Articles: mechanical-ventilation.
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Indian J Crit Care Med · Jul 2008
Prediction of arterial blood gas values from arterialized earlobe blood gas values in patients treated with mechanical ventilation.
Arterial blood gas (ABG) analysis is useful in evaluation of the clinical condition of critically ill patients; however, arterial puncture or insertion of an arterial catheter may sometimes be difficult and cause many complications. Arterialized ear lobe blood samples have been described as adequate to gauge gas exchange in acute and chronically ill pediatric patients. ⋯ Arterialized earlobe blood gas can accurately predict the ABG values of pH, PCO(2), BE, and HCO(3)- for patients who do not require regular continuous blood pressure measurements and close monitoring of arterial PO(2) measurements.
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A 29 year old male patient of Indian ancestry was admitted to an outside hospital with rapid deterioration of his level of consciousness. The patient required mechanical ventilation and transfer to MICU at Hamad Medical Corporation. ⋯ Chest X-ray, CT of chest, abdomen, pelvis and proximal areas of both lower limbs were performed. Pneumomediastinum, pneumoperitoneum, and extensive surgical emphysema were the diagnoses.
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Expert Rev Respir Med · Feb 2008
Current ventilatory management of patients with acute lung injury/acute respiratory distress syndrome.
The current main objective of mechanical ventilation during acute respiratory distress syndrome (ARDS) is to improve oxygenation while preventing ventilator-induced lung injury (VILI) in order to save a patient's life. The major determinants of VILI are both hyperinflation of normally aerated lung and repetitive opening and closing of lung units. There are two methods of preventing VILI and, hence, making mechanical ventilation lung protective. ⋯ This strategy requires alveolar pressures much larger than 30 cm H(2)O transiently to overcome the critical opening pressures of the lung. One drawback is hemodynamic impairment. To date, this strategy has not been found to be associated with an improvement of patient outcome.
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Expert Rev Respir Med · Feb 2008
Noninvasive positive pressure ventilation for patients with acute hypoxemic respiratory failure?
The re-emergence of noninvasive positive pressure ventilation (NIV) represents perhaps the single greatest advance in mechanical ventilation over the last 20 years. Clear benefit has been demonstrated for patients with respiratory failure in the setting of acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema. ⋯ Presently, there is little evidence to support the use of NIV for patients presenting with hypoxemic respiratory failure who fulfill the American and European Consensus Conference definition of acute lung injury or acute respiratory distress syndrome, other than in patients with high risk for death if endotracheally intubated (immunocompromised patients, postlung resection acute respiratory distress syndrome). As there are reasonable rationales for both benefit and harm, there is a need for a large, multicenter, randomized, controlled trial to clarify whether NIV offers benefit in terms of a reduced need for endotracheal intubation, length of stay and hospital mortality.
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Nursing in critical care · May 2007
Commentary: Saline versus Albumin Fluid Evaluation (SAFE) Investigators (2006). Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study.
The objectives of this study were to determine whether outcomes of resuscitation with albumin or saline in the intensive care unit (ICU) depend on patients' baseline serum albumin concentration. In this study we analyse data from a double-blind, randomized controlled trial. ICUs of 16 hospitals in Australia and New Zealand were included. ⋯ No significant interaction was found between baseline serum albumin concentration as a continuous variable and the effect of albumin and saline on mortality. No consistent interaction was found between baseline serum albumin concentration and treatment effects on length of stay in the ICU, length of hospital stay, duration of renal replacement therapy or duration of mechanical ventilation. The outcomes of resuscitation with albumin and saline are similar irrespective of patients' baseline serum albumin concentration.