Articles: mechanical-ventilation.
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Intensive care medicine · Dec 2020
ReviewExtracorporeal life support for adults with acute respiratory distress syndrome.
Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. ⋯ This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.
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Mechanical ventilation is a life-support therapy that can be associated with respiratory muscle dysfunction that may perturb the weaning process. The timed inspiratory effort (TIE) index is a recently proposed weaning index that has been reported to be effective in predicting successful weaning. We sought to analyze the respiratory muscle groups involved with the TIE index measurement utilizing the surface electromyography (sEMG). ⋯ Subjects succeeding in a weaning trial had higher muscle strength, confirmed in the pooled and the individual sEMG analysis. A vigorous diaphragm with low fatigue potential seems essential for successful weaning; the sternocleidomastoid may also be of importance in this regard.
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Automatic tube compensation (ATC) unloads endotracheal tube (ETT) resistance. We conducted a bench assessment of ATC functionality in ICU ventilators to improve clinical management. ⋯ ATC is used more frequently in clinical practice than expected. In addition, VT delivery by ATC differed slightly though significantly between ventilators.
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Intensive care medicine · Dec 2020
Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study.
To investigate whether COVID-19-ARDS differs from all-cause ARDS. ⋯ COVID-19-ARDS is a subset of ARDS characterized overall by higher compliance and lung gas volume for a given PaO2/FiO2, at least when considered within the timeframe of our study.
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Journal of critical care · Dec 2020
Predictors of survival after prolonged weaning from mechanical ventilation.
Weaning from mechanical ventilation is a key component of intensive care treatment; however, this process may be prolonged as some patients require care at specialised centres. Current data indicate that weaning from invasive mechanical ventilation is successful in approximately 65% of patients; however, data on long-term survival after discharge from a weaning centre are limited. ⋯ The identified predictors of survival after prolonged weaning could support therapeutic strategies during patients' intensive care unit stay. Patients should be closely monitored after discharge from a weaning centre.