Crit Care Resusc
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Flail chest after blunt trauma usually requires good pain control and positive pressure support. Continuous negative extrathoracic pressure (CNEP) causes a splinting effect around the anterior chest wall and upper abdomen which increases functional residual capacity and improves lung mechanics. ⋯ She was subsequently ventilated non-invasively using CNEP, allowing early successful extubation. This case illustrates the use of CNEP for weaning and ventilating patients with flail chest after blunt trauma.
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To study the frequency, rationale and process for withholding (WH) and withdrawing (WD) life-sustaining therapies in intensive care patients in Ireland. ⋯ The frequency of withdrawal or withholding of therapy in this Irish ICU is in line with current international practice. The time to EOL decision-making is variable and relatively short compared with that in the United States, but similar to that in Europe. Clinicians are the primary initiators of the EOL decision in Ireland, with little patient involvement. Family members are more likely to initiate an EOL decision than in Europe. EOL decisions were usually made during "routine" working hours after significant consultation with all groups.
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A reported association between extubation failure (EF) and increased hospital length of stay and mortality led us to assess outcome of EF in an Australian intensive care unit. ⋯ Our findings confirm an increased risk of adverse outcomes for patients with EF. We observed a comparatively low EF rate. Confirmation in similar patient cohorts is required.