Chest
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A prospective study of all unplanned adult extubations was conducted for 4 months period in four intensive care units (ICUs) of a community hospital. Our objective was to document the incidence of unplanned extubations, discern possible variables predictive of occurrence and outcome, and formulate preventive measures and guidelines for reintubation. ⋯ Our data suggested that self-extubation is relatively rare in our institution and that about half of self-extubated patients were reintubated. Staff vigilance, a proper weaning period, and the nasal method of intubation were some of the factors to which we attributed this low occurrence rate. However, a larger patient study population is required to show conclusively effective preventive measures and establish guidelines for reintubation.
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Comparative Study
Unplanned extubation. Predictors of successful termination of mechanical ventilatory support.
Unplanned extubation (self-extubation or accidental extubation) occurs commonly in mechanically ventilated patients, and many patients do not receive mechanical ventilation indefinitely. Unfortunately, weaning parameters are often unavailable in the setting of unplanned extubation, and it would be useful to define pre-extubation respiratory and ventilatory parameters that predict which patients require reintubation. ⋯ Reintubation after unplanned extubation should not be considered mandatory. Patients who require reintubation have significantly higher preextubation FIo2 and ventilatory requirements than patients who remain extubated.
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To learn about the status of junior faculty in the specialty of pulmonary diseases and about their attitudes concerning their future in academic medicine. ⋯ The success of junior faculty is important to the success of academic medicine. More attention should be paid to ensuring protected continuous time for research, educating about promotion, and improving funding opportunities.
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Work of breathing necessary to trigger a ventilator (WOBtr) was calculated during pressure support ventilation (PSV), and the effect of bias flow on WOBtr was evaluated. A spring-loaded bellows type lung model with two bellows placed in series was used to simulate spontaneous breathing. A Venturi mechanism of jet flow generated subatmospheric pressure inside the diaphragm bellows simulated inspiratory effort. ⋯ With bias flow, both triggering delay and WOBtr increased. An increase in bias flow at a given PS level resulted in both decreased pressure support time and tidal volume (VT). It is concluded that the bias flow system is not desirable for use during PSV.
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We studied hemodynamic and oxygen transport parameters in 12 stable critically ill patients on assist control (ACV), synchronized intermittent mandatory (SIMV), and pressure support (PSV) ventilatory modes. Patients were optimally ventilated on ACV, were awake, and capable of spontaneous breathing. After baseline measurements on ACV, patients were placed on SIMV and PSV for 30 min each and measurements were repeated at the end of each period. ⋯ Hemodynamic and oxygen transport parameters were not significantly different among the three groups, although there was a tendency toward higher cardiac index, oxygen transport, and oxygen consumption on SIMV and PSV. We conclude that in stable critically ill patients, SIMV and PSV used according to our study protocol for 30 min can provide adequate ventilation with lower airway pressure and possibly less adverse effects on hemodynamic and tissue oxygenation parameters compared with ACV. Because of a significant decrease in VT and an increase in f seen with SIMV, PSV may be a more desirable mode for ventilatory support.