Articles: mechanical-ventilation.
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Lung transplantation (LTx) has become an accepted treatment for carefully selected patients with end-stage lung disease. Critical care issues have gained importance concerning bridging of candidates by mechanical respiratory support and are involved in the care after transplantation. The nature of respiratory support varies from oxygen supply and noninvasive ventilation, to mechanical respiratory support either by mechanical ventilation and/or extracorporeal life support. ⋯ Primary graft dysfunction and prolonged mechanical ventilation are major obstacles to hospital survival after LTx. Clear evidence is lacking on how to ventilate and optimally manage patients after LTx. Prolonged extracorporeal life support after LTx may improve outcome in selected patients with a primary graft dysfunction.
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Hospital emergency department (ED) strain is common in North America. Excessive strain may result in prolonged ED length of stay and may lead to worse outcomes for patients admitted to intensive care units (ICUs). ⋯ In this population-based study, less than half of adult ED patients were admitted to an ICU 6 hours or less after arrival to an ED, an internationally recognized performance indicator for ED care quality. ED and ICU strain generated by time-varying demand on capacity was an important determinant of ED length of stay. However, prolonged length of stay in an ED did not measurably reduce 90-day mortality.
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Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation. ⋯ Patients received higher doses of opioids and benzodiazepines at night. Higher nighttime doses were associated with SBT failure and delayed extubation.
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Journal of critical care · Aug 2016
Usefulness of mitral annular plane systolic excursion in assessment of left ventricular systolic function in mechanically ventilated obese patients.
The management of mechanically ventilated patients depends on a combination of clinical skills and measurement of physiological parameters. ⋯ Mitral annular plane systolic excursion is useful, an easier technique, and shorter in duration compared with the eyeball method in the determination of LVSF in mechanically ventilated obese patients.
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Journal of critical care · Aug 2016
Observational StudyCharacteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study.
The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. The goal of this study was to describe the clinical and physiological effects of APRV in patients with established ARDS. ⋯ In patients with ARDS-related refractory hypoxaemia treated with APRV, an early and sustained improvement in oxygenation, low incidence of clinically significant barotrauma and progression to ECMO was observed. The safety and efficacy of APRV requires further consideration.