Articles: mechanical-ventilation.
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Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both their underlying disease states and the mechanical ventilation itself. Intensive monitoring is required to identify early signs of clinical worsening and to minimize the risk of iatrogenic harm. ⋯ Assessments of driving pressure, transpulmonary pressure, and the pressure-volume loop are performed to ensure that adequate PEEP is applied and excess distending pressure is minimized. Finally, monitoring and frequent adjustment of airway cuff pressures is performed to minimize the risk of airway injury and ventilator-associated pneumonia. We will discuss monitoring during mechanical ventilation with a focus on the accuracy, ease of use, and effectiveness in preventing harm for each of these monitoring modalities.
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To predict the added value of diaphragmatic and lung ultrasound indices (US) in anticipation of the outcome of mechanical ventilation of pediatric patients in the intensive care unit. ⋯ Diaphragmatic and lung US add a quick, accurate and non-invasive indices to the weaning readiness parameters compared to the other standard parameters alone. So, it is recommended to be added to the predictive parameters of weaning outcome.
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Indian J Crit Care Med · Jun 2020
"Six-dial Strategy"-Mechanical Ventilation during Cardiopulmonary Resuscitation.
As per current guidelines, whenever an advanced airway is in place during cardiopulmonary resuscitation, positive pressure ventilation should be provided without pausing for chest compression. Positive pressure ventilation can be provided through bag-valve resuscitator (BV) or mechanical ventilator (MV), which was found to be equally efficacious. In a busy emergency department, with less trained personnel use of MV is advantageous over BV in terms of reducing human errors and relieving the airway manager to focus on other resuscitation tasks. ⋯ We suggest use of volume control ventilation with the following settings: (1) positive end-expiratory pressure of 0 cm of water (to allow venous return), (2) tidal volume of 8 mL/kg with fraction of inspired oxygen at 100% (for adequate oxygenation), (3) respiratory rate of 10 per minute (for adequate ventilation), (4) maximum peak inspiratory pressure or P max alarm of 60 cm of water (to allow tidal volume delivery during chest compression), (5) switching OFF trigger (to avoid trigger by chest recoil), and (6) inspiratory to expiratory time ratio of 1:5 (to provide adequate inspiratory time of 1 second). How to cite this article: Sahu AK, Timilsina G, Mathew R, Jamshed N, Aggarwal P. "Six-dial Strategy"-Mechanical Ventilation during Cardiopulmonary Resuscitation. Indian J Crit Care Med 2020;24(6):487-489.
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Pediatric pulmonology · Jun 2020
Observational StudyAssessment of sidestream end-tidal capnography in ventilated infants on the neonatal unit.
Continuous monitoring of carbon dioxide (CO2 ) levels can be achieved by capnography. Our aims were to compare the performance of a sidestream capnograph with a low dead space and sampling rate to a mainstream device and evaluate whether its results correlated with arterial/capillary CO2 levels in infants with different respiratory disease severities. ⋯ The sidestream capnography performed similarly to the mainstream capnography. The poorer correlation of EtCO2 to PCO2 levels in infants with severe respiratory disease should highlight to clinicians increased ventilation-perfusion mismatch.
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Intensive Crit Care Nurs · Jun 2020
Randomized Controlled TrialThe effects of preoperative education of cardiac patients on haemodynamic parameters, comfort, anxiety and patient-ventilator synchrony: A randomised, controlled trial.
Patients on mechanical ventilation are likely to suffer stress, which may lead to problems of patient-ventilator synchrony, anxiety, haemodynamic instability and decrease in comfort levels. ⋯ Compared to the participants in the control group, the participants in the intervention group who received education had higher patient-ventilator synchrony, comfort and haemodynamic stability levels, as well as lower anxiety levels when they were under mechanical ventilation, showing that results were better in the intervention group than the control group.