Articles: mechanical-ventilation.
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Intensive care medicine · May 2016
Review Meta AnalysisProlonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients' data from four randomized trials and trial-level meta-analysis of the updated literature.
To investigate the effect of prolonged glucocorticoid treatment for patients with acute respiratory distress syndrome (ARDS). ⋯ Prolonged methylprednisolone treatment accelerates the resolution of ARDS, improving a broad spectrum of interrelated clinical outcomes and decreasing hospital mortality and healthcare utilization.
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Randomized Controlled Trial
Cerebral oxygenation in mechanically ventilated early cardiac arrest survivors: The impact of hypercapnia.
Optimal cerebral oxygenation is considered fundamental to cerebral protection in cardiac arrest (CA) patients. Hypercapnia increases cerebral blood flow and may also improve cerebral oxygenation. It is uncertain, however, whether this effect occurs in mechanically ventilated early survivors of CA. ⋯ During the early post-resuscitation period, in mechanically ventilated CA patients, mild hypercapnia increases cerebral oxygenation as assessed by NIRS. Further investigations of the effect of prolonged mild hypercapnia on cerebral oxygenation and patient outcomes appear justified.
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Noninvasive positive pressure ventilation (NPPV) for acute respiratory failure in the intensive care unit (ICU) is associated with a marked reduction in intubation rate, complications, hospital length of stay and mortality. Multiple studies have indicated that patients failing NPPV have worse outcomes compared with patients with successful NPPV treatment; however limited data is available on risks associated with NPPV failure resulting in (delayed) intubation and outcomes compared with initial intubation. The purpose of this study is to assess rates and predictors of NPPV failure and to compare hospital outcomes of patients with NPPV failure with those patients primarily intubated without a prior NPPV trial. ⋯ Patients with acute respiratory failure and NPPV failure have worse outcomes compared with NPPV success patients, however not worse than initially intubated patients. An initial trial of NPPV therefore may be suitable in selected cases of patients with acute respiratory failure, since NPPV could be potentially beneficial and does not seem to result in worse outcome in case of NPPV failure compared to primary intubation. A prospective trial is warranted to confirm findings.
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Randomized Controlled Trial
Comparison of pressure and volume-controlled ventilation in laparoscopic cholecystectomy operations.
Laparoscopic cholecystectomy has many advantages such as shorter hospital stay of patients, minimal postoperative pain, rapid recovery after the operation; however, systemic disadvantages because intra-abdominal pressure, position and general anaesthesia may also appear. In this study, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) modes during laparoscopic cholecystectomy operations were compared in terms of their effects on haemodynamic, respiratory and blood gas parameters. ⋯ In this study, with volume-controlled ventilation anaesthesia in laparoscopic cholecystectomy, higher tidal volume and lower alveolar-arterial oxygen gradient were achieved after pneumoperitoneum. These findings indicated that VCV mode can provide a better alveolar ventilation than PCV mode in laparoscopic cholecystectomy operations.
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Am. J. Physiol. Heart Circ. Physiol. · May 2016
Dynamic filling parameters in patients with atrial fibrillation: differentiating rhythm induced from ventilation-induced variations in pulse pressure.
In patients with sinus rhythm, the magnitude of mechanical ventilation (MV)-induced changes in pulse pressure (PP) is known to predict the effect of fluid loading on cardiac output. This approach, however, is not applicable in patients with atrial fibrillation (AF). We propose a method to isolate this effect of MV from the rhythm-induced chaotic changes in PP in patients with AF. ⋯ During T2 and T3, magnitude of PP deviations was related with the amplitude of tidal volume [mean bias error (SD) of -5 (6) and -8 (7) mmHg for T2 and T3, respectively; P = 0.003 repeated-measures ANOVA]. We conclude that LOC2 most accurately predicted rhythm-induced variations in PP. MV-induced deviations in PP can be quantified and may therefore provide a method to study cardiopulmonary interactions in the presence of arrhythmia.