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https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#1
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat
BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2 ) to the fraction of inspired oxygen (Fio2 ) of less than 50 mm Hg for more than 3 hours; a Pao2 :Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29787304/deterioration-of-regional-lung-strain-and-inflammation-during-early-lung-injury
#2
Gabriel C Motta-Ribeiro, Soshi Hashimoto, Tilo Winkler, Rebecca M Baron, Kira Grogg, Luís F S C Paula, Arnoldo Santos, Congli Zeng, Kathryn Hibbert, Robert S Harris, Ednan Bajwa, Marcos F Vidal Melo
RATIONALE: The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVE: Test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24h of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold...
May 22, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29782615/feasibility-study-applying-a-parametric-model-as-the-design-generator-for-3d-printed-orthosis-for-fracture-immobilization
#3
Jianyou Li, Hiroya Tanaka
Background: Applying 3D printing technology for the fabrication of custom-made orthoses provides significant advantages, including increased ventilation and lighter weights. Currently, the design of such orthoses is most often performed in the CAD environment, but creating the orthosis model is a time-consuming process that requires significant CAD experience. This skill gap limits clinicians from applying this technology in fracture treatment. The purpose of this study is to develop a parametric model as the design generator for 3D-printed orthoses for an inexperienced CAD user and to evaluate its feasibility and ease of use via a training and design exercise...
2018: 3D printing in medicine
https://www.readbyqxmd.com/read/29782356/acute-neurologic-complications-during-extracorporeal-membrane-oxygenation-a-systematic-review
#4
Raoul Sutter, Kai Tisljar, Stephan Marsch
OBJECTIVES: We determine the frequency, risk factors, and mortality of neurologic complications in adults on extracorporeal membrane oxygenation and propose an algorithm for preventive strategies. DATA SOURCES: PubMed, Embase, and Cochrane databases. STUDY SELECTION: Screening was performed using predefined search terms to identify cohort studies reporting neurologic complications in adults during extracorporeal membrane oxygenation from 1990 to 2017...
May 18, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29780032/severe-outcomes-associated-with-respiratory-viruses-in-newborns-and-infants-a-prospective-viral-surveillance-study-in-jordan
#5
Najwa Khuri-Bulos, Lindsey Lawrence, Bhinnata Piya, Li Wang, Christopher Fonnesbeck, Samir Faouri, Asem Shehabi, Sten H Vermund, John V Williams, Natasha B Halasa
OBJECTIVE: To assess virus-specific hospitalisation rates, risk factors for illness severity and seasonal trends in children hospitalised with acute respiratory infections (ARI). DESIGN: Prospective cohort study. SETTING: A government hospital serving low-income and middle-income population in Amman, Jordan. PARTICIPANTS: Children under 2 years of age hospitalised with fever and/or respiratory symptoms (n=3168) from 16 March 2010 to 31 March 2013...
May 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29777672/valvectomy-versus-replacement-for-the-surgical-treatment-of-tricuspid-endocarditis
#6
Adam N Protos, Jaimin R Trivedi, William M Whited, Michael P Rogers, Ugochukwu Owolabi, Kendra J Grubb, Kristen Sell-Dottin, Mark S Slaughter
BACKGROUND: Optimal surgical treatment of infective tricuspid endocarditis is debatable, especially in the setting of inherent social and pathologic concerns. This study seeks to compare tricuspid valve repair, replacement, and excision for the treatment of infective endocarditis METHODS: A single center cardiac surgery database was queried between 2012 and 2016 to identify patients >18 years who underwent tricuspid valve surgery for infective endocarditis. Patients were divided into 3 groups based on the type of tricuspid valve surgery: valvectomy, repair, or replacement and evaluated to identify differences between the pre-op factors and outcomes including mortality, length of stay, and complications...
May 16, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29776982/variable-effectiveness-of-stepwise-implementation-of-nudge-type-interventions-to-improve-provider-compliance-with-intraoperative-low-tidal-volume-ventilation
#7
Vikas N O'Reilly-Shah, George S Easton, Craig S Jabaley, Grant C Lynde
BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system...
May 18, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29776707/unplanned-extubations-in-an-intensive-care-unit-findings-from-a-critical-incident-technique
#8
Matteo Danielis, Simona Chiaruttini, Alvisa Palese
BACKGROUND: Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. OBJECTIVES: To gain a greater understanding of the antecedents of unplanned extubations...
May 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29775671/variable-ventilation-decreases-airway-responsiveness-and-improves-ventilation-efficiency-in-a-rat-model-of-asthma
#9
Fatemeh Ilka, Mohammad Javan, Mohammad Reza Raoufy
The optimal ventilation strategy in patients receiving mechanical ventilation for severe asthma remains unclear. The effect of conventional ventilation (with constant tidal volume and respiratory rate) and variable ventilation (with the same average but variable tidal volume and respiratory rate) on peak airway pressure and airway exacerbation induced by increasing doses of methacholine was compared in a rat model of asthma. The respiratory rate and tidal volume data were obtained from a spontaneously breathing intact rat during immobility using a whole-body plethysmograph...
May 15, 2018: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/29773072/formal-procedure-to-facilitate-the-decision-to-withhold-or-withdraw-life-sustaining-interventions-in-a-neonatal-intensive-care-unit-a-seven-year-retrospective-study
#10
G Sorin, R Vialet, B Tosello
BACKGROUND: Neonatal deaths are often associated with the complex decision to limit or withdraw life-sustaining interventions (LSIs) rather than therapeutic impasses. Despite the existence of a law, significant disparities in clinical procedures remain. This study aimed to assess deaths occurring in a Neonatal Intensive Care Unit (NICU) and measure the impact of a traceable Limitation or Withdrawal of Active Treatment (LWAT) file on the treatment of these newborns. METHODS: In this monocentric retrospective study, we reviewed all consecutive neonatal deaths occurring during two three-year periods among patients in the NICU at the North Hospital of Marseille: cohort 1 (from 2009 to 2011 without the LWAT file) and cohort 2 (from 2013 to 2015 after introduction of the LWAT file)...
May 17, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29772254/effect-of-interferon-alpha-and-cyclosporine-treatment-separately-and-in-combination-on-middle-east-respiratory-syndrome-coronavirus-mers-cov-replication-in-a-human-in-vitro-and-ex-vivo-culture-model
#11
H S Li, Denise I T Kuok, M C Cheung, Mandy M T Ng, K C Ng, Kenrie P Y Hui, J S Malik Peiris, Michael C W Chan, John M Nicholls
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has emerged as a coronavirus infection of humans in the past 5 years. Though confined to certain geographical regions of the world, infection has been associated with a case fatality rate of 35%, and this mortality may be higher in ventilated patients. As there are few readily available animal models that accurately mimic human disease, it has been a challenge to ethically determine what optimum treatment strategies can be used for this disease. We used in-vitro and human ex-vivo explant cultures to investigate the effect of two immunomodulatory agents, interferon alpha and cyclosporine, singly and in combination, on MERS-CoV replication...
May 14, 2018: Antiviral Research
https://www.readbyqxmd.com/read/29771608/paced-breathing-and-phrenic-nerve-responses-evoked-by-epidural-stimulation-following-complete-high-cervical-spinal-cord-injury-in-rats
#12
Tatiana Bezdudnaya, Michael A Lane, Vitaliy Marchenko
Spinal cord injury (SCI) at the level of cervical segments often results in life-threatening respiratory complications and requires long-term mechanical ventilator assistance. Thus, restoring diaphragm activity and regaining voluntary control of breathing are the primary clinical goals for patients with respiratory dysfunction following cervical SCI. Epidural stimulation (EDS) is a promising strategy that has been explored extensively for non-respiratory functions, and to a limited extent within the respiratory system...
May 17, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29763713/practice-of-mechanical-ventilation-in-cardiac-arrest-patients-and-effects-of-targeted-temperature-management-a-substudy-of-the-targeted-temperature-management-trial
#13
Matthew B A Harmon, David M P van Meenen, Annelou L I P van der Veen, Jan M Binnenkade, Josef Dankiewicz, Florian Ebner, Niklas Nielsen, Paolo Pelosi, Marcus J Schultz, Janneke Horn, Hans Friberg, Nicole P Juffermans
AIMS: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. METHODS: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36)...
May 12, 2018: Resuscitation
https://www.readbyqxmd.com/read/29756065/the-effects-of-mechanical-ventilation-on-the-quality-of-sleep-of-hospitalised-patients-in-the-intensive-care-unit
#14
REVIEW
Hana Locihová, Katarína Žiaková
Aim: To examine the effects of mechanical ventilation on the quality of sleep in patients in the intensive care unit (ICU) using recent and relevant literature. Methods: To verify the examined objective, the results of the analysis of available original scientific works have been used including defined inclusion/exclusion criteria and search strategy. Appropriate works found were analysed further. The applied methodology was in line with the general principles of Evidence-Based Medicine...
April 2018: Romanian journal of anaesthesia and intensive care
https://www.readbyqxmd.com/read/29753454/response-of-a-local-hospital-to-a-burn-disaster-contributory-factors-leading-to-zero-mortality-outcomes
#15
Eng-Kean Yeong, Ciaran P O'Boyle, Hui-Fu Huang, Hao-Chih Tai, Yen-Chun Hsu, Shu-Yang Chuang, Yu-Feng Wu, Che-Wei Chang, Tom J Liu, Hong-Shiee Lai
OBJECTIVE: To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS: Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan...
May 9, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29745620/non-ventilatory-therapies-for-acute-respiratory-distress-syndrome
#16
Jérémy Bourenne, Sami Hraiech, Romain Rambaud, Jean-Marie Forel, Nicolas Persico, Christophe Guervilly, Laurent Papazian
Acute respiratory distress syndrome (ARDS) commonly affects intensive care unit patients and is associated with high mortality. In addition to etiologic treatment and protective ventilation, non-ventilatory therapies represent a significant part of ARDS care. Pharmacological treatments, extra corporeal devices and prone positioning are commonly grouped under this term. Studies have evaluated the individual effects of some of these non- ventilatory therapies in large randomized controlled trials. Recent advances concerning the beneficial use of neuromuscular blocking agents and prone positioning deserve attention...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29745619/incidence-and-risk-factors-of-ventilator-associated-pneumonia-in-neonatal-intensive-care-unit-a-first-french-study
#17
Guillaume Geslain, Isabelle Guellec, Romain Guedj, Julia Guilbert, Sandrine Jean, Cécile Valentin, Maryne Demoulin, Yohann Soreze, Ricardo Carbajal, Pierre-Louis Leger, Jerome Rambaud
BACKGROUND: Ventilator-associated pneumonia (VAP) is a severe intensive complication and remains under estimated in neonatal intensive care unit (NICU). Center for Disease Control defined criteria for adults and pediatrics without neonatal criteria. The objective of this article was to evaluate the rate, the risks factors and the outcome of neonates suffering from ventilator-associated pneumonia in a French NICU. METHODS: We conducted a prospective observational study within a one-year period in our NICU...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29744563/diagnostic-workup-etiologies-and-management-of-acute-right-ventricle-failure-a-state-of-the-art-paper
#18
REVIEW
Antoine Vieillard-Baron, R Naeije, F Haddad, H J Bogaard, T M Bull, N Fletcher, T Lahm, S Magder, S Orde, G Schmidt, M R Pinsky
INTRODUCTION: This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. RESULTS: The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation...
May 9, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29743121/high-frequency-oscillatory-ventilation-guided-by-transpulmonary-pressure-in-acute-respiratory-syndrome-an-experimental-study-in-pigs
#19
Philipp Klapsing, Onnen Moerer, Christoph Wende, Peter Herrmann, Michael Quintel, Annalen Bleckmann, Jan Florian Heuer
BACKGROUND: Recent clinical studies have not shown an overall benefit of high-frequency oscillatory ventilation (HFOV), possibly due to injurious or non-individualized HFOV settings. We compared conventional HFOV (HFOVcon ) settings with HFOV settings based on mean transpulmonary pressures (PLmean ) in an animal model of experimental acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced in eight pigs by intrabronchial installation of hydrochloric acid (0...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29742448/linking-lung-function-to-structural-damage-of-alveolar-epithelium-in-ventilator-induced-lung-injury
#20
Katharine L Hamlington, Bradford J Smith, Celia M Dunn, Chantel M Charlebois, Gregory S Roy, Jason H T Bates
Understanding how the mechanisms of ventilator-induced lung injury (VILI), namely atelectrauma and volutrauma, contribute to the failure of the blood-gas barrier and subsequent intrusion of edematous fluid into the airspace is essential for the design of mechanical ventilation strategies that minimize VILI. We ventilated mice with different combinations of tidal volume and positive end-expiratory pressure (PEEP) and linked degradation in lung function measurements to injury of the alveolar epithelium observed via scanning electron microscopy...
May 6, 2018: Respiratory Physiology & Neurobiology
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