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Eventration of the diaphragm
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Robert E. Cilley
Response to operation may be immediate, allowing prompt weaning and extubation. In patients who have required prolonged mechanical ventilation prior to operation, slower ventilator weaning is performed. The most common postoperative complications include pneumonia and pleural effusion. Intrapleural drainage may be used briefly after surgery and is usually discontinued within a few days.
Ventilator-Associated Pneumonia
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Given the impact of VAP on individual patients and the health care systems, many studies have explored strategies to prevent VAP. It has been shown that ventilator-weaning protocols are an effective method in reducing the duration of mechanical ventilation and result a decrease in VAP incidence, especially in trauma patients (Marelich et al., 2000). In a study by Marelich and colleagues, introduction of a weaning protocol reduced the duration of mechanical ventilation by a median 154 hours compared to physician-directed weaning (Marelich et al., 2000). Other measures that have been used to reduce the risk of VAP include semi-recumbent positioning (up to 45° in patients without contraindications) and the usage of closed endotracheal suction systems (Dodek et al., 2004).
Spinal cord injuries and fractures
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Laura Sweeney, George M. Ghobrial, James S. Harrop
The need for surgery should be assessed first in order to provide spinal stability for the patient. After surgery, management of the body systems is important. Respiratory management includes early ventilator weaning, aggressive chest therapy, and determination of the need for tracheostomy or diaphragmatic pacemaker. Cardiovascular management is important in the early injury state. As health-care providers, we aim to have adequate spinal cord perfusion with elevated blood pressures (mean arterial pressure >85 mm Hg) for our patients. We also attempt to prevent autonomic dysreflexia. Other interventions we implement are skin protection, bowel and bladder regimens, pain control, and DVT prophylaxis.
Levosimendan: mechanistic insight and its diverse future aspects in cardiac care
Published in Acta Cardiologica, 2023
Md Sayeed Akhtar, Md Quamrul Hassan, Aisha Siddiqui, Sirajudeen S. Alavudeen, Obaid Afzal, Abdulmalik S.A Altamimi, Syed Obaidur Rahman, Mallika Khurana, Mohamed Jawed Ahsan, Arun Kumar Sharma, Fauzia Tabassum
Ventilator weaning is the process of a gradual decrease in ventilator support. Evidence indicated that LEVO can be used in weaning among the patients taking either inotropes or vasoconstrictors [16,84]. LEVO not only exhibits potential effects in weaning from mechanical ventilation but also improves splanchnic mucosal oxygenation suppressed by mechanical ventilation [85]. Moreover, LEVO also demonstrated efficacy in assisting weaning in patients with LV dysfunction after CABG [55]. A retrospective cohort study was conducted among 150 patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) in ICU. Data indicated its weaning advantage on these ICU patients. In another similar study among 240 patients studied LEVO for VA-ECMO therapy after cardiovascular surgery and data support its use to improve short- and long-term survival in these patients [86]. In an RCT, LEVO has been shown to improve both peak VO2 and Ventilation/VCO2 slope as well as myocardial crunch indicated by reduced plasma NT-proBNP level [87]. Moreover, study conducted in paediatric patients with anomalies to left coronary artery from pulmonary artery concurrent to impaired LV function showed strong potential of LEVO among patients who had undergone surgical repair [88]. On contrary, Mehta et al reported less benefits of LEVO in weaning from mechanical ventilation and possesses greater risk of supraventricular tachyarrhythmia (SVT) [89]. LEVO-CTS trial also indicated that LEVO with Heart-Lung Machine has been shown to be inefficient in improving the patient outcome [90].
Prospective analysis of a surgical algorithm to achieve ventilator weaning in cervical tetraplegia
Published in The Journal of Spinal Cord Medicine, 2022
Matthew R. Kaufman, Thomas Bauer, Stuart Campbell, Kristie Rossi, Andrew Elkwood, Reza Jarrahy
In properly selected patients diaphragm pacemakers have demonstrable efficacy at promoting ventilator weaning, implanted either around the phrenic nerves or at the nerve–muscle interface.3 However, as many as 20% of patients with ventilator dependency due to high spinal cord injury will fail pacing attempts.4 This is most often due to insufficiency in meeting the requirements for successful diaphragm pacing which include, most importantly, phrenic nerve integrity and preserved contractile function in the diaphragm. In multi-level cervical tetraplegia there will often be combined upper and lower motor neuron injuries rendering the phrenic nerves and diaphragm partially or completely dysfunctional. Furthermore, with longstanding, untreated spinal cord injury there is progressive neuromuscular degeneration leading to axonal loss in the phrenic nerves and irreversible denervation atrophy in the diaphragm.
High tidal volume ventilation is associated with ventilator-associated pneumonia in acute cervical spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Gabrielle E. Hatton, Patrick J. Mollett, Reginald E. Du, Shuyan Wei, Radha Korupolu, Charles E. Wade, Sasha D. Adams, Lillian S. Kao
Few studies have previously evaluated ventilator mode and weaning protocols as a preventive strategy for VAP in the acute post-SCI setting. Achievement of ventilator independence was associated with decreased incidence of VAP in patients with cervical SCI in a single-center cohort study by Call et al.22 To assess the feasibility of achieving ventilator independence by time of discharge, a multicenter observational study was conducted by the Western Trauma Association in 2013.23 Their study found that 63% of cervical SCI patients achieved ventilator independence by time of discharge. Those who were mechanically ventilated on discharge were more likely to have suffered VAP than those who achieved ventilator independence (81% vs 31%). The authors encouraged routine ventilator weaning in the acute post-SCI period.23 Similarly, the present study revealed 52% of cervical SCI patients achieved ventilator independence by hospital discharge and a similar proportion of high cervical spine injuries, reaffirming that ventilator weaning is feasible during the index hospitalization after SCI. These studies suggest that optimization of ventilator weaning and subsequent achievement of ventilator independence is likely to lead to decreased VAP and improved overall outcomes, however this has not been shown in a prospective study.