Scott K Epstein

..For the most frequent complication, tracheal stenosis, a multidisciplinary approach utilizing bronchoscopy, laser, airway stents, and tracheal surgery is most effective...

..Therefore, as with primary therapy, NIV should be considered for patients with COPD and post-extubation respiratory distress...

..Daily interruption of sedation (DIS) and sedation algorithms (SAs) have been shown to decrease mechanical ventilation (MV) duration. We conducted a randomized study comparing these strategies...

..Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation...

..Whether asynchrony is a marker of poor prognosis or causes these adverse outcomes remains to be determined...

..Therefore, safely weaning the patient from the ventilator as soon as possible is paramount. Recent randomized trials have addressed a number of key areas of interest...

..Despite the accuracy of this new test, a beneficial effect on outcome is yet to be proven...

..Whether these physiologic benefits are of clinical importance in enhancing weaning success remains to be elucidated...

..The predictors focus on detecting upper airway obstruction, inadequate cough, excess respiratory secretions, and abnormal mental status. Systematic application of these predictors has the potential to improve outcome...

..Patients extubated to NIV must have careful monitoring by skilled clinicians able to provide timely re-intubation if the patient shows signs of intolerance or worsening respiratory failure...

..For invasively ventilated patients the clinical emphasis should be on improving patient-ventilator interaction and avoiding dynamic hyperinflation (intrinsic positive end-expiratory pressure)...

..Rapid reinstitution of ventilatory support in patients who fail extubation may improve outcome...

..Therefore, improved outcome may derive from rapid identification of patients at increased risk, followed by expeditious reinstitution of ventilatory support when extubation failure occurs...

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..The aim of the study was to identify the nurse and patient-related factors predicting daily interruption of sedation (DIS) performance by nurses in the intensive care unit (ICU)...

..Emerging evidence indicates that protocol-directed weaning, driven by respiratory therapists and intensive care nurses, can improve outcome...

..Identification of predictors of survival at the time of listing for transplantation might lead to better resource allocation...

..Use of continuous infusions is associated with deeper levels of sedation, and patients receiving continuous infusions are more likely to be oversedated. Sedation therapy should be guided by subjective or objective assessment...

..We performed a systematic review and meta-analysis to ascertain the effect of intensive insulin therapy on the incidence of acute kidney injury (AKI) in adult critically ill patients...

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..To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial...

..We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting...

..The document was reworked with input from all concerned until a final product with consensus recommendations on 12 specific issues was achieved...

..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...

..In addition, the predictor did not confer survival benefit or reduce the incidence of extubation failure or tracheostomy. The results of this study indicate that f/Vt should not be used routinely in weaning decision making...

..The outcome of patients receiving mechanical ventilation for particular indications has been studied, but the outcome in a large number of unselected, heterogeneous patients has not been reported...