Articles: mechanical-ventilation.
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Revista clínica española · Oct 2014
Patients with cancer in the intensive monitoring unit. New perspectives.
In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. ⋯ However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation.
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Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma patient who presented to our emergency department via emergency medical services. The patient was responsive, diaphoretic, and breathing at 35 breaths/min on 100% oxygen with bag-mask assistance, with S(pO2) 88%, heart rate 110-120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8 °C. ⋯ NIV tolerance was supported with low doses of lorazepam. The patient was transferred to the ICU, moved to general care the next morning, and discharged 3 days later. We attribute our success to close monitoring in a critical care setting and the titration of lorazepam.
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Previous studies suggest that some medications, including proton pump inhibitors and β-agonist inhalers, are administered to hospitalized patients and sometimes continued without indications. Medication reconciliation has been offered as one mechanism to reduce the frequency of such medication errors and is now mandated by the Joint Commission (NPSG.03.06.01). We hypothesized that (1) β agonists and acid-blocking medications are prescribed following critical illness without indications, and (2) medication reconciliation can reduce the frequency of inappropriate continuation of these agents. The study was carried out in a 414-bed community teaching hospital affiliated with the University of Connecticut Medical School. All subjects were admitted to the ICU between February and April 2012 (physician-driven reconciliation) and between July and September 2012, just following implementation of pharmacy technician-driven medication reconciliation. This was a retrospective cohort study. ⋯ In our hospital, acid blockers and bronchodilators were often continued inappropriately following critical illness. The specific pharmacy technician-driven method of medication reconciliation deployed in our hospital reduced by half but did not eliminate this medication error.
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Respir Physiol Neurobiol · Sep 2014
Regional distribution of lung compliance by image analysis of computed tomograms.
Computed tomography (CT) can yield quantitative information about volume distribution in the lung. By combining information provided by CT and respiratory mechanics, this study aims at quantifying regional lung compliance (CL) and its distribution and homogeneity in mechanically ventilated pigs. The animals underwent inspiratory hold maneuvers at 12 lung volumes with simultaneous CT exposure at two end-expiratory pressure levels and before and after acute lung injury (ALI) by oleic acid administration. ⋯ A remarkably heterogeneous distribution of voxel compliance was found in the injured lungs. As the lung inflation increased, the homogeneity increased in healthy lungs but decreased in injured lungs. Image analysis brought novel findings regarding spatial homogeneity of compliance, which increases in ALI but not in healthy lungs by applying PEEP after a recruitment maneuver.