Articles: mechanical-ventilation.
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Single-dose etomidate is used as an induction agent for rapid-sequence intubation and is associated with transient adrenal insufficiency. There is ongoing debate as to the clinical consequences of this transient adrenal insufficiency for critically ill patients. ⋯ Single-dose etomidate does not adversely affect hemodynamic stability, as measured by the dose of vasopressors required at 24 h after administration.
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Mechanical ventilation with high tidal volumes may cause ventilator-induced lung injury (VILI) and enhanced generation of nitric oxide (NO). We demonstrated in sheep that pneumonectomy followed by injurious ventilation promotes pulmonary edema. We wished both to test the hypothesis that neuronal NOS (nNOS), which is distributed in airway epithelial and neuronal tissues, could be involved in the pathogenesis of VILI and we also aimed at investigating the influence of an inhibitor of nNOS on the course of VILI after pneumonectomy. ⋯ Inhibition of nNOS improved gas exchange, but did not reduce lung water extravasation following injurious ventilation after pneumonectomy in sheep.
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J Pediatr Intensive Care · Jun 2012
Effect of endotracheal tube leakage on respiratory function monitoring: Comparison of three neonatal ventilators.
In preterm infants, lung function monitoring is important for lung-protective mechanical ventilation. In this study, we used a neonatal lung model to investigate the effect of endotracheal tube (ETT) leakage on the monitoring of tidal volume (VT) and lung mechanics using different ventilators. A neonatal lung model was ventilated via a 3 mm ETT using three ventilators, Babylog 8000, Leoni, and Stephanie. ⋯ The displayed resistance increased with increasing ETT leakage for the three ventilators, but quite different. The effect of ETT leakage on displayed VT and lung mechanical parameters is ventilator-dependent. ETT leakage can lead to incorrect measurements that indicate reduced VT, improvement of lung compliance, or ETT obstruction.
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Open Access Emerg Med · Jan 2012
ReviewManagement of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department.
Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. ⋯ Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive and invasively ventilated patients are discussed, with a particular emphasis on initiation and ongoing monitoring priorities focused on maintaining patient safety and improving patient outcomes.
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There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. ⋯ Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.