Mechanically ventilated patients

Consider continuous subglottic suctioning in mechanically ventilated patients... 

Adjunctive therapies nutrition, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, and sedation for mechanically ventilated patients. 

Patients with progressive hypoxia leading to ARDS require mechanical ventilation. Critically ill patients may require sedation when high ventilator settings are used or when patients fight the ventilator. Mechanically ventilated patients should receive sedation by a protocol that includes a daily interruption or lightening of a sedative infusion until the patient is awake.24 The utilization of sedation protocols decreases the duration of mechanical ventilation, length of hospitalization, and tracheostomy rates. 

Ely EW, Shintani A, Truman B et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291 (14) 1753-1762... 

Sophisticated methods for assessing energy expenditures of hospitalized patients are now commercially available. One such method to calculate the REE involves the use of Vco, and V0, in expired air. An indirect calorimetric assay is employed to measure Vco, and V0, from the mechanically ventilated patient. REE can be calculated as follows ... 

PAOP This must be lower than the PA diastolic pressure to ensure forward flow. It is drawn as an undulating waveform similar to the CVP trace. The normal value is 6-12 mmHg. The values vary with the respiratory cycle and are read at the end of expiration. In spontaneously ventilating patients, this will be the highest reading and in mechanically ventilated patients, it will be the lowest. The PAOP is found at an insertion length of around 45 cm. 

Fuller, H.D., Dolovich, M.B., Posmituck, G., Wong, Pack, W., and Newhouse, M.T., Pressurized aerosol versus jet aerosol delivery to mechanically ventilated patients. Am. Rev. Resp. Dis., 142 440-444 (1990). 

O Riordan, T.G. Pahner, L.B. Smaldone, G.C. Aerosol deposition in mechanically ventilated patients optimizing nebulizer delivery. Amer. J. Resp. Crit. Care Med. 1994, 149, 214-219. 

Endotracheal instillation of mesna was compared with instillation of saline in mechanically ventilated patients. Following instillation of mesna, there was a significant increase in maximal airway resistance and impairment of oxygenation with a slight increase in PaC02 (SEDA-20, 183). A single episode of... 

Leatherman JW, Fluegel WL, David WS, Davies SF, Iber C. Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med 1996 153(5) 1686-90. 

Margolis BD, Khachikian D, Friedman Y, Garrard C. Prolonged reversible quadriparesis in mechanically ventilated patients who received long-term infusions of vecuronium. Chest 1991 100(3) 877-8. 

Fats have the lowest RQ, but administration of intravenous fat emulsions to mechanically ventilated patients may have the potential to adversely affect pulmonary gas exchange in some clinical conditions. ... 

Saux, R Martin, C. Mallet, M.-N. Papazian, L. Bruguerolle, B. De Mice, R Gouin, F. Penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia. Antimicrob.Agents Chemothen, 1994, 38, 901-904 [serum pharmacokinetics column-switching fluorescence detection LOD 15 ng/mL]... 

B. Propofol is useful in the intensive care unit for sedation of mechanically ventilated patients. It may be beneficial for conscious sedation in certain settings. 

MacInt5TC N, Silver R, Miller C, Schuler F, Coleman E. Aerosol delivery to intubated, mechanically ventilated patients. Crit Care Med 1985 13 81-84. 

Palmer LB, Smaldone GC, Simon SR, O Riordan TG, Cuccia A. Aerosolized antibiotics in mechanically ventilated patients delivery and response. Crit Care Med 1998 26 31-39. 

Gay PC, Patel HG, Nelson SB, Gilles B, Hubmayr RD. Metered dose inhalers for bronchodilator delivery in intubated, mechanically ventilated patients. Chest 1991 99 66-71. 

Pierce, L.N.B. 2007. Management of the Mechanically Ventilated Patients, 2nd ed., Saunders Elsevier, St. Louis, Missouri. 

To provide the range of support required, from the paralyzed mechanically ventilated patient to the patient receiving monitored anesthesia care, a versatile anesthesia delivery system must be available to the anesthesia care team. Today s anesthesia delivery system comprises six major elements (Figure 19.1) ... 

Ensure elevation of the head of the bed to more than 30° for all mechanically ventilated patients. Minimize the duration of mechanical ventilation by minimizing sedative administration (including daily sedation holidays) and/or using protocol-based weaning. 

Mcmullin, B.B., Chittock, D.R., Roscoe, D.L., Garcha, H., Wang, L., Miller, C.C., 2005. The antimicrobial effect of nitric oxide on the bacteria that cause nosocomial pneumonia in mechanically ventilated patients in the intensive care unit Respiratory Care 50,1451-1456. 

Dolch ME, Frey L, Homuss C, et al. Molecular breath-gas analysis by online mass spectrometry in mechanically ventilated patients a new software-based method of COj-controlled alveolar gas monitoring. J Breath Res. 2008 2 037010 10. 

Due to its potential for respiratory depression, remifentanil is not recommended for post-operative analgesia, except in mechanically ventilated patients in a properly supervised environment. 

Sedation for intubated and mechanically ventilated patients is generally achieved with a loading dose of 1 pg/kg infused over 10 minutes followed by a continuous infusion 0.2 to 0.7 pg/kg per h. Over this range, dexmedetomidine exhibits hnear effects and pharmacokinetics when administered for up to 24 hours in individuals with normal hepatic and renal function. 

Mylotte JM. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Crit Care 2009 13(4) R117-28. 

Pepe PE, Marini JJ. Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction the auto-PEEP effect. Am Rev Respir Dis 1982 126 166-170. 

Mechanically ventilated patients are at risk for pulmonary infections for several reasons (58-60). The natural glottic closure protective mechanism is compromised by an endotracheal tube. The tube itself impairs the cough reflex and serves as an additional potential portal for pathogens to enter the lungs, especially if the circuit is contaminated. The lung is more prone to infections, because of the underlying disease. And the intensive care unit environment is itself a risk for a variety of infections. 

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