Mechanical ventilator liberation protocol. Recommendation based on review of the evidence

Aurio, Fajardo-Campoverdi; Alejandro, González-Castro; Rodrigo, Adasme-Jeria; Angelo, Roncalli-Rocha; Miguel, Ibarra; Carmen, Chica-Meza; William, Cristancho-Gómez; Enrique, Monares-Zepeda; Alberto, Medina Villanueva; Alapont, Vicent, Modesto I; Fernando, Paziencia; Juan, Pérez; Yolanda, Lopez-Fernandez

doi:10.53097/jmv.10072

Cited by 2 publications

(1 citation statement)

References 64 publications

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“…Prolonged mechanical ventilation is associated with progressive deterioration of pulmonary function. In this case, tracheostomy and ventilatory support was required for 62 days, which correlates with higher mortality [ 10 ]. On the other hand, septic shock has a high morbimortality, estimated at 20–50% [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report

Sandoval,

Rojas,

Idrogo

2024

J Med Case Reports

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Background We present the case of a woman with cancer, which weakened the immune system and increased the risk of infection. Thus, infections are a frequent complication of cancer. The development of community-acquired pneumonia, an acute respiratory infectious disease that damages the lung parenchyma, caused by the invasion of pathogenic microorganisms, can lead to respiratory failure with multiorgan failure due to respiratory sepsis. Case presentation Case report of a 38-year-old mixed-race woman with diabetes mellitus and irregular treatment, who was admitted with community-acquired pneumonia complicated by type I respiratory failure requiring mechanical ventilation. During her hospital stay, she developed ventilator-associated pneumonia, recurrent empyema, bronchopleural fistula, refractory septic shock and multiorgan dysfunction despite multiple interventions. The patient required prolonged mechanical ventilation, vasopressor support and antibiotic therapy. After 62 days, metastatic papillary thyroid carcinoma was diagnosed. She presented with hypoparathyroidism and permanent hypocalcemia. She died after multiple complications and a refractory critical condition. Conclusion The case exemplifies the potential severity of community-acquired pneumonia in a patient with risk factors such as diabetes and immunosuppression. It highlights the complexity of treating multiple comorbidities and the importance of multidisciplinary management with close surveillance for timely interventions for complications.

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Section: Discussionmentioning

confidence: 99%

Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report

Sandoval,

Rojas,

Idrogo

2024

J Med Case Reports

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Estimation of inspiratory muscle effort using three common indices in various respiratory models, a bench study

Hu,

Hassan,

Shiraishi

et al. 2024

JMV

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Background Liberation from mechanical ventilation is a complex therapeutic challenge in the intensive care unit. Estimating inspiratory effort during mechanical ventilation can mitigate lung and diaphragmatic injury, along with weakness and atrophy. During a spontaneous breathing trial, it can be critical to predict over or under assistance to guide safe liberation. While estimation of the inspiratory effort requires special equipment, many other indices have been developed to estimate patient effort, work, and actual muscle pressure. In this bench study, we compare three commonly used maneuvers: airway occlusion at 100 msec (P0.1), airway pressure drop during full occlusion (Pocc), and pressure muscle index (PMI) for their accuracy in predicting the actual muscle effort. Methods A single active lung compartment using ASL5000 was modeled to simulate three common patient care scenarios, including “normal” (airway resistance 5 cm/l/s; compliance 60 ml/cm/H2O), “restrictive” (airway resistance 10 cm/l/s; compliance 30 ml/cm/H2O); and “obstructive” (airway resistance of 20 cm/l/s; compliance of 80 ml/cm/H2O) with respiratory rate of 15/minute, inspiratory time of 1 second (10 % rise, 0% hold, and 10% release while exhalation is passive). A Bellavista 1000e ventilator was used for pressure support of 5 cmH2O and positive end-expiratory pressure (PEEP) of 5 cmH2O. Each index was measured to the inputted Pmus, which ranged from 1 to 30 cmH2O and increased by increments of 1. Results were analyzed using Pearson correlation and regression analysis to predict an associated formula. These were compared to the inputted Pmus using single factor ANOVA followed by post Hoc Tukey test. Formulas from the P0.1 and the Pocc were then compared against previously published equations using single factor ANOVA. Statistics were performed using SPSS 20. P < 0.05 was considered statistically significant. Results All three indices had strong correlations to Pmus, P0.1 [R 0.978, 95% CI 0.97, 0.99, P < 0.001], Pocc [R 0.999, 95% CI 1.1, 1.12, P < 0.001], and PMI [R 0.722, 95% CI 0.61, 0.81, P < 0.001]. The equations to estimate Pmus were: P0.1: 3.95 (P0.1) - 2.05; Pocc: 1.11 (Pocc) + 0.82; and PMI: 1.03 (PMI) + 8.26. A significant difference (P < 0.001) was observed when comparing the inputted Pmus with Pmus estimated from P0.1, Pocc, or PMI. Post hoc analysis showed no difference between Pmus to Pmus estimated from P0.1, Pmus to Pmus estimated from Pocc, and Pmus estimated from P0.1 and Pocc; while comparisons of Pmus estimated from PMI to those from the P0.1 and Pocc revealed significant differences (P < 0.001 and P < 0.001, respectively). When comparing our formula for P0.1 to the previously published formula and the actual Pmus, no significant difference was observed (P 0.261), with post hoc tests revealing no significant differences between any pair. In contrast, a significant difference was found when comparing the formula for Pocc to the previously published formula and the actual Pmus (P < 0.001). Post hoc tests showed no difference between the new formula and Pmus (P 0.99), but a significant difference between Pmus and previous formula (P < 0.001). Conclusions While overall all three methods tested showed good correlation with the actual set Pmus, only P0.1 and the Pocc had strong correlation with the set Pmus in all three settings, suggesting that derived formulas can be useful to estimate muscle effort. PMI did not prove accurate, especially in obstructive scenarios, and may not be relied upon in practice. Keywords: Pmus, P0.1, P occlusion, PMI

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Mechanical ventilator liberation protocol. Recommendation based on review of the evidence

Cited by 2 publications

References 64 publications

Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report

Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report

Estimation of inspiratory muscle effort using three common indices in various respiratory models, a bench study

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