Articles: mechanical-ventilation.
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In respiratory distress, lung airways become flooded with liquid and may collapse due to surface-tension forces acting on air-liquid interfaces, inhibiting gas exchange. This paper proposes a mathematical multiscale model for the mechanical ventilation of a network of occluded airways, where air is forced into the network at a fixed tidal volume, allowing investigation of optimal recruitment strategies. The temporal response is derived from mechanistic models of individual airway reopening, incorporating feedback on the airway pressure due to recruitment. ⋯ However, the time taken for complete ventilation of the network increases significantly as the network becomes more heterogeneous, leading to increased stresses on airway walls. The model predicts that the most peripheral airways are most at risk of ventilation-induced damage. A positive-end-expiratory pressure reduces the total recruitment time but at the cost of larger stresses exerted on airway walls.
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Intensive Crit Care Nurs · Oct 2015
Contributors to fatigue in patients receiving mechanical ventilatory support: A descriptive correlational study.
To describe levels of fatigue and explore clinical factors that might contribute to fatigue in critically ill patients receiving mechanical ventilation. ⋯ Illness severity and more frequent sedative administration were related to higher fatigue ratings in these mechanically ventilated patients.
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Intensive care medicine · Oct 2015
Randomized Controlled Trial Comparative StudyEffect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial.
To evaluate the efficacy of a quality improvement (QI) program for protocol-directed weaning from mechanical ventilation. ⋯ The QI program involving protocol-directed weaning is associated with beneficial clinical outcomes in mechanically ventilated patients.
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Indian J Crit Care Med · Oct 2015
A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome.
There is sparse data on the role of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS) from India. Herein, we report our experience with the use of NIV in mild to moderate ARDS. ⋯ Use of NIV in mild to moderate ARDS helped in avoiding intubation in about 44% of the subjects. A baseline APACHE II score of >17 and a PaO2/FiO2 ratio <150 at 1 h predicts NIV failure.
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Journal of anesthesia · Oct 2015
Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?
Airway management in severe bronchial asthma exacerbation (BAE) carries very high risk and should be performed by experienced providers. However, no objective data are available on the association between the laryngoscopist's specialty and endotracheal intubation (ETI)-related adverse events in patients with severe bronchial asthma. In this paper, we compare emergency ETI-related adverse events in patients with severe BAE between anesthesiologists and other specialists. ⋯ Anesthesiologist as first exposure was independently associated with attenuated risk of ETI-related adverse events in patients with severe BAE. The skill and knowledge of anesthesiologists should be applied to high-risk airway management whenever possible.