Articles: respiratory-distress-syndrome.
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Observational Study
Removal of a catheter mount and heat-and-moisture exchanger improves hypercapnia in patients with acute respiratory distress syndrome: A retrospective observational study.
To avoid ventilator-associated lung injury in acute respiratory distress syndrome (ARDS) treatment, respiratory management should be performed at a low tidal volume of 6 to 8 mL/kg and plateau pressure of ≤30 cmH2O. However, such lung-protective ventilation often results in hypercapnia, which is a risk factor for poor outcomes. The purpose of this study was to retrospectively evaluate the effectiveness and safety of the removal of a catheter mount (CM) and using heated humidifiers (HH) instead of a heat-and-moisture exchanger (HME) for reducing the mechanical dead space created by the CM and HME, which may improve hypercapnia in patients with ARDS. ⋯ The removal of CM and HME reduced PaCO2 values without changing the ventilator settings in deeply sedated patients with mild-to-moderate ARDS on lung-protective ventilation. Caution should be exercised, as the removal of a CM may result in circuit disconnection or accidental extubation. Nevertheless, this intervention may improve hypercapnia and promote lung-protective ventilation.
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Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival. The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit. The study with 10/15/2020, 697 approval date, and number retrospectively registered. ⋯ In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher. Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.
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Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. ⋯ Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
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Int. J. Clin. Pract. · Sep 2021
Meta AnalysisExtracorporeal membrane oxygenation versus mechanical ventilation alone in adults with severe acute respiratory distress syndrome: a systematic review and meta-analysis.
COVID-19 can lead to acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is considered to be a salvage strategy for severe ARDS. However, the effect of ECMO therapy on severe ARDS remains inconclusive. We aimed to evaluate the effects of ECMO for adults with severe ARDS. ⋯ This study showed that the ECMO group exhibited a significantly lower mortality rate compared with the MV alone group at 90, 30 and 60 days for severe ARDS patients.