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

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Giorgio Conti ◽  
Jean Mantz ◽  
Dan Longrois ◽  
Peter Tonner
Keyword(s):  
Mechanical Ventilation ◽  
Best Practice ◽  
Weaning From Mechanical Ventilation ◽  
Ventilation Time ◽  
Catch Up ◽  
Mechanical Ventilation Time

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 The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

2016 ◽  
Vol 31 (12) ◽  
pp. 2033 ◽  
Author(s):  
Dong Won Park ◽  
Moritoki Egi ◽  
Masaji Nishimura ◽  
Youjin Chang ◽  
Gee Young Suh ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

scholarly journals Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS

2021 ◽  
pp. 088506662110241
Author(s):  
Pedro David Wendel Garcia ◽  
Daniel Andrea Hofmaenner ◽  
Silvio D. Brugger ◽  
Claudio T. Acevedo ◽  
Jan Bartussek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Odds Ratio ◽  
Closed Loop ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Mechanically Ventilated ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Background: Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.

scholarly journals Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

2019 ◽  
Author(s):  
Hesham Abowali ◽  
Matteo Paganini ◽  
Garrett A Enten ◽  
Ayman Elbadawi ◽  
Enrico Camporesi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Time Dependent ◽  
Hospital Length Of Stay ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

scholarly journals Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

2020 ◽  
Author(s):  
Jun Ma ◽  
Wenlin Shangguan ◽  
Liang-wan Chen ◽  
Dong-Shan Liao
Keyword(s):  
Mechanical Ventilation ◽  
Ventricular Septal Defect ◽  
Clinical Effect ◽  
Septal Defect ◽  
Operation Time ◽  
Ventilation Time ◽  
Significant Difference ◽  
Group A ◽  
Mechanical Ventilation Time ◽  
Group B

Abstract Background: To analyze the clinical effect of two different ways of minimally invasive transthoracic closure in children with ventricular septal defect (VSD) Methods: From January 2015 to July 2019, 294 children with VSD were enrolled in the Fujian Medical University Union Hospital, who underwent VSD closure through the left sternal fourth intercostal incision (group A: n = 95) and the lower sternal incision (group B: n = 129) Results: The operation time, bleeding volume, postoperative mechanical ventilation time, postoperative ICU monitoring time, postoperative hospitalization time and complication rate in group A were significantly lower than those in group B (P < 0.05). There was no significant difference between the two groups in the operation success rate, mechanical ventilation time and total hospitalization cost (P > 0.05). Conclusion : The transthoracic closure of ventricular septal defect through the left sternal fourth intercostal incision is feasible, safe, cosmetic, and worth popularizing.

scholarly journals The Risk and Outcomes of Reoperative Tricuspid Valve Replacement Surgery

2020 ◽  
Vol 23 (5) ◽  
pp. E658-E664
Author(s):  
Cheng Chen ◽  
Min Ge ◽  
Jiaxin Ye ◽  
Yongqing Cheng ◽  
Tao Chen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Cardiovascular Surgery ◽  
Univariate Analysis ◽  
Apache Ii ◽  
Tricuspid Valve Replacement ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Objectives: Functional tricuspid regurgitation (TR) usually occurs with previous cardiovascular surgery, which causes right-side heart failure and affects patient prognosis. Thus, we aimed to assess the risk and outcomes of isolated tricuspid valve replacement (TVR) after cardiovascular surgery. Methods: We reviewed our hospital medical records and found 107 patients, who had undergone TVR following cardiovascular surgery from June 2009 to November 2017. Follow up was performed by telephone calls, with a mean follow up of 51 months (one to 120 months). Previous surgical procedures of all patients were recorded, and we compared the differences in baseline and preoperative characteristics between the survival and non-survival groups by univariate analysis. Furthermore, logistic regression analysis was performed to identify the risk factors. The variables with a P value < .05 on univariate analysis were entered into a multivariate analysis using stepwise selection. Results: TVR was performed in 107 patients, including 89 survivors and 18 non-survivors during the follow up. There were 38 male and 69 female patients, and the mean age was 53.55 years. Hospital mortality was 16.8% (18/107). The APACHE II (P < .001) and mechanical ventilation time (P = .001) were higher in the non-survival group. The values of B-type natriuretic peptide (BNP), total bilirubin (TB), and blood urea nitrogen (BUN) before and after the operation and some preoperative values were different between the two groups (P < .05). The logistic regression analysis showed that APACHE II score, mechanical ventilation time, preoperative albumin, and postoperative TB were risk factors for TVR after cardiovascular surgery. Conclusions: Reoperation tricuspid valve replacement is associated with high operative mortality. High APACHE II scores, mechanical ventilation time and postoperative TB were associated with increased short-term mortality risk, while high preoperative albumin levels decreased the risk. Positive reoperation for tricuspid valve prosthesis dysfunction can obtain satisfactory therapeutic effects, and survivors could benefit from the surgery.

scholarly journals Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

2020 ◽  
Author(s):  
Rongyuan Zhang ◽  
Xu Wang ◽  
Shoujun Li ◽  
Jun Yan
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Congenital Heart ◽  
Low Dose ◽  
Distress Syndrome ◽  
Exogenous Surfactant ◽  
Control Group ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Abstract Purpose: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Materials and methods: We conducted a retrospective case-control study of the archive data of infants diagnosed with ARDS after cardiac surgery and admitted to pediatric cardiac surgical intensive care unit (PICU). A case was defined as a patient that received surfactant and standard therapy; a control was defined as a patient that underwent standard therapy. Controls were identified by matching patients based on age(±30d), weight(±3kg), risk adjustment congenital heart surgery-1 (RACHS-1), and initial ratio of partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (±10). Outcome variables namely oxygenation indices (OI), ventilation index (VI), mechanical ventilation time and PICU time were compared.Results: Forty-four patients, 22 who received surfactant (surfactant group) and 22 who did not (control group) were analyzed. Surfactant group obtained a significant improvement on OI (13.9 vs 5.62; p=0.000) and VI (42.0 vs 22.4; p=0.000) in 6 hours, while control group got no improvement on OI (13.2 vs 11.5; p=0.065) and VI (40.2 vs 36.4; p=0.100). Compared with control group, surfactant group had shorter ventilation time (133.6h vs 218.4h; p=0.000) and PICU time (10.7d vs 17.5d; p=0.001). Infants in surfactant group under 3 months benefit more from OI and VI than infants over 3 months.Conclusions: In congenital heart disease infants with post-surgery ARDS, low-dose exogenous surfactant treatment could prominently improve oxygenation and reduced mechanical ventilation time and PICU time. And the improvement of oxygenation is more effective for infants under 3 months.

Comparison of Transthoracic Device Closure and Surgical Repair with Right Submammary or Right Infra-axillary Thoracotomy for Perimembranous VSD

2018 ◽  
Vol 67 (01) ◽  
pp. 008-013 ◽  
Author(s):  
Ze-Wei Lin ◽  
Zhi-Nuan Hong ◽  
Hua Cao ◽  
Gui-Can Zhang ◽  
Liang-Wan Chen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Operative Time ◽  
Surgical Repair ◽  
Device Closure ◽  
Time Duration ◽  
Ventilation Time ◽  
Incision Size ◽  
Hospital Stays ◽  
Mechanical Ventilation Time

Background Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) or with right submammary thoracotomy (SRSMT) are all the primary alternative treatments for restrictive perimembranous ventricular septal defect (pmVSD). However, few studies have compared them in terms of effectiveness and complications. Methods Patients with restrictive pmVSD undergoing TTDC, or SRRIAT, or SRSMT from March 2016 to February 2017 were retrospectively reviewed in our cardiac center. There were no differences in age (1.3 ± 1.2 vs 1.1 ± 1.1 vs 1.2 ± 1.1 years), gender (35/37 vs 30/33 vs 29/29), body weight (8.3 ± 2.6 vs 8.2 ± 2.4 vs 8.1 ± 2.5 kg), and size of VSD (4.2 ± 1.1 vs 5.2 ± 1.3 vs 5.1 ± 1.2 mm) distribution between the three groups. Results The procedure success rates were similar in the three groups. The TTDC group had the shortest operative time, postoperative mechanical ventilation time, duration of intensive care, postoperative length of hospital stay, medical cost, and length of the incision. There were no significant differences in terms of operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion volume, mechanical ventilation time, duration of intensive care, duration of hospital stays, pleural fluid drainage, or cost between the SRSMT and SRRIAT groups. No significant differences were noted in terms of major adverse events. Conclusions TTDC, SRRIAT, and SRSMT all showed excellent outcomes and cosmetic appearances for selected VSD patients. TTDC had advantages over SRRIAT and SRSMT in terms of short operation duration and smaller incision size and shorter durations of intensive care and hospital stays.

Sign in / Sign up

Export Citation Format

Share Document