Heart & lung : the journal of critical care
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Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). ⋯ PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.
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Patients with chronic obstructive pulmonary disease (COPD) appear to have impaired cardiac autonomic modulation with depressed heart rate variability (HRV). Pulmonary rehabilitation (PR) is recommended as an integral part of the management. However, the effect of PR on HRV at peak exercise remains unclear. ⋯ PR results in significant improvements in autonomic function, with concurrent improvements in HRQL and exercise capacity.
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3, 4-methylenedioxymethamphetamine (MDMA), popularly known as "ecstasy" is a synthetic, psychoactive drug used recreationally for its euphoric and "energy increasing" effects. MDMA has been linked to several severe adverse effects including the development of serotonin syndrome and sudden death. ⋯ The patient initially received supportive care including ventilatory support; he eventually needed hemodialysis, but went on to make a full recovery within 3 weeks. This case shows and emphasizes the importance of 'aggressive' supportive care on patient prognosis particularly for patients on the extreme end of the serotonin syndrome.
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Randomized Controlled Trial Comparative Study
Seated and semi-recumbent positioning of the ventilated intensive care patient - effect on gas exchange, respiratory mechanics and hemodynamics.
To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation. ⋯ Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation.
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Meta Analysis
The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis.
To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure. ⋯ Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.