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Amal Jubran

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https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#1
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/26179876/pulse-oximetry
#2
REVIEW
Amal Jubran
Pulse oximetry is universally used for monitoring patients in the critical care setting. This article updates the review on pulse oximetry that was published in 1999 in Critical Care. A summary of the recently developed multiwavelength pulse oximeters and their ability in detecting dyshemoglobins is provided. The impact of the latest signal processing techniques and reflectance technology on improving the performance of pulse oximeters during motion artifact and low perfusion conditions is critically examined...
2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/25437305/validity-and-reliability-of-rectus-femoris-ultrasound-measurements-comparison-of-curved-array-and-linear-array-transducers
#3
COMPARATIVE STUDY
Kendra Hammond, Jobby Mampilly, Franco A Laghi, Amit Goyal, Eileen G Collins, Conor McBurney, Amal Jubran, Martin J Tobin
Muscle-mass loss augers increased morbidity and mortality in critically ill patients. Muscle-mass loss can be assessed by wide linear-array ultrasound transducers connected to cumbersome, expensive console units. Whether cheaper, hand-carried units equipped with curved-array transducers can be used as alternatives is unknown. Accordingly, our primary aim was to investigate in 15 nondisabled subjects the validity of measurements of rectus femoris cross-sectional area by using a curved-array transducer against a linear-array transducer-the reference-standard technique...
2014: Journal of Rehabilitation Research and Development
https://www.readbyqxmd.com/read/24747754/diaphragmatic-neuromechanical-coupling-and-mechanisms-of-hypercapnia-during-inspiratory-loading
#4
Franco Laghi, Hameeda S Shaikh, Daniel Morales, Christer Sinderby, Amal Jubran, Martin J Tobin
We hypothesized that improved diaphragmatic neuromechanical coupling during inspiratory loading is not sufficient to prevent alveolar hypoventilation and task failure, and that the latter results primarily from central-output inhibition of the diaphragm and air hunger rather than contractile fatigue. Eighteen subjects underwent progressive inspiratory loading. By task failure all developed hypercapnia. Tidal transdiaphragmatic pressure (ΔPdi) and diaphragmatic electrical activity (ΔEAdi) increased during loading - the former more than the latter; thus, neuromechanical coupling (ΔPdi/ΔEAdi) increased during loading...
July 1, 2014: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/24467647/the-application-of-esophageal-pressure-measurement-in-patients-with-respiratory-failure
#5
REVIEW
Evangelia Akoumianaki, Salvatore M Maggiore, Franco Valenza, Giacomo Bellani, Amal Jubran, Stephen H Loring, Paolo Pelosi, Daniel Talmor, Salvatore Grasso, Davide Chiumello, Claude Guérin, Nicolo Patroniti, V Marco Ranieri, Luciano Gattinoni, Stefano Nava, Pietro-Paolo Terragni, Antonio Pesenti, Martin Tobin, Jordi Mancebo, Laurent Brochard
This report summarizes current physiological and technical knowledge on esophageal pressure (Pes) measurements in patients receiving mechanical ventilation. The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure (Paw) and Pes is a valid estimate of transpulmonary pressure. Pes helps determine what fraction of Paw is applied to overcome lung and chest wall elastance. Pes is usually measured via a catheter with an air-filled thin-walled latex balloon inserted nasally or orally...
March 1, 2014: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/23855688/has-the-twitching-hour-arrived-for-the-ventilated-patient
#6
EDITORIAL
Amal Jubran
No abstract text is available yet for this article.
July 15, 2013: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/23720268/ventilatory-failure-ventilator-support-and-ventilator-weaning
#7
REVIEW
Martin J Tobin, Franco Laghi, Amal Jubran
The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles...
October 2012: Comprehensive Physiology
https://www.readbyqxmd.com/read/23340588/effect-of-pressure-support-vs-unassisted-breathing-through-a-tracheostomy-collar-on-weaning-duration-in-patients-requiring-prolonged-mechanical-ventilation-a-randomized-trial
#8
RANDOMIZED CONTROLLED TRIAL
Amal Jubran, Brydon J B Grant, Lisa A Duffner, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
IMPORTANCE: Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated. OBJECTIVE: To compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation. DESIGN, SETTING, AND PARTICIPANTS: Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation...
February 20, 2013: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/22546221/clinical-review-respiratory-monitoring-in-the-icu-a-consensus-of-16
#9
Laurent Brochard, Greg S Martin, Lluis Blanch, Paolo Pelosi, F Javier Belda, Amal Jubran, Luciano Gattinoni, Jordi Mancebo, V Marco Ranieri, Jean-Christophe M Richard, Diederik Gommers, Antoine Vieillard-Baron, Antonio Pesenti, Samir Jaber, Ola Stenqvist, Jean-Louis Vincent
Monitoring plays an important role in the current management of patients with acute respiratory failure but sometimes lacks definition regarding which 'signals' and 'derived variables' should be prioritized as well as specifics related to timing (continuous versus intermittent) and modality (static versus dynamic). Many new techniques of respiratory monitoring have been made available for clinical use recently, but their place is not always well defined. Appropriate use of available monitoring techniques and correct interpretation of the data provided can help improve our understanding of the disease processes involved and the effects of clinical interventions...
2012: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/22369739/nurses-and-ventilators
#10
COMMENT
Amal Jubran
In the previous issue of Critical Care, Rose and colleagues report the results of a survey on the frequency with which ICU nurses are involved in decision-making in ventilator management. About 63 to 88% of the decisions were made by nurses in collaboration with physicians, and as much as 68% of ventilator adjustments were performed by nurses independent of physicians. Nurse involvement in decision-making was twice as likely in ICUs that use weaning protocols. The ICU nurse performs many roles, the most important being the continuous observation of a patient...
2012: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/21330856/treating-the-septic-muscle-with-electrical-stimulations
#11
EDITORIAL
Franco Laghi, Amal Jubran
No abstract text is available yet for this article.
March 2011: Critical Care Medicine
https://www.readbyqxmd.com/read/20713792/narrative-review-ventilator-induced-respiratory-muscle-weakness
#12
REVIEW
Martin J Tobin, Franco Laghi, Amal Jubran
Clinicians have long been aware that substantial lung injury results when mechanical ventilation imposes too much stress on the pulmonary parenchyma. Evidence is accruing that substantial injury may also result when the ventilator imposes too little stress on the respiratory muscles. Through adjustment of ventilator settings and administration of pharmacotherapy, the respiratory muscles may be rendered almost (or completely) inactive. Research in animals has shown that diaphragmatic inactivity produces severe injury and atrophy of muscle fibers...
August 17, 2010: Annals of Internal Medicine
https://www.readbyqxmd.com/read/20661726/post-traumatic-stress-disorder-after-weaning-from-prolonged-mechanical-ventilation
#13
Amal Jubran, Gerald Lawm, Lisa A Duffner, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
PURPOSE: Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD. METHODS: A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later...
December 2010: Intensive Care Medicine
https://www.readbyqxmd.com/read/20232042/depressive-disorders-during-weaning-from-prolonged-mechanical-ventilation
#14
Amal Jubran, Gerald Lawm, Joanne Kelly, Lisa A Duffner, Gokay Gungor, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
PURPOSE: Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. METHODS: A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken...
May 2010: Intensive Care Medicine
https://www.readbyqxmd.com/read/18007269/meta-analysis-under-the-spotlight-focused-on-a-meta-analysis-of-ventilator-weaning
#15
Martin J Tobin, Amal Jubran
OBJECTIVE: Because the results of a meta-analysis are used to formulate the highest level recommendation in clinical practice guidelines, clinicians should be mindful of problems inherent in this technique. Rather than reviewing meta-analysis in abstract, general terms, we believe readers can gain a more concrete understanding of the problems through a detailed examination of one meta-analysis. The meta-analysis on which we focus is that conducted by an American College of Chest Physicians/American Association for Respiratory Care/American College of Critical Care Medicine Task Force on ventilator weaning...
January 2008: Critical Care Medicine
https://www.readbyqxmd.com/read/17395760/sternomastoid-rib-cage-and-expiratory-muscle-activity-during-weaning-failure
#16
Sairam Parthasarathy, Amal Jubran, Franco Laghi, Martin J Tobin
We hypothesized that patients who fail weaning from mechanical ventilation recruit their inspiratory rib cage muscles sooner than they recruit their expiratory muscles, and that rib cage muscle recruitment is accompanied by recruitment of sternomastoid muscles. Accordingly, we measured sternomastoid electrical activity and changes in esophageal (DeltaPes) and gastric pressure (DeltaPga) in 11 weaning-failure and 8 weaning-success patients. At the start of trial, failure patients exhibited a higher DeltaPga-to-DeltaPes ratio than did success patients (P = 0...
July 2007: Journal of Applied Physiology
https://www.readbyqxmd.com/read/17091239/variable-performance-of-weaning-predictor-tests-role-of-bayes-theorem-and-spectrum-and-test-referral-bias
#17
REVIEW
Martin J Tobin, Amal Jubran
OBJECTIVE: We examined whether variation in reported reliability of the frequency-to-tidal volume ratio (f/V(T)) in predicting weaning success is explained by spectrum and test-referral bias, as reflected by variation in pretest probability of success. DESIGN: Two authors extracted data from all studies on reliability of f/V(T) as a weaning predictor. RESULTS: Prevalence of successful weaning in studies of f/V(T) revealed significant heterogeneity; mean success rate was 0...
December 2006: Intensive Care Medicine
https://www.readbyqxmd.com/read/16934168/critical-illness-and-mechanical-ventilation-effects-on-the-diaphragm
#18
REVIEW
Amal Jubran
Although life-saving, mechanical ventilation is associated with numerous complications. These include pneumonia, cardiovascular compromise, barotrauma, and ventilator-induced lung injury. Recent data from animal studies suggest that controlled mechanical ventilation can cause dysfunction of the diaphragm, decreasing its force-generating capacity--a condition referred to as ventilator-induced diaphragmatic dysfunction (VIDD). The decrease in diaphragmatic contractility is time-dependent and worsens as mechanical ventilation is prolonged...
September 2006: Respiratory Care
https://www.readbyqxmd.com/read/15778489/fluctuations-in-end-expiratory-lung-volume-during-cheyne-stokes-respiration
#19
Thomas Brack, Amal Jubran, Franco Laghi, Martin J Tobin
We hypothesized that patients with Cheyne-Stokes respiration exhibit periodic increases in end-expiratory lung volume, mediated by changes in breath components, postinspiratory inspiratory muscle activity, or both. Calibrated inductive plethysmography revealed that 12 of 12 patients with Cheyne-Stokes respiration experienced increases in end-expiratory volume during hyperpnea: maximum 412 +/- 112 (SE) ml (range 75-1,543 ml). Compared with quiet breathing, the breath with largest increase in end-expiratory volume had larger tidal volume (867 +/- 107 vs...
June 15, 2005: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/15764727/weaning-prediction-esophageal-pressure-monitoring-complements-readiness-testing
#20
Amal Jubran, Brydon J B Grant, Franco Laghi, Sairam Parthasarathy, Martin J Tobin
Several variables are recommended for identifying if a patient is ready for a trial of weaning from mechanical ventilation, but there is no agreement as to whether monitoring any variable during the trial enhances patient management. To determine whether repeated measurements of esophageal pressure throughout a trial are more reliable than measurements of esophageal pressure or frequency-to-VT ratio during the first minute of the trial, we studied 60 patients. A trend index that quantified esophageal pressure swings over time was more reliable than the first-minute measurements: sensitivity, 0...
June 1, 2005: American Journal of Respiratory and Critical Care Medicine
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