Articles: mechanical-ventilation.
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The aim of this systematic review was to determine the effect of chlorhexidine at different concentration and frequency on ventilator-associated pneumonia and microbial colonization in mechanically ventilated patients. Relevant studies in English language were identified by searching data bases between January 2010 and December 2017. Ten studies met the inclusion criteria. ⋯ Twice-daily application was found to be effective reducing the rate of ventilator-associated pneumonia in three studies using 0.2% and 2% chlorhexidine. Microbial colonization was found to be less in 2% chlorhexidine group than herbal mouth wash 0.9% NaCl and 0.2% chlorhexidine in three studies. Chlorhexidine is an effective intervention in oral care for ventilator-associated pneumonia and microbial colonization.
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Best Pract Res Clin Anaesthesiol · Jun 2019
ReviewWhat the anaesthesiologist needs to know about heart-lung interactions.
The impact of positive pressure ventilation extends the effect on lungs and gas exchange because the altered intra-thoracic pressure conditions influence determinants of cardiovascular function. These mechanisms are called heart-lung interactions, which conceptually can be divided into two components (1) The effect of positive airway pressure on the cardiovascular system, which may be more or less pronounced under various pathologic cardiac conditions, and (2) The effect of cyclic airway pressure swing on the cardiovascular system, which can be useful in the interpretation of the individual patient's current haemodynamic state. It is imperative for the anaesthesiologist to understand the fundamental mechanisms of heart-lung interactions, as they are a foundation for the understanding of optimal, personalised cardiovascular treatment of patients undergoing surgery in general anaesthesia. The aim of this review is thus to describe what the anaesthesiologist needs to know about heart-lung interactions.
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The use of noninvasive ventilation (NIV) is common in adult acute care. As evidence to support the use of NIV has developed, there has been a concurrent proliferation of NIV technology. Efforts have been made to improve patient-ventilator synchrony, monitoring capabilities, and portability of devices used to deliver NIV. ⋯ Although this technology is generally superior to that of the past, a great deal of variation exists between devices. Clinicians need to be accustomed to the devices available to them to maximize the potential for clinical improvement and patient tolerance. The purpose of this paper is to review current technology, current literature comparing devices, and various clinical considerations associated with NIV use in adult acute care.
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The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes. ⋯ Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.
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Research in the area of adult invasive mechanical ventilation is rich and diverse. With more than 3,200 articles on mechanical ventilation published in 2018, isolating the most relevant literature is a challenge. Separated into 5 themes (ie, ventilatory support, hyperoxia, ventilator-associated events, prevention of events, and ventilator liberation), this article will describe the most important papers published on adult invasive mechanical ventilation in 2018.