Articles: mechanical-ventilation.
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Am. J. Respir. Crit. Care Med. · Jul 2023
Randomized Controlled TrialStructured Mobilization for Critically Ill Patients: A Pragmatic Cluster-Randomized Trial.
Rationale: Small trials and professional recommendations support mobilization interventions to improve recovery among critically ill patients, but their real-world effectiveness is unknown. Objective: To evaluate a low-cost, multifaceted mobilization intervention. Methods: We conducted a stepped-wedge cluster-randomized trial across 12 ICUs with diverse case mixes. ⋯ ICU mortality (31.5% vs. 29.0%), falls (0.7% vs. 0.4%), and unplanned extubations (2.0% vs. 1.8%) were similar between groups (all P > 0.3). Conclusions: A low-cost, multifaceted mobilization intervention did not improve overall mobility but improved patients' odds of standing and was safe. Clinical trial registered with www.clinicaltrials.gov (NCT03863470).
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Randomized Controlled Trial
A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory.
The efficacy of noninvasive ventilation (NIV) during procedures that require sedation and analgesia has not been established. We evaluated whether NIV reduces the incidence of respiratory events. ⋯ ClinicalTrials.gov (NCT02779998); registered 4 November 2015.
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Critical care medicine · Jul 2023
Observational StudyLimiting Dynamic Driving Pressure in Patients Requiring Mechanical Ventilation.
Previous studies reported an association between higher driving pressure (∆P) and increased mortality for different groups of mechanically ventilated patients. However, it remained unclear if sustained intervention on ∆P, in addition to traditional lung-protective ventilation, improves outcomes. We investigated if ventilation strategies limiting daily static or dynamic ∆P reduce mortality compared with usual care in adult patients requiring greater than or equal to 24 hours of mechanical ventilation. ⋯ Limiting either static or dynamic ∆P can further reduce the mortality of patients requiring mechanical ventilation.
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Am. J. Respir. Crit. Care Med. · Jul 2023
Clinical TrialInterventions Relieving Dyspnea in Intubated Patients Show Responsiveness of the Mechanical Ventilation - Respiratory Distress Observation Scale.
Rationale: Breathing difficulties are highly stressful. In critically ill patients, they are associated with an increased risk of posttraumatic manifestations. Dyspnea, the corresponding symptom, cannot be directly assessed in noncommunicative patients. ⋯ MV-RDOS scores were higher in patients with EEG preinspiratory potentials (4.9 [IQR, 4.2-6.3] vs. 4.0 [IQR, 2.1-4.9]; P = 0.002). Conclusions: The MV-RDOS seems able to detect and monitor respiratory symptoms reasonably well in noncommunicative intubated patients. Clinical trial registered with www.clinicaltrials.gov (NCT02801838).
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Acta Anaesthesiol Scand · Jul 2023
PaCO2 trajectories in mechanically ventilated patients with COVID-19: A population-based cohort study.
To identify PaCO2 trajectories and assess their associations with mortality in critically ill patients with coronavirus disease 2019 (COVID-19) during the first and second waves of the pandemic in Denmark. ⋯ Latent class analysis of arterial blood gases in mechanically ventilated COVID-19 patients identified distinct PaCO2 trajectories, which were independently associated with mortality.