Articles: mechanical-ventilation.
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Clinics in chest medicine · Dec 2014
ReviewThe use of paralytics in patients with acute respiratory distress syndrome.
Interest in the role of neuromuscular blocking agents (NMBAs) in the treatment of acute respiratory distress syndrome (ARDS) has been renewed since a recent randomized clinical trial showed a reduction in mortality associated with the use of NMBAs. However, the role of paralytics in a protective mechanical ventilation strategy should be detailed. This review summarizes data in the literature concerning the clinical effects of NMBAs on the outcome of patients with ARDS, in an attempt to explain some pathophysiologic hypotheses concerning their action and to integrate them into the overall management strategy for the mechanical ventilation of ARDS patients.
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Review
Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics.
The overall goal of the cardiorespiratory system is to provide the organs and tissues of the body with an adequate supply of oxygen in relation to oxygen consumption. An understanding of the complex physiologic interactions between the respiratory and cardiac systems is essential to optimal patient management. ⋯ Oxygen delivery to all organs and tissues of the body should be optimized, but not necessarily maximized. The heart and lungs are, obviously, connected anatomically but also physiologically in a complex relationship.
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Observational Study
Inhalation injury in burn patients: Establishing the link between diagnosis and prognosis.
This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1±13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24h of sustaining the burn. ⋯ Mechanical ventilation (adjusted odds ratio [OR]: 9.787) and severe inhalation injury on bronchoscopy (adjusted OR: 45.357) were independent predictors of mortality on multivariate logistic regression analysis. Inhalation injury diagnosed through history does not predict mortality from burns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.
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Journal of critical care · Dec 2014
Is pressure-regulated volume control mode appropriate for severely obstructed patients?
Management of mechanical ventilation in severely obstructed patients remains controversial. Pressure-regulated volume control ventilation (PRVCV) has been suggested to be the best option, as it should ensure a prefixed tidal volume at the lowest peak inspiratory pressure. We sought to determine the accuracy of the delivered volume, compared with the programmed volume, when using PRVCV. ⋯ In high-resistance simulations, the delivered volume was lower when using PCV or PRVCV modes than VCV mode. Pressure control ventilation or PRVCV may fail to provide programmed TV, ultimately leading to hypoventilation of the patient.
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Pediatric pulmonology · Dec 2014
Case ReportsSonographic dynamic assessment of lung injury in a child with hypoplastic left heart syndrome undergoing extracorporeal membrane oxygenation.
Performed for many years in clinical settings, pleural and lung ultrasound (PLUS) has emerged to be an invaluable tool to diagnose underlying conditions of respiratory failure, to monitor disease progression and to ensure appropriate therapeutic intervention. PLUS basically relies on the analysis of two prevalent ultrasound artefacts: A-lines and B-lines. A-lines are hyperechoic reverberation artefacts of the pleural line. A-lines combined with lung sliding show that lungs are well aerated. B-lines are vertical hyperechoic reverberation artefacts arising from pleural line extending to the bottom of the screen. The prevalence of B-lines indicates a pathologic parenchyma. Since PLUS is readily available, easily affordable, and biologically non-invasive, it is especially suitable for bedside clinical care in critically ill and unstable adult patients. Several authors have recently proposed PLUS for application in critically ill neonates and children. We report a case in which PLUS was used to clinically monitor a complex lung lesion during treatment of a child with congenital heart disease suffering from severe lung injury. ⋯ Due to its non-ionizing nature, low cost, easy availability, easy repeatability and real-time results, PLUS is a feasible and beneficial bedside imaging technique for critically ill and unstable adult and pediatric patients. A reliable monitoring of ongoing treatments is certainly helpful to provide appropriate intervention, correctly schedule chest X-ray and CT-scan, and optimize ECMO weaning. The present case suggests that PLUS may be a successful and useful tool for monitoring lung diseases in children with CHD with severe post-operative complex lung injury.