Articles: mechanical-ventilation.
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Randomized Controlled Trial
Influence of ambient temperature and minute ventilation on passive and active heat and moisture exchangers.
During invasive mechanical ventilation, inspired gases must be humidified. We previously showed that high ambient temperature greatly impaired the hygrometric performance of heated wire-heated humidifiers. The aim of this bench and clinical study was to assess the humidification performance of passive and active heat and moisture exchangers (HMEs) and the impact of ambient temperature and ventilator settings. ⋯ In this study both passive and active HMEs had stable humidification performance with negligible influence of ambient temperature and minute ventilation. This contrasts with previous findings with heated wire-heated humidifiers. Although there are no clear data demonstrating that higher humidification impacts outcomes, it is worth noting that humidity was significantly higher with the active HME.
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Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. ⋯ The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways.
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Patients receiving invasive mechanical ventilation with an endotracheal tube (ETT) can often benefit from pharmaceutical aerosols; however, drug delivery through the ventilator circuit is known to be very inefficient. The objective of this study was to improve the delivery of aerosol through an invasive mechanical ventilation system by redesigning circuit components using a streamlining approach. ⋯ Streamlined components can significantly improve the delivery of pharmaceutical aerosols during mechanical ventilation based on an analysis of multiple aerosol generation devices, ETT sizes, and flows.
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Practice Guideline
Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle.
"Zero-VAP" is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. ⋯ We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the online data recording and compliance control systems, as well as the existence of a pre-defined objective are the distinct features of "Zero VAP".
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The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown. ⋯ There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.