Mechanical Ventilation Archives - PulmCCM
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Mechanical Ventilation Articles

Oct 162014
 
ICU Physiology in 1,000 Words: Stroke Volume Variation and the Concept of Dose-Response

Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [… read more]

Oct 142014
 
Total parenteral nutrition vs enteral nutrition: no difference in critically ill? (CALORIES trial)

Feeding patients enterally (nasogastric or nasojejunal tube feedings) has been the standard of care for critically ill patients, based on weak evidence that it reduces infection rates; hence the adage “feed the gut, if you can.” That last caveat is included because so many critically ill patients have gastric motility impairment (with inability to achieve [… read more]

Sep 012014
 
ICU Physiology in 1000 Words: The Hemodynamics of Prone

ICU Physiology in 1,000 Words  “The Hemodynamics of Prone” by Jon-Emile S. Kenny MD A physiological maelstrom has recently swirled about the hemodynamic effects of the prone position in severe ARDS [1-5]; but how exactly does this maneuver alter the cardiovascular system?  A good approach to this problem is a Guytonian one whereby we consider [… read more]

Jul 302014
 
What are Ventilator-Associated Events (and why should you care)?

Have you heard of ventilator-associated events (VAEs)? Like it or not, this neologism of healthcare-speak is coming to an ICU near you soon. Here’s the lowdown on VAEs and why they matter to the practicing intensivist. What are Ventilator-Associated Events? Ventilator-associated events are an invention of the Centers for Disease Control and Prevention (CDC), created in [… read more]

Jul 112014
 
Prone positioning reduces ARDS mortality by 26%: meta-analysis

Image: Rotoprone Acute respiratory distress syndrome (ARDS) injures the lungs in a heterogeneous pattern, and the damaged areas are particularly vulnerable to further ventilator-induced lung injury. This is why a lung-protective ventilator strategy using low tidal volumes reduces mortality from ARDS, experts believe. Tidal volumes of 6 mL/kg ideal body weight (calculated from height) using conventional [… read more]

May 162014
 
How to provide nutrition for critically ill patients (Review)

Nutritional Support During Critical Illness This PulmCCM topic review will be periodically updated and expanded as new research is published. Originally published 22 September 2013. Most recent update: 16 May 2013. During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism (synthesis of these same macromolecules). Historically, the [… read more]

May 022014
 
Diaphragmatic ultrasound could predict extubation success

Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate to tidal volume have all been used with varying reported sensitivity [… read more]

Apr 182014
 
Steroids did not improve outcomes in severe COPD exacerbations (RCT)

Image: 1800petmeds Systemic steroids in COPD exacerbations requiring ventilator support: Are we treating our patients, or ourselves? By Muhammad Adrish, MD Acute exacerbations of COPD are a major cause of hospitalizations, and are associated with more rapid decline in lung function and reduced survival. Because COPD exacerbations are associated with increased inflammatory responses, corticosteroids have [… read more]

Apr 032014
 
PulmCCM Roundup, Issue #2

PulmCCM Roundup #2 Welcome back to the PulmCCM Roundup, formerly the Critical Care Roundup. Let’s jump right in to issue #2. Browse all the PulmCCM Roundups here. Etomidate for intubation in sepsis: what’s the risk, really?  Etomidate has been suspected of causing adrenal insufficiency and potentially death in patients with severe sepsis, when used as an anesthesia-induction agent [… read more]

Feb 222014
 
Epitaph for nitric oxide for ARDS

Image: Dartmouth Nitric Oxide: No Benefit Even in Severe ARDS Giving inhaled nitric oxide to people with acute respiratory distress syndrome (ARDS) improves oxygenation, but has never been demonstrated to improve survival. Not many physicians seem to use nitric oxide for ARDS anymore, except possibly as salvage therapy in life-threatening refractory disease. Even that well-meaning [… read more]

Feb 092014
 
Sedation and Analgesia in the Critically Ill (Review)

Pain, agitation, and delirium are all extremely common in ICU patients–so much so that they’ve been termed the “ICU triad.” No one knows exactly how common each is, because ICU patients are often too delirious to complain of pain; or their agitation hides their delirium; or their unidentified pain may cause their agitation; or …. [… read more]

Jan 122014
 
Cognitive impairment after critical illness as bad as Alzheimer's

People who survive critical illness often experience long-term cognitive impairment, even among those with normal or near-normal pre-hospital brain function. Cognitive impairment after critical illness is poorly understood; relatively few prospective clinical trials in critical care have followed patients after hospital discharge, and measuring cognitive impairment and determining its onset is difficult. Cognitive impairment reduces [… read more]

Dec 082013
 
Ventilator-Induced Lung Injury Review (Part 2 of 2)

Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [… read more]

Dec 072013
 
Ventilator-Induced Lung Injury Review (Part 1 of 2)

Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, especially when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation can damage fragile alveoli already made vulnerable [… read more]

Nov 082013
 
Statins don't help in ventilator-associated pneumonia treatment

Statins have anti-inflammatory and immune-modulating effects, and among critically ill patients, continuing or starting statins have improved soft outcomes in observational and small randomized studies. For example, starting a statin reduced progression of sepsis in ward patients and statins improved organ failure scores in acute lung injury (the HARP trial). But in their first shot at [… read more]

Oct 242013
 
Dysphagia and swallowing disorders in the ICU (Review)

ICU-related Dysphagia and Swallowing Disorders More than 700,000 people develop respiratory failure requiring mechanical ventilation each year in the U.S. alone, and those that survive are at elevated risk for developing swallowing dysfunction. The aspiration syndromes that follow can be devastating, especially if not recognized and addressed early. Denver’s Madison Macht et al provide a clinical [… read more]

Oct 192013
 
Overnight intensivists unnecessary in well-staffed ICUs? (Meta-analysis)

24/7 Intensivist Coverage Does Not Improve Outcomes: Meta-Analysis The debate over whether ICUs should be staffed around the clock by intensivist physicians has simmered for more than 20 years, with opinions on both sides driven more by values and personal biases than evidence. Recent studies have confirmed the benefit of daytime intensivists in ICUs but failed [… read more]

Oct 062013
 
Mechanical ventilation in ARDS due to sepsis (Surviving Sepsis Guidelines)

Mechanical Ventilation in ARDS Due to Sepsis See All the Surviving Sepsis Guidelines Sepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in [… read more]

Sep 282013
 
Intubation Checklists -- are theirs better than yours?

Intubation Checklists in the ICU and ED Can They Save Lives? Endotracheal intubation in the ICU or emergency department is often challenging, to understate by a lot. Intubations outside the operating room are often emergent rush jobs on crashing, hypotensive, severely hypoxemic patients, or people with who have just self-extubated. Pulmonologists’ and emergency physicians’ familiarity [… read more]

Aug 112013
 
Low tidal volume ventilation reduces complications from abdominal surgery

Low Tidal Volume Ventilation Improves Outcomes in Elective Surgery Using low tidal volumes (6-8 mL/kg ideal body weight, or about 500 mL in the average man) during mechanical ventilation has been known for more than a decade to be lifesaving for people with acute respiratory distress syndrome (ARDS). Since reducing mortality by a relative 22% [… read more]