Articles: mechanical-ventilation.
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Anaesth Crit Care Pain Med · Feb 2017
Observational StudyUltrasonographic diaphragmatic excursion is inaccurate and not better than the MRC score for predicting weaning-failure in mechanically ventilated patients.
To assess the ability of diaphragmatic ultrasound (US) to predict weaning failure in mechanically ventilated patients undergoing a first spontaneous breathing trial (SBT). ⋯ A decrease in MDE values may be associated with an unfavourable weaning outcome. Diaphragmatic excursion measured by ultrasound is however unable by itself to predict weaning failure at the bedside of patients undergoing a first spontaneous breathing trial and does not provide any additional value compared to the MRC score.
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J Clin Monit Comput · Feb 2017
Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery.
Robotic assisted surgery (RAS) represents a great challenge for anesthesiology due to the increased intraabdomial pressures required for surgical optimal approach. The changes in lung physiology are difficult to predict and require fast decision making in order to prevent altered gas exchange. The aim of this study was to document the combined effect of patient physical status, medical history and intraoperative position during RAS on lung physiology and to determine perioperative risk factors for hypercapnia. ⋯ A significant higher increase in arterial CO2 tension was registered in patients undergoing RAS in steep Trendelenburg position (p = 0.05), but no significant changes in end-tidal CO2 were recorded. A higher arterial to end-tidal CO2 tension gradient was observed in patients with a BMI > 30 (p < 0.001). In conclusion, patients' physical status, especially obesity, represents the main risk factor for decreased lung compliance during RAS and patient positioning in either Trendelenburg or steep Trendelenburg during surgery has limited effects on respiratory physiology.
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Intensive Crit Care Nurs · Feb 2017
Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients.
To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations. ⋯ Maximum tissue interface pressure was above critical levels for the majority of the documented periods, especially in the sacrum, although few changes in skin integrity were documented. Time spent above critical levels for mean pressures were considerably less compared to maximum pressures. Maximum pressures may have reflected pressure spikes, but the large amount of time above the critical pressure levels remains substantial.
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Am. J. Respir. Crit. Care Med. · Feb 2017
Mitigation of Ventilator-Induced Diaphragm Atrophy by Transvenous Phrenic Nerve Stimulation.
Ventilator-induced diaphragm dysfunction is a significant contributor to weaning difficulty in ventilated critically ill patients. It has been hypothesized that electrically pacing the diaphragm during mechanical ventilation could reduce diaphragm dysfunction. ⋯ These results suggest that early transvenous phrenic nerve pacing may mitigate ventilator-induced diaphragm dysfunction.
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Breathing discomfort (dyspnea) during mechanical ventilation in the ICU may contribute to patient distress and complicate care. Assessment of nonverbal cues may allow caregivers to estimate patient breathing discomfort. This study assesses the accuracy of those caregiver estimates. ⋯ Significant breathing discomfort is prevalent in mechanically ventilated ICU patients and is underestimated by caregivers, regardless of profession. The increasing disparity in caregiver estimate as breathing discomfort rises may expose patients to levels of dyspnea that promote anxiety and fear. This study demonstrates the need for further development and standardization of methods to assess dyspnea in nonverbal patients.