Presentation
Anxiety during weaning was present in 0, 9 and 24% patients in the DEX, SOC and SOCDEX groups, respectively. Anxiety after extubation was present in 41, 20 and 34% in the DEX, SOC and SOCDEX groups, respectively. [ncbi.nlm.nih.gov]
Presenter: Herb Saravanamuttoo Herb Saravanamuttoo was born in Scotland and educated at the University of Glasgow. [ingeniumcanada.org]
Respiratoric
- Aspiration
[…] occurred: with the drain tube, open aspiration was eliminated. [ceaccp.oxfordjournals.org]
Owing to the severe bleedings during endotracheal aspirations, it was decided to change her mechanical ventilation to NIMV. [ncbi.nlm.nih.gov]
Efforts should be made to minimize the risk of aspiration. [clinicaladvisor.com]
- Stridor
An 86-year-old man developed stridor and acute respiratory failure after being treated for a chronic obstructive pulmonary disease exacerbation and a urinary tract infection that required mechanical ventilation. [ncbi.nlm.nih.gov]
Extubation Obese patients are particularly at risk of post‐extubation stridor [ 29 ]. [ccforum.biomedcentral.com]
[…] weaning from mechanical ventilation CCC — Weaning from mechanical ventilation (Hot Case) CCC — Non-invasive ventilation for weaning CCC — Extubation assessment in ICU CCC — Extubation assessment (Hot Case) CCC — Cuff Leak Test CCC — Post-extubation stridor [lifeinthefastlane.com]
Additionally, NIPPV may be an effective intermediary therapy for children experiencing post-extubation de-recruitment or stridor/stertor. [academic.oup.com]
- Respiratory Insufficiency
The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery. [ncbi.nlm.nih.gov]
Noninvasive ventilation (NIV) provides ventilatory support to patients who suffer from respiratory insufficiency. Comfortable equipment, proper replacement, follow-up and education are critical to helping patients adapt to and stay on therapy. [resmed.com]
- Hypercapnic Respiratory Failure
BACKGROUND: Long-term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic [ncbi.nlm.nih.gov]
NIV is as efficient in patients with obesity hypoventilation syndrome as in patients with chronic obstructive pulmonary disease (COPD), in case of acute hypercapnic respiratory failure [ 17 ]. [ccforum.biomedcentral.com]
Indications for Mechanical Ventilation Indications for endotracheal (ET) intubation and mechanical ventilation include: respiratory failure; whether hypoxic respiratory failure (type I), or hypercapnic respiratory failure (type II) or both, loss of... [link.springer.com]
The evidence for use of NIV in COPD patients and those with hypoxic respiratory failure with concomitant hypercapnic respiratory failure is substantially stronger than in other groups. [erj.ersjournals.com]
Gastrointestinal
- Regurgitation
In our case, the oscillatory movements due to the aortic regurgitation are transmitted to the airway. [ncbi.nlm.nih.gov]
Should regurgitation occur, the drain tube vents fluid and small solids beyond the pharynx. This reduces the risk of aspiration and its appearance in the drain tube alerts the anaesthetist to the existence of regurgitation. [ceaccp.oxfordjournals.org]
During this sequence, as consciousness is lost, cricoid pressure is applied to reduce the risk of regurgitation and aspiration. [doi.org]
Workup
X-Ray
- Atelectasis
Bronchoscopy is a commonly used technique in patients with atelectasis due to mucus plugs. [ncbi.nlm.nih.gov]
In obese patients, particularly at risk of atelectasis, the same rules can be applied. [ccforum.biomedcentral.com]
The second is to prevent collapse of alveoli during expiration and hence preventing cyclic atelectasis. [clinicaladvisor.com]
Too high a volume risks overinflation; too low a volume allows for atelectasis. [msdmanuals.com]
- Pneumoperitoneum
This can manifest as pneumothorax, pneumoperitoneum, subcutaneous emphysema, pneumomediastinum and can sometimes progress to bronchopleural fistula or tension pneumothorax. [clinicaladvisor.com]
In case of increase in airway resistance (bronchospasm, obstructed tube) or decrease in compliance of the respiratory system (obesity, atelectasis, selective intubation, surgical pneumoperitoneum, pneumothorax …), the tidal volume decreases, leading to [ccforum.biomedcentral.com]
Serum
- Hypercapnia
A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. [ncbi.nlm.nih.gov]
Hypercapnia and hypoxemia may coexist, although some disorders may affect gas exchange differentially. HYPERCAPNIA Hypercapnia usually is caused by hypoventilation or severe ventilation-perfusion mismatch. [pedsinreview.aappublications.org]
Permissive Hypercapnia Permissive Hypercapnia in ARDS This single-minded focus on reducing plateau pressures derives from the likely survival benefit from low tidal volume ventilation and low plateau pressures observed in clinical trials (or if you prefer [pulmccm.org]
Treatment
Asthma is a major cause of morbidity and mortality despite advances in outpatient treatment. Sometimes, children fail to respond to standard treatment and can potentially require mechanical ventilation. [ncbi.nlm.nih.gov]
Prognosis
PMX-DHP may improve the prognosis of severe respiratory failure in patients with AE-IPF. [ncbi.nlm.nih.gov]
Outlook (Prognosis) The outlook will depend on the reason the procedure needed to be done. References Driver BE, Reardon RF. Tracheal intubation. In: Roberts JR, Custalow CB, Thomsen TW, eds. [mountsinai.org]
Etiology
Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. [ncbi.nlm.nih.gov]
To determine the etiology, the lower airway tract needs to be sampled. This can be done by endotracheal aspiration, bronchoalveolar lavage or by using a protected specimen brush (during bronchoscopy). [clinicaladvisor.com]
If there are no physical findings suggesting tension pneumothorax, and if ventilation-related causes of hypotension are a possible etiology, pending a portable chest x-ray, the patient may be disconnected from the ventilator and gently bagged manually [msdmanuals.com]
Epidemiology
Crit Care Med 2010; 38:1947-1953 Mechanical ventilation : epidemiological insights into current practices. E Goligher, N Ferguson. Curr Opin Crit Care 15:44-51 Epidemiological insights into current practices. E Goligher, N Ferguson. [aast.org]
The epidemiologic characteristics and outcomes of severe trauma patients requiring prolonged mechanical ventilation (PMV) remain unclear. This retrospective study aims to investigate the outcomes of PMV in this specific group. [ncbi.nlm.nih.gov]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 1999 ; 28 : 964 -74. ↵ Sauerbrei W, Meier-Hirmer C, Benner A, Royston P. [bmj.com]
Pathophysiology
OBJECTIVES: To provide a critical review of the experimental evidence surrounding the pathophysiology of ventilator-induced lung injury and to help clinicians apply the clinical recommendations to individual patients. [ncbi.nlm.nih.gov]
Prevention
Moreover, it discusses practical approaches for detecting, correcting, and preventing asynchronies. Current evidence suggests that the best approach to managing asynchronies is by adjusting ventilator settings. [ncbi.nlm.nih.gov]