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Ventilation Strategies

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https://www.readbyqxmd.com/read/28930639/50-years-of-research-in-ards-tidal-volume-selection-in-the-acute-respiratory-distress-syndrome
#1
Sarina K Sahetya, Jordi Mancebo, Roy G Brower
Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Since the publication of a large randomized clinical trial demonstrating the benefit of lower tidal volumes, the use of tidal volumes of 6 mL/kg predicted body weight (PBW, based on sex and height) has been recommended in clinical practice guidelines...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28926488/potential-acceptability-of-a-pediatric-ventilator-management-computer-protocol
#2
Katherine A Sward, Christopher J L Newth, Robinder G Khemani, Kent Page, Kathleen L Meert, Joseph A Carcillo, Thomas P Shanley, Frank W Moler, Murray M Pollack, Heidi J Dalton, David L Wessel, John T Berger, Robert A Berg, Rick E Harrison, Allan Doctor, J Michael Dean, Richard Holobkov, Tammara L Jenkins, Carol E Nicholson
OBJECTIVES: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. DESIGN: Survey/questionnaire. SETTING: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. PARTICIPANTS: One hundred twenty-two physicians (attendings and fellows). INTERVENTIONS: None...
September 16, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28926214/diagnosis-and-management-of-acute-exacerbations-of-chronic-obstructive-pulmonary-disease
#3
Van Holden, Donald Slack III, Michael T. McCurdy, Nirav G. Shah
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a clinical diagnosis that is based on changes in dyspnea, cough, and/or sputum production in a COPD patient; however, patients presenting with an acute exacerbation may be undiagnosed or have a variety of comorbid conditions that can complicate diagnosis. This issue presents strategies and algorithms for the early use of evidence-based interventions, including appropriate use of antibiotics, bronchodilators, and corticosteroids, along with noninvasive ventilation with capnography, to minimize morbidity and mortality associated with this disease...
October 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28923828/attenuated-pdgf-signaling-drives-alveolar-and-microvascular-defects-in-neonatal-chronic-lung%C3%A2-disease
#4
Prajakta Oak, Tina Pritzke, Isabella Thiel, Markus Koschlig, Daphne S Mous, Anita Windhorst, Noopur Jain, Oliver Eickelberg, Kai Foerster, Andreas Schulze, Wolfgang Goepel, Tobias Reicherzer, Harald Ehrhardt, Robbert J Rottier, Peter Ahnert, Ludwig Gortner, Tushar J Desai, Anne Hilgendorff
Neonatal chronic lung disease (nCLD) affects a significant number of neonates receiving mechanical ventilation with oxygen-rich gas (MV-O2). Regardless, the primary molecular driver of the disease remains elusive. We discover significant enrichment for SNPs in the PDGF-Rα gene in preterms with nCLD and directly test the effect of PDGF-Rα haploinsufficiency on the development of nCLD using a preclinical mouse model of MV-O2 In the context of MV-O2, attenuated PDGF signaling independently contributes to defective septation and endothelial cell apoptosis stemming from a PDGF-Rα-dependent reduction in lung VEGF-A...
September 18, 2017: EMBO Molecular Medicine
https://www.readbyqxmd.com/read/28918667/poor-outcomes-among-elderly-patients-hospitalized-for-influenza-like-illness
#5
Mine Durusa Tanriover, Tülay Bagci Bosi, Lale Ozisik, Emre Bilgin, Özlem Güzel Tunçcan, Özge Özgen, Necla Tülek, Metin Özsoy, Hasan Tezer, Tugba Bedir Demirdağ, Ates Kara, Sevgen Tanir Basaranoglu, Kubra Aykac, Aslinur Ozkaya-Parlakay, Belgin Gulhan, Serhat Unal
BACKGROUND AND OBJECTIVE: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and the vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza like illness and the outcomes of the enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room...
September 18, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28917004/critical-illness-associated-diaphragm-weakness
#6
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/28910905/-application-of-noninvasive-ventilation-in-postoperative-patients-indications-and-clinical-strategies
#7
Y Xi, Y M Li
No abstract text is available yet for this article.
September 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28910146/management-of-ards-and-refractory-hypoxemia-a-multicenter-observational-study
#8
Erick H Duan, Neill Kj Adhikari, Frederick D'Aragon, Deborah J Cook, Sangeeta Mehta, Waleed Alhazzani, Ewan Goligher, Emmanuel Charbonney, Yaseen M Arabi, Tim Karachi, Alexis F Turgeon, Lori Hand, Qi Zhou, Peggy Austin, Jan Friedrich, Francois Lamontagne, François Lauzier, Rakesh Patel, John Muscedere, Richard Hall, Pierre Aslanian, Thomas Piraino, Martin Albert, Sean M Bagshaw, Mike Jacka, Gordon Wood, William Henderson, Delbert Dorscheid, Niall D Ferguson, Maureen O Meade
RATIONALE: Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described. OBJECTIVES: To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS including refractory hypoxemia. METHODS: Prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring FiO2 ≥0.50 in 24 ICUs...
September 14, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28905944/snakebite-envenoming
#9
REVIEW
José María Gutiérrez, Juan J Calvete, Abdulrazaq G Habib, Robert A Harrison, David J Williams, David A Warrell
Snakebite envenoming is a neglected tropical disease that kills >100,000 people and maims >400,000 people every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Snake venoms are complex mixtures of proteins that exert a wide range of toxic actions. The high variability in snake venom composition is responsible for the various clinical manifestations in envenomings, ranging from local tissue damage to potentially life-threatening systemic effects...
September 14, 2017: Nature Reviews. Disease Primers
https://www.readbyqxmd.com/read/28904482/mathematics-of-ventilator-induced-lung-injury
#10
REVIEW
Ubaidur Rahaman
Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28904174/in-hospital-outcomes-of-tumor-lysis-syndrome-a-population-based-study-using-the-national-inpatient-sample
#11
Urshila Durani, Nilay D Shah, Ronald S Go
The epidemiology and outcomes of tumor lysis syndrome (TLS) are understudied. We used the National Inpatient Sample (NIS), a nationally representative weighted sample of all U.S. hospital discharges, to study outcomes and predictors of mortality in hospitalized patients with TLS. The NIS was queried for patients with a discharge diagnosis of TLS (ICD-9 code 277.88) from 2010-2013. Baseline characteristics and outcomes were analyzed. A multivariable logistic regression analysis was performed to identify predictors of mortality...
September 13, 2017: Oncologist
https://www.readbyqxmd.com/read/28901231/single-stage-repair-of-coarctation-of-the-aorta-and-ventricular-septal-defect-a-comparison-of-surgical-strategies-and-resource-utilization
#12
Connor Callahan, David Saudek, Amanda Shillingford, Sara Creighton, Garick Hill, William Johnson, James S Tweddell, Michael E Mitchell, Ronald K Woods
BACKGROUND: We sought to compare clinical outcomes and resource utilization for two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect (VSD). METHODS: This was a retrospective chart review of 21 consecutive neonates and infants undergoing single-stage repair of coarctation of the aorta and VSD. Group 1 included 13 patients with both arch repair and VSD repair completed via sternotomy. Group 2 included eight patients with off-pump arch repair via left thoracotomy followed by repositioning and VSD repair via sternotomy...
September 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28895380/how-to-optimize-the-lung-donor
#13
Gabriele Sales, Andrea Costamagna, Vito Fanelli, Massimo Boffini, Francesco Pugliese, Luciana Mascia, Luca Brazzi
In the last two decades, lung transplantation emerged as the standard of care for patients with advanced and terminal lung disease. Despite the increment in lung transplantation rates, in 2016 the overall mortality while on waiting list in Italy reached the 10%, whereas only the 39% of the wait-list patients were successfully transplanted. A number of approaches, including protective ventilatory strategy, accurate management of fluid balance, administration of a hormonal resuscitation therapy have been reported to improve lung donor performance before organ retrieval...
September 11, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28893792/influence-of-mechanical-ventilation-on-vancomycin-pharmacokinetics-administered-by-continuous-infusion-in-critically-ill-patients
#14
Susanna Edith Medellín-Garibay, Silvia Romano-Moreno, Pilar Tejedor-Prado, Noelia Rubio-Álvaro, Aida Rueda-Naharro, Miguel Angel Blasco-Navalpotro, Benito García, Emilia Barcia
Pathophysiological changes involved on drug disposition in critically ill patients, should be considered on the dosing optimization of vancomycin administered by continuous infusion, and certain strategies must be applied to reach therapeutic targets on the first day of treatment. The aim of this study was to develop a population pharmacokinetic model of vancomycin to determine clinical covariates, including mechanical ventilation, that influence the wide variability of this antimicrobial. Vancomycin plasma concentrations from 54 critically ill patients were simultaneously analyzed by population pharmacokinetic approach...
September 11, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28891372/controversies-and-advances-in-the-management-of-ventilator-associated-pneumonia
#15
Katherine L Roberts, Marin H Kollef, Scott T Micek, Paul Juang
Although national surveillance data suggests that the incidence of ventilator associated pneumonia (VAP) is down-trending, it remains one of the most commonly encountered hospital acquired infections in the United States and worldwide. Its association with increased healthcare costs and worsened patient outcomes warrants continued effort to improve the care of patients with VAP. Areas covered: The increasing prevalence of multi-drug resistant bacteria further drives the need to explore advances in diagnostic and treatment options...
September 11, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28891032/the-need-for-unique-risk-adjustment-for-surgical-site-infections-at-a-high-volume-tertiary-care-center-with-inherent-high-risk-colorectal-procedures
#16
E Gorgun, C Benlice, J Hammel, T Hull, L Stocchi
BACKGROUND: The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers...
September 11, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28890839/dpm-dispersion-inside-a-single-straight-entry-using-dynamic-mesh-model
#17
Yi Zheng, Ying Li, Magesh Thiruvengadam, Hai Lan, Jerry C Tien
Three-dimensional simulations of diesel particulate matter (DPM) distribution inside a single straight entry for the Load-Haul-Dump loader (LHD)-truck loading and truck hauling operations were conducted by using ANSYS FLUENT computational fluid dynamics software. The loading operation was performed for a fixed period of 3 min. The dynamic mesh technique in FLUENT was used to study the impact of truck motion on DPM distribution. The resultant DPM distributions are presented for the cases when the truck were driving upstream and downstream of the loading face...
2017: International Journal of Coal Science & Technology
https://www.readbyqxmd.com/read/28889192/the-economic-impact-of-prematurity-and-bronchopulmonary-dysplasia
#18
María Álvarez-Fuente, Luis Arruza, Marta Muro, Carlos Zozaya, Alejandro Avila, Paloma López-Ortego, Carmen González-Armengod, Alba Torrent, Jose Luis Gavilán, María Jesús Del Cerro
Bronchopulmonary dysplasia (BPD) is one of the most serious chronic lung diseases in infancy and one of the most important sequels of premature birth (prevalence of 15-50%). Our objective was to estimate the cost of BPD of one preterm baby, with no other major prematurity-related complications, during the first 2 years of life in Spain. Data from the Spanish Ministry of Health regarding costs of diagnosis-related group of preterm birth, hospital admissions and visits, palivizumab administration, and oxygen therapy in the year 2013 were analyzed...
September 9, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28882178/differential-lung-ventilation-via-tracheostomy-using-two-endotracheal-tubes-in-an-infant-a-case-report
#19
Demet Demirkol, Yasemin Ataman, Gökhan Gündoğdu
BACKGROUND: This case report presents differential lung ventilation in an infant. The aim is to define an alternative technique for performing differential lung ventilation in children. To the best of our knowledge, this is the first report of this kind. CASE PRESENTATION: A 4.2-kg, 2.5-month-old Asian boy was referred to our facility with refractory hypoxemia and hypercarbia due to asymmetric lung disease with atelectasis of the left lung and hyperinflation of the right lung...
September 8, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28881101/nasal-high-frequency-oscillatory-ventilation-impairs-heated-humidification-a-neonatal-bench-study
#20
Tim L Ullrich, Christoph Czernik, Christoph Bührer, Gerd Schmalisch, Hendrik S Fischer
OBJECTIVE: Nasal high-frequency oscillatory ventilation (nHFOV) is a novel mode of non-invasive ventilation used in neonates. However, upper airway obstructions due to viscous secretions have been described as specific adverse effects. We hypothesized that high-frequency oscillations reduce air humidity in the oropharynx, resulting in upper airway desiccation. Therefore, we aimed to investigate the effects of nHFOV ventilatory settings on oropharyngeal gas conditions. METHODS: NHFOV or nasal continuous positive airway pressure (nCPAP) was applied, along with heated humidification, to a previously established neonatal bench model that simulates oropharyngeal gas conditions during spontaneous breathing through an open mouth...
September 7, 2017: Pediatric Pulmonology
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