Respiratory care
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Children dependent on invasive home mechanical ventilation (HMV) represent a growing population worldwide. The objective of this study was to assess the experience of 10 years of medical assistance given to pediatric patients on continuous invasive HMV at a Brazilian Home Care Service (HCS), specifically patient characteristics and predictors of outcome (ie, hospital readmission, death, and location of death). ⋯ The most prevalent diagnosis of children on continuous invasive HMV was cerebral palsy. The main cause of hospital readmission was respiratory tract infection, especially tracheitis. Having the first hospital readmission at < 6 months after discharge was shown to be a risk factor associated with mortality.
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The patient who is morbidly obese is not adequately represented in the evidence recommending intraoperative low tidal volume (VT) ventilation. We aimed to explore the association between VT adjusted for ideal body weight (IBW) and the occurrence of postoperative pulmonary complications in subjects who were morbidly obese and undergoing abdominal surgery, as well as its implications on intraoperative ventilatory variables. ⋯ VT/IBW was not associated with the occurrence of postoperative pulmonary complications in subjects who were morbidly obese and undergoing prolonged abdominal surgery. Future prospective studies are indicated to guide the optimum ventilation strategy for patients who are morbidly obese.
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In actuality, it is difficult to obtain an early prognostic stratification for patients with acute respiratory failure treated with noninvasive ventilation (NIV). We tested whether an early evaluation through a predictive scoring system could identify subjects at risk of in-hospital mortality or NIV failure. ⋯ Among the subjects treated with NIV for acute respiratory failure, the HACOR score seemed to be a useful tool to identify those at risk of in-hospital mortality.