Articles: mechanical-ventilation.
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Comparative Study
Associations between different sedatives and ventilator-associated events, length-of-stay, and mortality in mechanically ventilated patients.
Current sedation guidelines recommend avoiding benzodiazepines but express no preference for propofol vs dexmedetomidine. In addition, few data exist on whether randomized controlled trials of sedatives can be successfully generalized to routine practice, in which conditions tend to be more varied and complex. ⋯ In this large, real-world cohort, propofol and dexmedetomidine were associated with less time to extubation compared with benzodiazepines, but dexmedetomidine was also associated with less time to extubation vs propofol. These possible differences merit further study.
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Intermittent mandatory ventilation (IMV) was introduced nearly 50 years ago. Despite the initial fanfare and early adoption by many, the role of IMV continues to be questioned. ⋯ Spontaneous breathing, however, has a number of salutatory effects on gas exchange, the distribution of ventilation, and hemodynamics. These issues will be explored in light of a growing body of evidence.
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To assess the safety of mechanical ventilation and effectiveness of extrinsic positive end-expiratory pressure (PEEP) (PEEPe) in improving peripheral oxygen saturation (SpO2) during direct microlaryngeal laser surgery; to assess the incidence, amount, and nature (dynamic hyperinflation or airflow obstruction) of ensuing intrinsic PEEP (PEEPi); and to find a surrogate PEEPi indicator. ⋯ During ventilation through small endotracheal tubes, PEEPi (mostly due to dynamic hyperinflation) is common. Hemodynamic complications, barotrauma, and O2 desaturation (reversible with PEEPe) are rare. Pawplateau provided by ventilators is useful in suspecting and monitoring the occurrence of PEEPi and allows detection of lung overdistension as PEEPe is applied.
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Patients requiring mechanical ventilation can have complications related to their underlying diseases and hospital-related events. It is possible that easily obtained information early in the course of mechanical ventilation can provide information about important outcomes. ⋯ Easily available information collected on day 2 of mechanical ventilation can help identify patients at risk for poor outcomes, including the duration of mechanical ventilation, the development of ventilator-associated complications and mortality. Prospective studies measuring peak pressures are needed to evaluate the utility of this simple measurement in the management of patients requiring mechanical ventilation.
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Indian J Crit Care Med · Jun 2016
Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature.
This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. ⋯ Sleep disturbances are common in ARDS survivors early after discharge from the ICU.