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Search Results: 1 - 10 of 6154 matches for " ventilators mechanical "
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Impacto de um protocolo de desmame de ventila??o mecanica na taxa de falha de extuba??o em pacientes de difícil desmame
Teixeira, Cassiano;Maccari, Ju?ara Gasparetto;Vieira, Silvia Regina Rios;Oliveira, Roselaine Pinheiro;Savi, Augusto;Machado, André Sant'Ana;Tonietto, Túlio Frederico;Cremonese, Ricardo Viegas;Wickert, Ricardo;Pinto, Kamile Borba;Callefe, Fernanda;Gehm, Fernanda;Borges, Luis Guilherme;Oliveira, Eubrando Silvestre;
Jornal Brasileiro de Pneumologia , 2012, DOI: 10.1590/S1806-37132012000300012
Abstract: objective: to determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool. methods: this was a multicenter prospective cohort study carried out at three medical/surgical icus. the study involved all consecutive difficult-to-wean icu patients (failure in the first spontaneous breathing trial [sbt]), on mechanical ventilation (mv) for more than 48 h, admitted between january of 2002 and december of 2005. the patients in the protocol group (pg) were extubated after a t-piece weaning trial and were compared with patients who were otherwise extubated (non-protocol group, npg). the primary outcome measure was reintubation within 48 h after extubation. results: we included 731 patients-533 (72.9%) and 198 (27.1%) in the pg and npg, respectively. the overall reintubation rate was 17.9%. the extubation success rates in the pg and npg were 86.7% and 69.6%, respectively (p < 0.001). there were no significant differences between the groups in terms of age, gender, severity score, or pre-inclusion time on mv. however, copd was more common in the npg than in the pg (44.4% vs. 17.6%; p < 0.001), whereas sepsis and being a post-operative patient were more common in the pg (23.8% vs. 11.6% and 42.4% vs. 26.4%, respectively; p < 0.001 for both). the time on mv after the failure in the first sbt was higher in the pg than in the npg (9 ± 5 days vs. 7 ± 2 days; p < 0.001). conclusions: in this sample of difficult-to-wean patients, the use of a weaning protocol improved the decision-making process, decreasing the possibility of extubation failure.
O uso da hiperinsufla??o como recurso fisioterapêutico em unidade de terapia intensiva
Lemes, Daniela Aires;Guimar?es, Fernando Silva;
Revista Brasileira de Terapia Intensiva , 2007, DOI: 10.1590/S0103-507X2007000200014
Abstract: background and objectives: mechanically ventilated patients usually present larger amounts of pulmonary secretions because of impairment in mucociliary function and mucus transport. the manual resuscitator is considered a resource for pulmonary hyperinflation with the aim of preventing mucus retention and pulmonary complications, improving oxygenation and reexpanding collapsed areas. alternatively, the hyperinflation by mechanical ventilator is a reliable and practical device to promote lung expansion and desobstruction. the objective of this study was to review the literature concerning manual and ventilator hyperinflation treatments for patients in the intensive care units (icu) setting. contents: literature searches were performed using the databases medline, cinahl, scielo and lilacs with appropriate keywords, including: intensive care units, manual hyperinflation, mechanical ventilator, physiotherapy, physical therapy and ventilator hyperinflation. conclusions: although there are few studies demonstrating the efficacy of ventilator hyperinflation as a physical therapy device, it can be a safety option to promote therapeutic hyperinflation in icu, compared to manual hyperinflation.
Epidemia de neumonía asociada a ventilación mecánica en Mérida, Yucatán
Zaidi,Mussaret; Martín,Gloria; Rosado,Rilke;
Salud Pública de México , 1999, DOI: 10.1590/S0036-36341999000700008
Abstract: objectives. to determine the main epidemiological, clinical, and microbiologic characteristics of an outbreak of ventilator-associated pneumonia at an intensive care unit in yucatan. material and methods. an 11-month prospective and observational study was designed to determine incidence, mortality, potential reservoirs, etiologic agents and antibiotic susceptibility patterns. results. the incidence of ventilator-associated pneumonia was 74%. the crude mortality rate was 88% compared to a 19.5% expected-mortality rate. gram-negative bacteria were isolated from 98% of the cultures, of which 46% were susceptible to third generation cephalosporins, 59% to fourth generation cephalosporins, 70% to ciprofloxacin and 100% to imipenem. klebsiella pneumoniae and pseudomonas aeruginosa were isolated from some of the ventilator circuits and the sink. conclusions. the high incidence of pneumonia and associated mortality in our intensive care unit may be attributed to the absence of infection control measures and the high prevalence of multiresistant organisms which is related to antibiotic abuse.
Ventilación mecánica en pacientes con patologías agudas del Sistema Nervioso Central: sobrevida y pronóstico funcional
Norero M,Enrique; Altschwager K,Pablo; Romero P,Carlos; Mellado T,Patricio; Hernández P,Glenn; Castillo F,Luis; Bugedo T,Guillermo;
Revista médica de Chile , 2004, DOI: 10.4067/S0034-98872004000100002
Abstract: background: the need of mechanical ventilation among patients with acute neurological diseases is considered a poor prognostic sign. aim: to determine the mortality and functional recovery of neurological patients requiring mechanical ventilation. patients and methods: prospective study of 77 patients (42 men, age 54±19 years, with 11±4 points of glasgow coma scale (gcs), 61% with cerebrovascular disease), that were admitted to the intensive care unit with neurological disease and that required mechanical ventilation. functional recovery was assessed at 18 months with glasgow outcome scale (gos) and barthel index. results: thirty percent of patients died during follow up. among surviving patients, 47% had a good recovery or moderate disability, and 74% had a barthel index equal to or over 70. arterial hypertension, age over 70 and mechanical ventilation longer than 6 days were associated with bad functional prognosis. conclusions: neurological patients requiring mechanical ventilation had a lower mortality than previously reported, and half of the survivors have an independent life. this study supports intensive care management in this group of patients (rev méd chile 2004; 132: 11-8).
Ventilación mecánica en pacientes con patologías agudas del Sistema Nervioso Central: sobrevida y pronóstico funcional Mechanical ventilation in patients with acute neurological disease: Survival and functional outcome
Enrique Norero M,Pablo Altschwager K,Carlos Romero P,Patricio Mellado T
Revista médica de Chile , 2004,
Abstract: Background: The need of mechanical ventilation among patients with acute neurological diseases is considered a poor prognostic sign. Aim: To determine the mortality and functional recovery of neurological patients requiring mechanical ventilation. Patients and methods: Prospective study of 77 patients (42 men, age 54±19 years, with 11±4 points of Glasgow coma scale (GCS), 61% with cerebrovascular disease), that were admitted to the intensive care unit with neurological disease and that required mechanical ventilation. Functional recovery was assessed at 18 months with Glasgow outcome scale (GOS) and Barthel index. Results: Thirty percent of patients died during follow up. Among surviving patients, 47% had a good recovery or moderate disability, and 74% had a Barthel index equal to or over 70. Arterial hypertension, age over 70 and mechanical ventilation longer than 6 days were associated with bad functional prognosis. Conclusions: Neurological patients requiring mechanical ventilation had a lower mortality than previously reported, and half of the survivors have an independent life. This study supports intensive care management in this group of patients (Rev Méd Chile 2004; 132: 11-8).
Mecanica respiratória de pacientes neurocríticos sob ventila??o mecanica submetidos à umidifica??o aquosa aquecida e a um modelo de filtro trocador de calor
Siqueira, Tiago Branco;Costa, Juliana Cristina Gomes de Freitas;Tavares, Isnar Campos;Torres, Priscilla Muniz;Andrade, Maria do Amparo;Fran?a, Eduardo ériko Tenório de;Galindo Filho, Valdecir Castor;Andrade, Flávio Maciel Dias;
Revista Brasileira de Terapia Intensiva , 2010, DOI: 10.1590/S0103-507X2010000300008
Abstract: objectives: in mechanically ventilated patients, humidifier devices are used to heat and moisturize the inspired gas. heating and humidifying inspired gas may prevent complications associated with the respiratory mucosa dryness such as mucus plugging and endotracheal tube occlusion. two devices have been commonly used to this, either heated humidifier or the heat moisture exchange filter. this study aimed to compare the effects of the heated humidifier and a model of heat moisture exchange filter on respiratory mechanics in mechanically ventilated neurological patients. methods: this was a randomized crossover trial, involving 31 neurological patients under mechanical ventilation randomly assigned to the humidification devices. expired tidal volume, peak inspiratory flow, peak expiratory flow, static compliance, dynamic compliance and respiratory system resistance were evaluated. statistical analysis used the kolmogorov-smirnov test and student's t test for paired samples, in which p values < 0.05 were considered significant. results: the heat moisture exchanger filter decreased expired tidal volume, peak inspiratory flow, peak expiratory flow (p < 0.001) and dynamic compliance (p = 0.002), and increased respiratory system resistance (p < 0.001). conclusion: in the studied population, the use of a heat moisture exchange filter model leaded to several changes on respiratory mechanics parameters.
Transporte intra-hospitalar de pacientes sob ventila??o invasiva: repercuss?es cardiorrespiratórias e eventos adversos
Zuchelo, Lea Tami Suzuki;Chiavone, Paulo Ant?nio;
Jornal Brasileiro de Pneumologia , 2009, DOI: 10.1590/S1806-37132009000400011
Abstract: objective: to determine the occurrence of cardiorespiratory alterations and to identify adverse events during the intrahospital transport of patients on invasive ventilation. methods: a prospective observational non-randomized study was conducted at two tertiary hospitals between april of 2005 and december of 2006. we included patients on invasive ventilation who required intrahospital transport during the study period. exclusion criteria were as follows: being under suspicion of brain death; being submitted to alternate periods of mechanical ventilation/nebulization via a t-piece; and being transported to the operating room. prior to and after transport, we evaluated blood gas analysis results, vital signs, use of medications by means of a continuous infusion pump, parameters regarding the mechanical ventilator, duration of transport, transport distance and number of professionals involved. results: we included 48 patients in a total of 58 intrahospital transports. relevant cardiorespiratory alterations were identified in 39 transports, totaling 86 episodes, as well as 16 adverse events related to equipment or personnel failure, such as problems related to batteries and to miscommunication. conclusions: during the intrahospital transport of patients on invasive ventilation, cardiorespiratory alterations were common (67.2%), and adverse events occurred in 75.7% of the transports.
Adapta??o do Bird Mark 7 para oferta de press?o positiva contínua nas vias aéreas em ventila??o n?o-invasiva: estudo em modelo mecanico
Kikuti, Beatriz Mayumi;Utsunomia, Karen;Colaneri, Renata Potonyacz;Carvalho, Carlos Roberto Ribeiro de;Caruso, Pedro;
Jornal Brasileiro de Pneumologia , 2008, DOI: 10.1590/S1806-37132008000300007
Abstract: objective: to test the efficiency of the bird mark 7 ventilator adapted to deliver continuous positive airway pressure (cpap) in noninvasive positive pressure ventilation. methods: this was an experimental study using a mechanical model of the respiratory system. a bird mark 7 ventilator was supplied with 400 and 500 kpa and tested at cpap of 5, 10 and 15 cmh2o. the following variables were analyzed: difference between the preset cpap and the cpap actually attained cpap (truecpap); area of airway pressure at the cpap level employed (areacpap); and tidal volume generated. results: adapting the bird mark 7 to offer cpap achieved the expected tidal volume in all situations of inspiratory effort (normal or high), ventilator pressure supply (400 or 500 kpa) and cpap value (5, 10 or 15 cmh2o). at a cpap of 5 or 10 cmh2o, the truecpap was near the preset level, and the areacpap was near zero. however, at a cpap of 15 cmh2o, the value remained below the preset, and the areacpap was high. conclusion: the efficiency of bird mark 7 adaptation in offering cpap was satisfactory at 5 and 10 cmh2o but insufficient at 15 cmh2o. if adapted as described in our study, the bird mark 7 might be an option for offering cpap up to 10 cmh2o in areas where little or no equipment is available.
Parametros preditivos para o desmame da ventila??o mecanica
Nemer, Sérgio Nogueira;Barbas, Carmen Sílvia Valente;
Jornal Brasileiro de Pneumologia , 2011, DOI: 10.1590/S1806-37132011000500016
Abstract: the use of predictive parameters for weaning from mechanical ventilation is a rather polemic topic, and the results of studies on this topic are divergent. regardless of the use of these predictive parameters, the spontaneous breathing trial (sbt) is recommended. the objective of the present study was to review the utility of predictive parameters for weaning in adults. to that end, we searched the medline, lilacs, and pubmed databases in order to review articles published between 1991 and 2009, in english or in portuguese, using the following search terms: weaning/desmame, extubation/extuba??o, and weaning indexes/indices de desmame. the use of clinical impression is an inexact means of predicting weaning outcomes. the most widely used weaning parameter is the rr/tidal volume (vt) ratio, although this parameter presents heterogeneous results in terms of accuracy. other relevant parameters are mip, airway occlusion pressure (p0.1), the p0.1/mip ratio, rr, vt, minute volume, and the index based on compliance, rr, oxygenation, and mip. an index created in brazil, the integrative weaning index, has shown high accuracy. although recommended, the sbt is inaccurate, approximately 15% of extubation failures going unidentified in sbts. the main limitations of the weaning indexes are related to their use in specific populations, the cut-off points selected, and variations in the types of measurement. since the sbt and the clinical impression are not 100% accurate, the weaning parameters can be useful, especially in situations in which the decision as to weaning is difficult.
Contamina??o do aparelho de anestesia por agentes patógenos
Arai, Luiza Alves de Castro;Azevedo, Ricardo Bentes;
Revista Brasileira de Anestesiologia , 2011, DOI: 10.1590/S0034-70942011000100006
Abstract: background and objectives: evaluation of contamination of anesthesia circuits by collecting 56 culture samples from the circular system; previously reprocessed tracheas by disinfection with 1% hypochlorite or 2% glutaraldehyde after being washed in non-sterile water and soap and dried by using compressed air and stored in surgical grade paper; and from other places of the non-reprocessed respiratory circuit, before anesthetic procedures. methods: samples from the inspiratory and expiratory branches of the tracheas, canister, soda-lime, and collector jar (drain) through swab in stuart medium and streaked in agar blood, mac conkey, and sabouraud growth media. results: the level of contamination with fungus and bacteria in the inspiratory and expiratory branches of tracheas reached up to 39.3% in some sites; in some cases, more than one microorganism was present, 75% fungal and 25% bacterial contamination. cultures were positive for candida sp., dermatophytus sp., penicillium sp., aspergillus sp., staphylococcus aureus, staphylococcus saprophyticus, and staphylococcus epider midis. contamination was observed in 25% of the canisters with growth of candida sp., penicillium sp., dermatophytus sp., aspergillus sp., and fusarium sp. in the collector jar, a contamination rate of 36% was observed with growth of candida sp., dermatophytus sp., s. saprophyticus and acinetobacter baumannii. microorganisms did not grow in soda-lime cultures. conclusions: in all sites investigated except for soda-lime growth of microorganisms was observed with the possibility of cross infection.
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