Articles: mechanical-ventilation.
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Management of critically ill patients in austere environments is a logistic challenge. Availability of oxygen cylinders for the mechanically ventilated patient may be difficult in such a context. A solution is to use a ventilator able to function with an oxygen concentrator. ⋯ The ability of an oxygen concentrator to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders in austere environments when used with a turbine ventilator. However, FiO2 has to be monitored continuously because delivered FiO2 decreases when minute ventilation is increased.
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The Journal of infection · Sep 2014
Multicenter StudyAspergillus in the lower respiratory tract of immunocompetent critically ill patients.
To shed light on the meaning of Aspergillus-positive lower-respiratory-tract samples in non immunocompromized critically ill patients. ⋯ In critically ill immunocompetent patients, risk factors for presence of Aspergillus in lower respiratory tract specimens are steroid therapy (either chronic or initiated in the ICU), ARDS, and high severity of the acute illness. Prospective studies are warranted to further examine these risk factors and to investigate immune functions as well as the impact of antifungal therapy on patient outcomes.
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Randomized Controlled Trial Comparative Study
Home Mechanical Ventilation for COPD: High-Intensity Versus Target Volume Noninvasive Ventilation.
High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V(T) NIV) provides additional benefits remains unclear. ⋯ Switching subjects from well-established HI-NIV to target V(T) NIV shows no clinical benefits in chronic hypercapnic COPD. In particular, sleep quality, the control of nocturnal hypoventilation, daytime hypercapnia, overnight ventilation patterns, subjects' tolerance, health-related quality of life, lung function, and exercise capability were all similar in subjects who underwent HI-NIV and target V(T) NIV. Nevertheless, target V(T) NIV might offer some physiological advantages in breathing pattern and might be beneficial in some individual patients. (German Clinical Trials Register [www.drks.de] Registration DRKS00000450.).
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Prior researches have showed that weaning protocols may decrease the duration of mechanical ventilation. The effect of these protocols on chronic obstructive pulmonary disease (COPD) patients is unknown. The purpose of this study was to evaluate the impact of an extensive mechanical ventilation protocol including weaning applied by a respiratory therapist (RT) on the duration of mechanical ventilation and intensive care unit (ICU) stay in COPD patients. ⋯ In our center, a protocolized mechanical ventilation and weaning strategy improved weaning success and shortened the total duration of mechanical ventilation and ICU stay in COPD patients requiring mechanical ventilation.
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Randomized Controlled Trial Comparative Study
In COPD patients on prolonged mechanical ventilation heart rate variability during the T-piece trial is better after pressure support plus PEEP: a pilot physiological study.
To evaluate heart rate variability (HRV), hemodynamics, mechanics, dyspnea and blood gases following different mechanical ventilation (MV) settings. ⋯ The T-piece trial following setting-2 seems less stressful on neural control of HRV. Future studies on T-piece trials should consider the residual effect of the MV setting.