Heart & lung : the journal of critical care
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Multicenter Study
Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patients.
An estimated 24% to 70% of individuals have prolonged paralysis or severe weakness after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated. ⋯ Prolonged recovery of muscle activity and extreme weakness may occur despite brisk recovery of NMT after neuromuscular blockade.
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Since more sophisticated ventilation techniques have enabled patients to comply with the ventilator with little or no sedation, deep sedation levels can easily be avoided. However, successful ventilation techniques also expanded the treatment possibilities for more severely ill patients who require deeper sedation levels. We developed a new sedation score to improve the prevention of oversedation and to simplify scoring practice in the intensive care unit (ICU). ⋯ The Sedic score demonstrates sufficient reliability and validity, and correlates well with wake-up time. It allows for frequent use by nurses to avoid oversedation in patients.
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Case Reports
Tracheal tear and tension pneumothorax complicating bronchoscopy-guided percutaneous tracheostomy.
Percutaneous dilatational tracheostomy (PDT) is a frequently conducted procedure in critically ill patients. Bronchoscopic guidance of PDT is generally recommended to minimize the risk of unintentional tracheal injury. ⋯ Sealing the large tracheal air fistula with the cuff of an endotracheal tube helped bridge time to definitive surgical repair in our patient. Bronchoscopic guidance may minimize, but cannot completely eliminate, the risk of tracheal injury during PDT.
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Previous studies have emphasized the importance of coping in patients with chronic obstructive pulmonary disease (COPD). In other medical conditions, inadequate coping is associated with higher levels of psychological distress. Therefore, the types of coping strategies that patients use may also influence the distress that accompanies an acute exacerbation of COPD. ⋯ Timely identification and use of problem-solving coping strategies may help reduce the psychological distress experienced during acute hospitalizations for COPD.
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Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) in 30% to 50% of patients. This study evaluated whether association with bronchiectasis has any influence on morbidity and mortality in patients with COPD during their intensive care unit (ICU) stay. ⋯ These results suggest that the coexistence of bronchiectasis in patients with COPD may increase the duration of ICU stay and hospitalization but does not influence the mortality.