Articles: mechanical-ventilation.
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In patients with acute hypoxemic respiratory failure (AHRF) under mechanical ventilation, the change in pressure slope during a low-flow insufflation indicates a global airway opening pressure (AOP) needed to reopen closed airways and may be used for titration of positive end-expiratory pressure. ⋯ AOPglobal mostly reflects the lowest opening pressure in the lung and frequently underestimates the highest regional AOP in mechanically ventilated patients with AHRF. A progressive slope change during the low-flow pressure-time curve indicates the presence of several and higher regional AOPs.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewAwake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts.
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. ⋯ Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.
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Pediatric emergency care · Jan 2025
Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis.
Postintubation sedation is a critical intervention for patients undergoing mechanical ventilation. Research in the intensive care unit (ICU) and adult emergency department (ED) demonstrates that appropriate postintubation sedation has a significant impact on patient outcomes. There are minimal published data regarding postintubation sedation for pediatric ED patients. ⋯ Data on postintubation sedation in pediatric ED patients are limited. Administration of postintubation sedation is inconsistent and may be substantially delayed. Further high-quality research into the use of postintubation sedation in this setting is needed, and appropriate postintubation sedation should be a target for quality improvement.
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Observational Study
Tracheostomy Practice in the Italian Intensive Care Units: A Point-Prevalence Survey.
Background and Objectives: A tracheostomy is a frequently performed surgical intervention in intensive care units (ICUs) for patients requiring prolonged mechanical ventilation. This procedure can offer significant benefits, including reduced sedation requirements, improved patient comfort, and enhanced airway management. However, it is also associated with various risks, and the absence of standardized clinical guidelines complicates its implementation. ⋯ Conclusions: These findings highlight the critical role of tracheostomy in the management of critically ill patients within Italian ICUs. The high prevalence and notable complication rates emphasize the urgent need for standardized clinical protocols aimed at optimizing patient outcomes and minimizing adverse events. Further research is essential to refine current practices and develop comprehensive guidelines for the management of tracheostomy in critically ill patients.