Articles: mechanical-ventilation.
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Ann Fr Anesth Reanim · Dec 2013
Case Reports[Hypoxic accident during pediatric anesthesia due to an inappropriate setting of respirator.]
A 3-year-old child was anesthetized for ENT examination and surgery. After induction and tracheal intubation, the patient was ventilated (controlled mode). The respirator screen showed information compatible with a failure of intubation: no expired CO2, no expired flow, no alarm of high pressure limit, and no respiratory chest movement. ⋯ The expiratory CO2 was present when the patient was ventilated manually and disappeared under controlled ventilation. The increase in the value of the maximal insufflation pressure allowed efficient ventilation with an expiratory CO2 curve and showed high ventilation pressure compatible with a bronchospasm. This case report shows that in case of bronchospasm, if the value of the maximal insufflation pressure is low, this may lead to an erroneous diagnosis of failure of intubation.
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Review
Hypoxaemic rescue therapies in acute respiratory distress syndrome: Why, when, what and which one?
Acute respiratory distress syndrome (ARDS) is an inflammatory condition of the lungs which can result in refractory and life-threatening hypoxaemic respiratory failure. The risk factors for the development of ARDS are many but include trauma, multiple blood transfusions, burns and major surgery, therefore this condition is not uncommon in the severely injured patient. When ARDS is severe, high-inspired oxygen concentrations are frequently required to minimise hypoxaemia. ⋯ First line hypoxaemic rescue therapies include inhaled nitric oxide, prone positioning, alveolar recruitment manoeuvres and high frequency oscillatory ventilation, which have all been shown to be effective in improving oxygenation. In situations where these first line rescue therapies are inadequate extra-corporeal membrane oxygenation has emerged as a lifesaving second line rescue therapy. Rescue therapies in critically ill patients with traumatic injuries presents specific challenges and requires careful assessment of both the short and longer term benefits, therapeutic limitations, and specific adverse effects before their use.
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Journal of critical care · Dec 2013
Multicenter StudyFactors associated with timing of initiation of physical therapy in patients with acute lung injury.
Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation. ⋯ In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.
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Eur Heart J Acute Cardiovasc Care · Dec 2013
Evaluation of a clinical pathway for sedation and analgesia of mechanically ventilated patients in a cardiac intensive care unit (CICU): The Brigham and Women's Hospital Levine CICU sedation pathways.
Intravenous sedation and analgesia are important therapies during mechanical ventilation (MV). However, daily interruption of these medications is associated with improved outcomes in mechanically ventilated patients. We tested a clinical pathway for the use of sedation and analgesia during MV in a cardiac intensive care unit (CICU). ⋯ Implementation of a pragmatic pathway for sedation and analgesia in a CICU was associated with an increase in the daily interruption of sedation and a corresponding decrease in the duration of MV days and the need for neuroimaging.