Articles: mechanical-ventilation.
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To examine the elements of the intensive care environment and consider the impact on nurses' involvement in decision-making when weaning from mechanical ventilation. ⋯ Methods to enhance nurses' role in teamwork and collaborative decision-making are suggested.
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Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. ⋯ Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation II score or PaO2/FiO2 < 200 mmHg were found to have higher mortality.
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Journal of critical care · Feb 2014
Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation.
The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma. ⋯ Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.
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Respir Physiol Neurobiol · Feb 2014
An open-source software for automatic calculation of respiratory parameters based on esophageal pressure.
We have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure-time product (PTPeso). ⋯ Our program provides a reliable method for the automatic calculation of PEEPi and respiratory effort indices, which may facilitate the use of these variables in clinical practice. The software is open source and can be improved with the development and validation of new respiratory parameters.
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Journal of critical care · Feb 2014
Ventilator settings and monitoring parameter targets for initiation of continuous mandatory ventilation: A questionnaire study.
To inform development of educational tools, we sought to identify initial ventilator settings and monitoring targets for 3 scenarios. ⋯ Lung protective ventilation was favored, yet distinct differences in ventilator settings were evident. Monitoring targets suggested relatively conservative practices for Fio2 reduction but an understanding of permissive hypercapnia.