Articles: ventilators.
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Anesthesia and analgesia · Nov 2023
Tris-Hydroxymethyl Aminomethane in Critically Ill Adults: A Systematic Review.
Tris-hydroxymethyl aminomethane (THAM) is an amino alcohol used clinically to buffer acid loads and raise pH in acidotic conditions. Unlike sodium bicarbonate, which increases plasma sodium levels with use and produces carbon dioxide (CO 2 ) as part of the buffering process, THAM does neither. Although not widely used in modern critical care and unavailable for clinical use in 2016, THAM has been available in the United States since 2020. ⋯ In general, THAM corrected acidosis with an efficacy equivalent to sodium bicarbonate and did so with less hypercarbia and hypernatremia. Adverse effects of THAM included hyperkalemia, hypoglycemia, ventilator depression, and tissue damage with extravasation. We conclude that THAM may have potential advantages in some critical care settings, but that clinical evidence is limited, and high-quality evaluations are necessary.
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Critical care medicine · Nov 2023
Asynchrony Injures Lung and Diaphragm in Acute Respiratory Distress Syndrome.
Patient-ventilator asynchrony is often observed during mechanical ventilation and is associated with higher mortality. We hypothesized that patient-ventilator asynchrony causes lung and diaphragm injury and dysfunction. ⋯ Breath stacking caused lung and diaphragm injury, whereas reverse triggering caused diaphragm injury. Thus, careful monitoring and management of patient-ventilator asynchrony may be important to minimize lung and diaphragm injury from spontaneous breathing in ARDS.
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Randomized Controlled Trial
Comparison of the novel membrane-based carbon dioxide filter memsorb™ with a chemical granulate absorbent using a high-fidelity lung simulator: a prospective randomized in vitro trial.
Memsorb™ is a novel device for carbon dioxide (CO2) removal from anesthesia circuits via a semipermeable polymeric membrane. We evaluated the performance of the memsorb device for the removal of CO2 in an Aisys™ CS2 machine and compared it with a standard chemical granulate absorber (CGA) using a high-fidelity lung simulator. ⋯ CO2 was successfully removed from the anesthesia circuit. FICO2 was significantly higher with memsorb throughout the observation period. Nevertheless, the clinical impact of these observations remains unclear. Further clinical trials are required to determine the utility of the novel device.