Enhancing the awakening to family engagement bundle with music therapy.

Survivors of prolonged intensive care unit (ICU) admissions may present undesirable long-term outcomes. In particular, physical impairment and cognitive dysfunction have both been described in patients surviving episodes requiring mechanical ventilation and sedation. One of the strategies to prevent the aforementioned outcomes involves the implementation of a bundle composed by: (1) Spontaneous awakening trial; (2) Spontaneous breathing trial; (3) Choosing proper sedation strategies; (4) Delirium detection and management; (5) Early ICU mobility; and (6) Family engagement (ABCDEF bundle).

A 55-Year-Old Woman With Frequent Pulmonary Exacerbations and Endobronchial Lesions.

A 55-year-old woman with COPD, heart failure with preserved ejection fraction (congestive heart failure), diabetes mellitus, and hypertension presented with baseline dyspnea at rest that had worsened over the last week. She reported associated runny nose, congestion, and cough productive of green sputum. She smoked six cigarettes per day and denied alcohol, drugs, or occupational exposure.

The dynamic treatment of SARS-CoV-2 disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or novel coronavirus disease 2019 (COVID-19) emerged from China in December 2019 and progressed to become a global pandemic. Our understanding of its pathophysiology and potential management was initially extrapolated from previous epidemics of coronaviruses like SARS and MERS. SARS-CoV-2 is asymptomatic or minimally symptomatic in more than 80% of patients and requires no additional management; however, the remaining patients progress to pneumonia and hypoxemia with ranging severity, including a smaller group that requires intensive care unit admission.

The acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a prevalent cause of acute respiratory failure with high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of well-demonstrated therapeutic interventions are essential to change the natural course of this entity and bring about positive clinical outcomes. In this article, we review updated concepts in ARDS.

Model for End-Stage Liver Disease-Lactate and Prediction of Inpatient Mortality in Patients With Chronic Liver Disease.

Background And Aims: Compared to other chronic diseases, patients with chronic liver disease (CLD) have significantly higher inpatient mortality; accurate models to predict inpatient mortality are lacking. Serum lactate (LA) may be elevated in patients with CLD due to both tissue hypoperfusion as well as decreased LA clearance. We hypothesized that a parsimonious model consisting of Model for End-Stage Liver Disease (MELD) and LA at admission may predict inpatient mortality in patients with CLD.

Strategies for communicating with conscious mechanically ventilated critically ill patients.

Critically ill patients admitted to the intensive care unit (ICU) frequently require ventilatory support. To provide this life-saving therapy, oral intubation or tracheostomy placements are needed. Consequently, verbal ability to communicate is lost.

Hereditary afibrinogenemia and pulmonary-renal hydralazine-induced vasculitis.

Combined pulmonary-renal hydralazine-induced vasculitis is rare, and hereditary afibrinogenemia is also rare. We present a case of a 62-year-old man with a history of hereditary afibrinogenemia who presented with hemoptysis and hematuria. Although he had prior episodes of hemoptysis that resolved with repletion of fibrinogen levels, a hydralazine-induced vasculitis was the ultimate cause of his recurrent hemoptysis and hematuria.

Use of neuromuscular blocking agents in acute respiratory distress syndrome.

Acute respiratory distress syndrome is the result of an acute inflammatory response of the lungs, causing severe hypoxemia. A variety of therapeutic modalities have been extensively studied, with only a few demonstrating improvement in survival. Specifically, mechanical ventilation with use of low tidal volumes, prone positioning, and treatment with neuromuscular blocking agents have proven beneficial.

Factors among patients receiving prone positioning for the acute respiratory distress syndrome found useful for predicting mortality in the intensive care unit.

Optimal mechanical ventilation management in patients with the acute respiratory distress syndrome (ARDS) involves the use of low tidal volumes and limited plateau pressure. Refractory hypoxemia may not respond to this strategy, requiring other interventions. The use of prone positioning in severe ARDS resulted in improvement in 28-day survival.

Comparison of Cisatracurium Versus Atracurium in Early ARDS.

Background: Administration of cisatracurium in severe ARDS decreases in-hospital mortality. Whether clinical outcomes are cisatracurium-specific or related with all neuromuscular blockers is unknown. This study aimed to compare outcomes in severe ARDS patients treated with cisatracurium versus atracurium.

Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function: A 5-Year Retrospective Analysis.

Background: The role of B-type natriuretic peptide (BNP) is less understood in the risk stratification of patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), especially in patients with normal left ventricular ejection fraction (LVEF).

Methods: This retrospective study from 2008 to 2012 evaluated all adult patients with AECOPD having BNP levels and available echocardiographic data demonstrating LVEF ≥40%. The patients were divided into groups 1, 2, and 3 with BNP ≤ 100, 101 to 500, and ≥501 pg/mL, respectively.

Mechanical Ventilation in Patients with the Acute Respiratory Distress Syndrome and Treated with Extracorporeal Membrane Oxygenation: Impact on Hospital and 30 Day Postdischarge Survival.

Mechanical ventilation support for acute respiratory distress syndrome (ARDS) patients involves the use of low tidal volumes and positive end-expiratory pressure. Nevertheless, the optimal ventilator strategy for ARDS patients undergoing extracorporeal membrane oxygenation (ECMO) therapy remains unknown. A retrospective analysis of a consecutive series of adult ARDS patients treated with V-V ECMO from October 2012 to May 2015 was performed.

Serum hyperchloremia as a risk factor for acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.

A high serum chloride concentration has been associated with the development of acute kidney injury in critically ill patients. However, the association between hyperchloremia and acute kidney injury (AKI) in patients admitted with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) is unknown. A retrospective analysis of consecutive patients admitted with the diagnosis of STEMI and treated with PCI was performed.

Liberal Manipulation of Ventilator Settings and Its Impact on Tracheostomy Rate and Ventilator-Free Days.

Background: The utilization of checklists, bundles, and protocols attempts to provide standardization in the delivery of patient care. Despite important progress obtained in the prevention of hospital-acquired infections, the daily management of mechanical ventilation is still prone to heterogeneity, depending on the number of providers manipulating the ventilator. Whether the number of changes made on ventilator parameters impacts clinical outcomes remains unknown.

The acute respiratory distress syndrome.

The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity.

Humidification during mechanical ventilation in the adult patient.

Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed.

Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Nonmechanically Ventilated Patients.

Background: Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown.

Methods: This is a retrospective analysis of data obtained during the implementation of a quality improvement project consisting of the utilization of a nurse-led ICU checklist.

The scientific basis for protocol-directed respiratory care.

As defined by the American Association for Respiratory Care, respiratory care protocols are "guidelines, usually written in algorithmic form, for providing respiratory therapy services." The need for protocols has been framed by the frequent occurrence of misallocation of respiratory care, consisting both of over-ordering (ie, prescribing respiratory care that is unlikely to confer benefit) and under-ordering services (ie, failing to prescribe services that would be expected to offer benefit). In this context, the current paper reviews available studies regarding the effectiveness of respiratory care protocols.

The effect of a mechanical ventilation discontinuation protocol in patients with simple and difficult weaning: impact on clinical outcomes.

Objective: We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning.

Methods: This was a retrospective analysis of prospectively collected data obtained during a quality improvement project. We collected data on 803 consecutive mechanically ventilated patients admitted to the ICU of an academic tertiary care hospital.

Extended utilization of noninvasive ventilation for acute respiratory failure and its clinical outcomes.

Background: Noninvasive ventilation (NIV) has increasingly been used for the treatment of acute respiratory failure. Despite recommendations supporting its utilization in a limited group of patients, NIV is frequently relied on as a first line treatment. We conducted a retrospective study to assess whether the extended use of NIV is associated with worse clinical outcomes.

Physician-ordered aerosol therapy versus respiratory therapist-driven aerosol protocol: the effect on resource utilization.

Background: The utilization of respiratory therapist (RT) driven protocols for single interventions, such as oxygen titration and bronchopulmonary hygiene, and protocols consisting of multiple interventions have been associated with improvements in resource utilization. Based on this, we started a quality improvement project to transition the delivery of respiratory care services from physician-ordered treatments to RT-driven protocols. During the first phase of our quality improvement project, we compared the frequency of bronchodilator administration and its associated costs, between a physician-ordered bronchodilator strategy and a RT-driven bronchodilator protocol strategy.

The ICU follow-up clinic: a new paradigm for intensivists.

Over the last 15 years the management of patients admitted in the ICU has changed dramatically. A growing number of well designed randomized controlled studies have been published, resulting in improved medical care and reduction of short-term morbidity and mortality. Despite these important achievements, little attention has been placed on the long-term complications of subjects discharged from the ICU.