Articles: mechanical-ventilation.
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Hospital-acquired delirium is a known risk factor for negative outcomes in patients admitted to the surgical intensive care unit (SICU). Outcomes worsen as the duration of delirium increases. The purpose of this study was to evaluate the efficacy of a delirium prevention program and determine whether it decreased the incidence and duration of hospital-acquired delirium in older adults (age>50 y) admitted to the SICU. ⋯ Although delirium prevention continues to be a challenge, this study successfully decreased the duration of delirium for older adults admitted to the SICU. Our simple, cost-effective program led to improved pain and sedation outcomes. Older adults with delirium spent less time on the ventilator and all patients spent less time in the SICU.
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Pediatric pulmonology · Jul 2014
Comparative StudyHigh frequency oscillation and airway pressure release ventilation in pediatric respiratory failure.
Airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV) are frequently used in acute lung injury (ALI) refractory to conventional ventilation. Our aim was to describe our experience with APRV and HFOV in refractory pediatric ALI, and to identify factors associated with survival. ⋯ In a heterogeneous PICU population with hypoxemia refractory to conventional ventilation transitioned to NCV, improvement in oxygenation at 24 hr was associated with survival. Immunocompromised status, number of vasopressor infusions, and the OI before transition to NCV were independently associated with survival.
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Previous bench studies suggest that dynamic hyperinflation may occur if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. We tested the hypothesis that pressure controlled continuous mandatory ventilation (PC-CMV) can protect against this risk. ⋯ When IPV is added to mechanical ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to avoid autotriggering.
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The extubation period is one of the most challenging aspects for intensive care teams. Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Several weaning predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. The purpose of this study was to analyze the predictive performance of the modified integrative weaning index (IWI) in the extubation process. ⋯ We concluded that modified IWI, similar to other extubation predictors, does not accurately predict extubation failure.
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Comparative Study
Differences in incidence and outcome of ventilator-associated pneumonia in surgical and medical ICUs in a tertiary hospital in China.
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in intensive care units (ICUs). The incidences and outcomes of VAP in a medical ICU (MICU) and a surgical ICU (SICU) were compared. ⋯ These data indicate that VAP prolonged time on ventilator and ICU stay in our institute and increased the mortality in the MICU. There were no differences in incidence of or mortality from VAP in the MICU and SICU.