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https://www.readbyqxmd.com/read/29679387/the-pharmacokinetics-and-pharmacodynamics-of-carfentanil-after-recreational-exposure-a-case-report
#1
Uvaraj Uddayasankar, Colin Lee, Curtis Oleschuk, Gregg Eschun, Robert E Ariano
Carfentanil and related fentanyl analogues have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34-year-old male admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures; in addition to utilizing high pressure liquid chromatography tandem mass spectrometry assay for quantification of carfentanil and its metabolite...
April 20, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29671605/effects-of-budesonide-and-surfactant-in-preterm-fetal-sheep
#2
T Brett Kothe, Emily Royse, Matthew W Kemp, Augusto F Schmidt, Fabrizio Salomone, Masatoshi Saito, Haruo Usuda, Shimpei Watanabe, Gabrielle C Musk, Alan H Jobe, Noah H Hillman
BACKGROUND: Mechanical ventilation causes lung injury and systemic inflammatory responses in preterm sheep, and is associated with bronchopulmonary dysplasia (BPD) in preterm infants. Budesonide added to surfactant decreased BPD by 20% in infants. OBJECTIVE: Determine the effects of budesonide and surfactant on injury from high tidal volume (VT) ventilation in preterm lambs. METHODS: Ewes at 125 {plus minus} 1 day GA had fetal surgery to expose fetal head and chest with placental circulation intact...
April 19, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/29557574/prevalence-and-variability-of-use-of-home-mechanical-ventilators-positive-airway-pressure-and-oxygen-devices-in-the-lombardy-region-italy
#3
Michele Vitacca, Luca Barbano, Daniele Colombo, Olivia Leoni, Enrico Guffanti
Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared...
January 29, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/29547976/argon-preconditioning-enhances-postischaemic-cardiac-functional-recovery-following-cardioplegic-arrest-and-global-cold-ischaemia
#4
Attila Kiss, Huaqing Shu, Ouafa Hamza, David Santer, Eva Verena Tretter, Shanglong Yao, Klaus Markstaller, Seth Hallström, Bruno K Podesser, Klaus Ulrich Klein
OBJECTIVES: Previous studies demonstrated that preconditioning with argon gas provided a marked reduction in inflammation and apoptosis and increased myocardial contractility in the setting of acute myocardial ischaemia-reperfusion (IR). There is substantial evidence that myocardial IR injury following cardioplegic arrest is associated with the enhancement of apoptosis and inflammation, which is considered to play a role in cardiac functional impairment. Therefore, the present study was designed to clarify whether preconditioning with argon gas enhances recovery of cardiac function following cardioplegic arrest...
March 13, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29547456/morphine-pharmacokinetics-in-children-with-down-syndrome-following-cardiac-surgery
#5
Benjamin H Goot, Jon Kaufman, Zhaoxing Pan, David W A Bourne, Francis Hickey, Mark Twite, Jeffrey Galinkin, Uwe Christians, Jeannie Zuk, Eduardo M da Cruz
OBJECTIVES: To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. DESIGN: Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations...
March 15, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29519280/-variability-of-peripheral-arterial-peak-velocity-predicts-fluid-responsiveness-in-patients-with-septic-shock
#6
Nianfang Lu, Li Jiang, Bo Zhu, Wenyong Han, Yingqi Zhao, Yuntao Shi, Fashuang Guo, Xiuming Xi
OBJECTIVE: To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. METHODS: A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29507615/systematic-assessment-of-strategies-for-lung-targeted-delivery-of-microrna-mimics
#7
Kenny Schlosser, Mohamad Taha, Duncan J Stewart
There is considerable interest in the use of synthetic miRNA mimics (or inhibitors) as potential therapeutic agents in pulmonary vascular disease; however, the optimal delivery method to achieve high efficiency, selective lung targeting has not been determined. Here, we sought to investigate the relative merits of different lung-targeted strategies for delivering miRNA mimics in rats. Methods: Tissue levels of a synthetic miRNA mimic, cel-miR-39-3p (0.5 nmol in 50 µL invivofectamine/PBS vehicle) were compared in male rats (n=3 rats/method) after delivery by commonly used lung-targeting strategies including intratracheal liquid instillation (IT-L), intratracheal aerosolization with (IT-AV ) or without ventilator assistance (IT-A), intranasal liquid instillation (IN-L) and intranasal aerosolization (IN-A)...
2018: Theranostics
https://www.readbyqxmd.com/read/29507033/-pseudo-calcifications-detection-of-perfluorocarbon-residue-on-a-computed-tomography-scan-15-years-after-liquid-ventilation-therapy-at-3-months-of-age
#8
Sameem Tak, Mary Barraclough
Partial liquid ventilation using perfluorocarbons is a therapy that was once frequently used in paediatric populations for patients with severe respiratory distress. Perfluorocarbon is a non-toxic, insoluble and radiopaque vector through which improved gas exchange can occur. Two previous cases have been reported of persistent perfluorocarbon residua, identified on imaging years after receiving liquid ventilation therapy. We report a case of perfluorocarbon detection on a CT scan 15 years after liquid ventilation at 3 months of age, and propose the probable mechanism of its appearance...
March 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29450740/perfluorocarbon-induces-alveolar-epithelial-cell-response-through-structural-and-mechanical-remodeling
#9
Sofia André Dias, Emmanuelle Planus, Christelle Angely, Luc Lotteau, Renaud Tissier, Marcel Filoche, Bruno Louis, Gabriel Pelle, Daniel Isabey
During total liquid ventilation, lung cells are exposed to perfluorocarbon (PFC) whose chemophysical properties highly differ from standard aqueous cell feeding medium (DMEM). We herein perform a systematic study of structural and mechanical properties of A549 alveolar epithelial cells in order to characterize their response to PFC exposure, using DMEM as control condition. Changes in F-actin structure, focal adhesion density and glycocalyx distribution are evaluated by confocal fluorescent microscopy. Changes in cell mechanics and adhesion are measured by multiscale magnetic twisting cytometry (MTC)...
February 15, 2018: Biomechanics and Modeling in Mechanobiology
https://www.readbyqxmd.com/read/29425465/excess-mucin-impairs-subglottic-epithelial-host-defense-in-mechanically-ventilated-patients
#10
Jason Powell, James Garnett, Michael W Mather, Faye A H Cooles, Andrew Nelson, Bernard Verdon, Jon Scott, Kasim Jiwa, Marie-Hélène Ruchaud-Sparagano, Stephen P Cummings, John D Perry, Stephen E Wright, Janet A Wilson, Jeffrey Pearson, Chris Ward, A John Simpson
RATIONALE: Aspiration of infective subglottic secretions causes ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Mechanisms underlying subglottic colonization in critical illness have not been defined, limiting strategies for targeted prevention of VAP. OBJECTIVES: To characterize subglottic host defense dysfunction in mechanically ventilated patients in the intensive care unit (ICU). To determine whether subglottic mucin contributes to neutrophil phagocytic impairment and bacterial growth...
February 9, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29398506/international-consensus-icon-on-management-of-otitis-media-with-effusion-in-children
#11
F Simon, M Haggard, R M Rosenfeld, H Jia, S Peer, M-N Calmels, V Couloigner, N Teissier
Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management...
February 2, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
https://www.readbyqxmd.com/read/29397598/-the-clinical-significance-of-microcirculation-and-oxygen-metabolism-evaluation-in-acute-kidney-injury-assessment-in-patients-with-septic-shock-after-resuscitation
#12
C Yu, D W Liu, X T Wang, H W He, P Pan, Z Q Xing
Objective: To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME) in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods: Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO(2))and venoarterial pressure of carbon dioxide difference (Pv-aCO(2)) /arteriovenous O(2) content difference (Ca-vO(2)) by blood gas analysis, i...
February 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29377922/assessing-the-impacts-of-total-liquid-ventilation-on-left-ventricular-diastolic-function-in-a-model-of-neonatal-respiratory-distress-syndrome
#13
Michaël Sage, Mathieu Nadeau, Claudia Forand-Choinière, Julien Mousseau, Jonathan Vandamme, Claire Berger, Jean-Sébastien Tremblay-Roy, Renaud Tissier, Philippe Micheau, Étienne Fortin-Pellerin
BACKGROUND: Filling the lung with dense liquid perfluorocarbons during total liquid ventilation (TLV) might compress the myocardium, a plausible explanation for the instability occasionally reported with this technique. Our objective is to assess the impacts of TLV on the cardiovascular system, particularly left ventricular diastolic function, in an ovine model of neonatal respiratory distress syndrome. METHOD: Eight newborns lambs, 3.0 ± 0.4 days (3.2 ± 0.3kg) were used in this crossover experimental study...
2018: PloS One
https://www.readbyqxmd.com/read/29355691/civilian-exposure-to-chlorine-gas-a-systematic-review
#14
P Govier, J M Coulson
INTRODUCTION: Halogen pulmonary irritants (HPIs) are volatile liquids that directly damage the respiratory mucosa. Chlorine is readily available in large volumes as an industrial chemical and has a significant potential for accidental or deliberate release. We conducted a systematic review to determine the clinical features; treatment and long-term sequelae of civilian chlorine gas exposure. METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology...
January 19, 2018: Toxicology Letters
https://www.readbyqxmd.com/read/29302897/efficient-application-of-volatile-anaesthetics-total-rebreathing-or-specific-reflection
#15
REVIEW
Hagen Bomberg, Thomas Volk, Heinrich V Groesdonk, Andreas Meiser
The circle system has been in use for more than a 100 years, whereas the first clinical application of an anaesthetic reflector was reported just 15 years ago. Its functional basis relies on molecular sieves such as zeolite crystals or activated carbon. In a circle system, the breathing gas is rebreathed after carbon dioxide absorption; a reflector on the other hand specifically retains the anaesthetic during expiration and resupplies it during the next inspiration. Reflection systems can be used in conjunction with intensive care ventilators and do not need the permanent presence of trained qualified staff...
January 4, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29290827/local-intratracheal-delivery-of-perfluorocarbon-nanoparticles-to-lung-cancer-demonstrated-with-magnetic-resonance-multimodal-imaging
#16
Lina Wu, Xiaofei Wen, Xiance Wang, Chunan Wang, Xilin Sun, Kai Wang, Huiying Zhang, Todd Williams, Allen J Stacy, Junjie Chen, Anne H Schmieder, Gregory M Lanza, Baozhong Shen
Eighty percent of lung cancers originate as subtle premalignant changes in the airway mucosal epithelial layer of bronchi and alveoli, which evolve and penetrate deeper into the parenchyma. Liquid-ventilation, with perfluorocarbons (PFC) was first demonstrated in rodents in 1966 then subsequently applied as lipid-encapsulated PFC emulsions to improve pulmonary function in neonatal infants suffering with respiratory distress syndrome in 1996. Subsequently, PFC nanoparticles (NP) were extensively studied as intravenous (IV) vascular-constrained nanotechnologies for diagnostic imaging and targeted drug delivery applications...
2018: Theranostics
https://www.readbyqxmd.com/read/29276307/in-vitro-assessment-of-small-charged-pharmaceutical-aerosols-in-a-model-of-a-ventilated-neonate
#17
Landon Holbrook, Michael Hindle, P Worth Longest
Aerosolized medications may benefit infants receiving mechanical ventilation; however, the lung delivery efficiency of these aerosols is unacceptably low. In vitro experiments were conducted to evaluate aerosol delivery through conventional and modified ventilation systems to the end of a 3mm endotracheal tube (ETT) under steady state and realistic cyclic flow conditions. System modifications were employed to investigate the use of small charged particles and included streamlined components, a reduction in nebulizer liquid flow rate, synchronization with inspiration, and implementation of a previously designed low-flow induction charger (LF-IC), which was further modified in this study...
August 2017: Journal of Aerosol Science
https://www.readbyqxmd.com/read/29262474/-clinical-application-of-electrical-velocimetry-in-monitoring-pediatric-blood-volume-after-cardiopulmonary-bypass
#18
RANDOMIZED CONTROLLED TRIAL
J R Xue, B Li
Objective: To investigate the clinical applicability of electrical velocimetry (EV) in monitoring pediatric blood volume after cardiopulmonary bypass. Method: Between July 2016 and November 2016, 60 children with congenital heart disease were divided into EV group and traditional central venous pressure (CVP) group randomly. For EV group, the volume of fluid and vascular active medicine was adjusted according to the monitoring stroke volume variation (SVV) hemodynamic parameters. Whereas for CVP group empirical volume of fluid infusion was managed by the monitoring traditional hemodynamic parameters such as CVP, blood pressure, heart rate, urine volume and blood gas analysis...
December 2, 2017: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/29228436/the-effect-of-ventilator-mask-atomization-inhalation-of-ipratropium-bromide-and-budesonide-suspension-liquid-in-the-treatment-of-copd-in-acute-exacerbation-period-on-circulating-levels-of-inflammation-and-prognosis
#19
D-H Jiang, X Wang, L-S Liu, D-D Ji, N Zhang
OBJECTIVE: We investigated the effects of ventilator mask atomization inhalation of ipratropium bromide and budesonide suspension liquid in the treatment of acute exacerbation COPD (AECOPD) on circulating levels of inflammatory factors and prognosis. PATIENTS AND METHODS: A total of 86 cases of patients on ventilator support were randomly divided into control group and observation group with 43 cases each. The control group was administered routine treatment including basic disease treatment, anti-infection, maintenance of a stable internal environment, nutritional support, oxygen inhalation and so on...
November 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29089460/measurements-obtained-from-esophageal-balloon-catheters-are-affected-by-the-esophageal-balloon-filling-volume-in-children-with-ards
#20
Justin C Hotz, Cary T Sodetani, Jeffrey Van Steenbergen, Robinder G Khemani, Timothy W Deakers, Christopher J Newth
BACKGROUND: Esophageal balloon inflation volume may affect the accuracy of transpulmo-nary pressure estimates in adults, but the effect is unknown in pediatrics. Using a combination bench and human study, we sought to determine a range of optimal filling volumes for esophageal balloon catheters and to derive a technique to inflate catheters to yield the most accurate estimates of pleural pressure. METHODS: In the laboratory study, we evaluated 4 pediatric and adult esophageal balloon catheters, a liquid-filled catheter, and a micro-tip catheter, both with and without a model esophagus...
February 2018: Respiratory Care
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