Mechanical Ventilation Beyond the Intensive Care Unit

Make, Barry J.; Hill, Nicholas S.; Goldberg, Allen I.; Bach, John R.; Criner, Gerard J.; Dunne, P.; Gilmartin, Mary E.; Heffner, John E.; Kacmarek, Robert M.; Keens, Thomas G.; McInturff, Susan L.; OʼDonohue, Walter J.; Oppenheimer, E. A.; Robert, Dominique

doi:10.1378/chest.113.5_supplement.289s

Cited by 199 publications

(103 citation statements)

References 132 publications

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“…5,6,18 Crude mortality rates of 30-75% have been reported for nosocomial pneumonia caused by P. aeruginosa and/or Acinetobacter spp. with the highest rates reported in ventilator-dependent patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is more appropriate to refer to these patients as long-term ventilated-associated individuals. 5 Acute spinal cord injury is a devastating event whose incidence varies from country to country, according to cause, methodology applied, and national and local database registries. 6 In the United States, its incidence ranges from 28 to 50 injuries per million persons per year.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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Background: Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients. Methods: All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) X10 5 CFU ml À1 in quantitative bacterial culture of tracheal aspirates or X10 3 CFU ml À1 in quantitative mini-bronchoalveolar lavage cultures. Results: In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P ¼ 0.03), administration of antacids (P ¼ 0.002) and length of mechanical ventilation (P ¼ 0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP. Conclusions: Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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“…It is advisable to maintain cuff pressures below 20 cm H 2 O [7] and avoid using more than 8 mL of air for cuff inflation. [8] Routine cuff deflation and re-inflation are no longer recommended. [7,9] Proper placement of the tracheostomy and tracheostomy tube, use of thin-walled cuffs to minimise movement of the tracheostomy tube relative to the trachea and initiation of weaning as early as possible may help in curtailing trauma to the trachea.…”

Section: Discussionmentioning

confidence: 99%

Post-tracheostomy tracheo-oesophageal fistula – an unusual presentation

2016

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Tracheostomy, one of the oldest known surgical procedures in the history of medicine, is regularly performed in modern intensive care units. Acquired ulcerative tracheo-oesophageal fistula (TOF) is an uncommon but potentially fatal complication of tracheostomy. We report a case of ulcerative TOF with an unusual yet characteristic presentation, in a ventilator-dependent tracheostomised patient with Guillain-Barré syndrome. It presented as sudden progressive severe abdominal distension that was rhythmic with each ventilator breath. The predisposing factors, clinical features and preventive measures of post-tracheostomy TOF are discussed in this case report. Regular monitoring of tracheal tube cuff pressures and volumes, along with avoidance and treatment of various predisposing factors, are advisable for the prevention of this serious consequence.

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“…Basic knowledge of the principles of ventilator functioning [26] may be helpful when choosing a HCV. This enables the physician or respiratory therapist to consider the HCV technical performance in relation to the patient's clinical characteristics and underlying disease, the home care environment and the available financial resources [27]. The primary purpose of this guide is not to compare the individual features of each ventilator, but rather to provide general information about the technical aspects of such ventilators, which may help in the decision-making process.…”

Section: Statement Of Interestmentioning

confidence: 99%

Choosing a ventilator for home mechanical ventilation

Gregoretti¹,

Navalesi

S³

et al. 2013

breathe

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Educational aimsTo discuss the basic principles of ventilator functionTo help the reader to recognise the different features of a home care ventilatorTo outline the advantages and drawbacks of the different home care ventilatorsTo provide some recommendations to facilitate the clinical management of patients on home care ventilatorSummaryMechanical ventilation, applied either invasively through a tracheotomy tube or noninvasivelyviaa mask, is increasingly used for long-term management of many forms of severe chronic respiratory failure in the home setting. In recent years, the quality of the ventilators for long-term home mechanical ventilation has improved considerably and, concomitantly, the number of machines available has also increased. This broader range of commercially available machines is clearly an advantage; however, it makes the choice of the optimal device for a specific patient more difficult. The aim of the present article is to provide useful information to help and guide the choice of device for long-term mechanical ventilation in the home setting.

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Mechanical Ventilation Beyond the Intensive Care Unit

Cited by 199 publications

References 132 publications

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Post-tracheostomy tracheo-oesophageal fistula – an unusual presentation

Choosing a ventilator for home mechanical ventilation

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