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critical ill,mechanical ventilation,monitor

Zhuo Wang, Wei Ding, Qi Fang, Lulu Zhang, Xueyun Liu, Zaixiang Tang
BACKGROUND: Monitoring gastric residual volume has been a common practice in intensive care patients receiving enteral feeding worldwide. Recent studies though, have challenged the reliability and necessity of this routine monitoring process. Several studies even reported improvements in the delivery of enteral feeding without monitoring gastric residual volume, while incurring no additional adverse events. However, the benefit of monitoring gastric residual volume remains controversial in intensive care patients...
January 3, 2019: International Journal of Nursing Studies
Eu Gene Park, Jiwon Lee, Jeehun Lee
OBJECTIVES: Super-refractory status epilepticus (SRSE) is one of the most challenging issues in intensive care units (ICUs) in that it is associated with high morbidity and mortality. Although the ketogenic diet (KD) has been reported to be effective in treating of SRSE, the use of the diet as therapy can be complicated by concomitant medical problems specific to critically ill patients. In this study, we aimed to describe our experience of the KD for SRSE patients in ICUs. METHODS: We retrospectively reviewed the medical records of 16 patients (10 males, 6 females) with SRSE who were treated with the KD in the ICUs at Samsung Medical Center from July 2005 to July 2017...
January 9, 2019: Brain & Development
Romain Barthélémy, Arthur Neuschwander, Fatou Dramé, Maximilien Redouté, David Ditchi, Jules Stern, Alexandre Mebazaa, Romain Pirracchio, Benjamin G Chousterman
BACKGROUND: The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE: Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN: Prospective, observational study...
February 2019: European Journal of Anaesthesiology
Katerina Vaporidi, Charalambos Psarologakis, Athanasia Proklou, Emmanouil Pediaditis, Evangelia Akoumianaki, Elisavet Koutsiana, Achilleas Chytas, Ioanna Chouvarda, Eumorfia Kondili, Dimitris Georgopoulos
BACKGROUND: During passive mechanical ventilation, the driving pressure of the respiratory system is an important mediator of ventilator-induced lung injury. Monitoring of driving pressure during assisted ventilation, similar to controlled ventilation, could be a tool to identify patients at risk of ventilator-induced lung injury. The aim of this study was to describe driving pressure over time and to identify whether and when high driving pressure occurs in critically ill patients during assisted ventilation...
January 3, 2019: Annals of Intensive Care
Martha A Q Curley, Rainer G Gedeit, Brenda L Dodson, June K Amling, Deborah J Soetenga, Christiane O Corriveau, Lisa A Asaro, David Wypij
BACKGROUND: Few papers discuss the pragmatics of conducting large, cluster randomized clinical trials. Here we describe the sequential steps taken to develop methods to implement the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial that tested the effect of a nurse-implemented, goal-directed, comfort algorithm on clinical outcomes in pediatric patients with acute respiratory failure. METHODS: After development in a single institution, the RESTORE intervention was pilot-tested in two pediatric intensive care units (PICUs) to evaluate safety and feasibility...
December 17, 2018: Trials
Romain Barthélémy, Arthur Neuschwander, Fatou Dramé, Maximilien Redouté, David Ditchi, Jules Stern, Alexandre Mebazaa, Romain Pirracchio, Benjamin G Chousterman
BACKGROUND: The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE: Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN: Prospective, observational study...
December 11, 2018: European Journal of Anaesthesiology
Yaroslav Marchuk, Rudys Magrans, Bernat Sales, Jaume Montanya, Josefina López-Aguilar, Candelaria de Haro, Gemma Gomà, Carles Subirà, Rafael Fernández, Robert M Kacmarek, Lluis Blanch
In mechanical ventilation, it is paramount to ensure the patient's ventilatory demand is met while minimizing asynchronies. We aimed to develop a model to predict the likelihood of asynchronies occurring. We analyzed 10,409,357 breaths from 51 critically ill patients who underwent mechanical ventilation >24 h. Patients were continuously monitored and common asynchronies were identified and regularly indexed. Based on discrete time-series data representing the total count of asynchronies, we defined four states or levels of risk of asynchronies, z1 (very-low-risk) - z4 (very-high-risk)...
December 4, 2018: Scientific Reports
Elias Baedorf Kassis, Stephen H Loring, Daniel Talmor
Ventilator management of patients with acute respiratory distress syndrome (ARDS) has been characterized by implementation of basic physiology principles by minimizing harmful distending pressures and preventing lung derecruitment. Such strategies have led to significant improvements in outcomes. Positive end expiratory pressure (PEEP) is an important part of a lung protective strategy but there is no standardized method to set PEEP level. With widely varying types of lung injury, body habitus and pulmonary mechanics, the use of esophageal manometry has become important for personalization and optimization of mechanical ventilation in patients with ARDS...
October 2018: Annals of Translational Medicine
Michele Umbrello, Davide Chiumello
Mechanical ventilation is a life-saving procedure, which takes over the function of the respiratory muscles while buying time for healing to take place. However, it can also promote or worsen lung injury, so that careful monitoring of respiratory mechanics is suggested to titrate the level of support and avoid injurious pressures and volumes to develop. Standard monitoring includes flow, volume and airway pressure (Paw). However, Paw represents the pressure acting on the respiratory system as a whole, and does not allow to differentiate the part of pressure that is spent di distend the chest wall...
October 2018: Annals of Translational Medicine
Francesco Mojoli, Francesca Torriglia, Anita Orlando, Isabella Bianchi, Eric Arisi, Marco Pozzi
Transpulmonary pressure, that is the difference between airway pressure (Paw) and pleural pressure, is considered one of the most important parameters to know in order to set a safe mechanical ventilation in acute respiratory distress syndrome (ARDS) patients but also in critically ill obese patients, in abdominal pathologies or in pathologies affecting the chest wall itself. Transpulmonary pressure should rely on the assessment of intrathoracic pleural pressure. Esophageal pressure (Pes) is considered the best surrogate of pleural pressure in critically ill patients, but concerns about its reliability exist...
October 2018: Annals of Translational Medicine
Pedro Leme Silva, Patricia R M Rocco
Mechanical ventilation is a life-support system used to maintain adequate lung function in patients who are critically ill or undergoing general anesthesia. The benefits and harms of mechanical ventilation depend not only on the operator's setting of the machine (input), but also on their interpretation of ventilator-derived parameters (outputs), which should guide ventilator strategies. Once the inputs-tidal volume (VT ), positive end-expiratory pressure (PEEP), respiratory rate (RR), and inspiratory airflow (V')-have been adjusted, the following outputs should be measured: intrinsic PEEP, peak (Ppeak) and plateau (Pplat) pressures, driving pressure (ΔP), transpulmonary pressure (PL ), mechanical energy, mechanical power, and intensity...
October 2018: Annals of Translational Medicine
Lars Eichler, Jakob Mueller, Jörn Grensemann, Inez Frerichs, Christian Zöllner, Stefan Kluge
BACKGROUND: Percutaneous dilatational tracheotomy (PDT) may lead to transient impairment of pulmonary function due to suboptimal ventilation, loss of positive end-expiratory pressure (PEEP) and repetitive suction maneuvers during the procedure. Possible changes in regional lung aeration were investigated using electrical impedance tomography (EIT), an increasingly implied instrument for bedside monitoring of pulmonary aeration. METHODS: With local ethics committee approval, after obtaining written informed consent 29 patients scheduled for elective PDT under bronchoscopic control were studied during mechanical ventilation in supine position...
November 15, 2018: Annals of Intensive Care
Sabrina Eggmann, Martin L Verra, Gere Luder, Jukka Takala, Stephan M Jakob
INTRODUCTION: Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk. METHODS: This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation...
2018: PloS One
Francesco Mojoli, Bélaid Bouhemad, Silvia Mongodi, Daniel Lichtenstein
Point-of-care ultrasound is increasingly used at the bedside to integrate the clinical assessment of the critically ill; in particular, lung ultrasound greatly developed in the last decade. This review describes basic lung ultrasound signs and focuses on their applications in critical care. Lung semiotic is made both of artifacts (derived by air/tissue interface) and real images (i.e. effusions and consolidations), both providing significant information to identify the main acute respiratory disorders. Lung ultrasound signs, either alone or combined to other point-of-care ultrasound techniques, are helpful in the diagnostic approach to patients with acute respiratory failure, circulatory shock or cardiac arrest...
October 29, 2018: American Journal of Respiratory and Critical Care Medicine
M Consuelo Bachmann, Caio Morais, Guillermo Bugedo, Alejandro Bruhn, Arturo Morales, João B Borges, Eduardo Costa, Jaime Retamal
Acute respiratory distress syndrome (ARDS) is a clinical entity that acutely affects the lung parenchyma, and is characterized by diffuse alveolar damage and increased pulmonary vascular permeability. Currently, computed tomography (CT) is commonly used for classifying and prognosticating ARDS. However, performing this examination in critically ill patients is complex, due to the need to transfer these patients to the CT room. Fortunately, new technologies have been developed that allow the monitoring of patients at the bedside...
October 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
Richard J Nies, Carsten Müller, Roman Pfister, Philipp S Binder, Nicole Nosseir, Felix S Nettersheim, Kathrin Kuhr, Martin H J Wiesen, Matthias Kochanek, Guido Michels
Background: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures...
2018: Journal of Intensive Care
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Anoopindar K Bhalla, Robinder G Khemani, Justin C Hotz, Rica P Morzov, Christopher Jl Newth
BACKGROUND: Widespread use of transcutaneous P CO2 ( P tcCO2 ) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of P tcCO2 with that of P aCO2 measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy. METHODS: We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring...
September 25, 2018: Respiratory Care
Sandra N Stapel, Peter J M Weijs, Armand R J Girbes, Heleen M Oudemans-van Straaten
BACKGROUND & AIMS: Indirect calorimetry is recommended to measure energy expenditure (EE) in critically ill, mechanically ventilated patients. The most validated system, the Deltatrac® (Datex-Ohmeda, Helsinki, Finland) is no longer in production. We tested the agreement of a new breath-by-breath metabolic monitor E-sCOVX® (GE healthcare, Helsinki, Finland), with the Deltatrac. We also compared the performance of the E-sCOVX to commonly used predictive equations. METHODS: We included mechanically ventilated patients eligible to undergo indirect calorimetry...
September 6, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Nadja C Carvalho, Leonardo L Portes, Alessandro Beda, Lucinara M S Tallarico, Luis A Aguirre
Inappropriate patient-ventilator interactions' (PVI) quality is associated with adverse clinical consequences, such as patient anxiety/fear and increased need of sedative and paralytic agents. Thus, technological devices/tools to support the recognition and monitoring of different PVI quality are of great interest. In the present study, we investigate two tools based on a recent landmark study which applied recurrence plots (RPs) and recurrence quantification analysis (RQA) techniques in non-invasive mechanical ventilation...
August 2018: Chaos
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