Prone positioning enhances lung recruitment and decreases alveolar instability and hyperinflation observed at high PEEP in patients with ARDS.

HCPs who have specific training in mechanical ventilation increase their ability to identify asynchrony using waveform analysis. Neither experience nor profession proved to be a relevant factor to identify asynchrony correctly using waveform analysis.

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International study conducted in 20 countries through an online survey. Participants: Physicians, respiratory therapists, nurses and physiotherapists that are currently working at the Intensive Care Unit (ICU). Main variables of interest: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) with the ability of HCPs to correctly identify and manage 6 PVA. Results: A total of 431 HCPs answered a validated survey. The main factors associated with the proper recognition of PVA were: specific training program in mechanicalventilation (MV) (OR 2.27; 95% CI 1.14-4.52; p = 0.019), courses with more than 100 hours completed (OR 2.28; 95% CI 1.29-4.03; p = 0.005) and the number of intensive care unit (ICU) beds (OR 1.037; 95% CI 1.01-1.06; p = 0.005). The main factor that influenced PVA management was recognizing 6 PVA correctly (OR 118.98;; p < 0.001). Conclusion:Identifying and managing PVA using ventilator waveform analysis is influenced by many factors including specific training programs in MV, number of ICU beds and the recognized number of PVA.

International study conducted in 20 countries through an online survey. Participants: Physicians, respiratory therapists, nurses and physiotherapists that are currently working at the Intensive Care Unit (ICU). Main variables of interest: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) with the ability of HCPs to correctly identify and manage 6 PVA. Results: A total of 431 HCPs answered a validated survey. The main factors associated with the proper recognition of PVA were: specific training program in mechanicalventilation (MV) (OR 2.27; 95% CI 1.14-4.52; p = 0.019), courses with more than 100 hours completed (OR 2.28; 95% CI 1.29-4.03; p = 0.005) and the number of intensive care unit (ICU) beds (OR 1.037; 95% CI 1.01-1.06; p = 0.005). The main factor that influenced PVA management was recognizing 6 PVA correctly (OR 118.98;; p < 0.001). Conclusion:Identifying and managing PVA using ventilator waveform analysis is influenced by many factors including specific training programs in MV, number of ICU beds and the recognized number of PVA.

The decrease in mortality in critical patient units led to an increase in intensive care unit acquired weakness (ICUAW) (Rev Med Chile 2017; 145: 1137-1144

BACKGROUND: Auscultation is a fundamental part of the physical examination, but its utility has been questioned due to the low inter-rater concordance. We therefore sought to evaluate the concordance of the discrimination of lung sound recordings between experienced physiotherapists. METHODS: Lung sound recordings were selected and validated by an expert panel when Fleiss concordance was > 0.75. Eleven recordings were played for subject recognition using a portable computer in their workplace. Results were analyzed using Fleiss when looking for concordance between physiotherapists. Univariate regression was performed to determine if there was an association with clinical training, years of experience, academic accomplishment, or university affiliation. RESULTS: Sixty-nine physiotherapists with a median of 4 years of working experience (interquartile range 2-6 y) completed the study. There was moderate concordance (‫؍‬ 0.562; 95% CI 0.462-0.605) for overall lung sound recording discrimination. For continuous and noncontinuous lung sound recordings, discrimination concordance was substantial (‫؍‬ 0.63 and ‫؍‬ 0.76, respectively). A bivariate analysis revealed that years of experience presented an inverse association with stridor recognition. CONCLUSIONS: Concordance between physiotherapists in discriminating recorded lung sounds was moderate. The ability to recognize stridor was inversely associated with years of work experience.

ObjectiveTo evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation.MethodsBetween the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates.ResultsThe mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma.ConclusionPercutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure.