The ventilator discontinuance process is one of the most important components of overall management of ventilator patients. In these cases, the clinician must balance between the patient’s capabilities and the patient’s demands. When the demands of the patient outweigh the capabilities of the patient, mechanical ventilation needs to be sustained and when the capabilities of the patient outweigh the demands of the patient, discontinuation of mechanical ventilation is possible. The role of the respiratory therapist in this decision to discontinue ventilator support is very important as many complications can be incurred if the patient is removed from ventilator support before the patient is ready or if the patient is left on the ventilator longer than necessary. These complications, along with the guidelines for ventilator discontinuance and protocol, will be discussed in this paper.
Mr J is sedated for comfort while intubated but it is proven that reducing sedation and extubating a patient as soon as appropriate will help avoid VAP (DeBakey 2010). The ETT can hinder natural mechanisms that normally protect the airways including muccocillary flow, hair, saliva, sneeze, and cough reflex, and this may lead to the result of bacteria moving into the lung and lower lobes easily (DeBakey 2010). Mr J had a MAAS score of 1 on admission (Responsive only to noxious stimuli) with one factor being heavy sedation, but later on his MAAS score improved to 3 (Calm and cooperative) which can enable the extubation assessment process (DeBakey 2010).
According to the Center for Disease Control and Prevention (CDC) (2014), “the number of times people were in the hospital with sepsis or septicemia (another word for sepsis) increased from 621,000 in the year 2000 to 1,141,000 in 2008. Between 28 and 50 percent of people who get sepsis die”. Sepsis is a complication of serious infection and has a high mortality rate. The CDC (2014) also mentioned the high risk groups are immunocompromised, infants and children, elderly, and patients with chronic illness. According to Gauer (2013), “Sepsis is responsible for 20% of all in-hospital deaths each year (210,000), which
In the United States alone 600,000 new cases are diagnosed each year. It has been referred to as "Economy Class Syndrome" due to the occurrence on long flights. One in every 100 patients who develop DVT die from pulmonary embolism (PE). If PE can be diagnosed and treatment started the mortality rate can be reduced from 30% to less than 10%.
Within the intensive care population, the use of prophylactic treatment is used to prevent the risk of venous thrombosis. These patients in particular are at a greater risk for developing thromboembolism due to heightened immobility. The increased risk of venous thrombosis occurs in this population due to the use of mechanical ventilation, sedation and paralytics (Cook & Crowther, 2010). Venous thrombosis can significantly increase the risk of a patient developing a pulmonary embolism. Additionally, it can create long term impacts such as post-thrombotic syndrome. This syndrome occurs twenty to fifty percent after the development of the thrombosis. This can have momentous impacts on individual’s ability
With an increasing number of patients presenting to the Emergency Department the time of door to TPA is becoming less and it is becoming more important for health care providers to recognize the signs of a stroke. According to the Center for Disease Control and Prevention (CDC) (2017) every 40 seconds someone in the United States has a stroke and every four minutes someone in the United States dies from a stroke. These numbers account for more than 795,000 strokes in the United States per year (Division for Heart Disease and Stroke Prevention, 2017). Cerebrovascular accidents (CVA) are the second leading cause of death in the world and the first leading cause of permanent disability in adults (Santos, J., Melo, E., Silveira Junior, J., Vasconcelos,
This case scenario also helped me appreciate evidence-based practice and the use of current published literature in informing healthcare decisions. It is essential during critical care the signs and symptoms of VAP must be assessed periodically and try to avoid it. I should be aware of the first line of intervention, If faced with a similar situation in the future, I will still follow the same interventions we employed in caring for patients with VAP for my continuing professional development, I will learn more about complications and how we can avoid
This is a direct consequence of acute airway narrowing and critical increases in airway resistance. These lead to two important mechanical changes: the increased pressures required for airflow may overload respiratory muscles leading to hypercapnic respiratory failure, and the narrowed airways create regions of lung that cannot properly empty and return to their resting volume (MacIntyre & Huang, 2008, p. 532). The patient needs to be monitored for tachypnea, cyanosis, altered LOC, or wheezing to alert the health care team to possible respiratory failure. Both of these complications will require immediate intervention, as both dysrhythmias and respiratory failure quickly decrease perfusion to vital organs and can be
Ventilator-associated pneumonia is the most common and deadly healthcare associated infection, affecting up to 28 percent of ventilated patients. VAP is estimated to occur is 9-27 percent of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization. VAP rates range from1.2 to 8.5 per 1000 ventilator days and are reliant on the definition used for diagnosis. Early onset VAP is defined as pneumonia that occurs within four days and this is
Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection associated with increased morbidity and mortality. It is recognized that 36-60% of all health associated infection-related deaths are attributable to VAP (Gupta et al, 2016). Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator for more than 48 hours, usually patients in the intensive care unit (ICU) at a hospital. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or
Sepsis has gained much focus as a major global health problem. Since 2003, an international team of experts came together to form the Surviving Sepsis Campaign (SSC), in the attempts to combat an effectively treat sepsis. Although, diagnostics and protocols have been developed to identify high risk patients, the need for human clinical assessment is still necessary to ensure a proper diagnosis is made and appropriate treatment is initiated in a timely manner. The use of a highly efficient and experienced team, such as, the electronic Intensive Care unit (eICU) could close the gap from diagnosis to treatment.
(PC - IRV) suggested for severe hypoxemia when high positive end expiratory pressure (PEEP) and high FiO2 have failed to improve oxygenation in (ALI / ARDS) (ega). The result is maintenance of numerous alveoli open and intrinsic Positive end expiratory pressure (PEEP), improving arterial oxygenation (Bates). (IRV ) with low (PEEP) levels during conventional ventilation, (IRV) is successful in improving Pao2, moderate PEEP levels that prevent recruitment, and when use high PEEP levels are required in severe ARDS, oxygenation is better preserved with conventional ventilation due to a lower shunt (Ferrando).The study’s by (Chaco): the three randomized trials compared pressure control ventilation (PCV) versus volume control ventilation (VCV) in a total of 1089 adults with (ALI / ARDS) from 43 intensive care unit (ICU).The method was they use (PC-IRV),equivalent pressure-controlled model compared with (VCV), we included parallel-group randomized controlled trials (RCTs) and quasi-RCTs irrespective of their language or publication status. Primary outcomes are 1- In-hospital mortality, including ICU mortality2- Mortality at 28 days. The result was 1-(PCV) probably reduces ICU mortality of (ALI / ARDS) compared with (VCV), 2- Risk of barotrauma may not differ between (PCV) and (VCV). There is some studies have shown