Articles: mechanical-ventilation.
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Journal of critical care · Aug 2021
Observational StudyEvaluation of ventilator associated events in critically ill patients with invasive mechanical ventilation: A prospective cohort study at a resource limited setting in Northern India.
The primary aim of this study was to identify the modifiable risk factors for acquiring ventilator associated events (VAE). Secondary aims were to investigate the intensive care unit (ICU) course and impact of VAE on patient outcome. ⋯ Prospective intervention studies are needed to determine if targeting these risk factors can lower VAE rates in our setting.
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[Formula: see text] may be a reliable noninvasive alternative to the [Formula: see text] index. Furthermore, the ROX index (ie, the ratio of [Formula: see text] to breathing frequency) has been validated to predict high-flow nasal cannula failure in subjects under spontaneous breathing. However, these indices have not been tested in subjects with COVID-19 receiving invasive mechanical ventilation. This study aims to verify the correlation between both the ROX index and [Formula: see text] with [Formula: see text] and the ratio of [Formula: see text] to breathing frequency, and to determine the accuracy of the indices that use [Formula: see text] for the prediction of extubation failure in subjects with COVID-19. ⋯ The indices presented a good correlation in subjects with COVID-19 on invasive mechanical ventilation, and both the ROX index and [Formula: see text] can discriminate extubation failure in this population.
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Conventional vital signs alone have limitations in determining the physiological status. Age-adjusted shock-index (SIPA), a comprehensive physiological variable, defined as the ratio of heart rate (HR) and systolic blood pressure (SBP) may be better at predicting hemodynamic stability and outcome than vital signs. ⋯ SIPA performs better than conventional vital-signs in recognising higher-level-of-care and early mortality.
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Multicenter Study Observational Study
Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS.
Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. ⋯ Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.