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]
Entire Body System
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Antipsychotic Agent
A second-generation antipsychotic agent was successfully used to facilitate weaning in a very anxious patient, possibly secondary to anxiolysis or direct effect on respiratory drive. [ncbi.nlm.nih.gov]
Respiratoric
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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]
Difficulty 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]
Eyes
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Diplopia
She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. [ncbi.nlm.nih.gov]
Neurologic
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Unstable Gait
We report a 34-year-old male with Gorham syndrome presenting as progressive kyphosis, severe back pain, unstable gait, and exertional dyspnea. Pulmonary function testing revealed severe restrictive ventilatory impairment. [ncbi.nlm.nih.gov]
Workup
X-Ray
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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
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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]
Microbiology
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Streptococcus Pneumoniae
Microorganisms implicated in VAP that occurs in the first 48 hours after intubation are flora of the upper airway, including Haemophilus influenza and Streptococcus pneumonia. [emedicine.com]
Treatment
Patient training, follow-up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment-improved health-related quality of life. 2017 The Authors. [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]