Articles: mechanical-ventilation.
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Adults and children who require extracorporeal membrane oxygenation for respiratory failure remain at risk for ongoing lung injury if ventilator management is not optimized. This review serves as a guide to assist the bedside clinician in ventilator titration for patients on extracorporeal membrane oxygenation, with a focus on lung-protective strategies. Existing data and guidelines for extracorporeal membrane oxygenation ventilator management are reviewed, including non-conventional ventilation modes and adjunct therapies.
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Journal of critical care · Jun 2023
Randomized Controlled TrialA randomized controlled trial comparing non-invasive ventilation delivered using neurally adjusted ventilator assist (NAVA) or adaptive support ventilation (ASV) in patients with acute exacerbation of chronic obstructive pulmonary disease.
No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). ⋯ The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality.
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Journal of critical care · Jun 2023
Observational StudyReverse triggering neural network and rules-based automated detection in acute respiratory distress syndrome.
Dyssynchrony may cause lung injury and is associated with worse outcomes in mechanically ventilated patients. Reverse triggering (RT) is a common type of dyssynchrony presenting with several phenotypes which may directly cause lung injury and be difficult to identify. Due to these challenges, automated software to assist in identification is needed. ⋯ Automated detection of RT demonstrated good performance, with the potential application of these programs for research and clinical care.
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Anesthesia and analgesia · Jun 2023
Restricted Polypharmacy Compared to Usual Care in Mechanically Ventilated Patients: A Retrospective Cohort Study.
Adverse effects of excessive sedation in critically ill mechanically ventilated patients are well described. Although guidelines strongly recommend minimizing sedative use, additional agents are added as infusions, often empirically. The tradeoffs associated with such decisions remain unclear. ⋯ Compared with UC, RP was associated with more coma- and ventilator-free days. Restricting addition of adjunct infusions to propofol may represent a viable strategy to reduce duration of coma and mechanical ventilation. These hypothesis-generating findings should be confirmed in a randomized control trial.
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Continuous aerosolized β2 agonist, namely albuterol, is the most commonly used therapy for critical asthma. Benzalkonium chloride is a preservative present in some formulations of aerosolized albuterol solutions that can induce bronchospasm. Recent studies have shown that inhalation of albuterol containing benzalkonium chloride might induce unintended bronchoconstriction and poor outcomes. This study aimed to investigate whether using albuterol solutions containing benzalkonium chloride results in prolonged hospital length of stay (LOS). ⋯ In contrast to published literature showing that benzalkonium chloride may be associated with a longer duration of continuous albuterol nebulization and hospital LOS, our study demonstrated that benzalkonium chloride-containing albuterol is safe for continuous nebulization in critically ill children and not associated with worse outcomes.