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1.
Clin Plast Surg ; 51(2): 221-232, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38429045

RESUMO

Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.


Assuntos
Queimaduras , Insuficiência Respiratória , Humanos , Ventiladores Mecânicos , Consenso , Cuidados Críticos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
2.
PLoS One ; 19(3): e0299653, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38478485

RESUMO

Mechanical ventilation techniques are vital for preserving individuals with a serious condition lives in the prolonged hospitalization unit. Nevertheless, an imbalance amid the hospitalized people demands and the respiratory structure could cause to inconsistencies in the patient's inhalation. To tackle this problem, this study presents an Iterative Learning PID Controller (ILC-PID), a unique current cycle feedback type controller that helps in gaining the correct pressure and volume. The paper also offers a clear and complete examination of the primarily efficient neural approach for generating optimal inhalation strategies. Moreover, machine learning-based classifiers are used to evaluate the precision and performance of the ILC-PID controller. These classifiers able to forecast and choose the perfect type for various inhalation modes, eliminating the likelihood that patients will require mechanical ventilation. In pressure control, the suggested accurate neural categorization exhibited an average accuracy rate of 88.2% in continuous positive airway pressure (CPAP) mode and 91.7% in proportional assist ventilation (PAV) mode while comparing with the other classifiers like ensemble classifier has reduced accuracy rate of 69.5% in CPAP mode and also 71.7% in PAV mode. An average accuracy of 78.9% rate in other classifiers compared to neutral network in CPAP. The neural model had an typical range of 81.6% in CPAP mode and 84.59% in PAV mode for 20 cm H2O of volume created by the neural network classifier in the volume investigation. Compared to the other classifiers, an average of 72.17% was in CPAP mode, and 77.83% was in PAV mode in volume control. Different approaches, such as decision trees, optimizable Bayes trees, naive Bayes trees, nearest neighbour trees, and an ensemble of trees, were also evaluated regarding the accuracy by confusion matrix concept, training duration, specificity, sensitivity, and F1 score.


Assuntos
Respiração Artificial , Ventiladores Mecânicos , Humanos , Teorema de Bayes , Respiração Artificial/métodos , Pressão Positiva Contínua nas Vias Aéreas , Algoritmos , Aprendizado de Máquina
3.
Sensors (Basel) ; 24(5)2024 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-38475015

RESUMO

Respiratory diseases are among the leading causes of death globally, with the COVID-19 pandemic serving as a prominent example. Issues such as infections affect a large population and, depending on the mode of transmission, can rapidly spread worldwide, impacting thousands of individuals. These diseases manifest in mild and severe forms, with severely affected patients requiring ventilatory support. The air-oxygen blender is a critical component of mechanical ventilators, responsible for mixing air and oxygen in precise proportions to ensure a constant supply. The most commonly used version of this equipment is the analog model, which faces several challenges. These include a lack of precision in adjustments and the inspiratory fraction of oxygen, as well as gas wastage from cylinders as pressure decreases. The research proposes a blender model utilizing only dynamic pressure sensors to calculate oxygen saturation, based on Bernoulli's equation. The model underwent validation through simulation, revealing a linear relationship between pressures and oxygen saturation up to a mixture outlet pressure of 500 cmH2O. Beyond this value, the relationship begins to exhibit non-linearities. However, these non-linearities can be mitigated through a calibration algorithm that adjusts the mathematical model. This research represents a relevant advancement in the field, addressing the scarcity of work focused on this essential equipment crucial for saving lives.


Assuntos
Oxigênio , Pandemias , Humanos , Ventiladores Mecânicos , Pressão , Calibragem
4.
Biomed Eng Online ; 23(1): 30, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454458

RESUMO

BACKGROUND: Critically ill patients undergoing liberation often encounter various physiological and clinical complexities and challenges. However, whether the combination of hyperbaric oxygen and in-cabin ventilator therapy could offer a comprehensive approach that may simultaneously address respiratory and potentially improve outcomes in this challenging patient population remain unclear. METHODS: This retrospective study involved 148 patients experiencing difficulty in liberation after tracheotomy. Inclusion criteria comprised ongoing mechanical ventilation need, lung inflammation on computed tomography (CT) scans, and Glasgow Coma Scale (GCS) scores of ≤ 9. Exclusion criteria excluded patients with active bleeding, untreated pneumothorax, cerebrospinal fluid leakage, and a heart rate below 50 beats per minute. Following exclusions, 111 cases were treated with hyperbaric oxygen combined cabin ventilator, of which 72 cases were successfully liberated (SL group) and 28 cases (NSL group) were not successfully liberated. The hyperbaric oxygen chamber group received pressurization to 0.20 MPa (2.0 ATA) for 20 min, followed by 60 min of ventilator oxygen inhalation. Successful liberation was determined by a strict process, including subjective and objective criteria, with a prolonged spontaneous breathing trial. GCS assessments were conducted to evaluate consciousness levels, with scores categorized as normal, mildly impaired, moderately impaired, or severely impaired. RESULTS: Patients who underwent treatment exhibited improved GCS, blood gas indicators, and cardiac function indexes. The improvement of GCS, partial pressure of oxygen (PaO2), oxygen saturation of blood (SaO2), oxygenation index (OI) in the SL group was significantly higher than that of the NSL group. However, there was no significant difference in the improvement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and stroke volume (SV) between the SL group and the NSL group after treatment. CONCLUSIONS: Hyperbaric oxygen combined with in-cabin ventilator therapy effectively enhances respiratory function, cardiopulmonary function, and various indicators of critically ill patients with liberation difficulty after tracheostomy.


Assuntos
Oxigenoterapia Hiperbárica , Traqueostomia , Humanos , Estudos Retrospectivos , Oxigenoterapia Hiperbárica/métodos , Volume Sistólico , Função Ventricular Esquerda , Estado Terminal/terapia , Oxigênio , Ventiladores Mecânicos
5.
Crit Care ; 28(1): 75, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38486268

RESUMO

BACKGROUND: Flow starvation is a type of patient-ventilator asynchrony that occurs when gas delivery does not fully meet the patients' ventilatory demand due to an insufficient airflow and/or a high inspiratory effort, and it is usually identified by visual inspection of airway pressure waveform. Clinical diagnosis is cumbersome and prone to underdiagnosis, being an opportunity for artificial intelligence. Our objective is to develop a supervised artificial intelligence algorithm for identifying airway pressure deformation during square-flow assisted ventilation and patient-triggered breaths. METHODS: Multicenter, observational study. Adult critically ill patients under mechanical ventilation > 24 h on square-flow assisted ventilation were included. As the reference, 5 intensive care experts classified airway pressure deformation severity. Convolutional neural network and recurrent neural network models were trained and evaluated using accuracy, precision, recall and F1 score. In a subgroup of patients with esophageal pressure measurement (ΔPes), we analyzed the association between the intensity of the inspiratory effort and the airway pressure deformation. RESULTS: 6428 breaths from 28 patients were analyzed, 42% were classified as having normal-mild, 23% moderate, and 34% severe airway pressure deformation. The accuracy of recurrent neural network algorithm and convolutional neural network were 87.9% [87.6-88.3], and 86.8% [86.6-87.4], respectively. Double triggering appeared in 8.8% of breaths, always in the presence of severe airway pressure deformation. The subgroup analysis demonstrated that 74.4% of breaths classified as severe airway pressure deformation had a ΔPes > 10 cmH2O and 37.2% a ΔPes > 15 cmH2O. CONCLUSIONS: Recurrent neural network model appears excellent to identify airway pressure deformation due to flow starvation. It could be used as a real-time, 24-h bedside monitoring tool to minimize unrecognized periods of inappropriate patient-ventilator interaction.


Assuntos
Aprendizado Profundo , Respiração Artificial , Adulto , Humanos , Respiração Artificial/métodos , Inteligência Artificial , Pulmão , Ventiladores Mecânicos
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 36(1): 86-89, 2024 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-38404279

RESUMO

OBJECTIVE: To explore a simple method for measuring the dynamic intrinsic positive end-expiratory pressure (PEEPi) during invasive mechanical ventilation. METHODS: A 60-year-old male patient was admitted to the critical care medicine department of Dongying People's Hospital in September 2020. He underwent invasive mechanical ventilation treatment for respiratory failure due to head and chest trauma, and incomplete expiratory flow occurred during the treatment. The expiratory flow-time curve of this patient was served as the research object. The expiratory flow-time curve of the patient was observed, the start time of exhalation was taken as T0, the time before the initiation of inspiratory action (inspiratory force) was taken as T1, and the time when expiratory flow was reduced to zero by inspiratory drive (inspiratory force continued) was taken as T2. Taking T1 as the starting point, the follow-up tracing line was drawn according to the evolution trending of the natural expiratory curve before the T1 point, until the expiratory flow reached to 0, which was called T3 point. According to the time phase, the intrapulmonary pressure at the time just from expiratory to inspiratory (T1 point) was called PEEPi1. When the expiratory flow was reduced to 0 (T2 point), the intrapulmonary pressure with the inhaling power being removed hypothetically was called PEEPi2. And it was equal to positive end-expiratory pressure (PEEP) set in the ventilator at T3 point. The area under the expiratory flow-time curve (expiratory volume) between T0 and T1 was called S1. And it was S2 between T0 and T2, S3 between T0 and T3. After sedation, in the volume controlled ventilation mode, approximately one-third of the tidal volume was selected, and the static compliance of patient's respiratory system called "C" was measured using the inspiratory pause method. PEEPi1 and PEEP2 were calculated according to the formula "C = ΔV/ΔP". Here, ΔV was the change in alveolar volume during a certain period of time, and ΔP represented the change in intrapulmonary pressure during the same time period. This estimation method had obtained a National Invention Patent of China (ZL 2020 1 0391736.1). RESULTS: (1) PEEPi1: according to the formula "C = ΔV/ΔP", the expiratory volume span from T1 to T3 was "S3-S1", and the intrapulmonary pressure decreased span was "PEEPi1-PEEP". So, C = (S3-S1)/(PEEPi1-PEEP), PEEPi1 = PEEP+(S3-S1)/C. (2)PEEPi2: the expiratory volume span from T2 to T3 was "S3-S2", and the intrapulmonary pressure decreased span was "PEEPi2-PEEP". So, C = (S3-S2)/(PEEPi2-PEEP), PEEPi2 = PEEP+(S3-S2)/C. CONCLUSIONS: For patients with incomplete expiratory during invasive mechanical ventilation, the expiratory flow-time curve extension method can theoretically be used to estimate the dynamic PEEPi in real time.


Assuntos
Respiração com Pressão Positiva , Respiração Artificial , Masculino , Humanos , Pessoa de Meia-Idade , Ventiladores Mecânicos , Respiração , Modelos Teóricos
7.
Discov Med ; 36(181): 402-414, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38409845

RESUMO

BACKGROUND: Mechanical ventilation (MV) sustains life in critically ill patients by providing adequate alveolar ventilation. However, prolonged MV could induce inspiratory muscle atrophy known as ventilator-induced diaphragmatic dysfunction (VIDD). Insulin-like growth factor (IGF)-1 has been proven to play crucial roles in regulating skeletal muscle size and function. Meanwhile, the forkhead box protein O1 (FOXO1) has been linked to muscle atrophy. This study aimed to explore the effect of IGF-1 on muscle degradation and remodeling in VIDD and delved into the association of the underlying mechanism involving FOXO1. METHODS: VIDD models were established by treating rats with MV. Adeno-associated virus (AAV) was used for transfection to construct IGF-1 and/or FOXO1 overexpressed rats. There were four groups in this study: normal rats (NC), normal rats with MV treatment (MV), IGF-1-overexpressed rats with MV treatment (MV+IGF-1), and rats overexpressing both IGF-1 and FOXO1 with MV treatment (MV+IGF-1+FOXO1). Protein levels were measured by western blot or enzyme-linked immunosorbent assay (ELISA), and mRNA levels were detected by real-time reverse transcriptase-polymerase chain reaction (RT-qPCR). IGF-1 and FOXO1 expression were validated by detecting mRNA and protein levels. Diaphragmatic muscle contractility and morphometry were tested using stimulating electrodes in conjunction with hematoxylin and eosin (H&E) staining. Interleukin (IL)-6 and carbonylated protein were used for evaluating muscle atrophy and oxidation, respectively. Protein degradation was determined by troponin-I level and tyrosine release. Apoptosis was assessed using the terminal deoxynucleotidyl transferase-mediated uridine 5'-triphosphate (UTP) nick-end labeling (TUNEL) assay, alongside markers like Bax, B-cell lymphoma 2 (BCL-2), and Cleaved Caspase-3. Atrogin-1, muscle RING finger 1 (MURF1), neuronally expressed developmentally downregulated 4 (NEDD4), muscle ubiquitin ligase of SCF complex in atrophy-1 (MUSA1), and ubiquitinated protein was used to determine proteolysis. Additionally, protein synthesis was measured by assessing the rates of mixed muscle protein (MMP) and myosin heavy chain (MHC). RESULTS: MV treatment caused IGF-1 downregulation (p < 0.01) and FOXO1 upregulation (p < 0.01). The IGF-1 upregulation downregulated FOXO1 in the MV+IGF-1 group (p < 0.001) while IGF-1 and FOXO1 were both upregulated in the MV+IGF-1+FOXO1 group (p < 0.001). The treatment of MV decreased muscle contractility and cross-sectional areas of diaphragm muscle fibers (p < 0.01). Additionally, IL-6, troponin-1, tyrosine release, carbonylated protein, TUNEL positive nuclei, Bax, Cleaved Caspase-3, Atrogin-1, MURF1, neuronally expressed developmentally downregulated 4 (NEDD4), MUSA1, and ubiquitinated protein levels increased significantly in MV group (p < 0.001) while levels of BCL-2, fractional synthetic rate of MMP and MHC, and type I and type II MHC protein mRNA expression decreased in MV group (p < 0.001). All of these alterations were reversed in the MV+IGF-1 group (p < 0.01), while the IGF-1-induced reversion was disrupted in the MV+IGF-1+FOXO1 group (p < 0.01). CONCLUSIONS: IGF-1 may protect diaphragmatic muscles from VIDD-induced structural damage and function loss by downregulating FOXO1. This action suppresses muscle breakdown and facilitates muscle remodeling in diaphragmatic muscles affected by VIDD.


Assuntos
Diafragma , Fator de Crescimento Insulin-Like I , Humanos , Ratos , Animais , Diafragma/metabolismo , Diafragma/patologia , Caspase 3/metabolismo , Proteína Forkhead Box O1/genética , Proteína Forkhead Box O1/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Proteína X Associada a bcl-2/metabolismo , Ventiladores Mecânicos/efeitos adversos , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Atrofia Muscular/etiologia , Atrofia Muscular/metabolismo , Atrofia Muscular/patologia , RNA Mensageiro , Tirosina/metabolismo
8.
Zhongguo Yi Liao Qi Xie Za Zhi ; 48(1): 44-50, 2024 Jan 30.
Artigo em Chinês | MEDLINE | ID: mdl-38384216

RESUMO

This study summarizes the application of automatic recognition technologies for patient-ventilator asynchrony (PVA) during mechanical ventilation. In the early stages, the method of setting rules and thresholds relied on manual interpretation of ventilator parameters and waveforms. While these methods were intuitive and easy to operate, they were relatively sensitive in threshold setting and rule selection and could not adapt well to minor changes in patient status. Subsequently, machine learning and deep learning technologies began to emerge and develop. These technologies automatically extract and learn data characteristics through algorithms, making PVA detection more robust and universal. Among them, logistic regression, support vector machines, random forest, hidden Markov models, convolutional autoencoders, long short-term memory networks, one-dimensional convolutional neural networks, etc., have all been successfully used for PVA recognition. Despite the significant advancements in feature extraction through deep learning methods, their demand for labelled data is high, potentially consuming significant medical resources. Therefore, the combination of reinforcement learning and self-supervised learning may be a viable solution. In addition, most algorithm validations are based on a single dataset, so the need for cross-dataset validation in the future will be an important and challenging direction for development.


Assuntos
Respiração Artificial , Humanos , Ventiladores Mecânicos , Algoritmos , Redes Neurais de Computação
9.
Zhongguo Yi Liao Qi Xie Za Zhi ; 48(1): 111-113, 2024 Jan 30.
Artigo em Chinês | MEDLINE | ID: mdl-38384229

RESUMO

Objective: To explore the effect of routine reusable pipeline and disposable pipeline on ventilator quality control results. Methods: 17 ventilators were randomly selected to conduct quality control using routine reusable pipeline and disposable pipeline respectively. Quality control data were recorded and then paired t-test method was used to analyze whether the difference between the two pipelines was significant or not. Results: There were no significant differences in respiratory rate, tidal volume and end airway pressure between the two types of pipes ( P>0.05). The airway peak pressure of routine reusable pipeline was significantly higher than disposable pipeline ( P<0.05), but the difference was very small, only about 0.2 mbar which would not affect the conclusion of quality control. Conclusion: Quality control of ventilator is not affected by routine reusable pipeline and disposable pipeline, which can be replaced by each other.


Assuntos
Equipamentos Descartáveis , Ventiladores Mecânicos , Volume de Ventilação Pulmonar
10.
Medicina (Kaunas) ; 60(2)2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38399567

RESUMO

Background and Objectives: This study aimed to assess the value of a novel prognostic model, based on clinical variables, comorbidities, and demographic characteristics, to predict long-term prognosis in patients who received mechanical ventilation (MV) for over 14 days and who underwent a tracheostomy during the first 14 days of MV. Materials and Methods: Data were obtained from 278 patients (66.2% male; median age: 71 years) who underwent a tracheostomy within the first 14 days of MV from February 2011 to February 2021. Factors predicting 1-year mortality after the initiation of MV were identified by binary logistic regression analysis. The resulting prognostic model, known as the tracheostomy-ProVent score, was computed by assigning points to variables based on their respective ß-coefficients. Results: The overall 1-year mortality rate was 64.7%. Six factors were identified as prognostic indicators: platelet count < 150 × 103/µL, PaO2/FiO2 < 200 mmHg, body mass index (BMI) < 23.0 kg/m2, albumin concentration < 2.8 g/dL on day 14 of MV, chronic cardiovascular diseases, and immunocompromised status at admission. The tracheostomy-ProVent score exhibited acceptable discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.786 (95% confidence interval: 0.733-0.833, p < 0.001) and acceptable calibration (Hosmer-Lemeshow chi-square: 2.753, df: 8, p = 0.949). Based on the maximum Youden index, the cut-off value for predicting mortality was set at ≥2, with a sensitivity of 67.4% and a specificity of 76.3%. Conclusions: The tracheostomy-ProVent score is a good predictive tool for estimating 1-year mortality in tracheostomized patients undergoing MV for >14 days. This comprehensive model integrates clinical variables and comorbidities, enhancing the precision of long-term prognosis in these patients.


Assuntos
Unidades de Terapia Intensiva , Ventiladores Mecânicos , Humanos , Masculino , Idoso , Feminino , Centros de Atenção Terciária , Prognóstico , Universidades , Estudos Retrospectivos
11.
Am J Respir Crit Care Med ; 209(5): 553-562, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38190707

RESUMO

Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (-1.1 ml/kg predicted body weight [IQR, -2.0 to -0.2]; P < 0.001; and -4.3 cm H2O [-8.2 to -1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [-1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4-1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.


Assuntos
Salas Cirúrgicas , Ventiladores Mecânicos , Humanos , Respiração Artificial , Morte , Unidades de Terapia Intensiva
12.
Disaster Med Public Health Prep ; 18: e10, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38287526

RESUMO

OBJECTIVES: Personal protective equipment (PPE) supply chain disruptions force US health-care entities to adopt conservation strategies such as procurement from different respirator manufacturers. This research seeks to better understand how the number of respirator models on hand can serve as an indicator of N95 filtering facepiece respirator (FFR) supply chain stability or disruption. METHODS: Researchers looked at differences in the mean number of N95 FFR models, averaged weekly, from 10 hospitals in a health-care system over 15 wk from June 1 to September 10, 2020. Participating hospitals entered near-daily PPE inventory data by manufacturer and model number. RESULTS: A linear mixed effect model was run in SPSS v. 26 using a random intercept for hospitals, with week as a fixed predictor and mean number of respirator models (averaged weekly) on hand as the dependent variable. Each week showed a small but significant effect compared with the past week (P < 0.001), where the average weekly number of respirator models on hand decreased. CONCLUSIONS: The limited data may indicate a resolution of supply chain disruptions and warrant further investigation. Consequently, the number of respirator models may be applicable as an indicator of supply chain stability and be more easily ascertained and tracked by health-care entities.


Assuntos
Exposição Ocupacional , Dispositivos de Proteção Respiratória , Humanos , Ventiladores Mecânicos , Respiradores N95 , Equipamento de Proteção Individual
13.
J Perinatol ; 44(2): 314-320, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38242961

RESUMO

BACKGROUND: Following the opening of an infant cardiac neonatal intensive care unit, our aim was to determine a baseline UE rate and implement initiatives to target a goal less than 0.5 UEs/100 ventilator days. METHODS: We utilized the Model for Improvement. Key stakeholders included neonatal providers, nurses, and respiratory therapists. We focused on the creation of an airway bundle that addressed securement methods, communication and education. RESULTS: From October 2017 to January 2018, our baseline UE rate was 0.92 UEs/100 ventilator days. Subsequent to the implementation of an airway bundle with high compliance, we observed a significant change in the centerline (0.45 to 0.02 UEs/100 ventilator days) during the spring of 2021, followed by a period of 480 days with no UEs. CONCLUSION: In a unit where UEs were infrequent events, high compliance with an airway bundle led to a significantly sustained decrease in our UE rates.


Assuntos
Extubação , Unidades de Terapia Intensiva Neonatal , Lactente , Recém-Nascido , Humanos , Unidades de Terapia Intensiva , Ventiladores Mecânicos , Comunicação , Intubação Intratraqueal , Respiração Artificial
14.
Pediatr Pulmonol ; 59(3): 609-616, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38206041

RESUMO

INTRODUCTION: For patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion- and HFOV-preferred treatment groups. METHODS: Ventilator settings and blood gases were retrospectively evaluated pre- and post-CMV conversion, and respiratory function tests for compliance of the respiratory system (Crs) and for resistance of the respiratory system (Rrs) were performed during the trial to CMV conversion. RESULTS: No differences were observed between the CMV conversion- and HFOV-preferred groups regarding gestational age, birth weight, and observed/expected lung area-to-head circumference ratios. The median Crs (ml/cmH2 O/kg) and Rrs (cmH2 Oï½¥kg/L/s) in the CMV conversion- and HFOV-preferred groups was 0.42 versus 0.53 (p = .44) and 467 versus 327 (p = .045), respectively. The pre and posttrial amount of change in blood gas levels and ventilator parameters in the CMV conversion- and HFOV-preferred groups were as follows: mean airway pressure, -2.0 versus 0 cmH2 O; partial pressure of carbon dioxide, 6.1 versus 2.9 Torr; alveolar-arterial oxygen difference, -39.5 versus -50 Torr; and oxygenation index, -1.0 versus -0.6; respectively. CONCLUSION: Respiratory function tests were useful in tailoring ventilator settings. Patients with high Rrs values responded better to CMV conversion.


Assuntos
Infecções por Citomegalovirus , Hérnias Diafragmáticas Congênitas , Ventilação de Alta Frequência , Humanos , Hérnias Diafragmáticas Congênitas/terapia , Estudos Retrospectivos , Respiração Artificial , Ventiladores Mecânicos
15.
J Tissue Viability ; 33(1): 144-149, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38184472

RESUMO

AIM: In this study, we aimed to investigate pressure injury (PI) and its associated factors in COVID-19 patients receiving invasive mechanical ventilation (IMV). METHODS: This was designed as a retrospective, descriptive and correlational study. In this study, there was no sample selection, and the data were collected by reviewing the files of 438 patients who had been followed up on IMV in the intensive care unit (ICU) with a diagnosis of COVID-19 between April 30, 2020, and April 30, 2022. The collected data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS) program. RESULTS: A total of 305 pressure injuries occurred in 36.3% of 438 patients receiving IMV. It was found that the length of IMV stay of the patients accelerated the occurrence of PI and that the length of stay in the intensive care unit, albumin and hemoglobin levels, Braden Pressure Sore Risk Assessment Score, APACHE-II value, nutritional status, glutamine supplementation, and vasopressor use were found to be significantly correlated with the incidence of PI (p < 0.05). CONCLUSIONS: Patients with COVID-19 who were followed up on IMV had a high incidence of PI, and prolonged ICU stays and intubations duration as well as low albumin and hemoglobin levels increased the occurrence of PI. Hence, it is recommended that the PI risk levels of COVID-19 patients followed up on IMV should be evaluated frequently and nursing interventions should be implemented according to the evaluations.


Assuntos
COVID-19 , Lesão por Pressão , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Estudos Retrospectivos , Ventiladores Mecânicos , Albuminas , Hemoglobinas
16.
Respir Med ; 223: 107541, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38290603

RESUMO

Ventilator-induced diaphragm dysfunction is gaining increased recognition. Evidence of diaphragm weakness can manifest within 12 h to a few days after the initiation of mechanical ventilation. Various noninvasive and invasive methods have been developed to assess diaphragm function. The implementation of diaphragm-protective ventilation strategies is crucial for preventing diaphragm injuries. Furthermore, diaphragm neurostimulation emerges as a promising and novel treatment option. In this rapid review, our objective is to discuss the current understanding of ventilator-induced diaphragm dysfunction, diagnostic approaches, and updates on strategies for prevention and management.


Assuntos
Diafragma , Respiração Artificial , Humanos , Respiração Artificial/efeitos adversos , Ventiladores Mecânicos , Respiração , Pulmão
17.
J Hosp Infect ; 145: 174-186, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38295905

RESUMO

Many meta-analyses have assessed the efficacy of preventive interventions against ventilator-associated pneumonia (VAP) in critically ill patients. However, there has been no comprehensive analysis of the strength and quality of evidence to date. Systematic reviews of randomized and quasi-randomized controlled trials, which evaluated the effect of preventive strategies on the incidence of VAP in critically ill patients receiving mechanical ventilation for at least 48 h, were included in this article. We identified a total of 34 interventions derived from 31 studies. Among these interventions, 19 resulted in a significantly reduced incidence of VAP. Among numerous strategies, only selective decontamination of the digestive tract (SDD) was supported by highly suggestive (Class II) evidence (risk ratio (RR)=0.439, 95% CI: 0.362-0.532). Based on data from the sensitivity analysis, the evidence for the efficacy of non-invasive ventilation in weaning from mechanical ventilation (NIV) was upgraded from weak (Class IV) to highly suggestive (Class II) (RR=0.32, 95% CI: 0.22-0.46). All preventive interventions were not supported by robust evidence for reducing mortality. Early mobilization exhibited suggestive (Class III) evidence in shortening both intensive length of stay (LOS) in the intensive care unit (ICU) (mean difference (MD)=-0.85, 95% CI: -1.21 to -0.49) and duration of mechanical ventilation (MD=-1.02, 95% CI: -1.41 to -0.63). In conclusion, SDD and NIV are supported by robust evidence for prevention against VAP, while early mobilization has been shown to significantly shorten the LOS in the ICU and the duration of mechanical ventilation. These three strategies are recommendable for inclusion in the ventilator bundle to lower the risk of VAP and improve the prognosis of critically ill patients.


Assuntos
Ventilação não Invasiva , Pneumonia Associada à Ventilação Mecânica , Humanos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Estado Terminal , Respiração Artificial/efeitos adversos , Ventiladores Mecânicos , Unidades de Terapia Intensiva
19.
Sci Rep ; 14(1): 1213, 2024 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-38216652

RESUMO

Disturbingly realistic triage scenarios during the COVID-19 pandemic provide an opportunity for studying discrimination in moral reasoning. Biases and favoritism do not need to be explicit and overt, but can remain implicit and covert. In addition to assessing laypeople's propensity for engaging in overt discrimination, the present study examines whether they reveal implicit biases through seemingly fair random allocations. We present a cross-sectional online study comprising 6 timepoints and a total of 2296 participants. Each individual evaluated 19 hypothetical scenarios that provide an allocation dilemma between two patients who are in need of ventilation and differ only in one focal feature. Participants could either allocate the last ventilator to a patient, or opt for random allocation to express impartiality. Overall, participants exhibited clear biases for the patient who was expected to be favored based on health factors, previous ethical or caretaking behaviors, and in-group favoritism. If one patient had been pre-allocated care, a higher probability of keeping the ventilator for the favored patient indicates persistent favoritism. Surprisingly, the absence of an asymmetry in random allocations indicates the absence of covert discrimination. Our results demonstrate that laypeople's hypothetical triage decisions discriminate overtly and show explicit biases.


Assuntos
COVID-19 , Humanos , Triagem , Pandemias , Estudos Transversais , Ventiladores Mecânicos
20.
J Microbiol Immunol Infect ; 57(2): 328-336, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38220536

RESUMO

BACKGROUND: This study investigates the impact of nontuberculous mycobacterial lung disease (NTM-LD) on mortality and mechanical ventilation use in critically ill patients. METHODS: We enrolled patients with NTM-LD or tuberculosis (TB) in intensive care units (ICU) and analysed their association with 30-day mortality and with mechanical ventilator-free survival (VFS) at 30 days after ICU admission. RESULTS: A total of 5996 ICU-admitted patients were included, of which 541 (9.0 %) had TB and 173 (2.9 %) had NTM-LD. The overall 30-day mortality was 22.2 %. The patients with NTM-LD had an adjusted hazard ratio (aHR) of 1.49 (95 % CI, 1.06-2.05), and TB patients had an aHR of 2.33 (95 % CI, 1.68-3.24), compared to ICU patients with negative sputum mycobacterial culture by multivariable Cox proportional hazard (PH) regression. The aHR of age<65 years, obesity, idiopathic pulmonary fibrosis, end-stage kidney disease, active cancer and autoimmune disease and diagnosis of respiratory failure were also significantly positively associated with ICU 30-day mortality. In multivariable Cox PH regression for VFS at 30 days in patients requiring invasive mechanical ventilation, NTM-LD was negatively associated with VFS (aHR 0.71, 95 % CI: 0.56-0.92, p = 0.009), while TB showed no significant association. The diagnosis of respiratory failure itself predicted unfavourable outcome for 30-day mortality and a negative impact on VFS at 30 days. CONCLUSIONS: NTM-LD and TB were not uncommon in ICU and both were correlated with increasing 30-day mortality in ICU patients. NTM-LD was associated with a poorer outcome in terms of VFS at 30 days.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Pneumonia , Insuficiência Respiratória , Tuberculose , Humanos , Idoso , Estado Terminal , Infecções por Mycobacterium não Tuberculosas/complicações , Pneumonia/complicações , Tuberculose/complicações , Ventiladores Mecânicos , Estudos Retrospectivos , Micobactérias não Tuberculosas
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