Articles: mechanical-ventilation.
-
Observational Study
Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score.
The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance. ⋯ Daily goal formation and computer-enhanced visualization of mechanical ventilation variance were associated with an improvement in goal attainment by evidence of an improved mechanical ventilation score. Further research is needed to determine whether improvements in mechanical ventilation score through a targeted, process-oriented intervention will lead to improved patient outcomes. (ClinicalTrials.gov registration NCT02184208.).
-
Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV; defined here as mechanical ventilation for longer than 21 d). ⋯ Critically ill patients who undergo mechanical ventilation in an ICU for longer than 21 days have high in-hospital mortality and greater postdischarge mortality, health care utilization, and health care costs compared with patients who undergo mechanical ventilation for a shorter period of time.
-
Editorial Comment
Ultrasound to assess diaphragmatic function in the critically ill-a critical perspective.
Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. The advantages include that it is widely available, non-invasive and examination can be performed after relatively short training and at low costs. It is used to estimate muscle mass by measurement of muscle thickness and diagnose weakness by the assessment of diaphragm movement during unassisted breathing. ⋯ The enthusiasm that surrounds this topic is shared by many clinicians and we agree that ultrasound is a valuable tool to screen for diaphragm dysfunction in intensive care unit (ICU) patients. However, in our opinion much more studies are required to validate ultrasound as a tool to quantify breathing effort. More sophisticated ultrasound techniques, such as speckle tracking imaging are promising techniques to evaluate respiratory muscle function in patients, including the critically ill.
-
JMIR research protocols · Feb 2017
Delirium After Mechanical Ventilation in Intensive Care Units: The Cognitive and Psychosocial Assessment (CAPA) Study Protocol.
In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment. ⋯ Delirium during mechanical ventilation has been linked to longer ICU and hospital stays, higher financial burdens, increased risks of long-term cognitive impairment (ie, dementia), poor functional outcomes and quality of life, and decreased survival. However, delirium during mechanical ventilation in the ICU is not well understood. This study will advance our knowledge of the comprehensive, long-term effects of delirium on cognitive and psychosocial function.
-
Review Meta Analysis
Clonidine for sedation in the critically ill: a systematic review and meta-analysis.
This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation. ⋯ Until further RCTs are performed, data remains insufficient to support the routine use of clonidine as a sedative in the mechanically ventilated population. Clonidine may act as a narcotic-sparing agent, albeit with an increased risk of clinically significant hypotension.