Publications by authors named "C E Rackley"

226 Publications

Fifty Years of Mechanical Ventilation-1970s to 2020.

Crit Care Med 2021 04;49(4):558-574

Department of Respiratory Therapy, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.

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http://dx.doi.org/10.1097/CCM.0000000000004894DOI Listing
April 2021

Monitoring During Mechanical Ventilation.

Authors:
Craig R Rackley

Respir Care 2020 Jun;65(6):832-846

Department of Medicine, Duke University Medical Center, Durham, North Carolina.

Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both their underlying disease states and the mechanical ventilation itself. Intensive monitoring is required to identify early signs of clinical worsening and to minimize the risk of iatrogenic harm. Pulse oximetry and capnography are used to ensure that appropriate oxygenation and ventilation are achieved and maintained. Assessments of driving pressure, transpulmonary pressure, and the pressure-volume loop are performed to ensure that adequate PEEP is applied and excess distending pressure is minimized. Finally, monitoring and frequent adjustment of airway cuff pressures is performed to minimize the risk of airway injury and ventilator-associated pneumonia. We will discuss monitoring during mechanical ventilation with a focus on the accuracy, ease of use, and effectiveness in preventing harm for each of these monitoring modalities.
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http://dx.doi.org/10.4187/respcare.07812DOI Listing
June 2020

Low Tidal Volumes for Everyone?

Chest 2019 10 27;156(4):783-791. Epub 2019 Jun 27.

Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC.

Since the first description of mechanical ventilation, our understanding of the positive and negative effects of this form of life support has continued to evolve. To maintain "normal" aeration of the lungs and "normal" blood gas measurements, patients often require much higher airway pressures and tidal volumes than would be expected in a healthy, spontaneously breathing adult. In the early days of mechanical ventilation, the goal was to normalize the blood gas levels, but over the last several decades, we have developed a much better appreciation for the deleterious effects of mechanical ventilation. We have found that lower tidal volumes, which may actually worsen oxygenation and reduce clearance of CO, can decrease the level of harm caused by mechanical ventilation. This scenario is best described and agreed upon in the setting of ARDS, but a growing body of evidence suggests that the use of higher tidal volumes is harmful in patients with normal lungs undergoing general anesthesia or in patients with lung diseases other than ARDS requiring mechanical ventilation. Finally, the concept of self-induced lung injury has emerged as a mechanism through which patients generating large negative intrathoracic pressures to achieve larger tidal volumes can contribute to worsened lung injury. Given a growing supportive evidence base, we suggest that efforts be made to achieve low tidal volume ventilation in all patients with lung injury or undergoing mechanical ventilation for any reason.
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http://dx.doi.org/10.1016/j.chest.2019.06.007DOI Listing
October 2019

Interhospital ECMO Transport: Regional Focus.

Semin Thorac Cardiovasc Surg 2019 Autumn;31(3):327-334. Epub 2019 Jan 4.

Duke University Medical Center, Department of Surgery, Durham, North Carolina. Electronic address:

Utilization of extracorporeal membrane oxygenation (ECMO) has increased dramatically over the last decade. Despite this trend, many medical centers have limited, if any, access to this technology or the resources necessary to manage these complex patients. In an effort to improve the current infrastructure of regional ECMO care, ECMO centers of excellence have an obligation to partner with facilities within their communities and regions to increase access to this potentially life-saving technology. While the need for this infrastructure is widely acknowledged in the ECMO community, few reports describe the actual mechanisms by which a successful interfacility transport program can operate. As such, the purpose of this document is to describe the elements of and methods for providing safe and efficient mobile ECMO services from the perspective of an experienced, high-volume tertiary ECMO center of excellence in the Southeastern United States.
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http://dx.doi.org/10.1053/j.semtcvs.2019.01.003DOI Listing
January 2020
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