Guillain–Barré syndrome
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Manual of Neuroanesthesia, 2017
The patients with suspected/proven GB syndrome should be admitted to a neurointensive care unit (NICU) or a high-dependency unit where the patient can be closely monitored for the development of respiratory failure. Approximately 30% of patients develop respiratory failure and require mechanical ventilation. Routine monitoring should include heart rate, respiratory rate, effort of breathing, use of accessory muscles of respiration, and signs and symptoms of autonomic dysfunction. Forced vital capacity and negative inspiratory force should be monitored to detect respiratory dysfunction early. A vital capacity of
Lung transplantation for ILD
Muhunthan Thillai, David R Moller, Keith C Meyer in Clinical Handbook of Interstitial Lung Disease, 2017
The outcome of acute exacerbations in IPF and other types of ILD is extremely poor, and there is general reluctance at initiating mechanical ventilation when acute respiratory failure occurs. Gaudry et al. (200) confirmed poor outcomes in a group of 27 IPF or fibrotic NSIP individuals who required mechanical ventilator support, and only 30% of these patients were successfully weaned from mechanical ventilation. Survival rates for those who did not undergo transplant were very poor (4% at 6 months). Mechanical ventilation is also associated with complications such as barotrauma and ventilator-acquired pneumonia. Extracorporeal life support (ECLS) has evolved and is now increasingly used to support critically ill individuals. It can be used as a bridge to lung transplantation for patients who have progressed to respiratory failure pre-transplant, to provide haemodynamic support intra-operatively when transplantation is performed or as rescue therapy for severe PGD. In a retrospective analysis of 108 lung transplant recipients, Bittner et al. (201) found that 25% required veno-arterial ECMO at any stage, and survival was reduced in this group. The 90-day, 1-year and 5-year survival were 44%, 33% and 21%, respectively, in the ECMO group. Hayes et al. (202) examined pooled UNOS data for recipients who required pre-transplant ECMO support and found that post-transplant survival was lower in the ECMO group, especially for recipients with an IPF diagnosis and those who underwent re-transplantation, which were labelled as poor prognostic factors. Several cases on ECMO bridging to transplant have been reported for ILD. One patient with IPF received a lung transplant following 3 days on ECMO support (203), and another with stage 4 pulmonary sarcoidosis was successfully transplanted following 35 days on ECMO (204). In the most recent consensus for the selection of lung transplant candidates, ECLS is recognized formally for bridging in acute decompensation (2), and it is recommended for younger individuals without other end-organ dysfunction (see Table 26.10). There should be prior involvement and assessment by the transplant team. ECLS is associated with various risks including vascular complications, haematomas, infections and haemorrhage.
Nursing care of the cardiac catheterisation patient
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Symptoms include dyspnea, cough, sputum production, wheeze, chest tightness, exercise limitation and at the severe spectrum, complicated by fatigue, weight loss, sleep disturbance and anorexia. COPD often co-exists with cardiovascular disease, and to rule out concomitant disease processes that contribute to dyspnea and exercise intolerance, cardiac catheterisation and echocardiography may reveal additional therapeutic options such as PCI or TAVR. COPD is characterised by a chronically high level of carbon dioxide and a low level of oxygen in the blood, with the physiological mechanisms involving a ventilation-perfusion (Va/Q) mismatch and the haldane effect. Patients most susceptible to oxygen-induced hypercapnia are those with severe hypoxemia, and cautious administration of oxygen using titrated administration to achieve an oxygen saturation of 88%–92% is the best approach. Routine use of oxygen therapy in any patient with a blood oxygen saturation (SaO2) >93% is not recommended, and in COPD patients, the target of 88%–92% is also supported in current guidelines. For COPD patients presenting for procedures in the CCL, it is important that patients who are experiencing acute exacerbations of COPD have their procedure postponed if possible. Chronic obstructive sleep apnea (OSA) is an underdiagnosed problem and associated with an increased risk of coronary artery disease, hypertension, left ventricular dysfunction, arrhythmias and sudden cardiac death. Patients may be unaware they have OSA, and it is often reported first by bed-partners or may become apparent during procedures such as in the CCL. OSA is characterised by disruptive snoring, witnessed apnea or gasping, hypersomnolence and morning headache, among other signs and risk factors (e.g. obesity). Nurses in the CCL are well placed to identify patients with snoring, apneic periods, labile oxygen saturations, and hypoxia often associated with sedation and should communicate this so that patients can be referred appropriately for follow-up. Patients who use non-invasive ventilation devices (continuous positive airway pressure [CPAP] or bi-level positive airway pressure [BiPap]) should bring these to the hospital.
Early clinical characteristics and pregnancy outcomes of patients with influenza A (H1N1) infection requiring mechanical ventilation during pregnancy
Published in Journal of Obstetrics and Gynaecology, 2013
C. Chang, H. L. Gao, W. Z. Yao, H. Gao, Y. Cui
The early clinical characteristics and pregnancy outcomes of H1N1-infected pregnant women with or without mechanical ventilation were compared. In H1N1-infected pregnant women with mechanical ventilation, the gestational age was greater, the early oxygenation index was lower and early-stage pneumonic lesions were wider than patients without mechanical ventilation. Moreover, compared with the non-mechanical ventilation group, the incidence of the adverse pregnancy outcomes was higher in the mechanical ventilation group.
Mechanical ventilation in the acute respiratory distress syndrome
Published in Hospital Practice, 2017
Oleg Epelbaum, Wilbert S. Aronow
ABSTRACT The management of the acute respiratory distress syndrome (ARDS) patient is fundamental to the field of intensive care medicine, and it presents unique challenges owing to the specialized mechanical ventilation techniques that such patients require. ARDS is a highly lethal disease, and there is compelling evidence that mechanical ventilation itself, if applied in an injurious fashion, can be a contributor to ARDS mortality. Therefore, it is imperative for any clinician central to the care of ARDS patients to understand the fundamental framework that underpins the approach to mechanical ventilation in this special scenario. The current review summarizes the major components of the mechanical ventilation strategy as it applies to ARDS.
Assessment of mechanical ventilation parameters on respiratory mechanics
Published in Journal of Medical Engineering & Technology, 2012
Ramana M. Pidaparti, Kittisak Koombua, Kevin R. Ward
Better understanding of airway mechanics is very important in order to avoid lung injuries for patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine, as well as pulmonary medicine. Mechanical ventilation depends on several parameters, all of which affect the patient outcome. As there are no systematic numerical investigations of the role of mechanical ventilation parameters on airway mechanics, the objective of this study was to investigate the role of mechanical ventilation parameters on airway mechanics using coupled fluid–solid computational analysis. For the airway geometry of 3 to 5 generations considered, the simulation results showed that airflow velocity increased with increasing airflow rate. Airway pressure increased with increasing airflow rate, tidal volume and positive end-expiratory pressure (PEEP). Airway displacement and airway strains increased with increasing airflow rate, tidal volume and PEEP form mechanical ventilation. Among various waveforms considered, sine waveform provided the highest airflow velocity and airway pressure while descending waveform provided the lowest airway pressure, airway displacement and airway strains. These results combined with optimization suggest that it is possible to obtain a set of mechanical ventilation strategies to avoid lung injuries in patients.