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Ventilation Strategies

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https://www.readbyqxmd.com/read/29145465/hospital-associated-methicillin-resistant-staphylococcus-aureus-a-cross-sectional-analysis-of-risk-factors-in-south-african-tertiary-public-hospitals
#1
Liliwe L Shuping, Lazarus Kuonza, Alfred Musekiwa, Samantha Iyaloo, Olga Perovic
INTRODUCTION: Hospital-associated methicillin-resistant S. aureus (HA-MRSA) remains a significant cause of morbidity and mortality worldwide. We conducted a study to determine risk factors for HA-MRSA in order to inform control strategies in South Africa. METHODS: We used surveillance data collected from five tertiary hospitals in Gauteng and Western Cape provinces during 2014 for analysis. A case of HA-MRSA was defined as isolation of MRSA from a blood culture 48 hours after admission and/or if the patient was hospitalised in the six months prior to the current culture...
2017: PloS One
https://www.readbyqxmd.com/read/29140969/risk-factors-for-ventilator-associated-events-in-a-picu
#2
Raeley Guess, Jarin Vaewpanich, Jorge A Coss-Bu, Siriporn Phongjitsiri, Curtis Kennedy, Jeffrey Starke, Satid Thammasitboon
OBJECTIVE: The term ventilator-associated events includes ventilator-associated condition, infection-related ventilator-associated complication, and ventilator-associated pneumonia. We sought to identify potential new risk factors for ventilator-associated condition and infection-related ventilator-associated complication in the PICU population. DESIGN: Matched case control study. SETTING: Children's hospital at a tertiary care academic medical center...
November 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29138115/active-forms-of-akt-and-erk-are-dominant-in-the-cerebral-cortex-of-newborn-pigs-that-are-unaffected-by-asphyxia
#3
Viktória Kovács, Valéria Tóth-Szűki, János Németh, Viktória Varga, Gábor Remzső, Ferenc Domoki
AIMS: Perinatal asphyxia (PA) often results in hypoxic-ischemic encephalopathy (HIE) in term neonates. Introduction of therapeutic hypothermia improved HIE outcome, but further neuroprotective therapies are still warranted. The present study sought to determine the feasibility of the activation of the cytoprotective PI-3-K/Akt and the MAPK/ERK signaling pathways in the subacute phase of HIE development in a translational newborn pig PA/HIE model. MAIN METHODS: Phosphorylated and total levels of Akt and ERK were determined by Western blotting in brain samples obtained from untreated naive, time control, and PA/HIE animals at 24-48h survival (n=3-3-6,respectively)...
November 11, 2017: Life Sciences
https://www.readbyqxmd.com/read/29137575/effect-of-hypocaloric-normoprotein-or-trophic-feeding-versus-target-full-enteral-feeding-on-patient-outcomes-in-critically-ill-adults-a-systematic-review
#4
K A Phan, C M Dux, E J Osland, M C Reade
Uncertainty surrounds the optimal approach to feeding the critically ill, with increasing interest in the concept of intentional underfeeding to reduce metabolic stress while maintaining gut integrity. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates clinical outcomes reported in studies comparing hypocaloric normonitrogenous or trophic feeding (collectively 'intentional underfeeding') targeted full energy feeding administered via enteral nutrition to adult critically ill patients...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29135753/prevention-of-neonatal-unplanned-extubations-in-the-neonatal-intensive-care-unit-a-best-practice-implementation-project
#5
Xiaojing Hu, Yuxia Zhang, Yun Cao, Guoying Huang, Yan Hu, Alexa McArthur
BACKGROUND: Adverse events of mechanically ventilated neonates such as unplanned extubations may be associated with serious negative outcomes. Unplanned extubation rates have been monitored by many neonatal intensive care units as a quality of care metric. OBJECTIVES: The objective was to implement evidence-based best practice and assess the effects of these strategies on minimizing unplanned extubation in the neonatal intensive care unit in a large tertiary children's hospital...
November 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29135500/association-of-driving-pressure-with-mortality-among-ventilated-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#6
Hiroko Aoyama, Tommaso Pettenuzzo, Kazuyoshi Aoyama, Ruxandra Pinto, Marina Englesakis, Eddy Fan
OBJECTIVES: A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality for higher versus lower driving pressure. DATA SOURCES: MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane CENTRAL from inception to February 10, 2017. STUDY SELECTION: Studies including mechanically ventilated adult patients with acute respiratory distress syndrome, reporting driving pressure and mortality...
November 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29134423/perioperative-respiratory-complications-current-evidence-and-strategy-discussed-in-2017-ja-symposium
#7
K Hirota, M Yamakage, S Hashimoto, T Asai, S Isono
Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea...
November 13, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/29134246/does-high-peep-prevent-alveolar-cycling
#8
REVIEW
M Cressoni, C Chiurazzi, D Chiumello, L Gattinoni
Acute respiratory distress syndrome (ARDS) patients need mechanical ventilation to sustain gas exchange. Animal experiments showed that mechanical ventilation with high volume/plateau pressure and no positive end-expiratory pressure (PEEP) damages healthy lungs, while low tidal volumes and the application of higher PEEP levels are protective. PEEP makes the lung homogeneous, reducing the pressure multiplication at the interface between lung units with different inflation statuses and keeps the lung open through the whole respiratory cycle, avoiding intratidal opening and closing...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29132514/ventilator-strategies-for-chronic-obstructive-pulmonary-disease-and-acute-respiratory-distress-syndrome
#9
REVIEW
Nathan T Mowery
The management of the ventilator in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS) has a dramatic effect on the overall outcome. The incidence of COPD is increasing as the US population grows older. The most effective means to deal with pulmonary complications is to avoid them, but both COPD and ARDS have evidence-based interventions that have been shown to improve outcomes. Pulmonary complications affect up to 40% of patients, and their occurrence is associated with an increased duration of hospital stay, and an increased mortality...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29122431/nonsurgical-strategies-to-reduce-mortality-in-patients-undergoing-cardiac-surgery-an-updated-consensus-process
#10
Giovanni Landoni, Vladimir Lomivorotov, Simona Silvietti, Caetano Nigro Neto, Antonio Pisano, Gabriele Alvaro, Ludmilla Abrahao Hajjar, Gianluca Paternoster, Hynek Riha, Fabrizio Monaco, Andrea Szekely, Rosalba Lembo, Nesrin A Aslan, Giovanni Affronti, Valery Likhvantsev, Cristiano Amarelli, Evgeny Fominskiy, Martina Baiardo Redaelli, Alessandro Putzu, Massimo Baiocchi, Jun Ma, Giuseppe Bono, Valentina Camarda, Remo Daniel Covello, Nora Di Tomasso, Miriam Labonia, Carlo Leggieri, Rosetta Lobreglio, Giacomo Monti, Paolo Mura, Anna Mara Scandroglio, Daniela Pasero, Stefano Turi, Agostino Roasio, Carmine D Votta, Emanuela Saporito, Claudio Riefolo, Chiara Sartini, Luca Brazzi, Rinaldo Bellomo, Alberto Zangrillo
OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference...
June 7, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29119122/pediatric-inhalation-injury
#11
REVIEW
Soman Sen
Smoke inhalation injury can cause severe physiologic perturbations. In pediatric patients, these perturbations cause profound changes in cardiac and pulmonary physiology. In this review, we examine the pathology, early management options, ventilator strategy, and long-term outcomes in pediatric patients who have suffered a smoke inhalation injury.
2017: Burns and trauma
https://www.readbyqxmd.com/read/29118830/a-multicentre-prospective-evaluation-of-alcohol-related-admissions-to-intensive-care-units-in-wales
#12
Ceri Lynch, Richard Pugh, Ceri Battle
Purpose: We conducted a prospective multicentre study in 13 Welsh intensive care units to assess what proportion of intensive care admissions relate to alcohol, and how outcomes among these patients compare with non-alcohol related admissions. Materials and methods: Data were prospectively collected for one month between June and July 2015. Every intensive care admission was screened for alcohol associations based on ICD-10 criteria, using a pre-designed pro-forma...
August 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29117063/effect-of-dexmedetomidine-on-lactate-clearance-in-patients-with-septic-shock-a-sub-analysis-of-a-multicenter-randomized-controlled-trial
#13
Kyohei Miyamoto, Tsuyoshi Nakashima, Nozomu Shima, Seiya Kato, Kentaro Ueda, Yu Kawazoe, Yoshinori Ohta, Takeshi Morimoto, Hitoshi Yamamura
Lactate clearance is useful to guide initial resuscitation of patients with septic shock. We conducted this study to evaluate whether dexmedetomidine increases lactate clearance in patients with septic shock. This was a randomized controlled trial that involved a post hoc subgroup analysis. Adult patients with septic shock under ventilation were randomized to receive sedation strategy with or without dexmedetomidine (60 in the dexmedetomidine and 51 in the non-dexmedetomidine groups). The primary outcome was the lactate clearance at 6 h, defined as the percent decrease in lactate from randomization to 6 h after...
November 7, 2017: Shock
https://www.readbyqxmd.com/read/29116547/the-bpd-trio-interaction-of-dysregulated-pdgf-vegf-and-tgf-signaling-in-neonatal-chronic-lung-disease
#14
REVIEW
Prajakta Oak, Anne Hilgendorff
The development of neonatal chronic lung disease (nCLD), i.e., bronchopulmonary dysplasia (BPD) in preterm infants, significantly determines long-term outcome in this patient population. Risk factors include mechanical ventilation and oxygen toxicity impacting on the immature lung resulting in impaired alveolarization and vascularization. Disease development is characterized by inflammation, extracellular matrix remodeling, and apoptosis, closely intertwined with the dysregulation of growth factor signaling...
November 7, 2017: Molecular and Cellular Pediatrics
https://www.readbyqxmd.com/read/29116464/venovenous-extracorporeal-membrane-oxygenation-devices-related-colonisations-and-infections
#15
Guillemette Thomas, Sami Hraiech, Nadim Cassir, Samuel Lehingue, Romain Rambaud, Sandrine Wiramus, Christophe Guervilly, Fanny Klasen, Mélanie Adda, Stéphanie Dizier, Antoine Roch, Laurent Papazian, Jean-Marie Forel
BACKGROUND: Nosocomial infections occurring during extracorporeal membrane oxygenation (ECMO) support have already been reported, but few studied infections directly related to ECMO devices. This study aims to evaluate the rate of both colonisations and infections related to ECMO devices at the time of ECMO removal. RESULTS: We included all consecutive adult patients treated with venovenous ECMO (VV-ECMO) for at least 48 h during a 34-month study. At the time of ECMO removal, blood cultures, swab cultures on insertion cannula site and intravascular cannula extremity cultures were systematically performed...
November 7, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29116360/role-of-the-extracellular-matrix-in-the-genesis-of-ventilator-induced-lung-injury
#16
REVIEW
F F Cruz, P R M Rocco, P Pelosi
The extracellular matrix represents the three-dimensional scaffold of the alveolar wall, which is composed of a layer of epithelial and endothelial cells, their basal membrane, and a thin interstitial layer containing fibrous proteins, glycoproteins, glycosaminoglycans, and proteoglycans. Mechanical ventilation with low and high tidal volumes can induce proteoglycan fragmentation, which may cause activation of the inflammatory cascade, leading to the main features of ventilator-induced lung injury (VILI): alveolar edema and collagen deposition...
November 7, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29112971/effects-of-positive-end-expiratory-pressure-and-recruitment-maneuvers-in-a-ventilator-induced-injury-mouse-model
#17
Laura A Cagle, Lisa M Franzi, Angela L Linderholm, Jerold A Last, Jason Y Adams, Richart W Harper, Nicholas J Kenyon
BACKGROUND: Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury...
2017: PloS One
https://www.readbyqxmd.com/read/29110799/acute-postoperative-management-after-lung-transplantation
#18
REVIEW
Christopher Potestio, Desmond Jordan, Bessie Kachulis
Despite many advances in the field of lung transplantation, lung transplant recipients have the lowest median survival of any solid organ transplant population. Complications such as reperfusion injury, graft rejection, infection, and anastomotic breakdown increase morbidity and mortality during the immediate postoperative period. Ventilator management with lung protective strategies can not only minimize ventilator time and mitigate the risk of ventilator-associated pneumonia, but it may also decrease the risk of primary graft dysfunction and graft failure...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29103845/negative-pressure-ventilation-decreases-inflammation-and-lung-edema-during-normothermic-ex-vivo-lung-perfusion
#19
Nader S Aboelnazar, Sayed Himmat, Sanaz Hatami, Christopher W White, Mohamad S Burhani, Peter Dromparis, Nobutoshi Matsumura, Ganghong Tian, Jason R B Dyck, Michael Mengel, Darren H Freed, Jayan Nagendran
BACKGROUND: Normothermic ex-vivo lung perfusion (EVLP) using positive pressure ventilation (PPV) and both acellular and red blood cell (RBC)-based perfusate solutions have increased the rate of donor organ utilization. We sought to determine whether a negative pressure ventilation (NPV) strategy would improve donor lung assessment during EVLP. METHODS: Thirty-two pig lungs were perfused ex vivo for 12 hours in a normothermic state, and were allocated equally to 4 groups according to the mode of ventilation (positive pressure ventilation [PPV] vs NPV) and perfusate composition (acellular vs RBC)...
September 14, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29102851/exploring-the-scope-of-communication-content-of-mechanically-ventilated-patients
#20
Czarina C H Leung, Jack Pun, Graham Lock, Diana Slade, Charles D Gomersall, Wai Tat Wong, Gavin M Joynt
PURPOSE: Ineffective communication during mechanical ventilation (MV) and critical illness is distressing to many patients. This study aimed to describe the scope of communication content of ventilated critically ill patients. MATERIALS AND METHODS: We performed a prospective qualitative interview study in a multidisciplinary intensive care unit. Ten alert, orientated adult patients who previously underwent MV for at least 24h and were able to speak at the time of interview were recruited...
October 29, 2017: Journal of Critical Care
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