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https://www.readbyqxmd.com/read/28941539/delirium-in-pediatric-critical-care
#1
REVIEW
Anita K Patel, Michael J Bell, Chani Traube
Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28940626/using-the-sophia-observational-withdrawal-scale-improved-the-assessment-of-paediatric-iatrogenic-withdrawal-symptoms
#2
Bettina N Nielsen, Ulrikka Nygaard, Lise Hvidt, Kaare Lundstrøm
Analgesia and sedation are standard practice when paediatric intensive care patients receive mechanical ventilation. Prolonged exposure to opioid and benzodiazepine leads to an increased risk of withdrawal symptoms when medication ceases or patients are weaned off them (1). When we were updating our local clinical guidelines for managing withdrawal symptoms, we identified the need to improve the assessment of withdrawal symptoms. This article is protected by copyright. All rights reserved.
September 22, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28935558/immediate-interruption-of-sedation-compared-with-usual-sedation-care-in-critically-ill-postoperative-patients-sos-ventilation-a-randomised-parallel-group-clinical-trial
#3
Gerald Chanques, Matthieu Conseil, Claire Roger, Jean-Michel Constantin, Albert Prades, Julie Carr, Laurent Muller, Boris Jung, Fouad Belafia, Moussa Cissé, Jean-Marc Delay, Audrey de Jong, Jean-Yves Lefrant, Emmanuel Futier, Grégoire Mercier, Nicolas Molinari, Samir Jaber
BACKGROUND: Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes. METHODS: We did a randomised, parallel-group, clinical trial at three ICUs in France. Stratified randomisation with minimisation (1:1 via a restricted web platform) was used to assign eligible patients (aged ≥18 years, admitted to an ICU after abdominal surgery, and expected to require at least 12 h of mechanical ventilation because of a critical illness defined by a Sequential Organ Failure Assessment score >1 for any organ, but without severe acute respiratory distress syndrome or brain injury) to usual sedation care provided according to recommended practices (control group) or to immediate interruption of sedation (intervention group)...
September 18, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28933231/temporary-tracheal-stenting-after-pulmonary-artery-sling-repair-in-a-newborn
#4
Sabrina Lueck, Michael Mohr, Claudius Werner, Christoph Schmidt, Edward Malec, Katarzyna Januszewska
Pulmonary artery sling (PAS) is a rare disease frequently associated with severe malacia and stenosis of the trachea. We present a two-day-old newborn that underwent urgent surgery for PAS and needed prolonged respiratory support afterward. Temporary airway stenting above the level of the tracheal bifurcation was performed five days after surgery to overcome severe airway obstruction caused by tracheomalacia and laceration of the tracheal mucosa after diagnostic bronchoscopy. Two days after the procedure, the child could be extubated and after two weeks the stent was removed without complications...
January 1, 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28932552/chylothorax-after-pediatric-cardiac-surgery-complicates-short-term-but-not-long-term-outcomes-a-propensity-matched-analysis
#5
Nikoletta R Czobor, György Roth, Zsolt Prodán, Daniel J Lex, Erzsébet Sápi, László Ablonczy, Mihály Gergely, Edgar A Székely, János Gál, Andrea Székely
BACKGROUND: The occurrence of postoperative chylothorax in children with congenital heart disease is a rare and serious complication in cardiac intensive care units (ICUs). The aim of our study was to identify the perioperative characteristics, treatment options, resource utilization and long term complications of patients having chylothorax after a pediatric cardiac surgery. METHODS: Patients were retrospectively assessed for the presence of chylothorax between January 2002 and December 2012 in a tertiary national cardiac center...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28930478/mechanical-ventilation-induced-diaphragm-atrophy-strongly-impacts-clinical-outcomes
#6
Ewan C Goligher, Martin Dres, Eddy Fan, Gordon D Rubenfeld, Damon C Scales, Margaret S Herridge, Stefannie Vorona, Michael C Sklar, Nuttapol Rittayamai, Ashley Lanys, Alistair Murray, Deborah Brace, Cristian Urrea, W Darlene Reid, George Tomlinson, Arthur S Slutsky, Brian P Kavanagh, Laurent J Brochard, Niall D Ferguson
Rationale Diaphragm dysfunction worsens outcomes in mechanically ventilated patients but the clinical impact of potentially preventable changes in diaphragm structure and function due to mechanical ventilation is unknown. Objectives To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation. Methods Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28930049/experience-with-the-syncardia-total-artificial-heart-in-a-canadian-centre
#7
Anthony Nguyen, Michel Pellerin, Louis P Perrault, Michel White, Anique Ducharme, Normand Racine, Michel Carrier
BACKGROUND: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. METHODS: We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. RESULTS: From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%)...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28927832/impact-of-weekend-admission-on-mortality-and-other-outcomes-among-patients-with-burn-injury-a-nationwide-analysis
#8
Heather Peluso, Marwan S Abougergi, Julie Caffrey
OBJECTIVE: To study the relationship between day of admission and important outcomes among patients with burn injuries. METHODS: The 2014 National Inpatient Sample database was used. Inclusion criterion was a principal diagnosis of burn injury. Exclusion criteria were age <18years, superficial burn, and non-urgent admission. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization charges and costs)...
September 16, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28921478/interstitial-pneumonia-with-autoimmune-features-an-additional-risk-factor-for-ards
#9
Giacomo Grasselli, Beatrice Vergnano, Maria Rosa Pozzi, Vittoria Sala, Gabriele D'Andrea, Vittorio Scaravilli, Marco Mantero, Alberto Pesci, Antonio Pesenti
BACKGROUND: Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period...
September 18, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28918203/short-term-effects-of-preoperative-beta-blocker-use-for-isolated-coronary-artery-bypass-grafting-a-systematic-review-and-meta-analysis
#10
Liangshan Wang, Hong Wang, Xiaotong Hou
OBJECTIVE: The use of preoperative beta-blockers has been used as a quality standard for patients undergoing coronary artery bypass grafting (CABG). However, the benefits of beta-blockers use before CABG remain controversial. We performed a systematic review and meta-analysis to investigate the short-term effects of preoperative beta-blocker use for patients undergoing isolated CABG. METHODS: We searched PubMed, Embase, and the Cochrane Library for English articles published from inception to August 16, 2016...
August 24, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28917004/critical-illness-associated-diaphragm-weakness
#11
REVIEW
Martin Dres, Ewan C Goligher, Leo M A Heunks, Laurent J Brochard
Diaphragm weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilation but it also frequently develops during the ICU stay. Several risk factors for diaphragm weakness have been identified; among them sepsis and mechanical ventilation play central roles. We employ the term critical illness-associated diaphragm weakness to refer to the collective effects of all mechanisms of diaphragm injury and weakness occurring in critically ill patients...
September 15, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28915171/determinants-of-care-when-is-prolonged-mechanical-ventilation-no-longer-appropriate-and-who-decides
#12
Neal H Cohen
No abstract text is available yet for this article.
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28904980/enterovirus-human-rhinovirus-a-rare-cause-of-acute-respiratory-distress-syndrome
#13
Parita Soni, Anand Rai, Nidhi Aggarwal, Stephan Kamholz, Taek Yoon, Yizhak Kupfer
A 22-year-old Asian woman presented with respiratory distress, cough, and wheezing for 1 week. Prior history included asthma and Turner syndrome. On presentation to the emergency department, the patient was hypotensive, tachycardic, tachypneic, with an oxyhemoglobin saturation in the mid 80% range while breathing ambient air. Chest radiograph revealed pulmonary vascular congestion and a left lower lobe infiltrate. Endotracheal intubation, mechanical ventilation, and vasopressors were initiated. Empiric therapy for community-acquired pneumonia was administered utilizing broad-spectrum intravenous antibiotics...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28904477/studying-the-power-of-the-integrative-weaning-index-in-predicting-the-success-rate-of-the-spontaneous-breathing-trial-in-patients-under-mechanical-ventilation
#14
Sahar Ebrahimabadi, Ahmad Bagheri Moghadam, Mohammadali Vakili, Mahnaz Modanloo, Homeira Khoddam
BACKGROUND AND AIMS: The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to determine the power of the integrative weaning index (IWI) in predicting the success rate of the spontaneous breathing trial (SBT) in patients under mechanical ventilation. MATERIALS AND METHODS: In this prospective study, 105 patients undergoing mechanical ventilation for over 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥25), the success rate of the SBT was predicted...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28894481/respiratory-research-networks-in-europe-and-beyond-aims-achievements-and-aspirations-for-the-21st-century
#15
Ignacio Martin-Loeches, Fernando Zampieri, Pedro Povoa, Otavio Ranzani, Lieuwe D Bos, Stefano Aliberti, Antoni Torres
Healthcare-associated infection, such as intensive care unit (ICU)-related respiratory infections, remain the most frequently encountered morbidity of ICU admission, prolonging hospital stay and increasing mortality rates. The epidemiology of ICU-related respiratory infections, particularly nonventilated ICU-associated pneumonia and ventilator-associated tracheobronchitis, appears to be quite different among different countries. European countries have different prevalence, patterns and mechanism of resistance, as well as different treatments chosen by different attending physicians...
September 2017: Breathe
https://www.readbyqxmd.com/read/28886850/transcatheter-aortic-valve-implantation-versus-surgical-aortic-valve-replacement-in-lower-surgical-risk-patients-with-chronic-obstructive-pulmonary-disease
#16
Vincent Auffret, Victor Becerra Munoz, Aurélie Loirat, Eric Dumont, Hervé Le Breton, Jean-Michel Paradis, Daniel Doyle, Robert De Larochellière, Siamak Mohammadi, Jean-Philippe Verhoye, François Dagenais, Marc Bedossa, Dominique Boulmier, Guillaume Leurent, Lluis Asmarats, Ander Regueiro, Chekrallah Chamandi, Tania Rodriguez-Gabella, Emile Voisine, Anne-Sophie Moisan, Martin Thoenes, Mélanie Côté, Rishi Puri, Pierre Voisine, Josep Rodés-Cabau
Respiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study...
August 7, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28884313/endocan-as-an-early-biomarker-of-severity-in-patients-with-acute-respiratory-distress-syndrome
#17
Diego Orbegozo, Lokmane Rahmania, Marian Irazabal, Manuel Mendoza, Filippo Annoni, Daniel De Backer, Jacques Creteur, Jean-Louis Vincent
BACKGROUND: Plasma concentrations of endocan, a proteoglycan preferentially expressed in the pulmonary vasculature, may represent a biomarker of lung (dys)function. We sought to determine whether the measurement of plasma endocan levels early in the course of acute respiratory distress syndrome (ARDS) could help predict risk of death or of prolonged ventilation. METHODS: All patients present in the department of intensive care during a 150-day period were screened for ARDS (using the Berlin definition)...
September 7, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28884212/routine-sildenafil-does-not-improve-clinical-outcomes-after-fontan-operation
#18
J Leslie Gaddis Collins, Mark A Law, Santiago Borasino, W Clinton Erwin, David C Cleveland, Jeffrey A Alten
Fontan operation can be complicated by persistent chest tube output (CTO) leading to prolonged hospital length of stay (LOS). Postoperative sildenafil administration has been shown to improve clinical outcomes in selected patients after Fontan. We initiated a practice change utilizing intravenous (IV) sildenafil in early postoperative period in all patients undergoing Fontan operation with aim to decrease LOS and CTO. Nineteen patients (February 2014-May 2016) received 0.35 mg/kg sildenafil IV (three doses) followed by enteral, 1 mg/kg every eight hours until hospital discharge...
September 7, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28879448/pre-decannulation-flexible-bronchoscopy-in-tracheostomized-children
#19
Anil Sachdev, Amrit Ghimiri, Neeraj Gupta, Dhiren Gupta
OBJECTIVES: This study was aimed to evaluate the utility and benefits of flexible fiberoptic bronchoscopy (FFB) prior to tracheostomy decannulation. METHODS: Besides demographic data, initial cause of tracheostomy, primary diagnosis, pre-tracheostomy and pre-decannulation bronchoscopic findings and duration of tracheostomy were collected from medical charts. The type of active intervention following bronchoscopy and outcome after decannulation were recorded. Departmental decannulation policy and procedure were used in all patients...
September 6, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28878814/thoracic-trauma-severity-contributes-to-differences-in-intensive-care-therapy-and-mortality-of-severely-injured-patients-analysis-based-on-the-traumaregister-dgu%C3%A2
#20
Jörg Bayer, Rolf Lefering, Sylvia Reinhardt, Jan Kühle, Jörn Zwingmann, Norbert P Südkamp, Thorsten Hammer
BACKGROUND: Thoracic trauma is a relevant source of comorbidity throughout multiply-injured patient care. We aim to determine a measurable influence of chest trauma's severity on early resuscitation, intensive care therapy, and mortality in severely injured patients. METHODS: Patients documented between 2002 and 2012 in the TraumaRegister DGU®, aged ≥ 16 years, injury severity score (ISS) ≥ 16 are analyzed. Isolated brain injury and severe head injury led to exclusion...
2017: World Journal of Emergency Surgery: WJES
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