Articles: mechanical-ventilation.
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Multicenter Study Observational Study
Epidemiology, Mechanical Power, and 3-Year Outcomes in Acute Respiratory Distress Syndrome Patients Using Standardized Screening. An Observational Cohort Study.
Rationale: Limited data on the epidemiology of acute respiratory distress syndrome (ARDS) using a standardized screening program exist. Objectives: To describe the population-based incidence of hypoxemic respiratory failure and ARDS using a prospective standardized screening protocol; and to describe the mechanical ventilation practice and the mechanical power and examine their association with 28-day and 3-year survival outcomes. Methods: A prospective standardized screening program for ARDS, as a quality improvement initiative, was initiated at four adult intensive care units over a 27-month period. ⋯ Increasing ARDS severity was associated with increased 28-day hospital and 3-year mortality. Increased mechanical power was associated with increased mortality. Potentially modifiable determinants of mechanical power associated with lower survival included plateau pressure and driving pressure.
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Comparative Study
Indirect calorimetry in critically ill mechanically ventilated patients: Comparison of E-sCOVX with the deltatrac.
Indirect calorimetry is recommended to measure energy expenditure (EE) in critically ill, mechanically ventilated patients. The most validated system, the Deltatrac® (Datex-Ohmeda, Helsinki, Finland) is no longer in production. We tested the agreement of a new breath-by-breath metabolic monitor E-sCOVX® (GE healthcare, Helsinki, Finland), with the Deltatrac. We also compared the performance of the E-sCOVX to commonly used predictive equations. ⋯ The E-sCOVX metabolic monitor is not accurate in estimating EE in critically ill mechanically ventilated patients when compared to the Deltatrac, the present reference method. The E-sCOVX overestimates EE with a bias and precision that are clinically unacceptable.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Observational StudyDevelopment and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation.
To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. ⋯ The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
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Observational Study
Serial Weekly Measurements of the Timed Inspiratory Effort Index Can Predict Successful Prolonged Weaning.
Patients who require prolonged weaning from mechanical ventilation represent a major challenge in intensive care, and the timed inspiratory effort (TIE) index has been shown to be a clinically valuable tool to predict weaning success. ⋯ When measured weekly, a TIE index of ≥1.0 cm H2O/s was a good predictor of success in subjects who required prolonged weaning in our hospital.
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PEEP is titrated to improve oxygenation during mechanical ventilation. It is clinically desirable to identify factors that are associated with a clinical improvement or deterioration following a PEEP change. However, these factors have not been adequately described in the literature. Therefore, we aimed to quantify the empirical probability of PEEP changes having a positive effect upon oxygenation, compliance of the respiratory system (CRS), and the ratio of dead space to tidal volume (VD/VT). Further, clinical factors associated with positive response during pediatric mechanical ventilation are described. ⋯ In children requiring mechanical ventilation, the responder rate was modest for both PEEPincrease and PEEPdecrease cases. These data suggest that PEEP titration often does not have the desired clinical effect, and predicting which patients will manifest a positive response is complex, requiring more sophisticated means of assessing individual subjects.