Development of a Lung Rescue Team to Improve Care of Subjects With Refractory Acute Respiratory Failure.
BACKGROUND: A lung-protective mechanical ventilation strategy has become the hallmark of ventilation management for patients with acute respiratory failure. However, some patients progress to more severe forms of acute respiratory failure with refractory hypoxemia. In such circumstances, individuali...
| Publicado en: | Respiratory Care Vol. 65; no. 4; pp. 420 - 427 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Apr2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143163377&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143163377 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Apr2020 vid: 65 iid: 4 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 143163377 143163377 143163377 10.4187/respcare.07350 143163377 ppf: 420 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Development of a Lung Rescue Team to Improve Care of Subjects With Refractory Acute Respiratory Failure. aug: au: Spina, Stefano Capriles, Martin De Santis Santiago, Roberta Florio, Gaetano Teggia-Droghi, Maddalena Grassi, Luigi Hu, Jie Kelley, Rosemary Bittner, Edward A. Kacmarek, Robert M. Berra, Lorenzo affil: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts sug: subj: Respiratory Failure Therapy Quality Improvement Respiration, Artificial Human Education, Continuing (Credit) Retrospective Design Descriptive Statistics Positive End-Expiratory Pressure Extracorporeal Membrane Oxygenation Manometry Echocardiography Electric Impedance Tomography Massachusetts Individualized Medicine Adult Middle Age Male Female Anoxemia Therapy Funding Source Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: BACKGROUND: A lung-protective mechanical ventilation strategy has become the hallmark of ventilation management for patients with acute respiratory failure. However, some patients progress to more severe forms of acute respiratory failure with refractory hypoxemia. In such circumstances, individualized titration of mechanical ventilation according to the patient's specific respiratory and cardiovascular pathophysiology is desirable. A lung rescue team (LRT) was recently established at our institution to improve the medical care of patients with acute respiratory failure when conventional treatment fails. The aim of this report is to describe the consultation processes, the cardiopulmonary assessment, and the procedures of the LRT. METHODS: This was a retrospective review of the LRT management of patients with acute respiratory failure and refractory hypoxemia at Massachusetts General Hospital in Boston, Massachusetts. The LRT is composed of a critical care physician, the ICU respiratory therapist on duty, the ICU nurse on duty, and 2 critical care fellows. In the LRT approach, respiratory mechanics are evaluated through lung recruitment maneuvers and decremental PEEP trials by means of 3 tools: esophageal manometry, echocardiography, and electrical impedance tomography lung imaging. RESULTS: The LRT was consulted 89 times from 2014 to 2019 for evaluation and management of severely critically ill patients with acute respiratory failure and refractory hypoxemia on mechanical ventilation. The LRT was requested a median of 2 (interquartile range 1–6) d after intubation to optimize mechanical ventilation and to titrate PEEP in 77 (86%) subjects, to manage ventilation in 8 (9%) subjects on extracorporeal membrane oxygenation (ECMO), and to manage weaning strategy from mechanical ventilation in 4 (5%) subjects. The LRT found consolidations with atelectasis responsive to recruitment maneuvers in 79% (n = 70) of consultations. The LRT findings translated into a change of care in 81% (n = 72) of subjects. CONCLUSIONS: The LRT individualized the management of severe acute respiratory failure. The LRT consultations were shown to be effective, safe, and efficient, with an impact on decision-making in the ICU. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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