Articles: mechanical-ventilation.
-
The majority of patients with acute stroke requiring mechanical ventilation have a poor prognosis and often present difficult decisions regarding extubation. The best criteria for planned extubation in these patients are uncertain. ⋯ The in-hospital mortality rate of patients with acute stroke who require mechanical ventilation is quite high. The success rate with planned extubation is relatively good and comparable to rates in previous studies which largely involved patients with respiratory failure. There is no single weaning parameter or Glasgow coma scale score which identifies patients with high success rates.
-
We recently reported that continuous negative abdominal pressure (CNAP) could recruit dorsal atelectasis in experimental lung injury and that oxygenation improved at different transpulmonary pressure values compared with increases in airway pressure (Yoshida T, Engelberts D, Otulakowski G, Katira BH, Post M, Ferguson ND, Brochard L, Amato MBP, Kavanagh BP. Am J Respir Crit Care Med 197: 534-537, 2018). The mechanism of recruitment with CNAP is uncertain, and its impact compared with a commonly proposed alternative approach to recruitment, prone positioning, is not known. ⋯ The mechanism of action of CNAP appears to be via selective narrowing of the vertical gradient of Ppl. CNAP appears to offer physiological advantages over prone positioning. NEW & NOTEWORTHY Continuous negative abdominal pressure reduces the vertical gradient in (dependent vs. nondependent) pleural pressure and increases oxygenation and lung compliance; it is more effective than prone positioning at comparable levels of positive end-expiratory pressure.
-
Poor synchrony between the delivery of mechanical breaths, the neural respiratory timing, and needs of patients is relatively frequent under mechanical ventilation in the intensive care unit. This review summarizes the current knowledge on the different types of dyssynchrony described to date, their mechanism, consequences, and potential management. There is still a long way to get to a comprehensive knowledge and uncertainties remain. Ongoing research and development of monitoring tools are urgently needed to allow a better appraisal of this area in a near future.
-
Am. J. Respir. Crit. Care Med. · Jul 2018
Randomized Controlled TrialTiming of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial.
The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. ⋯ Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01932190).
-
Extracorporeal gas exchange is increasingly used for various indications. Among these are refractory acute respiratory failure, including the acute respiratory distress syndrome (ARDS), and the avoidance of ventilator-induced lung injury (VILI) by enabling lung-protective ventilation. ⋯ These indications are based on a reasonable physiologic rationale but must be weighed against the costs and complications associated with the technique. This article summarizes current evidence and indications for extracorporeal gas exchange.