Articles: mechanical-ventilation.
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Am. J. Respir. Crit. Care Med. · Apr 2017
The Voice of Surrogate Decision Makers: Family Responses to Prognostic Information in Chronic Critical Illness.
Information from clinicians about the expected course of the patient's illness is relevant and important for decision-making by surrogates for chronically critically ill patients on mechanical ventilation. ⋯ Prognostic disclosure by skilled clinician communicators evokes a repertoire of responses from surrogates for the chronically critically ill. Recognition of these response patterns may help all clinicians better communicate their support to patients and families facing chronic critical illness and inform interventions to support surrogate decision-makers in ICUs. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01230099.
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Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test. ⋯ Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time.
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Journal of critical care · Apr 2017
Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome.
The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. ⋯ Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
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Recent findings suggest that using alveolar PCO2 (PACO2 ) estimated by volumetric capnography in the Bohr equation instead of PaCO2 (Enghoff modification) could be appropriate for the calculation of physiological dead space to tidal volume ratio (VD/VT Bohr and VD/VT Enghoff, respectively). We aimed to describe the relationship between these 2 measurements in mechanically ventilated children and their significance in cases of ARDS. ⋯ This study suggests that VD/VT Bohr and VD/VT Enghoff are not different when there is no hypoxemia (PaO2 /FIO2 > 300) except in the case of status asthmaticus. In subjects with a low PaO2 /FIO2 , the method to measure VD/VT must be reported, and results cannot be easily compared if the measurement methods are not the same.