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Non invasive positive pressure

M Creaney, R M Moriarty, M Milner, C Murphy
Congenital muscular dystrophies are characterised by progressive skeletal muscle weakness from birth or early infancy. Maternal respiratory compromise, joint contractures and presence of spinal instrumentation or fusion are some of the anaesthetic challenges that may be encountered in the obstetric setting. The choice of anaesthetic technique for surgical delivery needs to be considered on an individual basis. Multi-disciplinary involvement is paramount to optimise peripartum care and outcomes. In this case report, we present the use of dexmedetomidine, humidified high-flow nasal oxygen, rocuronium and sugammadex in the anaesthetic management of a wheelchair-bound, non-invasive bilevel positive airway pressure ventilation-dependent parturient with congenital muscular dystrophy, who was presenting for caesarean section...
February 9, 2018: International Journal of Obstetric Anesthesia
Clara Gregori-Pla, Gianluca Cotta, Igor Blanco, Peyman Zirak, Martina Giovannella, Anna Mola, Ana Fortuna, Turgut Durduran, Mercedes Mayos
MOTIVATION: Obstructive sleep apnea (OSA) can impair cerebral vasoreactivity and is associated with an increased risk of cerebrovascular disease. Unfortunately, an easy-to-use, non-invasive, portable monitor of cerebral vasoreactivity does not exist. Therefore, we have evaluated the use of near-infrared diffuse correlation spectroscopy to measure the microvascular cerebral blood flow (CBF) response to a mild head-of-bed position change as a biomarker for the evaluation of cerebral vasoreactivity alteration due to chronic OSA...
2018: PloS One
C Overbergh, S Installe, A Boudewyns, K Van Hoorenbeeck, S L Verhulst
Continuous positive airway pressure (CPAP) is being increasingly used in children of all age ranges. The limited number of commercially available masks especially in infants and young children may complicate its use and compliance. In this report, we describe our experience with the use of the Optiflow™ (Fisher and Paykel Healthcare) Nasal Cannula attached to a regular CPAP device in the setting of chronic CPAP use. This interface consists of a nasal cannula and was originally designed for the delivery of high-flow oxygen therapy...
April 2018: Sleep Medicine
Keamogetswe Molokoane-Mokgoro, Lara Nicole Goldstein, Mike Wells
INTRODUCTION: Ultrasound assessment of the inferior vena cava (IVC) has gained favour in aiding fluid management decisions for controlled, mechanically ventilated patients as well as in non-mechanically ventilated, spontaneously breathing patients. Its utility in spontaneously breathing patients during positive pressure non-invasive ventilation has not yet been determined. The use of the axillary vein, as an alternative option to the IVC due to its ease of accessibility and independence from intra-abdominal pressure, has also not been evaluated...
March 9, 2018: Emergency Medicine Journal: EMJ
Takashi Kanamori, Shigeru Kusumoto, Kenji Okita, Shinya Hagiwara, Chie Kato, Takahiro Nakashima, Satsuki Murakami, Tomoko Narita, Asahi Ito, Masaki Ri, Takashi Ishida, Hirokazu Komatsu, Noriyuki Matsukawa, Shinsuke Iida
A 40-year-old female presented with a skin rash, hepatosplenomegaly, hypothyroidism, IgG-λ monoclonal gammopathy, slightly elevated serum VEGF levels, and >1-year history of weakness in the posterior cervical muscles. Based on these symptoms and her clinical course, she was suspected of having POEMS syndrome. However, because there was no sign of peripheral neuropathy (PN), the criteria for the diagnosis of POEMS syndrome were not met. Consequently, she continued follow-up and was under close observation as an outpatient...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Caroline Crehan, Tim Colbourn, Michelle Heys, Elizabeth Molyneux
BACKGROUND: Non-invasive respiratory support using bubble continuous positive airway pressure (bCPAP) is useful in treating babies with respiratory distress syndrome. Despite its proven clinical and cost-effectiveness, implementation is hampered by the inappropriate administration of bCPAP in low-resource settings. A clinical algorithm-'TRY' (based on Tone: good; Respiratory distress; Yes, heart rate above 100 beats/min)-has been developed to correctly identify which newborns would benefit most from bCPAP in a teaching hospital in Malawi...
March 7, 2018: Archives of Disease in Childhood
Nicole Zimmermann, Svea Brandt, Jeanette Brünner, Carl Erb
INTRODUCTION: Our study compares the biomechanical properties of the cornea in patients with long-term pre-existing (for at least 10 years) systemic sclerosis (SSc) with those of healthy suspects. MATERIAL/METHODS: The examination was performed in 14 systemic SSc patients and 38 healthy volunteers. Non-invasive assessment of corneal biomechanical parameters, including central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF), was performed in one randomised study eye in accordance with a standardised protocol...
March 7, 2018: Klinische Monatsblätter Für Augenheilkunde
Kannayiram Alagiakrishnan, Ruojin Bu, Peter Hamilton, Ambikaipakan Senthilselvan, Raj Padwal
Background: Orthostatic hypotension (OH) is associated with falls and cardiovascular events. There is growing evidence that central blood pressure (CBP) is better than peripheral blood pressure (PBP) in predicting adverse outcomes. The objectives of this study were to assess 1) the prevalence of OH identified using PBP and CBP and the levels of agreement, 2) the respective associations between OH and falls and cardiovascular comorbidities, by PBP and CBP, and 3) the association of OH with arterial wall stiffness markers (augmentation pressure (AP) and augmentation index (AI))...
April 2018: Journal of Clinical Medicine Research
Takayasu Ito, Masahide Oki, Hideo Saka, Yasuhiro Kondoh, Tomoki Kimura, Kensuke Kataoka
A 71-year-old man, who had received long-term oxygen therapy for respiratory failure caused by chronic obstructive pulmonary disease, had an enlarged mediastinal lymph node for one year. As his lung function was poor, we tried performing endobronchial ultrasound-guided transbronchial needle aspiration under non-invasive positive pressure ventilation for diagnosis but could not obtain sufficient specimens. Later, we performed an endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) using a transesophageal approach...
May 2018: Respirology Case Reports
Timothy Johnson, Peter Richman, John R Allegra, Barnet Eskin, James Seger
BACKGROUND: Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65years old) patients in the emergency department (ED). OBJECTIVE: To determine if the percentage of elderly ED patients intubated has decreased in recent years. METHODS: Design: Retrospective multihospital cohort. SETTING: Consecutive ED patients in nine NJ hospitals (1/1/1999 to 9/30/2014)...
February 25, 2018: American Journal of Emergency Medicine
Kotb Abbass Metwalley, Sherifa Ahmed Hamed, Hekma Saad Farghaly
Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D). This study aimed to evaluate cardiac autonomic nervous system (ANS) function in children with T1D and its relation to different demographic, clinical and laboratory variable. This cross-sectional study included 60 children with T1D (mean age = 15.1 ± 3.3 years; duration of diabetes = 7.95 ± 3.83 years). The following 8 non-invasive autonomic testing were used for evaluation: heart rate at rest and in response to active standing (30:15 ratio), deep breathing and Valsalva maneuver (indicating parasympathetic function); blood pressure response to standing (orthostatic hypotension or OH), sustained handgrip and cold; and heart rate response to standing or positional orthostatic tachycardia syndrome or POTs (indicating sympathetic function)...
March 2, 2018: European Journal of Pediatrics
M T Berninger, F Kellermann, A Woltmann, V Bühren, M Lang
This article describes the operative stabilization of a flail chest due to traumatic serial rib fractures with extensive chest wall deformation and respiratory insufficiency. Initial conservative treatment including systemic and regional pain management and non-invasive positive pressure ventilation did not improve the pain or ventilation. Therefore, a single-port video-assisted thoracoscopic surgery (VATS) assisted internal fixation of the ribs was performed. The thoracoscopy enabled easy repositioning of the ribs and additionally an estimation of intrathoracic injuries...
March 2, 2018: Der Unfallchirurg
Iñigo Aramendia, Unai Fernandez-Gamiz, Alberto Lopez-Arraiza, Carmen Rey-Santano, Victoria Mielgo, Francisco Jose Basterretxea, Javier Sancho, Miguel Angel Gomez-Solaetxe
Respiratory distress syndrome (RDS) represents one of the major causes of mortality among preterm infants, and the best approach to treat it is an open research issue. The use of perfluorocarbons (PFC) along with non-invasive respiratory support techniques has proven the usefulness of PFC as a complementary substance to achieve a more homogeneous surfactant distribution. The aim of this work was to study the inhaled particles generated by means of an intracorporeal inhalation catheter, evaluating the size and mass distribution of different PFC aerosols...
February 28, 2018: International Journal of Environmental Research and Public Health
Maria Skytioti, Signe Søvik, Maja Elstad
Spontaneous breathing has beneficial effects on the circulation, since negative intrathoracic pressure enhances venous return and increases cardiac stroke volume. We quantified the contribution of the respiratory pump to preserve stroke volume during hypovolemia in awake, young, healthy subjects. Non-invasive stroke volume, cardiac output, heart rate and mean arterial pressure (Finometer) were recorded in 31 volunteers (19 females), 19-30 years old, during normovolemia and hypovolemia (approximating 450-500 ml reduction in central blood volume) induced by lower body negative pressure...
March 1, 2018: Journal of Applied Physiology
Zofia Czosnyka, Dong-Joo Kim, Olivier Balédent, Eric A Schmidt, Peter Smielewski, Marek Czosnyka
OBJECTIVE: The phase-contrast MRI technique permits the non-invasive assessment of CSF movements in cerebrospinal fluid cavities of the central nervous system. Of particular interest is pulsatile cerebrospinal fluid (CSF) flow through the aqueduct cerebri. It is allegedly increased in hydrocephalus, having potential diagnostic value, although not all scientific reports contain unequivocally positive conclusions. METHODS: For the mathematical simulation of CSF flow, we used a computational model of cerebrospinal blood/fluid circulation designed by a former student as his PhD project...
2018: Acta Neurochirurgica. Supplement
Sammy J Sharif, Cherith M Campbell-Bell, Diederik O Bulters, Robert J Marchbanks, Anthony A Birch
OBJECTIVES: Evoked tympanic membrane displacement (TMD) measurements, quantified by Vm , record small volume changes in the ear canal following stimulation of the acoustic reflex. Vm shows a correlation with intracranial pressure (ICP) and has been proposed as an option to non-invasively measure ICP. The spontaneous pulsing of the tympanic membrane, driven by the cardiovascular pulse, may contaminate the recordings and contribute to high measurement variability in some subjects. This study hypothesised that the larger the spontaneous vascular pulse, the larger the variability in Vm ...
2018: Acta Neurochirurgica. Supplement
Chiara Robba, Danilo Cardim, Tamara Tajsic, Justine Pietersen, Michael Bulman, Frank Rasulo, Rita Bertuetti, Joseph Donnelly, Liu Xiuyun, Zofia Czosnyka, Manuel Cabeleira, Peter Smielewski, Basil Matta, Alessandro Bertuccio, Marek Czosnyka
BACKGROUND: Non-invasive measurement of intracranial pressure (ICP) can be invaluable in the management of critically ill patients. Invasive measurement of ICP remains the "gold standard" and should be performed when clinical indications are met, but it is invasive and brings some risks. In this project, we aim to validate the non-invasive ICP (nICP) assessment models based on arterious and venous transcranial Doppler ultrasonography (TCD) and optic nerve sheath diameter (ONSD)...
2018: Acta Neurochirurgica. Supplement
Min Hur, Seokha Yoo, Jung-Yoon Choi, Sun-Kyung Park, Dhong Eun Jung, Won Ho Kim, Jin-Tae Kim, Jae-Hyon Bahk
BACKGROUND: Dynamic change in central venous pressure (CVP) was associated with fluid responsiveness. External jugular venous pressure (EJVP) may reliably estimate CVP and have the advantages of being less invasive. We investigated whether increase in EJVP induced by positive end-expiratory pressure (PEEP) could be a reliable predictor of fluid responsiveness in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). METHODS: Fifty patients who underwent RALP with steep Trendelenburg position were enrolled...
February 27, 2018: Journal of Anesthesia
Matthew L Bradshaw, Alexandre Déragon, Pramod Puligandla, Guillaume Emeriaud, Anne-Marie Canakis, Patricia S Fontela
OBJECTIVE: To describe management practices and the factors guiding admission and treatment decisions for viral bronchiolitis across Canadian pediatric intensive care units (PICUs). DESIGN: Cross-sectional survey. SETTING: Canadian PICUs. SUBJECTS: Pediatric intensivists. MEASUREMENTS AND MAIN RESULTS: A survey using two case scenarios (non-intubated vs intubated patients) was developed using focus groups and a literature review...
February 27, 2018: Pediatric Pulmonology
Abdulla Watad, Nicola L Bragazzi, Susanna Bacigaluppi, Howard Amital, Samaa Watad, Kassem Sharif, Bishara Bisharat, Anna Siri, Ala Mahamid, Hakim Abu Ras, Ahmed Nasr, Federico Bilotta, Chiara Robba, Mohammad Adawi
BACKGROUND: Artificial Intelligence (AI) techniques play a major role in anesthesiology, even though their importance is often overlooked. In the extant literature, AI approaches, such as Artificial Neural Networks (ANNs), have been underutilized, mainly being used to model patient's consciousness state, to predict the precise amount of anesthetic gases, the level of analgesia, or the need of anesthesiological blocks, among others. In the field of neurosurgery, ANNs have been effectively applied to the diagnosis and prognosis of cerebral tumors, seizures, low back pain, and also to the monitoring of intracranial pressure (ICP)...
February 23, 2018: Journal of Neurosurgical Sciences
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