Articles: mechanical-ventilation.
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Comparative Study
Mechanical Ventilation-Related Safety Incidents in General Care Wards and ICU Settings.
Although the ICU is the most appropriate place to care for mechanically ventilated patients, a considerable number are ventilated in general medical care wards all over the world. However, adverse events focusing on mechanically ventilated patients in general care have not been explored. ⋯ Human-factor issues were the most frequent reasons in both settings, while knowledge-based error rates were higher in general care. Our results suggest that proper education and training is needed to minimize patient safety incidents in facilities without respiratory therapists.
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Mechanical ventilation is a routine intervention for the critically ill but patients' experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors' accounts is required to provide health professionals with evidence about the patients' experience to deliver patient-centred care. ⋯ For the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors' experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation.
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Am. J. Respir. Crit. Care Med. · Oct 2018
Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury.
The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. ⋯ Mechanical ventilation consistent with clinical practice did not generate excessive regional strain in heterogeneously aerated supine lungs. However, it allowed worsening of spatial strain distribution in these lungs, associated with increased inflammation. Our results support the implementation of early aeration homogenization in normal lungs.
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Observational Study
Evaluation of three pain assessment scales used for ventilated neonates.
To compare and evaluate the reliability, validity, feasibility, clinical utility, and nurses' preference of the Premature Infant Pain Profile-Revised, the Neonatal Pain, Agitation, and Sedation Scale, and the Neonatal Infant Acute Pain Assessment Scale used for procedural pain in ventilated neonates. ⋯ Choosing a valid, reliable, feasible and practical measurement is the key step for better management of procedural pain for ventilated newborns. Using the right and suitable tool is helpful to accurately identify pain, ultimately improve the neonatal care and outcomes.
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Standard mechanical insufflation-exsufflation (MI-E) therapy is applied with fast insufflation-exsufflation pressures to achieve high peak expiratory flows (PEF) and assist airway clearance. No attention is given to the resultant high peak inspiratory flows (PIF), although it may impair secretion removal. It has been proposed that an expiratory flow bias (ie, PEF higher than PIF) might be the key determinant for mucus clearance instead of the PEF alone. We examined the effects of 2 MI-E maneuvers, standard versus optimized, with fast and slow insufflation, respectively, along with different MI-E pressure settings on secretion displacement in 3 lung-impedance scenarios that simulated a patient on mechanical ventilation. ⋯ The optimized MI-E maneuver, applied with slow insufflation, resulted in a higher expiratory flow bias, which made the therapy more effective at moving mucus outward, compared with the standard MI-E maneuver, typically applied with fast insufflation.