22 Mechanical Ventilation and Pulmonary Critical Care

2018 ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care

scholarly journals The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients

2018 ◽  
Vol 8 (6) ◽  
pp. 93
Author(s):  
Ghada Shalaby Khalaf Mahran ◽  
Sayed K. Abd-Elshafy ◽  
Manal Mohammed Abd El Neem ◽  
Jehan A. Sayed
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Body Position ◽  
Critical Issue ◽  
Lateral Position ◽  
Abdominal Pressure ◽  
University Hospitals ◽  
Abdominal Hypertension

Background and objective: Intra-abdominal hypertension (IAH) is a frequent plentiful problem in patients admitted to critical care units. It ranges from a surge incidence of morbidity and mortality to a particular need for nursing health care, so recognition of the occurrence of IAH is a very critical issue for critical care nurses and physician. This study aimed to recognize the effects of various body position with the various head of bed elevation on the intra-abdominal pressure (IAP) in patients with mechanical ventilation.Methods: Design: A non-randomized, prospective observational study was used. Setting: Trauma and general intensive care units at Assuit University Hospitals. Method: In a prospective observational study, during the third day of mechanical ventilation, 60 patients were screened for IAP via a urinary catheter, in two various body positions in three separate degrees of the head of the bed (HOB) elevation (0º, 15º, and 30º). The position was changed at least 4 hours apart over a 24-h period.Results: In lateral recumbence, IAP measurements were significantly elevated compared to supine position, they were 19.70 ± 3.09 mmHg versus 16.00 ± 3.14 (p < .001), 22.80 ± 3.56 mmHg versus 19.03 ± 2.95 (p < .001), and 26.08 ± 3.59 mmHg versus 21.46 ± 2.90 versus (p < .001) at 0º, 15º, and 30º respectively. The mean of IAP difference was 3.7 ± 3.0 mmHg at 0º, 3.8 ± 1.00 mmHg at 15º, and 5.5 ± 1.01 mmHg at 30 º (p < .005).Conclusions: IAP reading is significantly elevated by changing from supine to lateral position especially with HOB elevation and significantly correlated with mortality rate in patients with mechanical ventilation

Plug and Play: Mechanical Ventilation Utilization During Critical Care Transport of Patients with Advanced Airway

2018 ◽  
Vol 37 (5) ◽  
pp. 296-297
Author(s):  
Christine Aspiotes ◽  
M. David. Gothard ◽  
Hamilton P. Schwartz ◽  
Michael T. Bigham
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Plug And Play ◽  
Advanced Airway

Prognosis of Stroke Patients Requiring Mechanical Ventilation in a Neurological Critical Care Unit

Stroke ◽  
1997 ◽  
Vol 28 (4) ◽  
pp. 711-715 ◽  
Author(s):  
Thorsten Steiner ◽  
Gabriel Mendoza ◽  
Michael De Georgia ◽  
Peter Schellinger ◽  
Rolf Holle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Critical Care Unit ◽  
Stroke Patients ◽  
Neurological Critical Care

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.

Physicians’ Estimates of Cardiac Index and Intravascular Volume Based on Clinical Assessment Versus Transesophageal Doppler Measurements Obtained by Critical Care Nurses

2003 ◽  
Vol 12 (4) ◽  
pp. 336-342 ◽  
Author(s):  
Manuel G. Iregui ◽  
Donna Prentice ◽  
Glenda Sherman ◽  
Lynn Schallom ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Critical Care ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Critical Care Nurses ◽  
Doppler Imaging ◽  
Intravascular Volume ◽  
Pulmonary Artery Catheterization ◽  
Transesophageal Doppler

• Objectives To compare physicians’ estimates of cardiac index and intravascular volume with transesophageal Doppler measurements obtained by critical care nurses, to assess the overall safety of transesophageal Doppler imaging by critical care nurses, and to compare hemodynamic measurements obtained via transesophageal Doppler imaging with those obtained via pulmonary artery catheterization. • Methods Data were collected prospectively on 106 patients receiving mechanical ventilation. Physicians estimated cardiac index and intravascular volume status by using bedside clinical assessment; critical care nurses, by using transesophageal Doppler imaging. In 24 patients, Doppler measurements were obtained within 6 hours of placement of a pulmonary artery catheter and recording of cardiac output and pulmonary artery occlusion pressure. • Results With Doppler measurements as the reference, physicians correctly estimated cardiac index in 46 (43.8%) of 105 patients, underestimated it in 24 (22.9%), and overestimated it in 35 (33.3%). They correctly estimated volume status in 31 patients (29.5%), underestimated it in 16 (15.2%), and overestimated it in 58 (55.2%). Doppler measurements of cardiac output correlated with those obtained via pulmonary artery catheterization (r = 0.778; P &lt; .001). Two patients had minor complications: dislodgement of a nasogastric tube and inability to obtain a Doppler signal. • Conclusion Physicians’ assessment of cardiac index and intravascular volume in patients receiving mechanical ventilation is correct less than half of the time. Transesophageal Doppler imaging by critical care nurses appears to be a safe method for measuring cardiac index and estimating intravascular volume. Measurements obtained via Doppler imaging correlate well with those obtained via pulmonary artery catheterization.

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

scholarly journals Residual Neuromuscular Blockade in Critical Care

2012 ◽  
Vol 32 (3) ◽  
pp. e1-e10 ◽  
Author(s):  
Jason Wilson ◽  
Angela S. Collins ◽  
Brea O. Rowan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Upper Airway ◽  
Surgical Interventions ◽  
Residual Neuromuscular Blockade ◽  
Factors Affecting ◽  
Anesthesia Time

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

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