Articles: mechanical-ventilation.
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J Intensive Care Med · Sep 2014
Review Case ReportsChiari syndrome and respiratory failure: a literature review.
Patients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation. ⋯ Patients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.
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Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. ⋯ Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed.
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Expert Rev Respir Med · Aug 2014
ReviewA practical approach to the use of prone therapy in acute respiratory distress syndrome.
In this article we propose a practical approach to the use of prone therapy for acute respiratory distress syndrome (ARDS). We have attempted to provide information to improve the understanding and implementation of prone therapy based on the literature available and our own experience. We review the basic physiology behind ARDS and the theoretical mechanism by which prone therapy can be of benefit. ⋯ Also provided is a discussion of the nuances of utilizing prone therapy, including potential pitfalls, complications, and contraindications. The specific considerations of prone therapy in open abdomens and traumatic brain injuries are discussed as well. Finally, we supply suggested protocols for the implementation of prone therapy discussing criteria for initiation and cessation of therapy as well as addressing issues such as the use of neuromuscular blockade and nutritional supplementation.
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Significant psychological impacts, including post-traumatic stress disorder (PTSD), have been associated with patients under sedation in intensive care units (ICUs). However, it remains unknown if and how sedation is related to post-ICU psychological outcomes. This literature review explores the relationships between sedation, the depth of sedation and psychological disorders. ⋯ To ensure subject relevance pre-2006, non-English and paediatric-based research was excluded. Findings highlighted that reduced sedation levels did not significantly reduce the outcome of PTSD, yet reduced ICU length of stay and length of mechanical ventilation (MV) were both associated with lighter sedation. Further research is recommended into more specific factual and delusional memories post ICU in relation to the level of sedation and to psychological distress.
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Severe sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. In 2002, the guideline titled "Surviving Sepsis Campaign" was published by American and European Critical Care Medicine to decrease the mortality of severe sepsis and septic shock patients, which has been the basis of the treatment for those patients. ⋯ Other important revised guidelines in critical care field such as 'Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit' were revised in 2013. This article will review the revised guidelines and several additional interesting published papers of until March 2014, including the part of ventilator-induced lung injury and the preventive strategies.