Articles: mechanical-ventilation.
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Journal of critical care · Aug 2023
Review Meta AnalysisClinical outcomes in patients undergoing invasive mechanical ventilation using NAVA and other ventilation modes - A systematic review and meta-analysis.
Neurally adjusted ventilatory assist mode (NAVA) benefit in mechanical ventilation (MV) patients with regard to clinically outcomes is still uncertain. Recent randomized clinical trials (RCTs) have addressed this issue, making it important to assess the real impact of NAVA in relation to these outcomes. ⋯ NAVA mode has a modest impact on MV-free days and weaning success, with no association with improvements in other relevant clinical outcomes.
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Randomized Controlled Trial
Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation.
The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non-cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in-hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. ⋯ Pre-operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1-2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference -5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra-operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube.
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Journal of critical care · Aug 2023
Effects of aggressive and conservative strategies for mechanical ventilation liberation.
The optimal approach for transitioning from strict lung protective ventilation to support modes of ventilation when patients determine their own respiratory rate and tidal volume remains unclear. While aggressive liberation from lung protective settings could expedite extubation and prevent harm from prolonged ventilation and sedation, conservative liberation could prevent lung injury from spontaneous breathing. ⋯ Aggressive liberation may improve ventilator free and ICU free days with little impact on mortality in patients with SOFA score < 12. Trials are needed.
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Multicenter Study Observational Study
Work of Breathing During Proportional Assist Ventilation as a Predictor of Extubation Failure.
Despite decades of research on predictors of extubation success, use of ventilatory support after extubation is common and 10-20% of patients require re-intubation. Proportional assist ventilation (PAV) mode automatically calculates estimated total work of breathing (total WOB). Here, we assessed the performance of total WOB to predict extubation failure in invasively ventilated subjects. ⋯ The discriminative performance of a PAV-derived total WOB value to predict extubation failure was good, indicating total WOB may represent an adjunctive tool for assessing extubation readiness. However, these results should be interpreted as preliminary, with specific thresholds of PAV-derived total WOB requiring further investigation in a large multi-center study.