scholarly journals Sedation and weaning from mechanical ventilation: time for ‘best practice’ to catch up with new realities?

2014 ◽  
Vol 9 ◽  
Author(s):  
Giorgio Conti ◽  
Jean Mantz ◽  
Dan Longrois ◽  
Peter Tonner
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Best Practice ◽  
Prolonged Mechanical Ventilation ◽  
Adult Patients ◽  
Critical Care Medicine ◽  
Weaning From Mechanical Ventilation ◽  
Catch Up ◽  
Mechanical Ventilation Time ◽  
Robust Evidence

Delivery of sedation in anticipation of weaning of adult patients from prolonged mechanical ventilation is an arena of critical care medicine where opinion-based practice is currently hard to avoid because robust evidence is lacking. We offer some views on this subject, hoping to stimulate debate among colleagues.

scholarly journals Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoqiang Yin ◽  
Mei Xin ◽  
Sheng Ding ◽  
Feng Gao ◽  
Fan Wu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arterial ◽  
Mechanical Ventilation Time

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

scholarly journals Multicountry survey of emergency and critical care medicine physicians’ fluid resuscitation practices for adult patients with early septic shock

BMJ Open ◽  
2016 ◽  
Vol 6 (7) ◽  
pp. e010041 ◽  
Author(s):  
Lauralyn McIntyre ◽  
Brian H Rowe ◽  
Timothy S Walsh ◽  
Alasdair Gray ◽  
Yaseen Arabi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Fluid Resuscitation ◽  
Adult Patients ◽  
Critical Care Medicine

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

Critical Care Medicine

2012 ◽  
Author(s):  
Otis B. Rickman
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Distress Syndrome ◽  
Life Support ◽  
Venous Access ◽  
Critical Care Medicine ◽  
Organ Support ◽  
Disease States ◽  
Cardiopulmonary Monitoring

Critical care medicine is a multidisciplinary branch of medicine encompassing the provision of organ support to patients who are severely ill. All areas of medicine may have relevance for critically ill patients; however, this review focuses only on aspects of cardiopulmonary monitoring, life support, technologic interventions, and disease states typically managed in the intensive care unit (ICU). Airway management, venous access, respiratory failure, mechanical ventilation, acute respiratory distress syndrome, shock, and sepsis are reviewed.

scholarly journals Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature

2019 ◽  
Vol 11 (4) ◽  
pp. 389-401 ◽  
Author(s):  
Jonathan M. Keller ◽  
Dru Claar ◽  
Juliana Carvalho Ferreira ◽  
David C. Chu ◽  
Tanzib Hossain ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Medical Education ◽  
Critical Care ◽  
Best Practices ◽  
Graduate Medical Education ◽  
Assessment Tools ◽  
Critical Care Medicine ◽  
Subspecialty Training ◽  
Review Of The Literature ◽  
Graduate Medical

ABSTRACT Background Management of mechanical ventilation (MV) is an important and complex aspect of caring for critically ill patients. Management strategies and technical operation of the ventilator are key skills for physicians in training, as lack of expertise can lead to substantial patient harm. Objective We performed a narrative review of the literature describing MV education in graduate medical education (GME) and identified best practices for training and assessment methods. Methods We searched MEDLINE, PubMed, and Google Scholar for English-language, peer-reviewed articles describing MV education and assessment. We included articles from 2000 through July 2018 pertaining to MV education or training in GME. Results Fifteen articles met inclusion criteria. Studies related to MV training in anesthesiology, emergency medicine, general surgery, and internal medicine residency programs, as well as subspecialty training in critical care medicine, pediatric critical care medicine, and pulmonary and critical care medicine. Nearly half of trainees assessed were dissatisfied with their MV education. Six studies evaluated educational interventions, all employing simulation as an educational strategy, although there was considerable heterogeneity in content. Most outcomes were assessed with multiple-choice knowledge testing; only 2 studies evaluated the care of actual patients after an educational intervention. Conclusions There is a paucity of information describing MV education in GME. The available literature demonstrates that trainees are generally dissatisfied with MV training. Best practices include establishing MV-specific learning objectives and incorporating simulation. Next research steps include developing competency standards and validity evidence for assessment tools that can be utilized across MV educational curricula.

Acute care physiotherapy management of COVID-19 patients in Qatar: best practice recommendations

2020 ◽  
Vol 27 (11) ◽  
pp. 1-15
Author(s):  
MS Ajimsha ◽  
Neeraj Gampawar ◽  
Praveen J Surendran ◽  
Prasobh Jacob ◽  
Reshma Praveen ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Care ◽  
Clinical Reasoning ◽  
Best Practice ◽  
Critical Evaluation ◽  
Adult Patients ◽  
Consensus Process ◽  
Practice Recommendations ◽  
Reasoning Algorithm

This document outlines best practice recommendations for acute care physiotherapy for patients with COVID-19, with an emphasis on critical care rehabilitation, including patients on extracorporeal membrane oxygenation support. These recommendations were developed for practice in Qatar but are adaptable to any setting. This recommendation is the result of a combination of systematic evidence searches, subsequent critical evaluation of the retrieved evidence and a consensus process. The agreed recommendations were integrated into a physiotherapeutic clinical reasoning algorithm. It includes recommendations on physiotherapy referrals, screening, management categories and best practice recommendations. It is intended for use by physiotherapists and other relevant stakeholders, in acute care settings, for adult patients with suspected or confirmed COVID-19.

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