Articles: mechanical-ventilation.
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Case Reports
Use of a Novel Negative-Pressure Tent During Bedside Tracheostomy in COVID-19 Patients.
Many COVID-19 patients with neurological manifestations and respiratory failure remain dependent on mechanical ventilation and require tracheostomy, which is an aerosol generating procedure (AGP). The risk of SARS-CoV-2 transmission to healthcare staff during AGPs is well documented, and negative-pressure rooms are often unavailable. Innovative techniques to decrease risk to healthcare providers during AGPs are necessary. Our objective was to demonstrate the feasibility of percutaneous dilatational tracheostomy (PDT) performed using a novel prefabricated low-cost negative-pressure tent (AerosolVE). ⋯ It is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
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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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Obese subjects are at higher risk of development and progression of ARDS. There are limited data regarding mechanical ventilation practices and use of adjunctive therapies in subjects with ARDS across different obesity classes. We hypothesized that the adherence to lung-protective ventilation would be worse with rising body mass index class in patients with ARDS. ⋯ In this study, the risk of exposure to higher tidal volumes and the need for specific rescue therapies rose with higher classes of obesity in subjects with ARDS. More research is needed to identify how to better implement lung-protective ventilation in patients with obesity.
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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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J Crit Care Med (Targu Mures) · Oct 2020
Case ReportsThe Prolonged Use of VV ECMO Support in COVID-19: A Case Report.
COVID-19 has resulted in unprecedented global health and economic challenges. The reported mortality in patients with COVID-19 requiring mechanical ventilation is high. VV ECMO may serve as a lifesaving rescue therapy for a minority of patients with COVID-19; however, its impact on overall survival of these patients is unknown. ⋯ VV ECMO is a resource-intense form of respiratory support. Providing complex therapies such as VV ECMO during a pandemic has its unique challenges. This case report provides a unique insight into the potential clinical sequelae of COVID-19, supported in an intensive care environment which was not resource-limited at the time, and adds to the evolving experience of prolonged VV ECMO support for ARDS with a goal to lung recovery.