Articles: mechanical-ventilation.
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Comparative Study
A comparison of leak compensation in acute care ventilators during non-invasive and invasive ventilation; a lung model study.
Although leak compensation has been widely introduced to acute care ventilators to improve patient-ventilator synchronization in the presence of system leaks, there are no data on these ventilators' ability to prevent triggering and cycling asynchrony. The goal of this study was to evaluate the ability of leak compensation in acute care ventilators during invasive and noninvasive ventilation (NIV). ⋯ Leak compensation in invasive and noninvasive modes has wide variations between ventilators. The PB840 and the V60 were the only ventilators to acclimate to all leaks, but there were differences in performance between these 2 ventilators. It is not clear if these differences have clinical importance.
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In this prospective clinical trial we aimed to answer if spontaneous exhaled breath condensate (EBC) in the trap of the expiratory arm of the ventilator could replace EBC collected by coolant chamber standardized with Argon as an inert gas. Second, if EBC pH could predict ventilator associated pneumonia (VAP) and mortality. ⋯ Spontaneous EBC pH could not be extrapolated to EBC pH from coolant chamber and it did not change in subjects who dead, neither subject with VAP in comparison with baseline data. The lack of other biomarker in EBC and the lack of a control group determinate the need for further studies in this setting.
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Review Meta Analysis
Benefits of early tracheotomy: a meta-analysis based on six observational studies.
Whether early tracheotomy can improve the clinical outcomes of critically ill patients remains controversial. The current study aimed to discuss the potential benefits of early tracheotomy compared to late tracheotomy with meta-analysis of observational studies. ⋯ Our meta-analysis of retrospective observational studies suggests that early tracheotomy performed between days 3 and 7 after intubation had some advantages, including decreased mortality and reduced ICU stay, hospital stay, and mechanical ventilation duration in ICU patients.
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Respiratory medicine · Nov 2013
Randomized Controlled Trial Comparative StudyPhysiologic response to various levels of pressure support and NAVA in prolonged weaning.
Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation wherein the delivered assistance is proportional to diaphragm electrical activity (EAdi) throughout inspiration. We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV) in 13 tracheostomised patients with prolonged weaning. Each patient randomly underwent 8 trials, at four levels of assistance either in PSV and NAVA. i - high (no dyspnoea and/or distress); iv - low (associated with dyspnoea and/or distress; ii and iii - at ∼75% and ∼25% of the difference between high and low support respectively. ⋯ VT variability significantly increased when reducing ventilatory assistance in PSV only, while remained unchanged varying the NAVA level. The ineffective triggering index was not significantly different between the two modes. In patients with prolonged weaning, with the specific settings adopted, compared to PSV, NAVA reduced the risk of over-assistance and overall improved patient-ventilator interaction, while not significantly affecting patient-ventilator synchrony.
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Worldviews Evid Based Nurs · Nov 2013
Use of evidence in clinical guidelines and everyday practice for mechanical ventilation in Swedish intensive care units.
One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice. ⋯ Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.