Articles: mechanical-ventilation.
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In the ICU, SpO2≥96% are regularly targeted implying that more oxygen may be given than desirable. To reduce exposure to hyperoxia a conservative oxygen therapy protocol (targeted SpO2 90-92% using lowest FiO2) for mechanically ventilated patients was introduced in a single tertiary ICU in September 2012. ⋯ Intensive care clinicians readily accepted the introduction of a conservative oxygen therapy protocol into their practice. Most respondents found conservative oxygen therapy easy and not stressful to perform. Further evaluation the administration of oxygen therapy, its management by intensive care clinicians and possible impact on outcome for mechanically ventilated patients appears well accepted by clinical staff.
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Continuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes. ⋯ Registered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU nurses from this research is positive regardless of level of ICU experience and may influence the type of continuing education on invasive MV provided to ICU nurses in the future, not only in the ICU involved in this study, but other units throughout Australia.
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In the following perspective, we will highlight seemingly remote, downstream consequences of common ventilator management decisions. For example, a change in PEEP may alter venous return, blood pressure, cardiac output, arterial and venous blood gas tensions, metabolic rate, respiratory sensations, breathing pattern, and the work of breathing. If providers consider any of these changes dangerous or maladaptive, they may initiate additional interventions in the form of vasoactive agents, intravenous fluids, and/or sedatives, all of which have their own risk/benefit profile. ⋯ Therefore, it is often impossible to infer intervention-specific mechanisms of action and/or identify the phenotype of responders and nonresponders in such trials. On the flip side, in preclinical research intended to uncover mechanisms, experimental animals are rarely treated the way a critically ill patient would be. For respiratory therapists, this knowledge gap stresses the imperative to think beyond the lungs and to communicate ventilator management decisions with all members of the healthcare team.
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Am. J. Respir. Crit. Care Med. · Aug 2014
Ventilator-induced Lung Injury: Similarity and Differences Between Children and Adults.
It is well established that mechanical ventilation can injure the lung, producing an entity known as ventilator-induced lung injury (VILI). There are various forms of VILI, including volutrauma (i.e., injury caused by overdistending the lung), atelectrauma (injury due to repeated opening/closing of lung units), and biotrauma (release of mediators that can induce lung injury or aggravate pre-existing injury, potentially leading to multiple organ failure). ⋯ Given the physiological and biological differences in the respiratory systems of infants, children, and adults, it is difficult to directly extrapolate clinical practice from adults to children. This Critical Care Perspective analyzes the relevance of VILI to the pediatric population, and addresses why pediatric patients might be less susceptible than adults to VILI.