Articles: mechanical-ventilation.
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Nutrition therapy protocols seek to correlate current scientific knowledge with clinical practice by converting evidence-based efficacy data into clinical effectiveness. Implementing nutrition therapy protocols should be justified by their impact on clinical outcomes. Thus, our objective was to analyze studies that verified the effect of implementing protocols for enteral nutrition (EN) in critically ill patients who are mechanically ventilated. We investigated initiation of nutrition therapy, time until nutrition requirements are met, optimization of protein and energy intake, duration of mechanical ventilation, length of hospital and intensive care unit stay, mortality, and adherence to protocols. ⋯ Our analysis of previously published studies indicates that implementing a nutrition therapy protocol can lead to optimization of various aspects of nutrition practice. Further studies that take into consideration local facilitating (as well as hindering) factors may reveal the impact of strategic EN protocols on clinical outcomes.
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Multicenter Study Observational Study
Health-Related Quality of Life in Australasian Survivors of H1N1 Influenza Undergoing Mechanical Ventilation. A Multicenter Cohort Study.
Patients surviving acute respiratory distress syndrome suffer decrements in physical function and health-related quality of life (HR-QoL); however, it is unclear whether HR-QoL is disproportionately affected in those with H1N1 influenza. ⋯ Health-related quality of life of Australasian survivors of severe H1N1 influenza was comparable to the healthy population 1 year after ICU discharge. Consensus should be sought on standardization of follow-up time points and outcome measurement. Clinical trial registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12609001037291).
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Interact Cardiovasc Thorac Surg · Jun 2015
Extracorporeal life support in patients with refractory cardiogenic shock: keep them awake.
Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanically ventilated and therefore prone to complications related to immobility and ventilation. We adopted this 'Awake ECLS' strategy for the patients with refractory cardiogenic shock (RCS) as a bridge to decision. ⋯ ECLS as a bridge to decision in RCS is effective in restoring adequate systemic perfusion and recovering end-organ function. ECLS can be initiated in awake patients with RCS and patients can be awakened on ECLS. The 'awake ECLS' strategy may avoid complications related to mechanical ventilation, sedation and immobilization. RCS patients supported on ECLS without severe metabolic acidosis, multiorgan failure, intra-aortic balloon pump or uncertain neurological status are more likely to be weaned from the ventilator. Patients that are awake at the time of ECLS implantation are more likely to remain awake during ECLS.
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Journal of critical care · Jun 2015
Observational StudyPredictive models of prolonged mechanical ventilation yield moderate accuracy.
To develop a model to predict prolonged mechanical ventilation within 48 hours of its initiation. ⋯ Different predictive models of prolonged mechanical ventilation in general intensive care unit patients achieve a moderate level of overall accuracy, likely insufficient to assist in clinical decisions.
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Journal of critical care · Jun 2015
Passive orthostatism (tilt table) in critical patients: Clinicophysiologic evaluation.
To assess the effects of passive orthostatism on various clinicophysiologic parameters of adult intensive care unit (ICU) patients, by daily placement on a tilt table. ⋯ A protocol with daily use of a tilt table for ICU patients is safe and improves the level of consciousness and inspiratory maximum pressure, without causing deleterious acute physiological effects.