Articles: mechanical-ventilation.
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Assessment of a patient's readiness for removal of the endotracheal tube in the ICU is based on respiratory, airway, and neurological measures. However, nearly 20% of patients require reintubation. We created a prediction model for the need for reintubation, which incorporates variables importantly contributing to extubation failure. ⋯ A small number of independent variables explains a substantial portion of the variability of extubation failure, and can help identify patients at high risk of needing reintubation. These characteristics should be incorporated in the decision-making process of ICU extubation.
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Int. Immunopharmacol. · Feb 2014
A study on circadian rhythm disorder of rat lung tissue caused by mechanical ventilation induced lung injury.
Ventilator-induced lung injury (VILI), the most serious complication of mechanical ventilation therapy, is an excessive inflammatory response in lung tissue characterized by infiltration of inflammatory cells and overproduction of inflammatory mediators. The pathogenesis of VILI is very complex. It is becoming increasingly evident that disruption of circadian rhythm affects the immune response. ⋯ We found that Rev-erbα mRNA was significantly decreased in high tide volume mechanical ventilation group compared with spontaneous group, the same as REV-ERBα protein product which was tested by Western blot approach. Stimulation of REV-ERBα activity by SR9009 greatly diminished VILI-induced lung edema, inflammatory cell infiltration and the production of the pro-inflammatory cytokine TNF-α. Collectively, our findings are the first to show that REV-ERBα plays an important role in VILI and inflammation, and circadian rhythm disorder in inflammation response may be a novel pathogenesis of VILI.
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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.