Articles: mechanical-ventilation.
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Multicenter Study
Epidemiology of Weaning From Invasive Mechanical Ventilation in Subjects With COVID-19.
Patients requiring mechanical ventilation due to COVID-19 have different characteristics of evolution and outcome compared to the general ICU population. Although early weaning from mechanical ventilation is associated with improved outcomes, inadequate identification of patients unable to be weaned may lead to extubation failure and increased days on mechanical ventilation. Outcomes related to mechanical ventilation weaning in this population are scare and inconclusive. Therefore, the objective of this study was to describe the characteristics of mechanical ventilation weaning in subjects with acute respiratory failure induced by COVID-19. ⋯ The mechanical ventilation weaning process in subjects with COVID-19 was negatively affected by the disease, with many subjects never completing an SBT. Even though temporal variables were modified, the clinical outcomes in each weaning group were similar to those previously reported.
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Observational Study
Extracorporeal Membrane Oxygenation (ECMO) for Refractory Asthma Exacerbations with Respiratory Failure.
Asthma exacerbations with respiratory failure (AERF) are associated with hospital mortality of 7% to 15%. Extracorporeal membrane oxygenation (ECMO) has been used as a salvage therapy for refractory AERF, but controlled studies showing its association with mortality have not been performed. ⋯ ECMO was associated with lower mortality and higher hospital costs, suggesting that it may be an important salvage therapy for refractory AERF following confirmatory clinical trials.
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The objectives of this study are to establish the usefulness of lung ultrasound with a handheld device to predict the risk of developing heart failure with the need for mechanical ventilation (MV) in acute coronary syndrome (ACS). This is a prospective study of consecutive patients admitted because of ACS-type myocardial infarction, without data of HF at admission in a tertiary hospital, between February 2017 and February 2018. Lung ultrasounds were performed with a handheld cardiologic device in the first 24 h, and defined as echo-positive (PE+) when exams revealed 3 or more B-lines in 2 or more bilateral quadrants. ⋯ In Cox regression analysis adjusted by CRUSADE score and Killip class, PE+ patients had a hazard ratio of 64.55 (CI 7.87; 529.25, p < 0.001) of needing MV. PE+ was associated with more frequent use of inotropes and mortality. Pulmonary ultrasonography with a handheld echocardiograph was predictive of severe heart failure and the need for mechanical ventilation in ACS with high specificity and sensitivity.
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Randomized Controlled Trial
Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome: An analysis of three randomised clinical trials.
The mechanical power of ventilation (MP) has an association with outcome in invasively ventilated patients with the acute respiratory distress syndrome (ARDS). Whether a similar association exists in invasively ventilated patients without ARDS is less certain. ⋯ In ICU patients receiving invasive ventilation for reasons other than ARDS, MP had an independent association with mortality. This finding suggests that MP holds an added predictive value over its individual components, making MP an attractive measure to monitor and possibly target in these patients.
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Critical care medicine · Jan 2023
Observational StudyIncidence and Outcome of Pneumomediastinum in Non-ICU Hospitalized COVID-19 Patients.
Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia. ⋯ Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.