Articles: mechanical-ventilation.
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Minerva anestesiologica · Jun 2019
ReviewPatient-ventilator asynchrony in adult critically ill patients.
Patient-ventilator asynchrony is considered a major clinical problem for mechanically ventilated patients. It occurs during partial ventilatory support, when the respiratory muscles and the ventilator interact to contribute generating the volume output. In this review article, we consider all studies published on patient-ventilator asynchrony in the last 25 years. ⋯ Given the varying outcomes considered and the erratic results, it remains unclear whether asynchronies really affects patient outcome, and the relationship between asynchronies and outcome is causative or associative.
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The use of noninvasive ventilation (NIV) is common in adult acute care. As evidence to support the use of NIV has developed, there has been a concurrent proliferation of NIV technology. Efforts have been made to improve patient-ventilator synchrony, monitoring capabilities, and portability of devices used to deliver NIV. ⋯ Although this technology is generally superior to that of the past, a great deal of variation exists between devices. Clinicians need to be accustomed to the devices available to them to maximize the potential for clinical improvement and patient tolerance. The purpose of this paper is to review current technology, current literature comparing devices, and various clinical considerations associated with NIV use in adult acute care.
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The aim of this systematic review was to determine the effect of chlorhexidine at different concentration and frequency on ventilator-associated pneumonia and microbial colonization in mechanically ventilated patients. Relevant studies in English language were identified by searching data bases between January 2010 and December 2017. Ten studies met the inclusion criteria. ⋯ Twice-daily application was found to be effective reducing the rate of ventilator-associated pneumonia in three studies using 0.2% and 2% chlorhexidine. Microbial colonization was found to be less in 2% chlorhexidine group than herbal mouth wash 0.9% NaCl and 0.2% chlorhexidine in three studies. Chlorhexidine is an effective intervention in oral care for ventilator-associated pneumonia and microbial colonization.
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There is limited data regarding the sleep quality in survivors of critical illness, while the time course of the sleep abnormalities observed after ICU discharge is not known. The aim of this study was to assess sleep quality and the time course of sleep abnormalities in survivors of critical illness. ⋯ Survivors of critical illness exhibited a high prevalence of obstructive sleep-disordered breathing and poor sleep architecture at hospital discharge, which slightly improved 6 months later, indicating that reversible factors are partly responsible for these abnormalities.
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Journal of critical care · Jun 2019
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. ⋯ Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.