Annals of translational medicine
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The objective of this study was to assess the impact of hyperoxemia on mortality in critically ill patients with ventilator-associated pneumonia (VAP). ⋯ Hyperoxemia at ICU admission, or during ICU stay, had no significant impact on ICU mortality in critically ill patients with VAP.
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Microaspiration is a major factor in ventilator-associated pneumonia (VAP) pathophysiology. Subglottic secretion drainage (SSD) aims at reducing its incidence. ⋯ SSD did not reduce the incidence of microaspiration, VAP, VAT or airway colonization in this observational study.
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Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICU) and is associated with increased mortality, use of antimicrobials, longer mechanical ventilation, and higher healthcare costs. Lung ultrasonography (LUS) can be used at the bedside and gained widespread acceptance in ICU. Although the visualization of a single LUS sign cannot be considered specific for a diagnosis, clinically-driven LUS examination in particular setting and clinical conditions allow ruling in or out quickly and accurately several causes of acute respiratory failure. ⋯ LUS could ideally represent the decision-making tool for antimicrobial therapy administration in the timeframe of the technical time required for bronchoalveolar lavage analysis. A systematic approach for diagnosis and monitoring of VAP with LUS is also proposed in this review. But specific data on LUS specificity and sensitivity for the diagnosis of VAP are still lacking and should be investigated.
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Transpulmonary pressure, that is the difference between airway pressure (Paw) and pleural pressure, is considered one of the most important parameters to know in order to set a safe mechanical ventilation in acute respiratory distress syndrome (ARDS) patients but also in critically ill obese patients, in abdominal pathologies or in pathologies affecting the chest wall itself. Transpulmonary pressure should rely on the assessment of intrathoracic pleural pressure. Esophageal pressure (Pes) is considered the best surrogate of pleural pressure in critically ill patients, but concerns about its reliability exist. The aim of this article is to describe the technique of Pes measurement in mechanically ventilated patients: the catheter insertion, the proper balloon placement and filling, the validation test and specific procedures to remove the main artifacts will be discussed.
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Despite being a promising idea that combines several variables related to ventilator-induced lung injury (VILI), the concept of mechanical power (MP) carries a number of limitations, leaves several open questions, lacks proper modelling of positive end-expiratory pressure (PEEP) effects and, more importantly, does not respect the amount of lung tissue subjected to MP. First, the assessment of MP as a measure for development of VILI would have the highest relevance when volume displacement and related pressure changes are measured directly within the lung. Thus, ideally the relationship between MP delivered to the total respiratory system, and that delivered to lung tissue is discerned. ⋯ Fourth, in its current form, MP is modelled with a positive linear relationship with PEEP, which is based on incorrect mathematical modelling to integrate the role of PEEP into MP. Fifth, the present equation used to calculate MP is qualitatively in disagreement with clinical data on VILI. The reduction of MP to its elastic part, might not only result in a higher association with VILI, but also amplifies an indirect U-shaped relationship with PEEP.