Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended. Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia. Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia. Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience. Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia. (American Journal of Critical Care. 2010;19:272-277) by AACN on April 4, 2019 http://ajcc.aacnjournals.org/ Downloaded from Although knowledge of the guidelines does not guarantee implementation and adherence, lack of knowledge may be a barrier to adherence to and implementation of VAP prevention guidelines. Many studies have focused on assessing the knowledge of ICU nurses regarding measures for the prevention of VAP. [9][10][11][12][13] Other ICU health care providers-particularly respiratory therapists, who are involved in controlling endotracheal cuff pressure, avoiding microaspiration of subglottic secretions, and controlling contamination of mechanical ventilator equipment-can have a significant effect on the prevention of VAP in patients receiving mechanical ventilation in the ICU. 14 The aim of this study was to assess the knowledge of ICU health care providers (ie, physicians, nurses, and respiratory therapists) related to evidence-based guidelines for prevention of VAP. MethodsA multiple-choice questionnaire consisting of 9 items (Table 1) that had been developed, validated, and tested by Blot et al 12 and Labeau et al 13 was distributed to all physicians, nurses, and respiratory therapists working in the ICU of a 420-bed university hospital. The ICU had 20 beds with an approximate daily average of 12 patients receiving mechanical ventilation. Any staff member who was aware of the previous 2 studies by Blot et al 12 and Labeau et al 13 was not allowed to participate in the study; such exclusion was intended to eliminate any po...

Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation.In 1987, Hall and Wood [1] suggested that weaning from mechanical ventilation, which implies the gradual withdrawal of mechanical ventilation and concomitant resumption of spontaneous breathing, is unnecessary in most patients. They proposed that the ultimate objective is not to wean but rather to liberate the patient from mechanical ventilation. Over the ensuing decades, numerous studies have investigated methods and tools for identifying readiness of mechanically ventilated patients for successful liberation from mechanical ventilation [2][3][4][5][6][7][8]. Assessing readiness for liberation from mechanical ventilationThe evaluation of patients' readiness for liberation from mechanical ventilation starts with the resolution of respiratory failure and/or the disease entity that prompted the initiation of mechanical ventilation as well as the presence of a basic level of physiological readiness (Table 1). Prediction based on clinical 'gestalt' alone is frequently inaccurate. In a study by Stroetz and Hubmayr [9], intensivists could not accurately predict patient tolerance of a 1-hour period on minimal pressure support. Also, Afessa and colleagues [10] reported that critical care practitioners could not accurately forecast 3-day and 7-day weaning outcome for mechanically ventilated patients in a medical intensive care unit (ICU). Thus, there is a sound rationale that predicting readiness of patients to be successfully liberated from mechanical ventilation needs to be based on objective weaning predictors that can be applied in clinical decision making.A large spectrum of weaning predictors has been studied, which can be divided into simple weaning indices, simple measures of load and capacity, integrative weaning indices, and complex predictors requiring special equipment. A recent expert panel [11] sponsored by the American College of Chest Physicians, Society of Critical Care Medicine, and the American Association for Respiratory Care developed evidence-based weaning guidelines and noted that only eight variables had some predictive capacity: minute ventilation (V E ), negative inspiratory force, maximum inspiratory pressure, tidal volume (V T ), breathing freq...

The present study showed no difference between amiodarone (150 mg) and placebo in preventing ventricular fibrillation after release of aortic cross-clamp. In addition, the use of lidocaine was able to reduce the incidence of ventricular fibrillation as compared with both amiodarone and placebo.

Improvements in PFT variables are more frequent and profound with heliox-driven compared to air-driven bronchodilator therapy only in asthmatic patients with baseline FEV(1) ≤50 %.

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