Articles: mechanical-ventilation.
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Am. J. Respir. Crit. Care Med. · Jun 2015
ReviewUpdate in Mechanical Ventilation, Sedation, and Outcomes 2014.
Novel approaches to the management of acute respiratory distress syndrome include strategies to enhance alveolar liquid clearance, promote epithelial cell growth and recovery after acute lung injury, and individualize ventilator care on the basis of physiological responses. The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards such as those set out by the ECMONet working group. Prognostic tools such as the RESP score can assist clinicians in predicting outcomes for patients with severe acute respiratory failure but do not predict whether ECMO will enhance survival. ⋯ Many critically ill patients merit assessment by palliative care clinicians; the demand for palliative care services among critically ill patients is expected to grow. Future trials to test therapies for critical illness must ensure that study designs are adequately powered to detect benefit using realistic event rates. Integrating "big data" approaches into treatment decisions and trial designs offers a potential means of individualizing care to enhance outcomes for critically ill patients.
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Intensive Crit Care Nurs · Jun 2015
ReviewRehabilitation during mechanical ventilation: Review of the recent literature.
Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive care unit acquired weakness, delirium and a loss of physical function that may persist well beyond ICU and hospital discharge. ⋯ Implementation of rehabilitation in mechanically ventilated patients has been demonstrated to be both safe and feasible and provide benefits in terms of physical and psychological function and assist with weaning from mechanical ventilation. The recent relevant literature on the role of rehabilitation interventions in the mechanically ventilated patient will be discussed.
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Intensive Crit Care Nurs · Jun 2015
The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study.
Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption (DSI). ⋯ However, not many studies have reported ongoing communication difficulties after ICU hospitalisation. Recommendations are made for new models of care and support to mitigate critically ill patients' communication concerns in ICU and for further research into the causes and treatment to benefit this group of patients. Most importantly, extra care is recommended not to damage vocal cords during intubation and cuff inflation in the course of mechanical ventilation.
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Review
Patients' experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis.
Being a patient in an intensive care unit (ICU) and being mechanically ventilated is a scary and unpleasant experience to many patients. Qualitative studies describe these Patients' experiences, but the findings have not yet been synthesised. ⋯ In future practice, it is expected that patients will be more awake during mechanical ventilation. It is therefore important that health professionals have the knowledge that their presence and their support of the relationship between the patient and his/her relatives are of great importance in the care of patients.
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Aerosolized medications are routinely used for the treatment of critically ill patients. This paper reviews aerosol delivery devices with a focus on issues related to their performance in pulmonary critical care. Factors affecting aerosol drug delivery to mechanically ventilated adults and spontaneously breathing patients with artificial airways are reviewed. Device selection, optimum device technique, and unmet medical needs of aerosol medicine in pulmonary critical care are also discussed.