Current opinion in anaesthesiology
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Guidelines for weaning from sedation and weaning from ventilator gained increasing interest in recent years. This includes patients with acute respiratory distress syndrome, as well as other mechanically ventilated patients. This review will give an overview of the current literature and practice guidelines in ventilator and sedation weaning. ⋯ The most important conclusion we come to from recent randomized controlled trials is that only using an integrative algorithm for sedation and ventilator weaning can improve survival of ICU patients.
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Anaesthesiologists have a significantly higher frequency of substance abuse by a factor of nearly 3 when compared with other physicians. This is still a current problem that must be reviewed. ⋯ As drug abuse among anaesthesiologists has continued, new studies have been conducted to know the theories about susceptibility. Written substance abuse policies and controls must be taken in place and in all countries.
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Mechanical ventilation is essential for the support of critically ill patients, but may aggravate lung damage, leading to ventilator-associated lung injury (VALI). VALI results from a succession of events beginning with mechanical alteration of lung parenchyma, because of disproportionate stress and strain. The resulting structural tension initiates a biological inflammatory cascade; however, tension can reach the limits of stress, triggering the destruction of structures. This article reviews and discusses the ongoing research into the mechanisms of VALI and their implications for the management of ventilated patients. ⋯ How ventilation strategy, specific mechanisms of mechanotransduction, and their individual threshold values impact on VALI remains to be elucidated. In addition, clinical studies are required to evaluate the usefulness of individualized ventilator strategies based on lung mechanics.
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Sugammadex belongs to a new class of drugs termed selective relaxant binding agents and is now available for clinical use in over 50 countries. Because of its innovative mechanism of action, reversal of rocuronium or vecuronium becomes independent of the degree of residual neuromuscular blockade. Deep or intense neuromuscular blockade now can rapidly and predictably be reversed. However, compared with the classical acetylcholine esterase inhibitor-based reversal treatment costs are significantly higher. On the basis of the current literature, the cost-effectiveness of sugammadex will be evaluated. ⋯ The reduction of recovery times with sugammadex will reduce the incidence of prolonged extubation and may increase patients' throughput. However, the achievable reduction of costs depends on the individual organizational factors, also.
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To describe the most recent advances and clinical applications of adjunctive techniques in mechanical ventilation, focusing on their overall impact on mortality and their potential indications in critically ill patients. ⋯ Giving the complexity and dynamism of acute lung injury, timing, severity, and pathophysiologic pertinence are mandatory components of decision-making when considering the application of adjunctive measures to support mechanical ventilation.