Articles: mechanical-ventilation.
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J. Matern. Fetal. Neonatal. Med. · Aug 2019
Review Case ReportsDelivery during extracorporeal membrane oxygenation (ECMO) support of pregnant woman with severe respiratory distress syndrome caused by influenza: a case report and review of the literature.
To report a case of labour induction during extracorporeal membrane oxygenation (ECMO) support in a patient with acute respiratory distress syndrome (ARDS) caused by influenza and review of the literature. ⋯ Maternal oxygenation was improved after delivery, which may be beneficial to reduce the duration of ECMO. Caesarean section (CS) may be the most used mode and labour induction could be another option. The procedure should be performed by an experienced ECMO team, cooperating with the obstetrician, anaesthesiologist, and ICU doctors.
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Am. J. Physiol., Cell Physiol. · Aug 2019
ReviewDiaphragm contractile weakness due to reduced mechanical loading: role of titin.
The diaphragm, the main muscle of inspiration, is constantly subjected to mechanical loading. Only during controlled mechanical ventilation, as occurs during thoracic surgery and in the intensive care unit, is mechanical loading of the diaphragm arrested. Animal studies indicate that the diaphragm is highly sensitive to unloading, causing rapid muscle fiber atrophy and contractile weakness; unloading-induced diaphragm atrophy and contractile weakness have been suggested to contribute to the difficulties in weaning patients from ventilator support. ⋯ Titin is a giant protein that acts as a mechanosensor regulating muscle protein expression in a sarcomere strain-dependent fashion. Thus titin is an attractive candidate for sensing the sudden mechanical arrest of the diaphragm when patients are mechanically ventilated, leading to changes in muscle protein expression. Here, we provide a novel perspective on how titin and its biomechanical sensing and signaling might be involved in the development of mechanical unloading-induced diaphragm weakness.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewSedation and Analgesia for Mechanically Ventilated Patients in the Emergency Department.
Mechanically ventilated patients can experience significant pain and anxiety associated with their care. These symptoms should be aggressively treated, but can be challenging to manage without a systematic approach. This article reviews recent literature, current guidelines, and best practices in managing pain, agitation, and anxiety in mechanically ventilated patients in the emergency department.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewMechanical Ventilation Strategies for the Patient with Severe Obstructive Lung Disease.
Patients with respiratory failure due to obstructive lung disease present a challenge to the emergency physician. These patients have physiologic abnormalities that prevent adequate gas exchange and lung mechanics which render them at increased risk of cardiopulmonary decompensation when managed with invasive mechanical ventilation. This article addresses key principles when managing these challenging patients: patient-ventilator synchrony, air trapping and auto-positive end-expiratory pressure, and airway pressures. This article provides a practical workflow for the emergency physician responsible for managing these patients.
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Intensive care medicine · Aug 2019
ReviewExpiratory muscle dysfunction in critically ill patients: towards improved understanding.
This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. ⋯ The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.