Respiratory care
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Extubation is a crucial step in the weaning process of critically ill mechanically ventilated patients. Some patients may develop postextubation respiratory failure that may lead to the need for re-intubation, which is associated with increased morbidity and mortality. This review comprehensively explores postextubation respiratory support strategies, focusing on the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and noninvasive ventilation (NIV) in reducing re-intubation rates among various patient populations. ⋯ NIV, alternatively, appears to provide substantial advantages in reducing the rates of re-intubation and respiratory failure, especially in patients with obesity and patients with hypercapnia. Therefore, the indiscriminate application of these support strategies without consideration of individual patient characteristics may not improve outcomes, highlighting the need for careful patient selection and tailored therapeutic strategies based on specific risk factors and clinical conditions. By aligning postextubation respiratory support strategies with patient-specific needs, we may improve the success rates of extubation, enhance overall recovery, and reduce the burden of reintubations in the intensive care setting.
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Evidence on quality of care and sociodemographics in patients with COPD needing care during the COVID-19 pandemic is scarce. We aimed to examine indicators of quality and clinical outcomes (eg, readmissions, death) and sociodemographics in patients with COPD in need of hospital care during the COVID-19 pandemic compared to before the pandemic. ⋯ In this nationwide study of subjects with COPD, hospital contacts decreased during the pandemic due to lockdowns and isolation, which led to a decrease in infections overall in the society. Meanwhile, in-hospital care remained unaltered. However, concerns are raised about patients with COPD and low educational level and immigrants not seeking relevant health care.
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Cardiac arrest (CA) remains a major cause of death despite advancements in cardiopulmonary resuscitation (CPR), post-resuscitation care, and international efforts to develop evidence-based guidelines. Effectively managing ventilation and oxygenation during and after CPR is vital for patient survival and neurological outcomes, yet it remains a challenging task. This review examines current strategies for ventilation and oxygenation during and after CPR, focusing on evidence-based guidelines, the balance between ventilation effectiveness and risks, and proposed methods for monitoring ventilation quality. ⋯ The review also explores mechanical ventilation as an alternative to manual methods and the use of feedback devices. The impact of post-CA ventilation and oxygenation on patient outcomes and recommended management strategies are discussed. Finally, the review highlights current gaps in the literature and the need for more well-designed large clinical studies, such as the impact of different ventilation variables (tidal volume and respiratory rate) on the return of spontaneous circulation (ROSC) and long-term outcomes.
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Numerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20-25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV. ⋯ Subjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.