Respiratory care clinics of North America最新文献_第2页

The role of noninvasive ventilation for acute respiratory failure. 无创通气在急性呼吸衰竭中的作用。

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.007

Donna S Hamel, Hilary Klonin

{"title":"The role of noninvasive ventilation for acute respiratory failure.","authors":"Donna S Hamel, Hilary Klonin","doi":"10.1016/j.rcc.2006.06.007","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.06.007","url":null,"abstract":"The use of NIV has been shown to facilitate discontinuing ventilatory dependence as well as provide support for adult patients with chronic lung disease without the need for endotracheal intubation. In fact, NIV has recently described as a potential support strategy following extubation failure. Therefore, using NIV as a bridge to liberation from mechanical ventilation may decrease many of the complications associated with long-term use of invasive airway devices as well complications from reinsertion of an artificial airway. Although firm data supporting the use of NIV in the adult population exists, the use of NIV in the pediatric population is based primarily on a series of case studies, retrospective chart reviews, and extrapolation from the adult data. The use of NIV for infants and children remains controversial. The important question to be asked is why there is a lack of randomized controlled trials on NIV in pediatrics? The answer lies somewhere between the lack of equipment designed specifically for pediatrics and the smaller number of patients available compared with adults. Data from the adult population may be more readily adapted to older children; however, it remains difficult to determine the criteria for noninvasive ventilatory use in infants and young children. In fact, this lack of data makes the formulation of firm selection guidelines for infants and children essentially impossible. However, for a select groups of pediatric patients with acute respiratory failure for whom an appropriate noninvasive device with interface is available, a trial of NIV may be seem reasonable to avoid the known negative effects of intubation and invasive mechanical ventilation.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"421-35"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26294606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

What is the role of airway pressure release ventilation in the management of acute lung injury? 气道压力释放通气在急性肺损伤治疗中的作用?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.004

Douglas E Petsinger, Jan D Fernandez, John D Davies

{"title":"What is the role of airway pressure release ventilation in the management of acute lung injury?","authors":"Douglas E Petsinger, Jan D Fernandez, John D Davies","doi":"10.1016/j.rcc.2006.06.004","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.06.004","url":null,"abstract":"The lack of published evidence supporting the use of APRV in the pediatric critical care patient population may diminish its effective application in respiratory failure. The effect of APRV on the number of ventilator days, ICU stay, and mortality still remains to be studied. Further application of APRV in the role of rest settings for ECMO especially in the pediatric cardiac patient population needs to be investigated. Will the use of APRV decrease the time for adequate lung recruitment, decrease sheer trauma, and/or promote earlier decannulation upon the restoration of tolerable cardiac function? Can APRV be utilized as a re-recruitment maneuver? A comparison of APRV over sustained in a randomized-controlled fashion, will there be a significant difference in ventilator days, length of ICU stay, and/or mortality? Does re-recruitment at plateau pressures during suctioning, patient position changes, or in the face of increased airway resistance decrease the number of ventilator days, length of ICU stay, and/or mortality? Does the use of continuous monitoring of carbon dioxide production aid in optimizing P(high)? The list of questions, both speculative and scientific are too numerous to list. Speculation leads to inquiry which over time drives science. More focus is needed on randomized, controlled trials. Initially the comparison of APRV to HFOV needs to be the primary focus for a proactive approach for ALI. Once a comfort level is established with this modality, further scientific inquires will follow. In the meantime, its use is likely to remain controversial.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"483-8"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26295190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of inhaled nitric oxide and heliox in the management of acute respiratory failure. 吸入一氧化氮和heliox在急性呼吸衰竭治疗中的作用。

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.006

Michael A Gentile

引用次数: 6

Is permissive hypoxemia a beneficial strategy for pediatric acute lung injury? 容许性低氧血症是儿童急性肺损伤的有益策略吗?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.003

Ira M Cheifetz, Donna S Hamel

引用次数: 21

High-frequency jet and oscillatory ventilation for neonates: which strategy and when? 新生儿高频喷射和振荡通气:哪种策略，何时使用?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.005

Sherry E Courtney, Jeanette M Asselin

引用次数: 13

Ventilator management protocols in pediatrics. 儿科呼吸机管理方案。

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.05.002

Alan S Graham, Aileen L Kirby

{"title":"Ventilator management protocols in pediatrics.","authors":"Alan S Graham, Aileen L Kirby","doi":"10.1016/j.rcc.2006.05.002","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.05.002","url":null,"abstract":"Management of mechanical ventilation is a complex process with outcomes affected by multiple patient and caregiver variable. Well-constructed protocols represent the synthesis of best available evidence regarding ventilator management. In adults, protocols improve important outcomes such as duration of mechanical ventilation, length of stay, and complication rates; however, protocols are not uniformly successful. In pediatrics, the available evidence does not suggest that ventilator management protocols should be adopted routinely, which may be due to pediatric-specific attributes such as a generally shorter weaning duration. Evidence suggests support for protocols to carefully titrate sedation. In addition, daily assessment of SBTs improves patient outcomes and should be more uniformly adopted in pediatrics. Ventilator-related outcomes may be affected by other confounding factors such as nutrition and fluid balance. Specific subpopulations, such as children who have congenital heart disease, may present opportunities for focused use of ventilator management protocols. Protocolized ventilation has an important place in trials of new therapeutic strategies such as surfactant or proning. It is hoped that future research will further define the appropriate use of protocols in the general PICU population. Although specific protocols cannot be routinely recommended, a multidisciplinary team approach to synthesizing available literature and determining best practice is a useful model. This approach will foster \"team ownership\" of ventilator management by all involved, thus engendering the best possible outcomes for critically ill children who require mechanical ventilation.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"389-402"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26237204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 13

Extubation criteria in infants and children. 婴儿和儿童拔管标准。

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.05.005

Angela T Wratney, Ira M Cheifetz

引用次数: 13

Do all mechanically ventilated pediatric patients require continuous capnography? 是否所有机械通气的儿童患者都需要持续的血管造影?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.05.006

Donna S Hamel, Ira M Cheifetz

{"title":"Do all mechanically ventilated pediatric patients require continuous capnography?","authors":"Donna S Hamel, Ira M Cheifetz","doi":"10.1016/j.rcc.2006.05.006","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.05.006","url":null,"abstract":"With most patients in modern ICUs requiring mechanical ventilation, any technology that may lead to more optimal ventilatory strategies would be invaluable in the management of critically ill patients. The focus of most ventilator strategies is protecting the lung from the deleterious effects of mechanical ventilation. Every effort is made to minimize the duration of mechanical ventilation while optimizing the potential for successful extubation. A concise organized plan based on objective criteria that is adjusted to meet changes in patient status is clearly recommended. Continuous capnographic monitoring provides clinicians with clear, precise, objective data that may prove beneficial in the design and implementation of mechanical ventilatory strategies. There are no clear-cut methods for achieving the optimal ventilator strategy for a specific patient. Although guidelines and management theories exist throughout the medical literature, in practice, they often merely serve as loose guidelines. The dynamic properties of an acutely ill patient make the management of mechanical ventilation an ongoing process requiring clinical assessment and planning by multidisciplinary members of the patient care team. Comprehensive evaluation of ventilatory management strategies and patient responses must be made by a collaborative effort of physicians, respiratory care practitioners, and nurses. An objective, consistent approach to the overall management is essential. Although still controversial, it is the authors' opinion that volumetric capnograph provides the data necessary to establish adequate gas delivery, optimal PEEP, and effective ventilation with the least amount of mechanical assistance, regardless of clinician or institutional preferences.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"501-13"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26295192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

To stop or not to stop: how much support should be provided to mechanically ventilated pediatric bone marrow and stem cell transplant patients? 停止还是不停止:对机械通气的儿童骨髓和干细胞移植患者应给予多少支持?

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.06.002

Paul L Martin

{"title":"To stop or not to stop: how much support should be provided to mechanically ventilated pediatric bone marrow and stem cell transplant patients?","authors":"Paul L Martin","doi":"10.1016/j.rcc.2006.06.002","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.06.002","url":null,"abstract":"Every publication to date reporting the outcome of intensive care support for pediatric SCT patients must be viewed with caution because all are single-institution, retrospective reports. Nevertheless, some of the conclusions made by these investigators appear to be clinically relevant. First, an SCT patient who requires intensive care support does not automatically have a dismal chance of survival. Survival rates in recent reports range from 15% to 36%, which is reasonable when the overall post-transplant survival rate for non-ICU patients may be only 50%. Second, adverse risk factors differ from center to center, likely due to the wide variation in patient populations, donor source, and transplant preparation regimens. Third, MSOF is a consistent adverse risk factor for survival. An additional conclusion that can be drawn from the data presented in this article is that patients who do not show significant, objective improvement by the second week of PICU care are unlikely to survive. The limitation or withdrawal of life-sustaining medical support should be recommended to the patient, the patient's family, and the patient's doctors. Although there are no predictive models that are 100% reliable for these clinical situations, in the author's experience, most families and physicians view critical care support beyond 2 weeks, in the absence of clinical improvement, as futile care. It is clear that better data are needed in the form of prospective, multi-institutional studies that include the therapeutic efficacy of interventions such as high-frequency oscillatory ventilation, continuous venovenous hemodialysis, early use of noninvasive ventilation (ie, noninvasive positive pressure ventilation), the use of biologic agents to decrease inflammation, the impact of new antifungal medications, and lung-protective ventilation with permissive hypercapnia. Of these potential therapies, the author is aware of only one multi-institutional study involving continuous venovenous hemodialysis at this time.","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 3","pages":"403-19"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26294605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

Application of the acute respiratory distress syndrome network low-tidal volume strategy to pediatric acute lung injury. 急性呼吸窘迫综合征网络低潮气量策略在小儿急性肺损伤中的应用。

Respiratory care clinics of North America Pub Date : 2006-09-01 DOI: 10.1016/j.rcc.2006.05.003

James H Hanson, Heidi Flori

引用次数: 40