Articles: mechanical-ventilation.
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To examine whether increasing time between admission and intubation was associated with mortality in patients with coronavirus disease 2019 who underwent mechanical ventilation. ⋯ Among patients with coronavirus disease 2019 who were intubated and mechanically ventilated, intubation earlier in the course of hospital admission may be associated with improved survival.
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Early exercise has been recommended in critically ill patients, but its impact on subject-ventilator interaction is still unclear. Therefore, the aim of this study was to evaluate the occurrence of subject-ventilator asynchrony during passive exercise in mechanically ventilated subjects. ⋯ Early cycle ergometer passive exercise in deeply sedated subjects can worsen subject-ventilator interaction, due to ineffective triggering and insufficient flow. Adjustments in the ventilatory parameters may be necessary to avoid asynchrony during exercise.
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Randomized Controlled Trial Multicenter Study Comparative Study
Intensity of Renal Replacement Therapy and Duration of Mechanical Ventilation: Secondary Analysis of the Acute Renal Failure Trial Network Study.
Randomized clinical trials have failed to show benefit from increasing intensity of renal replacement therapy (RRT) for acute kidney injury, but continue to be frequently used. In addition, intensive RRT is associated with an increase in adverse events potentially secondary to small solute losses, such as phosphate. We hypothesized that, compared with less-intensive RRT, intensive RRT would lead to longer duration of mechanical ventilation. ⋯ Critically ill mechanically ventilated patients who were assigned randomly to more-intensive RRT had longer duration of mechanical ventilation compared with those who were assigned to less-intensive RRT. The reasons for this, such as excessive phosphate loss from more-intensive RRT, deserve further study to optimize the safety and effectiveness of CRRT delivery. This was a post hoc analysis of the Acute Renal Failure Trial Network study; clinical trial registration of the original trial is NCT00076219.
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Multicenter Study Comparative Study Clinical Trial
Pressure-support ventilation versus T-piece during spontaneous breathing trials before extubation among patients at high-risk of extubation failure: a post-hoc analysis of a clinical trial.
Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs. ⋯ In patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.