Quantitative image analysis in COVID-19 acute respiratory distress syndrome: a cohort observational study.

Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury commonly associated with pneumonia, including coronavirus disease-19 (COVID-19). The resultant effect can be persistent lung damage, but its extent is not known. We used quantitative high resolution computed tomography (QHR-CT) lung scans to radiographically characterize the lung damage in COVID-19 ARDS (CARDS) survivors.

Mechanical Ventilator Liberation of Patients With COVID-19 in Long-term Acute Care Hospital.

Background: Mechanical ventilation (MV) via tracheostomy is performed commonly for patients who are in long-term acute care hospitals (LTACHs) after respiratory failure. However, the outcome of MV in COVID-19-associated respiratory failure in LTACHs is not known.

Research Question: What is the ventilator liberation rate of patients who have received tracheostomy with COVID-19-associated respiratory failure compared with those with respiratory failure unrelated to COVID-19 in LTACHs?

Study Design And Methods: In this retrospective cohort study, we examined mechanically ventilated patients discharged between June 2020 and March 2021.

Post-COVID recovery: characteristics of chronically critically ill patients admitted to a long-term acute care hospital.

Survivors of COVID-19 pneumonia often suffer from chronic critical illness (CCI) and require long-term hospitalization. Long-term acute care (LTAC) hospitals are vital in the care of CCI patients, but their role for patients post COVID-19 infection is not known. Barlow Respiratory Hospital (BRH) is a 105-bed, LTAC hospital network serving ventilator-dependent and medically-complex patients transferred from the ICUs of hospitals in southern California.

Determining the best threshold of rapid shallow breathing index in a therapist-implemented patient-specific weaning protocol.

Background: For weaning patients from prolonged mechanical ventilation, we previously designed a respiratory-therapist-implemented weaning protocol that decreased median weaning time from 29 days to 17 days. An acceleration step at the start of the protocol allowed patients with a rapid shallow breathing index (RSBI) of < or = 80 to advance directly to spontaneous breathing trials (SBTs).

Methods: We prospectively evaluated whether calibrating the RSBI threshold allowed more patients to safely accelerate to the 1-hour SBT in the protocol, and whether that correlated with weaning duration and outcome.

Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study.

Study Objectives: This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients.

Design: Observational study with concurrent data collection.

Setting: Twenty-three LTCHs in the United States.

Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation.

Study Objectives: This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) for weaning from mechanical ventilation.

Design: Observational study with concurrent data collection. Characteristics of the LTCHs were also surveyed.

Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol.

Background: Therapist-implemented protocols have been used to extubate or wean patients in the ICU setting. Barlow Respiratory Hospital (BRH) functions as a center for weaning patients from prolonged mechanical ventilation (PMV) in the post-ICU setting of a long-term acute-care (LTAC) facility. A therapist-implemented patient-specific (TIPS) weaning protocol was developed at BRH to standardize weaning from PMV.

Approach to patients with long-term weaning failure.

Efforts to treat reversible disease processes that contribute to ventilator dependency in the intensive care unit (ICU) fail in up to 20% of patients, resulting in prolonged mechanical ventilation (PMV). Resolution of the insults that necessitated ICU admission and mechanical ventilation may be incomplete, and the economic pressure to transfer patients is ever increasing. The choice of post-ICU disposition depends on the patient's clinical condition, the resources of the transfer destination, and whether weaning attempts will continue.

Provision of long-term mechanical ventilation.

When patients suffer prolonged mechanical ventilation, physicians are faced with a series of decisions beginning in the intensive care unit (ICU) and extending into a broadening spectrum of post-ICU levels of care. This article reviews current thinking and outcome data on when and how to perform the tracheostomy, as well as when and where the patient should be transferred from the ICU for continued weaning efforts or support. Decannulation after success in weaning and continuation of ventilation at home are also addressed.

Weaning from mechanical ventilation.

For the ventilator-dependent patient, weaning should be accomplished by withdrawing support safely, efficaciously, and efficiently. Success depends largely on physiologic determinants of respiratory system function, avoidance of ventilator-associated complications, and attention to patient readiness. Recent clinical trials, predictors of weaning, current techniques of weaning, the concept of reloading the respiratory pump, and determinants of ventilator dependency are all discussed.

Patient-ventilator trigger asynchrony in prolonged mechanical ventilation.

Study Objective: To investigate patient-ventilator trigger asynchrony (TA), its prevalence, physiologic basis, and clinical implications in patients requiring prolonged mechanical ventilation (PMV).

Study Design: Descriptive and prospective cohort study.

Setting: Barlow Respiratory Hospital (BRH), a regional weaning center.

Post-ICU mechanical ventilation: treatment of 1,123 patients at a regional weaning center.

Study Objectives: To update our database, reporting changes in the results of weaning attempts and profile of patients transferred to us after prolonged mechanical ventilation (PMV) in the ICU.

Design: Retrospective record review, with prospective recording of physiologic measurements on admission from mid-1994.

Setting: Regional weaning center (RWC).

Impact of renal dysfunction on weaning from prolonged mechanical ventilation.

BACKGROUND: In the intensive care unit (ICU) setting, the combination of mechanical ventilation and renal replacement therapy (RRT) has been associated with prolonged length of hospital stay, high cost of care and poor outcome. We gathered outcome data on patients who had severe renal dysfunction on transfer to our regional weaning center (RWC) for attempted weaning from prolonged mechanical ventilation (PMV). We screened the admission laboratory values of 1077 patients transferred to our RWC over an 8-year period.

Predictors of weaning after 6 weeks of mechanical ventilation.

Study Objective: To identify variables associated with weaning outcome in long-term ventilator-dependent patients. Using those variables, to construct models to predict weaning success and to test the accuracy of those models.

Design: Retrospective medical record review.

Weaning from prolonged mechanical ventilation. The experience at a regional weaning center.

Study Objective: The aim of this study was to describe the facility, patient population, outcome of treatment, and survival of patients transferred to a regional weaning center (RWC) after prolonged mechanical ventilation in the ICU setting.

Design: Retrospective record review.

Setting: Regional weaning center.