Articles: mechanical-ventilation.
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Am. J. Respir. Crit. Care Med. · Apr 2020
Effective Care Practices in Patients Receiving Prolonged Mechanical Ventilation: An Ethnographic Study.
Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and incur high healthcare costs. However, little is known about how to optimally organize and manage their care. Objectives: To identify a set of effective care practices for patients receiving prolonged mechanical ventilation. ⋯ High-performing hospitals actively promoted interdisciplinary communication and coordination using a range of organizational practices, including factors related to leadership (e.g., leaders who communicate a culture of quality improvement), staffing (e.g., lower nurse-to-patient ratios and ready availability of psychologists and spiritual care providers), care protocols (e.g., specific yet flexible respiratory therapy-driven weaning protocols), team meetings (e.g., interdisciplinary meetings that include direct care providers), and the physical plant (e.g., large workstations that allow groups to interact). These practices were believed to facilitate care that is simultaneously goal directed and responsive to individual patient needs, leading to more successful liberation from mechanical ventilation and improved survival. Conclusions: High-performing long-term acute care hospitals employ several organizational practices that may be helpful in improving care for patients receiving prolonged mechanical ventilation.
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Observational Study
Adoption of low tidal volume ventilation in the emergency department: A quality improvement intervention.
Ventilator tidal volumes of >8 mL/kg of predicted body weight (PBW) may increase the risk of lung injury. We sought to evaluate the impact of a quality improvement intervention among intubated Emergency Department (ED) patients to protocolize the prescription of low tidal volume ventilation. ⋯ Pairing a ventilator initiation protocol with focused education and resources for emergency physicians and respiratory therapists was associated with a significant reduction in tidal volume delivered to ED patients.
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Journal of critical care · Apr 2020
Observational StudyEffects of intraoperative tidal volume on incidence of acute kidney injury after cardiovascular surgery: A retrospective cohort study.
We performed a retrospective cohort study to evaluate whether intraoperative low tidal volume ventilation reduces the incidence of acute kidney injury (AKI) after cardiovascular surgery. ⋯ This study suggests that intraoperative low tidal volume ventilation during cardiovascular surgery is associated with a decreased incidence of postoperative AKI. Lowering tidal volume might be a simple strategy for reducing AKI incidence after cardiovascular surgery.
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Pulmonary circulation · Apr 2020
Care of patients with pulmonary arterial hypertension during the coronavirus (COVID-19) pandemic.
The COVID-19 pandemic presents many unique challenges when caring for patients with pulmonary hypertension. The COVID-19 pandemic has altered routine standard of care practice and the acute management particularly for those patients with pulmonary arterial hypertension, where pulmonary arterial hypertension-specific treatments are used. ⋯ However, the COVID-19 outbreak may also represent a unique time when pulmonary hypertension experts have to weigh the risks and benefits of the diagnostic work-up including potential exposure to COVID-19 versus initiating targeted pulmonary arterial hypertension therapy in a select high-risk, high likelihood World Symposium Pulmonary Hypertension Group 1 pulmonary arterial hypertension patients. This document will highlight some of the issues facing providers, patients, and the pulmonary arterial hypertension community in real-time as the COVID-19 pandemic is evolving and is intended to share expected common clinical scenarios and best clinical practices to help the community at-large.