Abstract:Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by respiratory muscle insufficiency and/or lung parenchymal disease; that is, when other treatments such as medication, oxygen administration, secretion management, continuous positive airway pressure (CPAP), or nasal high-flow therapy have failed. MV is required for maintaining gas exchange and allows more time to curatively treat the underlying cause of respir… Show more
ZusammenfassungDie vorliegende Leitlinie umfasst ein aktualisiertes Konzept der Behandlung und Prävention von erwachsenen Patienten mit ambulant erworbener Pneumonie und löst die bisherige Leitlinie aus dem Jahre 2016 ab.Sie wurde entsprechend den Maßgaben zur Methodologie einer S3-Leitlinie erarbeitet und verabschiedet. Hierzu gehören eine systematische Literaturrecherche und -bewertung, die strukturierte Diskussion der aus der Literatur begründbaren Empfehlungen sowie eine Offenlegung und Bewertung möglicher Interessenskonflikte.Die Leitlinie zeichnet sich aus durch eine Zentrierung auf definierte klinische Situationen, eine aktualisierte Maßgabe der Schweregradbestimmung sowie Empfehlungen zu einer individualisierten Auswahl der initialen antimikrobiellen Therapie.Die Empfehlungen zielen gleichzeitig auf eine strukturierte Risikoevaluation als auch auf eine frühzeitige Bestimmung des Therapieziels, um einerseits bei kurativem Therapieziel die Letalität der Erkrankung zu reduzieren, andererseits bei palliativem Therapieziel eine palliative Therapie zu eröffnen.
ZusammenfassungDie vorliegende Leitlinie umfasst ein aktualisiertes Konzept der Behandlung und Prävention von erwachsenen Patienten mit ambulant erworbener Pneumonie und löst die bisherige Leitlinie aus dem Jahre 2016 ab.Sie wurde entsprechend den Maßgaben zur Methodologie einer S3-Leitlinie erarbeitet und verabschiedet. Hierzu gehören eine systematische Literaturrecherche und -bewertung, die strukturierte Diskussion der aus der Literatur begründbaren Empfehlungen sowie eine Offenlegung und Bewertung möglicher Interessenskonflikte.Die Leitlinie zeichnet sich aus durch eine Zentrierung auf definierte klinische Situationen, eine aktualisierte Maßgabe der Schweregradbestimmung sowie Empfehlungen zu einer individualisierten Auswahl der initialen antimikrobiellen Therapie.Die Empfehlungen zielen gleichzeitig auf eine strukturierte Risikoevaluation als auch auf eine frühzeitige Bestimmung des Therapieziels, um einerseits bei kurativem Therapieziel die Letalität der Erkrankung zu reduzieren, andererseits bei palliativem Therapieziel eine palliative Therapie zu eröffnen.
“… Part 1-Basic information: primary reasons for hospitalization, primary reasons for ICU admission, primary reasons for MV (indications for MV), the method for intubation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) ( 14) at before or within 24 hours after ICU admission, medical history (including smoking, time of MV) and complications (15,16). Part 2-Weaning information:…”
Section: Data Collection Of Registered Patientsmentioning
Background: Mechanical ventilation (MV) is an important lifesaving method in intensive care unit (ICU).Prolonged MV is associated with VAP and other complications. However, premature weaning from MV may lead to higher risk of reintubation or mortality. Therefore, timely and safe weaning from MV is important. In addition, identification of the right patient and performing a suitable weaning process is necessary. Although several guidelines about weaning have been reported, compliance with these guidelines is unknown.Therefore, the aim of this study is to explore the variation of weaning in China, associations between initial MV reason and clinical outcomes, and factors associated with weaning strategies using a multicenter cohort.Methods: This multicenter retrospective cohort study will be conducted at 17 adult ICUs in China, that included patients who were admitted in this 17 ICUs between October 2020 and February 2021. Patients under 18 years of age and patients without the possibility for weaning will be excluded. The questionnaire information will be registered by a specific clinician in each center who has been evaluated and qualified to carry out the study.
“…Additionally, weaning needs an adequate gas exchange (defined by the majority of studies as an increase in the arterial oxygen tension/fractional inspired oxygen ratio > 200), an intact sensorium, suitable muscular and neurological function, and stable cardiovascular function. A normal hemoglobin (Hb) level enhances oxygen transport to body cells, and a standard level of blood electrolyte and a status of good nutrition further reduce the risk of fatigue of respiratory muscle during the weaning phase (5) .…”
Background: Weaning from mechanical ventilation can be defined as the process of abruptly or gradually withdrawing ventilatory support. Recommendations for weaning practice would be based on the findings of multiple well-designed randomized trials conducted over the past decade. In comparison to more progressive removal of ventilatory aid, quick extubation following successful spontaneous breathing trials expedites weaning and minimizes the time of mechanical ventilation (MV). More recently, pressure support ventilation and bi-level positive airway pressure modes have become available. Modern ventilators are increasingly sensitive, allowing easy patient triggering of supported breaths, modes such as tube compensation, and measurement of numerous respiratory parameters. Developments in weaning techniques have paralleled these improvements in ventilator functionality. Objective: In this review article, the initially required criteria to start and the weaning methods from mechanical ventilation. Methods: These databases were searched for articles published in English in 3 databases [PubMed -Google scholar-science direct] and Boolean operators (AND, OR, NOT) had been used such as [Weaning AND Mechanical Ventilation OR Intensive Care Unit] and in peer-reviewed articles between 1992 and 2021. Documents in a language apart from English have been excluded as sources for interpretation were not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers, and dissertations. Conclusion: All cases that received ventilatory assistance should be evaluated daily for weaning suitability. This may include satisfying several preconditions and then undergoing an SBT. If weaning is ineffective, either PSV or daily spontaneous breathing spells of increasing length should be tried.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.