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mechanical ventilation

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https://www.readbyqxmd.com/read/29053492/significance-of-mini-bronchoalveolar-lavage-fluid-amylase-level-in-ventilator-associated-pneumonia-a-prospective-observational-study
#1
Sukhen Samanta, Banani Poddar, Afzal Azim, Ratender K Singh, Mohan Gurjar, Arvind K Baronia
OBJECTIVES: Aspiration of oropharyngeal or gastric contents in intubated patients can lead to ventilator-associated pneumonia. Amylase in respiratory secretion has been reported as a possible marker of aspiration. We studied whether elevated α-amylase in mini bronchoalveolar lavage specimens can be suggestive of ventilator-associated pneumonia in intubated patients with high clinical suspicion. DESIGN: Prospective single-center observational study. SETTING: Department of Critical Care Medicine, tertiary care academic institute...
October 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29053337/obesity-and-severity-of-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#2
Tadahiro Goto, Atsushi Hirayama, Mohammad Kamal Faridi, Carlos A Camargo, Kohei Hasegawa
RATIONALE: Obesity is relatively common among individuals with chronic obstructive pulmonary disease (COPD). However, little is known about the association of obesity with severity of acute exacerbation of COPD (AECOPD) and in-hospital mortality. OBJECTIVES: To examine the association of obesity with severity markers of AECOPD and in-hospital mortality. METHODS: This is a retrospective cohort study using population-based data - the 2012-2013 State Inpatient Databases - of seven US states (Arkansas, Florida, Iowa, Nebraska, New York, Utah, and Washington)...
October 20, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29051895/chronic-lymphocytic-leukemia-a-rare-cause-of-pathological-fracture-of-the-femur
#3
Parita Soni, Nidhi Aggarwal, Anand Rai, Vivek Kumar, Kamholz Stephan, Yoon Taek, Kupfer Yizhak
The incidence rate of chronic lymphocytic leukemia (CLL) in the United States is approximately 0.005%; men are at slightly higher risk than women. Bony involvement or pathological fracture rarely occurs in CLL, and it may be the initial presentation. An 85-year-old woman presented with acute respiratory failure secondary to pneumonia. Symptomatology included dyspnea. She was found to have pathological fracture of the femur caused by CLL. The diagnosis of CLL had been made 6 years previously, but the patient had refused therapy...
October 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/29051337/gravity-outweighs-the-contribution-of-structure-to-passive-ventilation-perfusion-matching-in-the-supine-adult-human-lung
#4
Wendy Kang, Alys R Clark, Merryn H Tawhai
Gravity and matched airway/vascular tree geometries are both hypothesized to be key contributors to ventilation-perfusion (V/Q) matching in the lung, but their relative contributions are challenging to quantify experimentally. We used a structure-based model to conduct an analysis of the relative contributions of tissue deformation (the 'Slinky' effect), other gravitational mechanisms (weight of blood and gravitational gradient in tissue elastic recoil), and matched airway and arterial tree geometry to V/Q matching and therefore to total lung oxygen exchange...
October 19, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29051332/parenchymal-strain-heterogeneity-during-oscillatory-ventilation-why-two-frequencies-are-better-than-one
#5
Jacob Herrmann, Merryn H Tawhai, David W Kaczka
High frequency oscillatory ventilation (HFOV) relies on low tidal volumes cycled at supraphysiologic rates, producing fundamentally different mechanisms for gas transport and exchange compared with conventional mechanical ventilation. Despite the appeal of using low tidal volumes to mitigate the risks of ventilator-induced lung injury (VILI), HFOV has not improved mortality for most clinical indications. This may be due to non-uniform and frequency-dependent distribution of flow throughout the lung. The goal of this study was to compare parenchymal strain heterogeneity during eucapnic HFOV when using oscillatory waveforms that consisted of either a single discrete frequency or two simultaneous frequencies...
October 19, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29050526/long-term-quality-of-life-after-extracorporeal-membrane-oxygenation-in-ards-survivors-systematic-review-and-meta-analysis
#6
M Elizabeth Wilcox, Valente Jaramillo-Rocha, Carol Hodgson, Michael S Taglione, Niall D Ferguson, Eddy Fan
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is an increasingly prevalent treatment for acute respiratory failure (ARF). To evaluate the impact of ECMO support on long-term outcomes for critically ill adults with ARF. METHODS: We searched electronic databases 1948 through to November 30 2016; selected controlled trials or observational studies of critically ill adults with acute respiratory distress syndrome, examining long-term morbidity specifically health-related quality of life (HRQL); 2 authors independently selected studies, extracted data, and assessed methodological quality...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29050461/comparison-of-clinical-utility-between-diaphragm-excursion-and-thickening-change-using-ultrasonography-to-predict-extubation-success
#7
Jung-Wan Yoo, Seung Jun Lee, Jong Deog Lee, Ho Cheol Kim
Background/Aims: Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubation success. Methods: This study included patients subjected to extubation trial in the medical or surgical intensive care unit of a university-affiliated hospital from May 2015 through February 2016...
October 19, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29049666/bivalirudin-anticoagulation-for-left-ventricular-assist-device-implantation-on-an-extracorporeal-life-support-system-in-patients-with-heparin-induced-thrombocytopenia-antibodies
#8
Edis Ljajikj, Armin Zittermann, Michiel Morshuis, Jochen Börgermann, Maria Ruiz-Cano, Michael Schoenbrodt, Jan Gummert, Andreas Koster
OBJECTIVES: Heparin-induced thrombocytopenia (HIT) requires alternative anticoagulation strategies. We investigated outcomes in patients with HIT antibodies undergoing low-dose bivalirudin anticoagulation during left ventricular assist device implantation on an extracorporeal life support system (ECLS) and compared the results with non-HIT patients treated with heparin and receiving left ventricular assist device implantation with ECLS support. METHODS: The institutional ventricular assist device database was searched for the period from March 2012 to March 2016...
July 28, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049534/high-frequency-percussive-ventilation-in-cardiac-surgery-patients-failing-mechanical-conventional-ventilation
#9
Ivan Wong, Berhane Worku, Jeremy A Weingarten, Alexander Ivanov, Felix Khusid, Ashwad Afzal, Robert F Tranbaugh, Iosif Gulkarov
OBJECTIVES: Failure of mechanical conventional ventilation (MCV) after cardiac surgery portends a dismal prognosis, with extracorporeal membrane oxygenation frequently utilized as a salvage therapy. We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue therapy for hypoxaemia refractory to MCV after cardiac surgery. METHODS: In a 6-year retrospective analysis from 2009 to 2015, we identified 16 subjects who required HFPV after cardiac surgery...
July 21, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049422/thoracic-trauma-now-and-then-a-10-year-experience-from-16-773-severely-injured-patients
#10
Klemens Horst, Hagen Andruszkow, Christian D Weber, Miguel Pishnamaz, Christian Herren, Qiao Zhi, Matthias Knobe, Rolf Lefering, Frank Hildebrand, Hans-Christoph Pape
BACKGROUND AND PURPOSE: Thoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse. METHODS: Multiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study...
2017: PloS One
https://www.readbyqxmd.com/read/29049285/2009-2010-influenza-a-h1n1-related-critical-illness-among-aboriginal-and-non-aboriginal-canadians
#11
James J Jung, Ruxandra Pinto, Ryan Zarychanski, Deborah J Cook, Philippe Jouvet, John C Marshall, Anand Kumar, Jennifer Long, Rachel Rodin, Robert A Fowler
BACKGROUND: Preliminary studies suggested that Aboriginal Canadians had disproportionately higher rates of infection, hospitalization, and critical illness due to pandemic Influenza A(H1N1)pdm09. METHODS: We used a prospective cohort study of critically ill patients with laboratory confirmed or probable H1N1 infection in Canada between April 16 2009 and April 12 2010. Baseline characteristics, medical interventions, clinical course and outcomes were compared between Aboriginal and non-Aboriginal patients...
2017: PloS One
https://www.readbyqxmd.com/read/29049073/postoperative-outcomes-in-obstructive-sleep-apnea-patients-undergoing-cardiac-surgery-a-systematic-review-and-meta-analysis-of-comparative-studies
#12
Mahesh Nagappa, George Ho, Jayadeep Patra, Jean Wong, Mandeep Singh, Roop Kaw, Davy Cheng, Frances Chung
BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in patients undergoing cardiac surgery and may predispose patients to postoperative complications. The purpose of this meta-analysis is to determine the evidence of postoperative complications associated with OSA patients undergoing cardiac surgery. METHODS: A literature search of Cochrane Database of Systematic Reviews, Medline, Medline In-process, Web of Science, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL until October 2016 was performed...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29048709/comparison-of-percutaneous-dilatational-tracheostomy-guided-by-ultrasound-and-bronchoscopy-in-critically-ill-obese-patients
#13
Jieqiong Song, Lizhen Xuan, Wei Wu, Duming Zhu, Yijun Zheng
OBJECTIVES: This study aimed to compare the efficacy and safety of percutaneous dilatational tracheostomy (PDT) with ultrasound (US) or bronchoscopic guidance for critically ill patients, notably obese patients. METHODS: This work was a retrospective study. The study included mechanically ventilated patients who underwent PDT from August 2013 to July 2015 in the Department of Critical Care Medicine of Zhongshan Hospital. The patients were classified according to the different guidance methods during tracheotomy and their body mass index in the following 4 groups: normal bronchoscopy group, normal US group, obese bronchoscopy group, and obese US group...
October 19, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29048703/a-pilot-study-on-the-efficacy-and-safety-of-a-minimally-invasive-surgical-and-anesthetic-approach-for-ventricular-assist-device-implantation
#14
Jonida Bejko, Demetrio Pittarello, Gianclaudio Falasco, Guido Di Gregorio, Vincenzo Tarzia, Giulio Rizzoli, Dario Gregori, Gino Gerosa, Tomaso Bottio
BACKGROUND: The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. METHODS: 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients)...
October 16, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29048544/valproic-acid-attenuates-the-risk-of-acute-respiratory-failure-in-patients-with-subarachnoid-hemorrhage
#15
Wen-I Liao, Wu-Chien Chien, Chi-Hsiang Chung, Jen-Chun Wang, Tzu-Tsao Chung, Shi-Jye Chu, Shih-Hung Tsai
Background: To determine whether the use of valproic acid (VPA) is associated with a decreased risk of acute respiratory failure (ARF) in patients with subarachnoid hemorrhage (SAH). Methods: The Taiwan National Health Insurance Research Database was used to analyze all patients newly diagnosed with SAH from 2000 to 2010. The VPA users were matched for age, gender and index date in 1:2 ratios with randomly selected non-VPA users as a comparison group. Multivariate Cox regression was used to identify the predictors of ARF and to compare the incidence rates of ARF among SAH patients using and not using VPA...
October 18, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29047417/levosimendan-for-patients-with-severely-reduced-left-ventricular-systolic-function-and-or-low-cardiac-output-syndrome-undergoing-cardiac-surgery-a-systematic-review-and-meta-analysis
#16
Filippo Sanfilippo, Joshua B Knight, Sabino Scolletta, Cristina Santonocito, Federico Pastore, Ferdinando L Lorini, Luigi Tritapepe, Andrea Morelli, Antonio Arcadipane
BACKGROUND: Previous studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan. METHODS: We performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) ≤ 35% and/or low cardiac output syndrome (LCOS)...
October 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29047093/cross-talk-between-mitochondrial-reactive-oxygen-species-and-sarcoplasmic-reticulum-calcium-in-pulmonary-arterial-smooth-muscle-cells
#17
Tengyao Song, Yun-Min Zheng, Yong-Xiao Wang
Hypoxic pulmonary vasoconstriction (HPV) occurs during both fetal and postnatal development and plays a critical role in matching regional alveolar perfusion with ventilation in humans and animals. HPV also contributes significantly to the development of pulmonary hypertension. Although the molecular mechanisms of HPV and pulmonary hypertension remain incompletely understood, increasing evidence demonstrates that hypoxia induces an elevated intracellular reactive oxygen species concentration ([ROS]i) in pulmonary artery smooth muscle cells (PASMCs)...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29046248/clinical-characteristics-and-treatment-outcomes-of-vancomycin-resistant-enterococcus-faecium-bacteremia
#18
Jung-Jr Ye, Shian-Sen Shie, Chun-Wen Cheng, Jeng-How Yang, Po-Yen Huang, Ting-Shu Wu, Ming-Hsun Lee, Ching-Tai Huang
BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE-fm) bacteremia causes significant mortality in hospitalized patients. We sought to investigate clinical characteristics, treatment outcomes, and microbiological eradication associated with VRE-fm bacteremia. METHODS: A retrospective cohort study was conducted and included 210 adult patients admitted between January 1, 2011 and December 31, 2015. RESULTS: The mean Pitt bacteremia score was 4...
October 5, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/29046009/-experiences-of-patients-with-invasive-and-non-invasive-home-mechanical-ventilation-a-systematic-review-of-qualitative-research
#19
V Nelißen, S Metzing, W Schnepp
Aim of the study Human beings can be ventilated outside of a hospital after a lung failure or due to a neurodegenerative disease. This can be done in different living conditions. This article examines the question of what experiences such patients have made with invasive home mechanical ventilation, and how they have adapted their new lives. Methodology On the basis of a systematic literature research, qualitative studies were analyzed that depict the social reality of patients with invasive and non-invasive home mechanical ventilation...
October 18, 2017: Pneumologie
https://www.readbyqxmd.com/read/29045567/individualized-positive-end-expiratory-pressure-in-obese-patients-during-general-anaesthesia-a-randomized-controlled-clinical-trial-using-electrical-impedance-tomography
#20
C Nestler, P Simon, D Petroff, S Hammermüller, D Kamrath, S Wolf, A Dietrich, L M Camilo, A Beda, A R Carvalho, A Giannella-Neto, A W Reske, H Wrigge
Background: General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects. Methods: Patients with a BMI ≥35 kg m-2 undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg-1 predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEPIND) or (ii) no RM and PEEP of 5 cm H2O (PEEP5)...
October 16, 2017: British Journal of Anaesthesia
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