Articles: mechanical-ventilation.
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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.
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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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The exponential increase in the complexity of ventilator technology has created a growing knowledge gap that hinders education, research, and ultimately the quality of patient care. This gap is best addressed with a standardized approach to educating clinicians, just as education for basic and advanced life support classes is standardized. We have developed such a program, called Standardized Education for Ventilatory Assistance (SEVA), based on a formal taxonomy for modes of mechanical ventilation. ⋯ The first 3 levels of SEVA are free and open to the public. We are developing mechanisms to offer the other levels. Spinoffs of the SEVA program include a free smartphone app that classifies virtually all modes on all ventilators used in the United States (Ventilator Mode Map), a free biweekly online training sessions focusing on waveform interpretation (SEVA-VentRounds), and modifications to the electronic health care record system for entering and charting ventilator orders.
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Am. J. Respir. Crit. Care Med. · Jun 2023
Linking Acute Physiology to Outcomes in the ICU: Challenges and Solutions for Research.
ICU clinicians rely on bedside physiological measurements to inform many routine clinical decisions. Because deranged physiology is usually associated with poor clinical outcomes, it is tempting to hypothesize that manipulating and intervening on physiological parameters might improve outcomes for patients. ⋯ Model building must therefore be approached with great care and forethought, because failure to consider relevant sources of measurement error, confounding, coupling, and time dependency or failure to assess the direction of causality for associations of interest before modeling may give rise to spurious results. This paper outlines the main challenges in analyzing and interpreting these models and offers potential solutions to address these challenges.