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[PMID]:28470921
[Au] Autor:Swol J; Strauch JT; Schildhauer TA
[Ad] Endereço:Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Germany.
[Ti] Título:Tracheostomy as a bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients.
[So] Source:Eur J Heart Fail;19 Suppl 2:120-123, 2017 May.
[Is] ISSN:1879-0844
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The tracheostomy is a frequently used procedure for the respiratory weaning of ventilated patients allows sedation free ECLS use in awake patient. The aim of this study is to assess the possibility and highlight the benefits of lowering the impact of sedation in surgical non-transplant patients on ECLS. The specific objective was to investigate the use of tracheostomy as a bridge to spontaneous breathing on ECLS. METHODS AND RESULTS: Of the 95 patients, 65 patients received a tracheostomy, and 5 patients were admitted with a tracheostoma. One patient was cannulated without intubation, one is extubated during ECLS course after 48 hours. 4 patients were extubated after weaning and the removal of ECLS. 19 patients died before the indication to tracheostomy was given. CONCLUSION: Tracheostomy can bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients. The "awake ECMO" strategy may avoid complications related to mechanical ventilation, sedation, and immobilization and provide comparable outcomes to other approaches for providing respiratory support.
[Mh] Termos MeSH primário: Oxigenação por Membrana Extracorpórea
Respiração Artificial/métodos
Respiração
Insuficiência Respiratória/terapia
Traqueostomia/métodos
Desmame do Respirador/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1002/ejhf.856


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[PMID]:29253019
[Au] Autor:Toida C; Muguruma T; Miyamoto M
[Ad] Endereço:Division of Critical Care Medicine, National Medical Center for Children and Mothers, Tokyo, Japan.
[Ti] Título:Detection and validation of predictors of successful extubation in critically ill children.
[So] Source:PLoS One;12(12):e0189787, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Availability of objective criteria for predicting successful extubation could avoid unnecessary prolongation of mechanical ventilation and/or inadvertent premature extubation, but the predictors of successful extubation in children are unclear. This study was performed to detect and validate respiratory function predictors of successful extubation in children admitted to the pediatric critical care unit. METHODS: A retrospective chart review from 2010 to 2012 identified 463 patients, who were divided into a derivation cohort (n = 294) and a validation cohort (n = 169). RESULTS: The incidence rate of failed extubation was 5% and 9% in the derivation and validation cohorts, respectively. The optimal cut-off values of crying vital capacity (CVC), peak inspiratory flow rate (PIFR), and maximum inspiratory pressure (MIP) were 17 ml/kg, 3.5 ml/sec/cm, and 50 cmH2O, respectively. The pass rates of CVC, PIFR, and MIP were 54.2%, 92.7%, and 55.5%, respectively. In the validation cohort, the successful extubation rate was 97.9% for patients who passed all 3 respiratory tests, 88.8% for those who passed at least one test, and 66.7% for those who failed all of the tests. Extubation failed in 5 patients who passed all three respiratory tests and failure was due to postoperative respiratory muscle fatigue or upper airway impairment. CONCLUSIONS: We detected and validated predictors of successful extubation in critically ill children. A combination of CVC, PIFR, and MIP may be used to predict successful extubation for critically ill children. It is necessary to pay attention when extubating patients with postoperative respiratory muscle fatigue or upper airway impairment due to disturbance of consciousness and/or glottal edema even if they pass the respiratory function tests.
[Mh] Termos MeSH primário: Extubação/métodos
Estado Terminal
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Edema/cirurgia
Seres Humanos
Lactente
Unidades de Terapia Intensiva Pediátrica
Curva ROC
Respiração
Respiração Artificial
Testes de Função Respiratória
Estudos Retrospectivos
Volume de Ventilação Pulmonar
Desmame do Respirador
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189787


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[PMID]:29202259
[Au] Autor:Rudas M; Orde S; Nalos M
[Ad] Endereço:Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia. rudasdoc@yahoo.com.
[Ti] Título:Bedside lung ultrasound in the care of the critically ill.
[So] Source:Crit Care Resusc;19(4):327-336, 2017 Dec.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe the technique and review the utility of bedside lung ultrasound in acute care. SUMMARY: Lung ultrasound is a useful point-of-care investigation in acute care, especially in patients with dyspnoea or haemodynamic instability. Although normal lung parenchyma is not accessible to ultrasound, distinctive artefacts arising from parietal and visceral pleura indirectly imply the presence of normal lung. As aeration of lung tissue reduces with disease process, visual assessment of several pathologic entities by ultrasound becomes possible. Ultrasound can be used for qualitative and quantitative assessment as well as to guide intervention. Compared with supine anteroposterior chest x-rays, lung ultrasound is faster and superior at ruling out pneumothorax and diagnosing lung consolidation, pleural effusions or pulmonary oedema. It is a logical and highly valuable extension of echocardiography and can be incorporated into diagnostic algorithms for assessment of dyspnoea, hypotension, chest pain or trauma. It provides rapid information about potentially reversible pathology in cardiac arrest scenarios. Other advantages include bedside availability, repeatability, provision of dynamic diagnostic information, ease of use and the absence of radiation exposure.
[Mh] Termos MeSH primário: Cuidados Críticos/métodos
Estado Terminal
Pulmão/diagnóstico por imagem
Sistemas Automatizados de Assistência Junto ao Leito
Ultrassonografia
[Mh] Termos MeSH secundário: Algoritmos
Dor no Peito/etiologia
Parada Cardíaca/etiologia
Seres Humanos
Hipotensão/etiologia
Pneumopatias/diagnóstico por imagem
Sons Respiratórios/etiologia
Ressuscitação
Choque/etiologia
Procedimentos Desnecessários
Desmame do Respirador
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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Registro de Ensaios Clínicos
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[PMID]:27771739
[Au] Autor:Futier E; Paugam-Burtz C; Godet T; Khoy-Ear L; Rozencwajg S; Delay JM; Verzilli D; Dupuis J; Chanques G; Bazin JE; Constantin JM; Pereira B; Jaber S; OPERA study investigators
[Ad] Endereço:CHU de Clermont-Ferrand, Pôle Médecine Périopératoire (MPO), Hôpital Estaing, 63003, Clermont-Ferrand, France.
[Ti] Título:Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA).
[So] Source:Intensive Care Med;42(12):1888-1898, 2016 Dec.
[Is] ISSN:1432-1238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: High-flow nasal cannula (HFNC) oxygen therapy is attracting increasing interest in acute medicine as an alternative to standard oxygen therapy; however, its use to prevent hypoxaemia after major abdominal surgery has not been evaluated. Our trial was designed to close this evidence gap. METHODS: A multicentre randomised controlled trial was carried out at three university hospitals in France. Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation. The primary endpoint was absolute risk reduction (ARR) for hypoxaemia at 1 h after extubation and after treatment discontinuation. Secondary outcomes included occurrence of postoperative pulmonary complications within 7 days after surgery, the duration of hospital stay, and in-hospital mortality. The analysis was performed on data from the modified intention-to-treat population. This trial was registered with ClinicalTrials.gov (NCT01887015). RESULTS: Between 6 November 2013 and 1 March 2015, 220 patients were randomly assigned to receive either HFNC (n = 108) or standard oxygen therapy (n = 112); all of these patients completed follow-up. The median duration of the allocated treatment was 16 h (interquartile range 14-18 h) with standard oxygen therapy and 15 h (interquartile range 12-18) with HFNC therapy. Twenty-three (21 %) of the 108 patients treated with HFNC 1 h after extubation and 29 (27 %) of the 108 patients after treatment discontinuation had postextubation hypoxaemia, compared with 27 (24 %) and 34 (30 %) of the 112 patients treated with standard oxygen (ARR 4, 95 % CI -8 to 15 %; p = 0.57; adjusted relative risk [RR] 0.87, 95 % CI 0.53-1.43; p = 0.58). Over the 7-day postoperative follow-up period, there was no statistically significant difference between the groups in the proportion of patients who remained free of any pulmonary complication (ARR 7, 95 % CI -6 to 20 %; p = 0.40). Other secondary outcomes also did not differ significantly between the two groups. CONCLUSIONS: Among patients undergoing major abdominal surgery, early preventive application of high-flow nasal cannula oxygen therapy after extubation did not result in improved pulmonary outcomes compared with standard oxygen therapy.
[Mh] Termos MeSH primário: Abdome/cirurgia
Extubação/efeitos adversos
Hipóxia/prevenção & controle
Oxigenoterapia/métodos
Complicações Pós-Operatórias/prevenção & controle
Respiração Artificial/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
França
Mortalidade Hospitalar
Seres Humanos
Hipóxia/etiologia
Análise de Intenção de Tratamento
Tempo de Internação
Masculino
Meia-Idade
Período Pós-Operatório
Fatores de Tempo
Desmame do Respirador
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171126
[Lr] Data última revisão:
171126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1007/s00134-016-4594-y


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[PMID]:28813495
[Au] Autor:Chao CM; Lai CC; Cheng AC; Chiang SR; Liu WL; Ho CH; Hsing SC; Chen CM; Cheng KC
[Ad] Endereço:Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan.
[Ti] Título:Establishing failure predictors for the planned extubation of overweight and obese patients.
[So] Source:PLoS One;12(8):e0183360, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0-29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1-28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16-5.80), ESRD (OR: 14.00; 95% CI: 6.25-31.35), and MIP levels (OR: 0.94; 95% CI: 0.90-0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.
[Mh] Termos MeSH primário: Extubação/efeitos adversos
Obesidade/complicações
Sobrepeso/complicações
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cuidados Críticos/estatística & dados numéricos
Feminino
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Insuficiência Respiratória/terapia
Fatores de Risco
Falha de Tratamento
Desmame do Respirador/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170817
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0183360


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[PMID]:28767913
[Au] Autor:Nascimento MS; Rebello CM; Vale LAPA; Santos É; Prado CD
[Ad] Endereço:Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
[Ti] Título:Spontaneous breathing test in the prediction of extubation failure in the pediatric population.
[So] Source:Einstein (Sao Paulo);15(2):162-166, 2017 Apr-Jun.
[Is] ISSN:2317-6385
[Cp] País de publicação:Brazil
[La] Idioma:eng; por
[Ab] Resumo:Objective: To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. Methods: A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. Results: A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). Conclusion: The spontaneous breathing test was not able to predict the extubation failure in pediatric population. Objetivo: Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Métodos: Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espontânea. Resultados: Dos 95 pacientes incluídos no estudo, 71 crianças eram do Grupo Teste e 24 eram do Grupo Controle. Os grupos foram comparados em relação a: sexo, idade, tempo de ventilação mecânica, indicação para início da ventilação mecânica e parâmetros ventilatórios pré-extubação, no Grupo Controle, e pré-realização do teste, no Grupo Teste. Não foram observadas diferenças entre os parâmetros analisados. Em relação à análise da probabilidade de falha da extubação entre os dois grupos de estudo, a chance de falha do Grupo Controle foi 1.412 maior do que a das crianças do Grupo Teste, porém este acréscimo não foi significativo (p=0,706). O modelo foi considerado bem ajustado de acordo com o teste de Hosmer-Lemeshow (p=0,758). Conclusão: O teste de respiração espontânea para a população pediátrica não foi capaz de prever a falha da extubação.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
Respiração Artificial/métodos
Testes de Função Respiratória/métodos
Desmame do Respirador/métodos
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
Valor Preditivo dos Testes
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE


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[PMID]:28693057
[Au] Autor:Liu LX; Su D; Hu ZJ
[Ti] Título:[The value of the excursion of diaphragm tested by ultrosonography to predict weaning from mechanical ventilation in ICU patients].
[So] Source:Zhonghua Nei Ke Za Zhi;56(7):495-499, 2017 Jul 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the excursion of the diaphragm and analyze the value in predicting weaning from mechanical ventilation in intensive care unit patients. The patients with mechanical ventilation (>48 hours) in ICU at Hebei Forth Medical University Hospital from June 2014 to December were classified into a success group or a failure group according to the weaning outcome. T-piece spontaneous breathing (SBT), airway occlusion pressure at 0.1 sec (P(0.1)) and maximal inspiratory pressure (MIP), rapid shallow breathing index (RSBI) and P(0.1)/MIP were measured or calculated. During the period of the 1st hour SBT, the excursion of diaphragm was measured with ultrasonography. The predictive value of each parameter to weaning was evaluated with ROC curve. A total of 98 patients were enrolled in this study, including 74 successfully weaning and 24 failed. There were significant differences between two groups(success group and failure group) in P(0.1)[(2.00±2.00)cmH(2)O (1 cmH(2)O=0.098 kPa) vs (3.00±2.75)cmH(2)O, <0.05], RSBI (39.14±16.81 vs 52.00±19.18, <0.05), left diaphragmatic excursion [(1.12±0.97)cm vs (0.69±1.00)cm, <0.001], right diaphragmatic excursion(1.87±0.75)cm vs (1.17±0.76)cm, <0.001] and mean value of left and right diaphragmatic excursion [(1.57±0.52)cm vs (0.83±0.53)cm, and <0.001]. The ventilation time [2.00(2.00-4.00)d vs 4.00(2.00-5.00)d], ICU hospital lengths of stay [4.50(3.00-7.25)d vs 8.50(6.25-15.25)d] and total hospital lengths of stay[20.00(15.00-25.25)d vs 25.00(20.25-37.25)d] were also statistically significant in success group and failure group respectively (all <0.05). The cutoff value of diaphragmatic excursion for predicting successful extubation was determined to be 1.14 cm by ROC curve analysis. The sensitivity of diaphragmatic excursion to predict successful weaning was 89.2% and the specificity was 75.0%, the AUC(ROC) was 0.849. As an early predictor of diaphragmatic dysfunction, diaphragmatic excursion is probably superior to the traditional parameters in predicting weaning from ventilator in ICU patients.
[Mh] Termos MeSH primário: Diafragma/diagnóstico por imagem
Ultrassonografia/métodos
Desmame do Respirador/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Estudos Prospectivos
Curva ROC
Respiração Artificial/métodos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2017.07.005


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[PMID]:28687380
[Au] Autor:Burns KEA; Devlin JW; Hill NS
[Ad] Endereço:Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: burnsk@smh.ca.
[Ti] Título:Patient and Family Engagement in Designing and Implementing a Weaning Trial: A Novel Research Paradigm in Critical Care.
[So] Source:Chest;152(4):707-711, 2017 Oct.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The call for meaningful patient and family engagement in research has recently gained considerable momentum. This article defines patient and family engagement broadly and specifically in clinical research. Using a multicenter, North American weaning trial as an exemplar, we describe our early experiences as clinical researchers with patient and family engagement. The role of our Patient and Family Advisory Committee in trial design and implementation is illustrated. Through our experiences, we share our insights regarding the perceived opportunities and also highlight some challenges associated with engaging patients and family engagement in critical care research. Although "engagement science" is in its infancy, engaging patients and families in research holds promise as a novel research paradigm that will not only provide new insights into the questions, methods, and outcomes used in ICU research, but it will also make investments in research more accountable and ensure a strong "patient- and family-centered focus" of our research.
[Mh] Termos MeSH primário: Pesquisa Biomédica
Cuidados Críticos/métodos
Estado Terminal/terapia
Família/psicologia
Participação do Paciente/métodos
Relações Profissional-Família
Desmame do Respirador/métodos
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28650414
[Au] Autor:Silva S; Ait Aissa D; Cocquet P; Hoarau L; Ruiz J; Ferre F; Rousset D; Mora M; Mari A; Fourcade O; Riu B; Jaber S; Bataille B
[Ad] Endereço:From the Critical Care Unit (S.S., D.A.A., L.H., F.F., D.R., A.M., B.R.) and Critical Care and Anaesthesiology Department (S.S., D.A.A., L.H., J.R., F.F., D.R., A.M., O.F., B.R.), University Teaching Hospital of Purpan, Toulouse, France; French National Institute of Health and Medical Research U1214, University Teaching Hospital of Purpan, Toulouse, France (S.S.); Critical Care Unit, Hopital Dieu Hospital, Narbonne, France (P.C., M.M., B.B.); Critical Care Unit, University Cancer Institute Hospital of Toulouse, France (J.R.); and Intensive Care Unit and Transplantation, Department of Anaesthesiology and Critical Care B, Saint Eloi Hospital, Montpellier, France (S.J.).
[Ti] Título:Combined Thoracic Ultrasound Assessment during a Successful Weaning Trial Predicts Postextubation Distress.
[So] Source:Anesthesiology;127(4):666-674, 2017 Oct.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress. METHODS: Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial. In case of postextubation distress (31 of 136 patients), an additional combined ultrasound assessment was performed while the patient was still in acute respiratory failure. We applied machine-learning methods to improve the accuracy of the related predictive assessments. RESULTS: Overall, integrated thoracic ultrasound models accurately predict postextubation distress when applied to thoracic ultrasound data immediately recorded before the start and at the end of the trial of pressure support ventilation (learning sample area under the curve: start, 0.921; end, 0.951; test sample area under the curve: start, 0.972; end, 0.920). Among integrated thoracic ultrasound data, the recognition of lung interstitial edema and the increased telediastolic left ventricular pressure were the most relevant predictive factors. In addition, the use of thoracic ultrasound appeared to be highly accurate in identifying the causes of postextubation distress. CONCLUSIONS: The decision to attempt extubation could be significantly assisted by an integrative, dynamic, and fully bedside ultrasonographic assessment of cardiac, lung, and diaphragm functions.
[Mh] Termos MeSH primário: Extubação
Diafragma/diagnóstico por imagem
Coração/diagnóstico por imagem
Insuficiência Respiratória/diagnóstico
Sistema Respiratório/diagnóstico por imagem
Ultrassonografia
Desmame do Respirador
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170627
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001773


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[PMID]:28637077
[Au] Autor:Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung (DIGAB e. V.) zusammen mit Bund der Pneumologen (BdP); Deutsche Gesellschaft für Neurologische Intensivmedizin (DGNI e. V.); Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP e. V.); Deutscher Hausärzteverband e. V.; Deutsche Interdisziplinäre Vereinigung für Intensivmedizin (DIVI e. V.); Verband Pneumologischer Kliniken (VPK)
[Ti] Título:[Tracheostomy Home Care of Patients after Long Term Ventilation on the ICU - a Position Paper].
[Ti] Título:Ambulante Intensivpflege nach Tracheotomie..
[So] Source:Dtsch Med Wochenschr;142(12):909-911, 2017 Jun.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Serviços de Assistência Domiciliar
Traqueostomia
[Mh] Termos MeSH secundário: Serviços de Assistência Domiciliar/economia
Serviços de Assistência Domiciliar/organização & administração
Serviços de Assistência Domiciliar/normas
Seres Humanos
Unidades de Terapia Intensiva
Respiração Artificial
Traqueostomia/economia
Traqueostomia/normas
Desmame do Respirador
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170622
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-109101



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