Respiratory care
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Patients who are obese are at risk for developing high pleural pressure, which leads to alveolar collapse. Esophageal pressure (Pes) can be used as a surrogate for pleural pressure and can be used to guide PEEP titration. Although recent clinical data on Pes-guided PEEP has shown no benefit, its utility in the subgroup of patients who are obese has not been studied. ⋯ Individualization of PEEP with Pes guidance may have a role in patients who are obese.
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Observational Study
Tracheostomy Decannulation and Disorders of Consciousness Evolution.
Tracheostomy is a frequent surgical procedure in subjects with chronic disorders of consciousness (DOC). There is no consensus about safety of tracheostomy decannulation in this population.The aim of our study was to estimate if DOC improvement is a predictor for tracheostomy decannulation. Secondary outcomes include mortality rate and discharge destination. ⋯ Subjects who improve their DOC are more likely to achieve tracheostomy decannulation. Some subjects in VS were decannulated, with lower mortality than those who remained tracheostomized.
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Humidification of inspiratory gases is mandatory in all mechanically ventilated patients in ICUs, either with heated humidifiers (HHs) or with heat and moisture exchangers (HMEs). In patients with COVID-19, the choice of the humidification device may have relevant impact on patients' management as demonstrated in recent studies. We reported data from 2 ICUs using either HME or HH. ⋯ The choice of the humidification device used in subjects with COVID-19 had a relevant impact on ventilation efficiency (increased CO2 removal with lower dead space) and on complications related to low humidity, including ETOs that may be present with heated-wire HHs when used with high ambient temperatures.