Archive for November, 2008

Spontaneous breathing is good!?

  • A combination of 18-69 hours of diaphragmatic inactivity and controlled mechanical ventilation results in 53-57% reduction of diaphragm muscle fibers!
  • Asynchrony and over-assisting contribute to disappearing muscle… so tailor Ti, Insp Rise, and set rates appropriately!

Wake up and Breathe! (ABC trial)

  • Paired sedation and ventilator weaning protocol consisting of daily SATs plus SBTs resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved 1-year survival compared with usual care.

The ICU patient remembers…
~20% of ICU patients suffer post-traumatic stress disorder leading to physical & mental health issues.
What they remember? (see Granja article)
1.       Daily needle punctures
2.       Tracheal tube aspiration
3.       Nose tube
4.       Bladder tube
5.       Noise from conversation
6.       Noise from engines and ventilators
7.       Pain
8.       Bedridden
9.       Music in the intensive care unit
10.   Comments from doctors and nurses

Lung Weight (Gattinoni lecture)

  • A normal lung weighs 800-1200 grams
  • An ARDS lung weighs 2000-4000 grams!  At least 10-15 cm H2O PEEP to overcome the compressive forces in an ARDS lung.

Subclinical Delirium = Brain Failure?!

  • Patients suffering subclinical or transient delirium are more likely to have a longer hospital stay, higher mortality rate and require increased assistance at home.
  • Current debates about benzos altering the structure of the brain and increasing incidence of delirium
  • Should ICUs move to Remifentanil, Propofol, Dexmedetomidine?

sunVancouver Sun
Published: Saturday, October 11, 2008

I have watched with interest your readers’ responses to the Oct. 2 editorial, “Private clinics and insurers are part of the Canadian health care system.” I wonder whether the public realizes that the patients seeking treatment or diagnosis in private facilities frequently end up back in the public system.

As a doctor in a community hospital, I have…

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PAVProportional assist ventilation (PAV) a significant advance or a futile struggle between logic and practice?

Thorax

[From  Thorax Online ]

Proportional assist ventilation is a promising addition to
other more conventional modes of mechanical
ventilation with the theoretical advantage of improving
patient-ventilator interaction. It may also be of use as a
diagnostic tool in the control of breathing in
mechanically ventilated patients.

PAV

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    CTV Report Video


    Robert A. Lachmann, MSc, Jack J. Haitsma, MD, and Burkhard Lachmann, MD, PhD. Department of Anaesthesiology, Erasmus Medical Centre Rotterdam, The Netherlands.

    Professor Lachmann has obtained the reputation as the open lung man. He has worked for many years with respiratory problems and developed the technique for reducing atelectasis in patients on ventilator. During the international joint meeting with the Czech Society of Anaesthesiology and the CENSA Oct 2002, he gave an inspired lecture on the status for ventilation during ARDS.

    Introduction

    ARDS was mentioned in an historic article by David Ashbaugh and colleagues in 1967. They described 12 patients with severe dyspnoea, tachypnoea, cyanosis, loss of lung compliance and diffuse alveolar infiltration seen on the chest X-ray [1]. They observed and reported several clinical and pathological similarities with neonates with respiratory distress syndrome, notably surfactant dysfunction [1].

    What did we learn from the last ten years of mechanical ventilation?

    In 1990 Hickling and colleagues demonstrated that mechanical ventilation could influence mortality in ARDS patients [3]. Lowering tidal volume (TV) in a retrospective study of 50 ARDS patients decreased mortality [3]. The outcome of this study sparked renewed interest in lowering TV in ARDS patients.

    Read Full Article

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