Articles: mechanical-ventilation.
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Am. J. Respir. Crit. Care Med. · Oct 2017
ReviewFifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. ⋯ This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts, such as plateau pressures, driving pressure, transpulmonary pressures, stress index, and measurement of strain. In addition, the concept of the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.
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Review Meta Analysis
Low Tidal Volume versus Non-Volume-Limited Strategies for Patients with Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis.
Trials investigating use of lower tidal volumes and inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) have shown mixed results. ⋯ The trend toward lower mortality with LTV ventilation in the primary analysis and the significant relationship between the degree of tidal volume reduction and the mortality effect together suggest, but do not prove, that LTV ventilation improves mortality among critically ill adults with ARDS.
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Anaesth Crit Care Pain Med · Oct 2017
Rationale, study design and analysis plan of the lung imaging morphology for ventilator settings in acute respiratory distress syndrome study (LIVE study): Study protocol for a randomised controlled trial.
Different acute respiratory distress syndrome (ARDS) phenotypes may explain controversial results in clinical trials. Lung-morphology is one of the ARDS-phenotypes and physiological studies suggest different responses in terms of positive-end-expiratory-pressure (PEEP) and recruitment-manoeuvres (RM) according to loss of aeration. To evaluate whether tailored ventilator regimens may impact ARDS outcomes, our group has designed a randomised-clinical-trial of ventilator settings according to lung morphology in moderate-to-severe ARDS (LIVE study).
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Pediatr. Clin. North Am. · Oct 2017
ReviewMechanical Ventilation and Decision Support in Pediatric Intensive Care.
Respiratory support is required in most children in the pediatric intensive care unit. Decision-support tools (paper or electronic) have been shown to improve the quality of medical care, reduce errors, and improve outcomes. Computers can assist clinicians by standardizing descriptors and procedures, consistently performing calculations, incorporating complex rules with patient data, and capturing relevant data. This article discusses computer decision-support tools to assist clinicians in making flexible but consistent, evidence-based decisions for equivalent patient states.
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J Clin Monit Comput · Oct 2017
Analysis and compensation for errors in electrical impedance tomography images and ventilation-related measures due to serial data collection.
Electrical impedance tomography (EIT) is increasingly being used as a bedside tool for monitoring regional lung ventilation. However, most clinical systems use serial data collection which, if uncorrected, results in image distortion, particularly at high breathing rates. The objective of this study was to determine the extent to which this affects derived parameters. ⋯ Values from the original and corrected data were compared using paired t-tests. Of the 33 data sets, 23 showed significant differences in filling index for at least one region, 11 had significant differences in calculated tidal impedance change and 12 had significantly different filling fractions (p = 0.05). We conclude that serial collection errors should be corrected before image reconstruction to avoid clinically misleading results.