Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2012
Weaning from mechanical ventilation: where were we then, and where are we now?
Weaning patients from long-term mechanical ventilation (LTMV) has been an important focus of clinical process improvement initiatives and research for decades. The purpose of this article is to describe the science that drives our current weaning practices, including (1) preweaning assessment, (2) individualized weaning plans, (3) weaning prediction, (4) the use of protocols and guidelines for weaning trials and sedation management, (5) timing of tracheostomy placement, and (6) system initiatives for the management of LTMV patients. Finally, this article discusses potential interventions for improving the outcomes of patients who require prolonged mechanical ventilation.
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Crit Care Nurs Clin North Am · Sep 2012
Current knowledge of acute lung injury and acute respiratory distress syndrome.
Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) continues to be a major cause of mortality in adult and pediatric critical care medicine. This article discusses the pulmonary sequelae associated with ALI and ARDS, the support of ARDS with mechanical ventilation, available adjunctive therapies, and experimental therapies currently being tested. It is hoped that further understanding of the fundamental biology, improved identification of the patient's inflammatory state, and application of therapies directed at multiple sites of action may ultimately prove beneficial for patients suffering from ALI/ARDS.
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Chronic obstructive pulmonary disease (COPD) is characterized by expiratory airflow limitation that is not fully reversible. Acute exacerbations in patients with moderate to severe COPD can cause severe hypoxia and persistent or severe respiratory acidosis, resulting in respiratory failure and the need for ventilator support. ⋯ Noninvasive and invasive ventilator support in conjunction with pharmacotherapy can be lifesaving, although mortality remains high. It is important also to consider pulmonary rehabilitation and palliative care.
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Patients undergoing critical illness and mechanical ventilation are at risk of developing neuromuscular and neurocognitive impairments that can impact physical function and quality of life. Mobilizing patients early in the course of critical illness may improve outcomes. Recent literature on early mobilization is reviewed, suggestions for implementation are discussed, and areas for future research are identified.