Articles: mechanical-ventilation.
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J Clin Monit Comput · Aug 2020
Comparative StudyA comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation.
After induction, but before intubation, many general anesthesia patients are manually bag-mask ventilated. The objective of this study was to determine the efficacy of bag-mask ventilation (MkV) of an anesthetized patient versus mask ventilation using a noninvasive ventilator (NIV). We hypothesized that feedback-controlled, mask ventilation via NIV is more efficacious and safer. ⋯ It can deliver more optimal tidal volumes with the operator utilizing only one hand. The airway pressures are fixed at safe limits during a period where the goal is to reach a maximal level of oxygenation prior to intubation. Over-ventilation or over-pressurization of the airway is not a concern with NIV since the pressures are maintained well within safe thresholds to avoid injury.
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Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. ⋯ Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation.
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To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2.
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Eur Arch Otorhinolaryngol · Aug 2020
ReviewRecommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic.
The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure. ⋯ In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
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J Clin Monit Comput · Aug 2020
A novel method for transpulmonary pressure estimation using fluctuation of central venous pressure.
The objective of the study is to develop a correction method for estimating the change in pleural pressure (ΔPpl) and plateau transpulmonary pressure (PL) by using the change in central venous pressure (ΔCVP). Seven children (aged < 15 years) with acute respiratory failure (PaO2/FIO2 < 300 mmHg), who were paralyzed and mechanically ventilated with a PEEP of < 10 cmH2O and had central venous catheters and esophageal balloon catheters placed for clinical purposes, were enrolled prospectively. ⋯ The plateau PL calculated using the cΔCVP-derived ΔPpl (17.6 ± 2.6 cmH2O) correlated well with the ΔPes-derived plateau PL (18.1 ± 2.3 cmH2O) (R2 = 0.90, p = 0.001). Our correction method can estimate ΔPpl and plateau PL from ΔCVP with a reasonable accuracy in paralyzed and mechanically ventilated pediatric patients with respiratory failure.