm Hg (P = .05) within minutes after transpleural spiracle ventilation and further decreased at 1 to 2 h (36 ± 4 mm Hg; P = .002 compared with baseline) on unchanged ventilator settings. This observation of increased alveolar ventilation supports further studies of spiracles as a possible therapy for advanced emphysema.
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Indian J Crit Care Med · Jun 2016
Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature.
This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. ⋯ Sleep disturbances are common in ARDS survivors early after discharge from the ICU.