Articles: mechanical-ventilation.
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Respiratory variations in the inferior vena cava diameter (ΔIVCD) have been studied extensively with respect to their value in predicting fluid responsiveness, but the results are conflicting. The aim of this meta-analysis was to explore the value of ΔIVCD for predicting fluid responsiveness in patients with circulatory shock receiving mechanical ventilation. ⋯ The findings of this study suggest that the ΔIVCD performed moderately well in predicting fluid responsiveness in patients with circulatory shock receiving mechanical ventilation.
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Am. J. Respir. Crit. Care Med. · Aug 2018
Positive End-Expiratory Pressure Ventilation Induces Longitudinal Atrophy in Diaphragm Fibers.
Diaphragm weakness in critically ill patients prolongs ventilator dependency and duration of hospital stay and increases mortality and healthcare costs. The mechanisms underlying diaphragm weakness include cross-sectional fiber atrophy and contractile protein dysfunction, but whether additional mechanisms are at play is unknown. ⋯ Mechanical ventilation with PEEP results in longitudinal atrophy of diaphragm fibers, a response that is modulated by the elasticity of the giant sarcomeric protein titin. We postulate that longitudinal atrophy, in concert with the aforementioned cross-sectional atrophy, hampers spontaneous breathing trials in critically ill patients: during these efforts, end-expiratory lung volume is reduced, and the shortened diaphragm fibers are stretched to excessive sarcomere lengths. At these lengths, muscle fibers generate less force, and diaphragm weakness ensues.
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Antimicrob. Agents Chemother. · Aug 2018
Meta AnalysisIncidences of Pseudomonas aeruginosa-Associated Ventilator-Associated Pneumonia within Studies of Respiratory Tract Applications of Polymyxin: Testing the Stoutenbeek Concurrency Postulates.
Regimens containing topical polymyxin appear highly effective at preventing ventilator-associated pneumonia (VAP) overall and, more so, VAP caused by Gram-negative bacteria. However, Stoutenbeek's postulates that VAP incidences within studies of topical antibiotics depend on the context of whether the component (control and intervention) groups of each study were concurrent versus nonconcurrent remain untested. The literature was searched for concurrent control (CC) versus nonconcurrent control (NCC) designed studies of respiratory tract applications of topical polymyxin to mechanically ventilated (MV) patients that reported incidences of Pseudomonas-associated ventilator-associated pneumonia (PsVAP). ⋯ The mean PsVAP within CC polymyxin control groups (9.9%; CI, 7.6 to 12.8%) is higher than that of all other component group categories. The PsVAP incidences of control and intervention groups of studies of respiratory tract applications of polymyxin are dependent on whether the groups were within a concurrent versus nonconcurrent study. Stoutenbeek's concurrency postulates are validated.
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J Clin Monit Comput · Aug 2018
Review Historical ArticleA technical review of the history, development and performance of the anaesthetic conserving device "AnaConDa" for delivering volatile anaesthetic in intensive and post-operative critical care.
There is a shift in critical care to adopt volatile anaesthetics as sedatives for certain patients using mechanical ventilation. Accompanying this shift is a growing body of literature describing the advantages or disadvantages of using isoflurane or sevoflurane for long term sedation. This practise requires a cost effective, efficient and safe means to deliver these drugs that can simultaneously operate with modern critical care ventilators and ventilation protocols while protecting the care environment and care workers from excessive exposure to the drugs. ⋯ This reflection reduces the total amount of anaesthetic needed, reducing that which is exhausted or scavenged upon exhalation. It can be used for 24 h of sedation, and fits into current critical care ventilator circuits almost without modifications. This article will describe the physical characteristics of the device, how it works, its development history and the performance parameters under which it can be used.
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Journal of critical care · Aug 2018
Multicenter StudyVariation in mortality rates after admission to long-term acute care hospitals for ventilator weaning.
We sought to examine variation in long-term acute care hospital (LTACH) quality based on 90-day in-hospital mortality for patients admitted for weaning from mechanical ventilation. ⋯ LTACHs vary widely in mortality rates, underscoring the need to better understand the sources of this variation and improve the quality of care for patients requiring long-term ventilator weaning.