Articles: mechanical-ventilation.
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Extubation readiness testing (ERT) is often performed in children with congenital heart disease prior to liberation from mechanical ventilation. The ideal ERT method in this population is unknown. We recently changed our ERT method from variable (10, 8, or 6 cm H2O, depending on endotracheal tube size) to fixed (5 cm H2O) pressure support (PS). Our study assessed the association between this change and time to first extubation and need for re-intubation. ⋯ The use of a fixed PS of 5 cm H2O instead of variable PS during ERT was not associated with longer time to first extubation or extubation failure.
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Observational Study
Ventilatory ratio, dead space, and venous admixture in acute respiratory distress syndrome.
Ventilatory ratio (VR) has been proposed as an alternative approach to estimate physiological dead space. However, the absolute value of VR, at constant dead space, might be affected by venous admixture and CO2 volume expired per minute (VCO2). ⋯ VR is a useful aggregate variable associated with outcome, but variables not associated with ventilation (VCO2 and venous admixture) strongly contribute to the high values of VR seen in patients with severe illness.
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Pediatr Crit Care Me · Mar 2023
Observational StudyInter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study.
To determine the inter-rater reliability (IRR) of the Cornell Assessment for Pediatric Delirium (CAP-D) in infants admitted to a cardiac ICU (CVICU) and to explore the impact of younger age and mechanical ventilation on IRR. ⋯ In the youngest, most vulnerable infants admitted to the CVICU, further evaluation of the CAP-D tool is needed.
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Am. J. Respir. Crit. Care Med. · Mar 2023
Reverse Triggering During Controlled Ventilation: From Physiology to Clinical Management.
Reverse triggering dyssynchrony is a frequent phenomenon recently recognized in sedated critically ill patients under controlled ventilation. It occurs in at least 30-55% of these patients and often occurs in the transition from fully passive to assisted mechanical ventilation. During reverse triggering, patient inspiratory efforts start after the passive insufflation by mechanical breaths. ⋯ On the basis of physiological data, reverse triggering might be beneficial or injurious for the diaphragm and the lung, depending on the magnitude of the inspiratory effort. Reverse triggering can cause breath-stacking and loss of protective lung ventilation when triggering a second cycle. Little is known about how to manage patients with reverse triggering; however, available evidence can guide management on the basis of physiological principles.
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To evaluate whether intraoperative ventilation using lower driving pressure decreases the risk of nonhome discharge. ⋯ Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure. Future randomized controlled trials should target driving pressure as a potential intervention to decrease nonhome discharge.