Weaning from Mechanical Ventilation in ARDS: Aspects to Think about for Better Understanding, Evaluation, and Management

Wawrzeniak, Iuri Christmann; Vieira, Sílvia Regina Rios; Victorino, J.A.

doi:10.1155/2018/5423639

Cited by 23 publications

(27 citation statements)

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“…In the most severe cases, the use of a Neuro-muscular blockade (NMB), prone position, and Extra-corporeal membrane oxygenation (ECMO) will be evaluated when there is refractory hypoxemia. These initial strategies are the key to successfully treating ARDS and therefore weaning success and reducing MV time [14].…”

Section: Resultsmentioning

confidence: 99%

“…The presence of asynchrony during the weaning of ARDS patients from MV could be better quantified and distinguished. The presence of asynchrony, both quantity, and type, could be considered a predictor of MV weaning failure in patients with ARDS [14]. 35.4% of respondents agreed to monitor asynchrony for the treatment of ARDS, making it the least agreed from all the other possible solutions.…”

Section: Resultsmentioning

confidence: 99%

“…In this surge of Covid 19, the use of ventilators has increased to a great extent [11]. Overuse of ventilators welcomes several complications like Ventilator-Associated pneumonia and microaspiration [12], barotrauma [13], Acute respiratory distress syndrome (ARDS) [14].…”

Section: Introductionmentioning

confidence: 99%

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Unmasking the Current Scenario of Indian Biomedical Devices Industry: Ventilators being the Heart of the Discussion

Pramanik

Karmakar

Mukherjee

et al. 2021

Preprint

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Background The Indian Biomedical Device Industry has been growing at an unprecedented rate, but several hindrances need to be acknowledged in offering access to quality, budget-friendly medical devices in India. This article explores the current loopholes of the Indian biomedical device industry along with the proposal of various innovative solutions, with emphasis on ventilators. Methods An online survey with the help of Google forms was conducted from 1st November to 25th December 2020, addressing the problems of the Indian medical device industry (MDI) along with probable solutions. The survey also provides a glimpse into the complications aroused from the frequent use of ventilators during COVID-19 outburst, along with possible measures. Results According to the survey, 51.6%, 46.5%, 55.7%, and 47.5% of respondents have agreed to 'Stringent laws and implementation,' 'Safety testing and strict regulations,' 'Unfavorable duty structure,' and 'Reducing tax rate on domestic manufacturers,' as a possible solution to advance the implementation of ISO 13485 and ISO 10651, implementation of ISO 14971, the probable cause of limitations of Indian MDI, possible measure to overcome limitations of Indian MDI, respectively. 46.7%, 47.5%, 46.2%, and 44.6% of respondents have agreed to 'Surgical decompression,' 'Nebulized and broad-spectrum antibiotics,' 'PEEP,' and 'Adopting lung protective ventilation strategies' as possible solutions to treat various ventilator complications, respectively. Conclusion The study briefs about the people's perception of the Indian MDI as well as on the ventilator complications. The results complied with our hypothesis as the majority of the respondents have agreed with almost all the probable solutions in both the sections given by us as options.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Unmasking the Current Scenario of Indian Biomedical Devices Industry: Ventilators being the Heart of the Discussion

Pramanik

Karmakar

Mukherjee

et al. 2021

Preprint

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“…The reason for the reintubation could be exacerbation of the respiratory workload owing to the lung brosis. It has been reported that the success rate of extubation is higher when respiratory effort and diaphragmatic muscle strength are added to the evaluation, besides the conventional extubation criteria [41,42].…”

Section: Discussionmentioning

confidence: 99%

Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

Taniguchi

Ohya

Yamagata

et al. 2021

Preprint

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Background: Some patients with severe coronavirus disease (COVID-19) who present with fibrosis on computed tomography (CT) require prolonged mechanical ventilation (PMV). Lung ultrasound (LUS), a rapid, bedside test, has been reported to have findings consistent with those of CT. Thus, this study aimed to assess whether serial LUS scores could predict PMV or successful extubation in severe COVID-19 patients.Methods: LUS was performed for 20 consecutive severe COVID-19 patients at three time points: admission (day 1), after 48 h (day 3), and seventh-day follow-up (day 7). We compared the LUS score with the results of chest X-rays and laboratory tests at three time points. Moreover, we assessed LUS score to determine the inter-rater reliability (IRR) of the results among examiners.Results: While there were no significant differences in mortality in each PMV and successful extubation groups, there were significant differences in LUS scores on day 3 and day 7; XP score on day 7; and P/F ratio on day 7 in the PMV group (p<0.05). There were significant differences in LUS scores on days 3 and 7, C-reactive protein (CRP) levels on day 7, and P/F ratio on day 7 in the successful extubation group (p<0.05). The areas under the curves (AUCs) of LUS score on days 3 and 7, XP score on day 7, and P/F ratio were 0.88, 0.98, 0.77, and 0.80, respectively in the PMV group; and the AUCs of LUS score on days 3 and 7, CRP levels on day 7, and P/F ratio 0.79, 0.90, 0.82, and 0.79, respectively, in the successful extubation group. Variations in serial LUS scores exhibited significant differences between the groups. The serial LUS score on day 7 was higher than that on day 1 in the PMV group but lower in the successful extubation group (p<0.05). However, there was slight IRR agreement in the LUS score changes on days 1 to 7 (κ= 0.15 [95% CI: 0-0.31]). Conclusions: The serial LUS score of severe COVID-19 patients could predicted PMV and successful extubation. To overcome IRR disagreement, the automatic ultrasound judgement, such as deep learning, would be needed.

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“…3 Weaning from mechanical ventilation is studied for many years and includes skills as well as thorough knowledge .Weaning can be simple in few patients but it may be difficult in others and may lead to prolonged weaning. 4 As associated mechanical ventilation complications, one must try to wean from mechanical ventilation as early as underlying cause is towards resolving side and spontaneous breathing can be maintained by patient. Weaning failure is an important concern because it may end in increased morbidity, prolonged hospital stay, increased cost and mortality.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dexmedetomidine versus Midazolam in weaning from mechanical ventilation and length of stay in ICU.

Dodhy¹

2020

TPMJ

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Objectives: To compare the role of dexmedetomidine versus midazolam as sedative in facilitating early mechanical ventilation weaning thereby decreasing ICU cost. Study Design: Randomized Controlled trial. Setting: Surgical ICU of Lahore General Hospital, Lahore. Period: December 2018 to July 2019. Material & Methods: Total of 60 adult postoperative patients (30 in each group) who required mechanical ventilation in the surgical ICU for minimum 24 hours postoperatively after major pelvi-abdominal operations were included. Patients of group “A” and “B” received midazolam infusion 20-100 mcg/kg/hr & dexmedetomidine infusion 0.2-0.7 μg/kg/hr respectively while being mechanically ventilated. The degree of sedation was measured by using the Richmond agitation sedation score (RASS) every 6 hourly. Extubation time (i.e. time from termination of drug to extubation) was recorded. The time of ICU length of stay was also recorded Results: Mean age of patients was 41.97 ±10.21 and 42.57±10.93 years in group-A and B, respectively. In group-A 18 patients (60%) and in group-B 16 patients (53.0%) were male while 12 patients (40%) in group-A and 14 patients (47.0%) were females. A significant decrease in extubation time was observed in Group-B when compared with the Group-A (p=0.046) along with odds ratio 0.938 while no significant relationship could be proved between length of stay at ICU between two groups. Stratification with regard to age, gender height, weight and type of surgery was carried out. Conclusion: Dexmedetomidine is more favourable than midazolam for sedation in intensive care patients by facilitating early exubation and decreasing the duration of invasive ventilation while no significant relationship could be proved in two groups between length of stay in intensive care unit.

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Weaning from Mechanical Ventilation in ARDS: Aspects to Think about for Better Understanding, Evaluation, and Management

Cited by 23 publications

References 100 publications

Unmasking the Current Scenario of Indian Biomedical Devices Industry: Ventilators being the Heart of the Discussion

Unmasking the Current Scenario of Indian Biomedical Devices Industry: Ventilators being the Heart of the Discussion

Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

Comparison of Dexmedetomidine versus Midazolam in weaning from mechanical ventilation and length of stay in ICU.

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