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https://www.readbyqxmd.com/read/28448318/two-state-collaborative-study-of-a-multifaceted-intervention-to-decrease-ventilator-associated-events
#1
Nishi Rawat, Ting Yang, Kisha J Ali, Mary Catanzaro, Mariah D Cohen, Donna O Farley, Lisa H Lubomski, David A Thompson, Bradford D Winters, Sara E Cosgrove, Michael Klompas, Kathleen A Speck, Sean M Berenholtz
OBJECTIVES: Ventilator-associated events are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the National Institute of Health and Agency for Healthcare Research and Quality funded a two-state collaborative to reduce ventilator-associated events. We describe the collaborative's impact on ventilator-associated event rates in 56 ICUs. DESIGN: Longitudinal quasi-experimental study...
April 26, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28446775/delivering-prolonged-intensive-care-to-a-non-human-primate-a-high-fidelity-animal-model-of-critical-illness
#2
P Guillaume Poliquin, Mia Biondi, Charlene Ranadheera, Mable Hagan, Alexander Bello, Trina Racine, Mark Allan, Duane Funk, Gregory Hansen, B J Hancock, Murray Kesselman, Todd Mortimer, Anand Kumar, Shane Jones, Anders Leung, Allen Grolla, Kaylie N Tran, Kevin Tierney, Xiangguo Qiu, Darwyn Kobasa, James E Strong
Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35-54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care delivery. Unfortunately, research has been hampered by the lack of an animal model that replicates the complex care provided to humans in an intensive care unit (ICU)...
April 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28445793/predictors-of-30-day-pulmonary-complications-after-outpatient-surgery-relative-importance-of-body-mass-index-weight-classifications-in-risk-assessment
#3
Gildasio S De Oliveira, Robert J McCarthy, Kristopher Davignon, Herb Chen, Heather Panaro, William G Cioffi
BACKGROUND: The current literature is controversial regarding the importance of obese body mass index (BMI) classifications as a risk factor for pulmonary complications following outpatient surgery. The objective of the current investigation was to evaluate predictors of pulmonary outcomes following outpatient surgery and to assess the importance of BMI weight classifications in risk assessment. STUDY DESIGN: Patients with "outpatient" recorded as their inpatient/outpatient status in the 2012-2013 NSQIP database were included...
April 23, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28444366/intraoperative-air-leak-measured-after-lobectomy-is-associated-with-postoperative-duration-of-air-leak
#4
Alessandro Brunelli, Michele Salati, Cecilia Pompili, Paolo Gentili, Armando Sabbatini
OBJECTIVES: To verify the association between the air leak objectively measured intraoperatively (IAL) using the ventilator and the air leak duration after pulmonary lobectomy. METHODS: Prospective analysis on 111 patients submitted to pulmonary lobectomy (33 by video-assisted thoracic surgery). After resection, objective assessment of air leak (in milliliter per minute) was performed before closure of the chest by measuring the difference between a fixed inspired and expired volume, using a tidal volume of 8 ml/kg, a respiratory rate of 10 and a positive-end expiratory pressure of 5 cmH 2 O...
April 24, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28444071/reducing-pressure-ulcers-in-patients-with-prolonged-acute-mechanical-ventilation-a-quasi-experimental-study
#5
Cecilia Inés Loudet, María Cecilia Marchena, María Roxana Maradeo, Silvia Laura Fernández, María Victoria Romero, Graciela Esther Valenzuela, Isabel Eustaquia Herrera, Martha Teresa Ramírez, Silvia Rojas Palomino, Mariana Virginia Teberobsky, Leandro Ismael Tumino, Ana Laura González, Rosa Reina, Elisa Estenssoro
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle"...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28444069/predictors-and-pattern-of-weaning-and-long-term-outcome-of-patients-with-prolonged-mechanical-ventilation-at-an-acute-intensive-care-unit-in-north-india
#6
Syed Nabeel Muzaffar, Mohan Gurjar, Arvind K Baronia, Afzal Azim, Prabhakar Mishra, Banani Poddar, Ratender K Singh
Objective: This study aimed to examine the clinical characteristics, weaning pattern, and outcome of patients requiring prolonged mechanical ventilation in acute intensive care unit settings in a resource-limited country. Methods: This was a prospective single-center observational study in India, where all adult patients requiring prolonged ventilation were followed for weaning duration and pattern and for survival at both intensive care unit discharge and at 12 months...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28443559/the-evolution-of-modern-respiratory-care-for-preterm-infants
#7
REVIEW
Louise S Owen, Brett J Manley, Peter G Davis, Lex W Doyle
Preterm birth rates are rising, and many preterm infants have breathing difficulty after birth. Treatments for infants with prolonged breathing difficulty include oxygen therapy, exogenous surfactant, various modes of respiratory support, and postnatal corticosteroids. In this Series paper, we review the history of neonatal respiratory care and its effect on long-term outcomes, and we outline the future direction of the research field. The delivery and monitoring of oxygen therapy remains controversial, despite being in use for more than 50 years...
April 22, 2017: Lancet
https://www.readbyqxmd.com/read/28443268/complicated-postoperative-course-after-pulmonary-artery-sling-repair-and-slide-tracheoplasty
#8
Angelika Weber, Birgit Donner, Marie-Hélène Perez, Stefano Di Bernardo, Daniel Trachsel, Kishore Sandu, Nicole Sekarski
Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28440922/pseudomonas-aeruginosa-and-post-tracheotomy-bacterial-respiratory-tract-infection-readmissions
#9
Christopher J Russell, Tamara D Simon, Mary R Mamey, Christopher J L Newth, Michael N Neely
OBJECTIVE: Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy. DESIGN/METHODS: We performed a retrospective cohort study of 240 children who underwent tracheotomy and were discharged with tracheotsomy in place between January 1, 2005 and June 30, 2013. Children with prolonged total or post-tracheotomy length of stay (LOS), less than 12 months of follow-up, or who died during the index hospitalization were excluded...
April 25, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28437209/conversations-about-goals-and-values-are-feasible-and-acceptable-in-long-term-acute-care-hospitals-a-pilot-study
#10
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Susan T Moore, Rachelle E Bernacki, Susan D Block
RATIONALE: The chronically critically ill have survived acute critical illness but require prolonged mechanical ventilation. These patients are frequently transferred from acute care to long-term acute care hospitals (LTACHs) for prolonged recovery, yet many suffer setbacks requiring readmission to acute care. The patient's relatively improved condition while at the LTACH might be an opportunity for communication regarding care goals; however, there have been no prior studies of the feasibility of such conversations in the LTACH...
February 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28431419/creation-and-validation-of-an-automated-algorithm-to-determine-postoperative-ventilator-requirements-after-cardiac-surgery
#11
Eilon Gabel, Ira S Hofer, Nancy Satou, Tristan Grogan, Richard Shemin, Aman Mahajan, Maxime Cannesson
BACKGROUND: In medical practice today, clinical data registries have become a powerful tool for measuring and driving quality improvement, especially among multicenter projects. Registries face the known problem of trying to create dependable and clear metrics from electronic medical records data, which are typically scattered and often based on unreliable data sources. The Society for Thoracic Surgery (STS) is one such example, and it supports manually collected data by trained clinical staff in an effort to obtain the highest-fidelity data possible...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28428892/a-comparison-of-earlier-and-enhanced-rehabilitation-of-mechanically-ventilated-patients-in-critical-care-compared-to-standard-care-rehab-study-protocol-for-a-single-site-randomised-controlled-feasibility-trial
#12
Catherine Snelson, Charlotte Jones, Gemma Atkins, James Hodson, Tony Whitehouse, Tonny Veenith, David Thickett, Emma Reeves, Aisling McLaughlin, Lauren Cooper, David McWilliams
BACKGROUND: Mortality from critical illness is improving, but survivors suffer from prolonged weakness and psychological and cognitive impairments. Maximising the recovery after critical illness has been highlighted as a research priority, especially in relation to an ageing population who present with higher rates of pre-morbid disability. Small studies have shown that starting rehabilitation early within the intensive care unit (ICU) improves short-term outcomes. Systematic reviews have highlighted the need for robust multicentre randomised controlled trials with longer term follow-up...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28426384/a-2-year-old-boy-with-circulatory-failure-owing-to-streptococcal-toxic-shock-syndrome-case-report
#13
Werner Keenswijk, Johan Vande Walle
A 2-year-old boy presented with severe hypotension and acute kidney injury after a prodrome of non-bloody diarrhoea and fever in the preceding 3 days. He had a mild Ebstein cardiac anomaly but otherwise a normal past history and growth. On examination, he looked ill, his temperature was 37.5 °C, circulation was poor, and there were several purpuric lesions on the face, hands and scrotum. Haemoglobin was 7.8 g/dL (11-14), total white cell count 27 × 10(9)/L, platelets 62 × 10(9)/L, blood urea nitrogen 20...
April 20, 2017: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/28425979/factors-leading-to-rehospitalization-for-tracheostomized-and-ventilator-dependent-infants-through-2-years-of-age
#14
G Akangire, W Manimtim, M Nyp, N Townley, H Dai, M Norberg, J B Taylor
OBJECTIVE: To identify factors leading to readmission for tracheostomized, ventilator-dependent infants <2 years of age. STUDY DESIGN: Retrospective cohort study of 117 tracheostomized, ventilator-dependent infants followed through 2 years of age. RESULTS: Home ventilator use (at hospital discharge, 6 and 12 months of age), inhaled steroid use (at 12 and 24 months of age), oxygen dependence (at 6 and 12 months of age) and tracheostomy (at discharge, 6 and 12 months of age) were increased risks for rehospitalization...
April 20, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28420862/clinical-characteristics-treatment-and-prognosis-of-patients-with-acute-severe-heart-failure-of-ischemic-and-non-ischemic-etiology-analysis-from-the-commit-ahf-registry
#15
Mateusz Ostręga, Marek J Gierlotka, Grzegorz Słonka, Paweł Nadziakiewicz, Mariusz Gąsior
INTRODUCTION    There are limited data on the impact of ischemic etiology on clinical status and long-term prognosis among patients with acute severe heart failure (ASHF) not associated with acute coronary syndrome (ACS).  OBJECTIVES    To assess clinical characteristics, treatment and the 12-month mortality of patients with no-ACS ASHF according to etiology.  PATIENTS AND METHODS    The data from 112 patients with ASHF that was not associated with ACS were analyzed: 61 with ischemic (IASHF) and 51 with non-ischemic (NIASHF) etiology...
April 18, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28416020/patient-and-family-centered-performance-measures-focused-on-actionable-processes-of-care-for-persistent-and-chronic-critical-illness-protocol-for-a-systematic-review
#16
Louise Rose, Laura Istanboulian, Laura Allum, Lisa Burry, Craig Dale, Nicholas Hart, Claire Kydonaki, Pam Ramsay, Natalie Pattison, Bronwen Connolly
BACKGROUND: Approximately 5 to 10% of critically ill patients transition from acute critical illness to a state of persistent and in some cases chronic critical illness. These patients have unique and complex needs that require a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, discharge planning, and in some cases, end-of-life care. However, existing indicators and measures of care quality, and tools such as checklists, that foster implementation of best practices, may not be sufficiently inclusive in terms of actionable processes of care relevant to these patients...
April 17, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28413621/recent-advances-in-pediatric-ventilatory-assistance
#17
REVIEW
Nicolas Nardi, Guillaume Mortamet, Laurence Ducharme-Crevier, Guillaume Emeriaud, Philippe Jouvet
In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance...
2017: F1000Research
https://www.readbyqxmd.com/read/28410251/association-of-need-for-tracheotomy-with-decreasing-mechanical-in-exsufflation-flows-in-amyotrophic-lateral-sclerosis
#18
John R Bach, Neelam Upadhyaya
Although patients with lower motor neuron and myopathic disorders can prolong their lives by depending on continuous noninvasive ventilatory support, most patients with amyotrophic lateral sclerosis (ALS) cannot and must use tracheostomy mechanical ventilation to prolong survival. This case demonstrates that this occurs because amyotrophic lateral sclerosis patients' upper motor neuron reflex laryngeal closure and stridor cause upper airway collapse that renders mechanical insufflation-exsufflation (MIE) ineffective in expulsing airway secretions as well as for permitting continuous noninvasive ventilatory support...
April 13, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28405997/tracheoesophageal-fistula-following-endotracheal-intubation-for-organophosphorus-poisoning
#19
Shailaja V Rao, Ajay K Boralkar, Prabhakar S Jirvankar, Mangala V Sonavani, Varsha Rotte Kaginalkar, Chimu Chinte
Tracheoesophageal fistula (TEF) is an abnormal communication between the trachea and esophagus. Iatrogenic TEF can be due to endotracheal intubation, rigid bronchoscopy or tracheostomy. Tracheostomy tube cuff volumes and pressures require constant monitoring to avoid tracheal injury. Acquired TEF which occurs after prolonged intubation, usually develops after 15-200 days of mechanical ventilation. We report a case of a large TEF secondary to endotracheal intubation for organophosphorus poison-induced respiratory failure...
December 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28403404/hospital-outcomes-and-long-term-survival-after-referral-to-a-specialized-weaning-unit
#20
M G Davies, T G Quinnell, N S Oscroft, S P Clutterbuck, J M Shneerson, I E Smith
Background.: Prolonged invasive mechanical ventilation (IMV) is a frequent challenge, and an increasing number of patients are transferred from intensive care units to long-term acute care hospitals or specialized weaning units. There are few published data for discharge home rates, use of noninvasive ventilation (NIV), or long-term survival. Methods.: A case-note and database review was conducted of patients admitted to a UK national specialized weaning unit for weaning from IMV between 1992 and 2012...
April 1, 2017: British Journal of Anaesthesia
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