Respiratory care
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Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. ⋯ These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk.
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The use of shared ventilation, or the simultaneous support of multiple patients connected in parallel to a single mechanical ventilator, is receiving considerable interest for addressing the severe shortage of mechanical ventilators available during the novel coronavirus pandemic (COVID-19). In this paper we highlight the potentially disastrous consequences of naïve shared ventilation, in which patients are simply connected in parallel to a ventilator without any regard to their individual ventilatory requirements. We then examine possible approaches for individualization of mechanical ventilation, using modifications to the breathing circuit that may enable tuning of individual tidal volumes and driving pressures during either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV). ⋯ Of the shared ventilation strategies considered, shared PCV, with the inclusion of in-line pressure-relief valves in the individual inspiratory and expiratory limbs, offers the greatest degree of safety and lowest risk of catastrophic mechanical interactions between multiple patients connected to a single ventilator.
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Respiratory ICUs (RICUs) have recently been implemented in France to fill the gap between ICUs and respiratory wards for patients who will require prolonged mechanical ventilation (PMV). The aim of this study was to describe the outcomes of subjects with tracheostomy who were undergoing PMV before and after implementing a RICU in our hospital. ⋯ Implementing a RICU improved the outcomes of the subjects with tracheostomy who were undergoing PMV by reducing the length of stay and increasing complete or partial weaning. However, the 1-year survival remained unchanged.
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Redirection of our clinical attention from the pressures and volumes of the individual cycle to the broader and more inclusive considerations of energy load and power has untapped potential to reduce iatrogenic risk from ventilation (ie, ventilator-induced lung injury). Power is the product of breathing frequency and inflation energy per breath. ⋯ If some arbitrary level of alveolar pressure were accepted as a sharply defined hazard boundary, a rather straightforward geometric analysis theoretically would allow partitioning of overall tidal energy into components above and below a damage threshold. In this discussion, we introduce the concept of quantitative power partitioning and illustrate how tidal energy and power might be deconstructed into their key parts.