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https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#1
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28912263/hemodynamic-phenotyping-of-pulmonary-hypertension-in-left-heart-failure
#2
REVIEW
Robert Naeije, Mario Gerges, Jean-Luc Vachiery, Sergio Caravita, Christian Gerges, Irene M Lang
Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU)...
September 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/28875324/-extreme-obesity-particular-aspect-of-invasive-and-noninvasive-ventilation
#3
REVIEW
M Deppe, P Lebiedz
The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Therefore, current strategies are based on the individual experiences of ICU physicians and single-center studies. Noninvasive ventilation (NIV) in critically ill patients with acute respiratory failure and obesity hypoventilation syndrome (OHS) is an efficient treatment option and should be provided as early as possible is an effort to avoid intubation...
September 5, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28874612/role-of-integrated-pulmonary-index-in-identifying-extubation-failure
#4
Ramandeep Kaur, David L Vines, Li Liu, Robert A Balk
BACKGROUND: The integrated pulmonary index (IPI) utilizes an algorithm based on the measurement of end-tidal carbon dioxide, breathing frequency, heart rate, and oxygen saturation to provide an assessment of the patient's ventilatory status. This clinical trial was designed to determine whether lower IPI values were associated with extubation failure. METHODS: This prospective observational trial was conducted in an academic medical center. After institutional review board approval, 100 mechanically ventilated subjects were enrolled...
September 5, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#5
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28867128/severely-impaired-cardiorespiratory-fitness-in-patients-with-recently-decompensated-systolic-heart-failure
#6
Justin McNair Canada, Cory Ross Trankle, Leo Francis Buckley, Salvatore Carbone, Nayef Antar Abouzaki, Dinesh Kadariya, Keyur Shah, Richard Cooke, Michael Christopher Kontos, Jaideep Patel, Pranav Mankad, Aaron Schatz, Amit Bhatnagar, Ross Arena, Benjamin Wallace Van Tassell, Antonio Abbate
Hospital admission for decompensated heart failure marks a critical inflection point in a patient's health. Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload...
August 7, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28862962/inspiratory-muscle-training-is-associated-with-improved-inspiratory-muscle-strength-resting-cardiac-output-and-the-ventilatory-efficiency-of-exercise-in-patients-with-a-fontan-circulation
#7
Karina Laohachai, David Winlaw, Hiran Selvadurai, Ganesh Kumar Gnanappa, Yves d'Udekem, David Celermajer, Julian Ayer
BACKGROUND: Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS: Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily...
August 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28862210/pulmonary-toxicity-following-bleomycin-use-a-single-center-experience
#8
Irappa Madabhavi, Gaurang Modi, Apurva Patel, Asha Anand, Harsha Panchal, Sonia Parikh
BACKGROUND: Bleomycin-induced pulmonary (BIP) toxicity is a notorious entity and cropped up in roughly 10% of cases. The aim of the study is to evaluate BIP at our tertiary care cancer center. PATIENTS AND METHODS: This is a retrospective, analytical study conducted at a tertiary care center from January 1998 to December 2012. Records of all the patients who were offered bleomycin chemotherapy as an integral part of adriamycin, bleomycin, vinblastine, and dacarbazine or bleomycin, etoposide, and cisplatin regimen in Hodgkin disease (HD) or germ cell tumor (GCT) were studied for the study inclusion criteria...
July 2017: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28845544/ventilatory-choices-for-intubated-patients-during-helicopter-stretcher-winching
#9
John Hollott
INTRODUCTION: The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety...
August 28, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28839496/use-of-nasal-non-invasive-ventilation-with-a-ram-cannula-in-the-outpatient-home-setting
#10
Wilfredo De Jesus Rojas, Cheryl L Samuels, Traci R Gonzales, Katrina E McBeth, Aravind Yadav, James M Stark, Cindy Jon, Ricardo A Mosquera
BACKGROUND: Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings. OBJECTIVE: To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure...
2017: Open Respiratory Medicine Journal
https://www.readbyqxmd.com/read/28822818/phrenic-long-term-facilitation-following-intrapleural-ctb-sap-induced-respiratory-motor-neuron-death
#11
Nicole L Nichols, Taylor A Craig, Miles A Tanner
Amyotrophic lateral sclerosis (ALS) is a devastating disease leading to progressive motor neuron degeneration and death by ventilatory failure. In a rat model of ALS (SOD1(G93A)), phrenic long-term facilitation (pLTF) following acute intermittent hypoxia (AIH) is enhanced greater than expected at disease end-stage but the mechanism is unknown. We suggest that one trigger for this enhancement is motor neuron death itself. Intrapleural injections of cholera toxin B fragment conjugated to saporin (CTB-SAP) selectively kill respiratory motor neurons and mimic motor neuron death observed in SOD1(G93A) rats...
August 16, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28808320/carotid-body-mediated-chemoreflex-drive-in-the-setting-of-low-and-high-output-heart-failure
#12
Rodrigo Del Rio, David C Andrade, Camilo Toledo, Hugo S Diaz, Claudia Lucero, Alexis Arce-Alvarez, Noah J Marcus, Harold D Schultz
Enhanced carotid body (CB) chemoreflex function is strongly related to cardiorespiratory disorders and disease progression in heart failure (HF). The mechanisms underlying CB sensitization during HF are not fully understood, however previous work indicates blood flow per se can affect CB function. Then, we hypothesized that the CB-mediated chemoreflex drive will be enhanced only in low output HF but not in high output HF. Myocardial infarcted rats and aorto-caval fistulated rats were used as a low output HF model (MI-CHF) and as a high output HF model (AV-CHF), respectively...
August 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28802543/outcomes-and-predictors-of-failure-of-non-invasive-ventilation-in-patients-with-community-acquired-pneumonia-in-the-emergency-department
#13
Amjad Al-Rajhi, Anwar Murad, P Z Li, Jason Shahin
OBJECTIVE: We set out to describe the use and analyze the predictors of non-invasive ventilation failure in patients with community-acquired pneumonia who receive non-invasive ventilation as first line ventilatory therapy in the emergency department. METHODS: A retrospective cohort study was conducted among consecutive patients with community acquired pneumonia requiring ventilator support presenting to two tertiary care university-affiliated emergency departments...
August 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28780488/development-of-a-risk-score-to-predict-extubation-failure-in-patients-with-traumatic-brain-injury
#14
Helena França Correia Dos Reis, Mansueto Gomes-Neto, Mônica Lajana Oliveira Almeida, Mário Ferreira da Silva, Lorena Barreto Arruda Guedes, Bruno Prata Martinez, Mário de Seixas Rocha
PURPOSE: To identify predictors and develop a risk score for the prediction of extubation failure in TBI patients. MATERIALS AND METHODS: We prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient...
July 31, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28760461/effect-of-dead-space-on-breathing-stability-at-exercise-in-hypoxia
#15
Eric Hermand, François J Lhuissier, Jean-Paul Richalet
Recent studies have shown that normal subjects exhibit periodic breathing when submitted to concomitant environmental (hypoxia) and physiological (exercise) stresses. A mathematical model including mass balance equations confirmed the short period of ventilatory oscillations and pointed out an important role of dead space in the genesis of these phenomena. Ten healthy subjects performed mild exercise on a cycloergometer in different conditions: rest/exercise, normoxia/hypoxia and no added dead space/added dead space (aDS)...
July 29, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28758083/successful-extubation-after-weaning-failure-by-noninvasive-ventilation-in-patients-with-neuromuscular-disease-case-series
#16
Sun Mi Kim, Seong-Woong Kang, Young-Chul Choi, Yoon Ghil Park, Yu Hui Won
OBJECTIVE: To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. METHODS: Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO2 (ETCO2) and pulse oxyhemoglobin saturation (SpO2) monitoring were performed...
June 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28743311/hypercapnic-respiratory-failure-during-pregnancy-due-to-polymyositis-related-respiratory-muscle-weakness-a-case-report
#17
Husain Shabbir Ali, Ibrahim Fawzy Hassan, Saibu George, Abdalrazig Elsadig Fadlelmula
BACKGROUND: Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-threatening hypercapnic respiratory failure due to polymyositis-related respiratory muscle weakness in a pregnant woman. CASE PRESENTATION: A 31-year-old, African woman in her second trimester of pregnancy presented to the emergency department with fever, shortness of breath and muscle weakness...
July 26, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28736291/clinical-and-hemodynamic-correlates-and-prognostic-value-of-ve-vco2-slope-in-patients-with-heart-failure-with-preserved-ejection-fraction-and-pulmonary-hypertension
#18
Sebastiaan H C Klaassen, Licette C Y Liu, Yoran M Hummel, Kevin Damman, P van der Meer, Adriaan A Voors, Elke S Hoendermis, Dirk J van Veldhuisen
BACKGROUND: Impaired exercise capacity is one of the hallmarks of heart failure with preserved ejection fraction (HFpEF), but the clinical and hemodynamic correlates and prognostic value of exercise testing in patients with HFpEF is unknown. METHODS: Patients with HFpEF (Left ventricular ejection fraction [LVEF] ≥ 45%) and pulmonary hypertension, underwent cardiopulmonary exercise test (CPX) to measure maximal (peak VO2) and sub maximal (ventilatory equivalent for carbon dioxide [VE/VCO2] slope) exercise capacity...
July 20, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28698268/effects-of-volume-guaranteed-ventilation-combined-with-two-different-modes-in-preterm-infants
#19
Sezin Unal, Ebru Ergenekon, Selma Aktas, Nilgun Altuntas, Serdar Beken, Ebru Kazanci, Ferit Kulali, Ozlem Gulbahar, Ibrahim M Hirfanoglu, Esra Onal, Canan Turkyilmaz, Esin Koc, Yildiz Atalay
BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes...
July 11, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#20
Federico Longhini, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: Noninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony...
July 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
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