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https://www.readbyqxmd.com/read/29782482/trauma-patients-are-safe-to-fly-72-hours-after-tube-thoracostomy-removal
#1
David Zonies, Joel Elterman, Christopher Burns, Vincent Paul, John Oh, Jeremy Cannon
BACKGROUND: Current recommendations for safe air travel following traumatic pneumothorax are 2-3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus which cite a theoretical risk of recurrence and hypoxia due to decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel. METHODS: A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken...
May 18, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29782242/case-254-posttraumatic-migrating-fat-embolus-causing-fat-emboli-syndrome
#2
Sébastien Molière, Stéphane Kremer, Guillaume Bierry
History An otherwise healthy 18-year-old man was admitted to the emergency department with a closed displaced fracture of the left femoral shaft ( Fig 1 ) after a high-velocity motorbike accident. At admission, other physical examination findings were unremarkable. Initial unenhanced and contrast material-enhanced (120 mL of Iomeron 400; Bracco Imaging, Milan, Italy) computed tomography (CT) was performed in the arterial and venous phases from the head to the knees. No abnormalities were noted in the brain or chest at initial CT...
June 2018: Radiology
https://www.readbyqxmd.com/read/29780244/severity-of-acidosis-affects-long-term-survival-in-copd-patients-with-hypoxemia-after-intensive-care-unit-discharge
#3
Sinem Gungor, Feyza Kargin, Ilim Irmak, Fulya Ciyiltepe, Eylem Acartürk Tunçay, Pinar Atagun Guney, Emine Aksoy, Birsen Ocakli, Nalan Adiguzel, Zuhal Karakurt
Background: Patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) due to COPD have high mortality and morbidity. Acidosis has several harmful effects on hemodynamics and metabolism, and the current knowledge regarding the relationship between respiratory acidosis severity on the short- and long-term survival of COPD patients is limited. We hypothesized that COPD patients with severe acidosis would have a poorer short- and long-term prognosis compared with COPD patients with mild-to-moderate acidosis...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29780224/correlative-study-between-c-reactive-protein-clinical-severity-and-nerve-conduction-studies-in-guillain-barr%C3%A3-syndrome
#4
Yosria A Altaweel, Sawsan Abdelaziz, Hala A Fathy, Shimaa AbdelBadea
Background: Guillain-Barre' syndrome (GBS) is a serious autoimmune disorder in which the immune system attacks healthy nerve cells of the peripheral nervous system causing polyradiculoneuropathy which leads to weakness, numbness, and tingling, and can eventually cause paralysis. Autoimmune conditions like GBS can induce a high level of inflammation resulting in an increase in the C-reactive protein( CRP) production. The aim of this study is to assess the relationship between CRP level and the clinical severity as well as the electrophysiological findings of nerve conduction studies in patients with GBS...
2018: Egypt J Neurol Psychiatr Neurosurg
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/29779912/how-often-do-we-perform-painful-and-stressful-procedures-in-the-paediatric-intensive-care-unit-a-prospective-observational-study
#6
Manuel A Baarslag, Sharan Jhingoer, Erwin Ista, Karel Allegaert, Dick Tibboel, Monique van Dijk
BACKGROUND: Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management. OBJECTIVE: The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures...
May 17, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29779887/pulmonary-capillary-hemorrhage-induced-by-diagnostic-ultrasound-in-ventilated-rats
#7
Douglas L Miller, Zhihong Dong, Chunyan Dou, Krishnan Raghavendran
Pulmonary capillary hemorrhage (PCH) can be induced by diagnostic ultrasound-a potential safety issue. Anesthetized rats were intubated for intermittent positive-pressure ventilation (IPPV) with 0 end-expiratory pressure, +4 cm H2 O end-expiratory pressure (PEEP) and -4 cm H2 O end-expiratory pressure (NEEP). Rats were imaged at 7.6 MHz with a Philips HDI 5000 ultrasound machine. The output was low (mechanical index [MI] = 0.22) for aiming and then was raised for 5 min in 20 different exposure groups with n = 8...
May 17, 2018: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/29779802/feasibility-of-initiating-early-enteral-nutrition-after-congenital-heart-surgery-in-neonates-and-infants
#8
Rajat Kalra, Rohit Vohra, Malti Negi, Reena Joshi, Neeraj Aggarwal, Mridul Aggarwal, Raja Joshi
OBJECTIVE: To assess the feasibility of initiating enteral nutrition support with first 24 h of congenital heart repairs in neonates and Infants and its impact on outcomes following surgery. DESIGN: It is a prospective randomized control single blind study. SETTING: It is a single centre prospective study carried out in a tertiary care centre at Pediatric cardiac intensive care unit. PATIENTS: All patients with the cyanotic congenital heart disease with increase pulmonary blood flow, weighing less than 5 kg and undergoing congenital heart repair during the study period were included in the study...
June 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29779725/anterior-subtemporal-approach-for-severe-upper-pontine-hematomas-a-report-of-28-surgically-treated-cases
#9
Hong-Tian Zhang, Li-Hua Chen, Miao-Chun Bai, Ru-Xiang Xu
The efficacy and safety of surgery for patients with primary pontine hemorrhage (PPH) remain debatable. Twenty-eight consecutive patients with huge upper PPH were included in this study. They underwent surgical management through a subtemporal approach between January 2009 and October 2013. We analyzed clinical and radiological parameters to assess the patient outcomes. The near-complete (>90%) evacuation rate was 67.9%, and there was no surgery-related death. The overall survival rate at 3 months was 64...
May 17, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29779705/an-investigation-into-the-use-of-ultrasound-as-a-surrogate-measure-of-diaphragm-function
#10
Samantha Holtzhausen, Marianne Unger, Alison Lupton-Smith, Susan Hanekom
PURPOSE: Sonographic assessment of the diaphragm may be a surrogate for interpretation of diaphragm function in mechanically ventilated patients. This study aimed to determine the correlation between respiratory muscle function and diaphragm thickness in a healthy population. METHODS: A descriptive study was conducted. Diaphragm thickness was determined by sonographic measurement. Respiratory muscle strength, fatigue and endurance was determined using a mouth pressure manometer...
May 17, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29779603/diaphragm-pacing
#11
REVIEW
Anthony F DiMarco
Diaphragm pacing (DP) is a useful and cost-effective alternative to mechanical ventilation in patients with ventilator-dependent spinal cord injury and central hypoventilation syndrome. Patients with SCI should be carefully screened to assess the integrity of their phrenic nerves. In eligible patients, DP improves mobility, speech, olfaction, and quality of life. The stigma of being attached to a mechanical device and risk of ventilator disconnection are eliminated. There is also some evidence that DP results in a reduction in the rate of respiratory tract infections...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779589/chest-wall-diseases-respiratory-pathophysiology
#12
REVIEW
George E Tzelepis
The chest wall consists of various structures that function in an integrated fashion to ventilate the lungs. Disorders affecting the bony structures or soft tissues of the chest wall may impose elastic loads by stiffening the chest wall and decreasing respiratory system compliance. These alterations increase the work of breathing and lead to hypoventilation and hypercapnia. Respiratory failure may occur acutely or after a variable period of time. This review focuses on the pathophysiology of respiratory function in specific diseases and disorders of the chest wall, and highlights pathogenic mechanisms of respiratory failure...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779449/continuous-cytokine-haemoadsorption-incorporated-into-a-venoarterial-ecmo-circuit-for-the-management-of-postcardiotomy-cardiogenic-and-septic-shock-a-case-report
#13
Endre Nemeth, Szabolcs Szigeti, Tamas Varga, Laszlo Daroczi, Zoltan Barati, Bela Merkely, Janos Gal
INTRODUCTION: The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. CASE REPORT: A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO...
May 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29777602/-suspension-of-respiratory-support-in-patients-with-amyotrophic-lateral-sclerosis
#14
Agustín A Silberberg, Josefina Robetto, Mora Achával
Decision making in advanced Amyotrophic Lateral Sclerosis (ALS) patients keeps on being a controversial issue. The aim of this work is to discuss ethical implications of withdrawing respiratory support treatment in patients with ALS. Through a bibliographic search on Pubmed database (2010-2016) we investigated whether or not the use of Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV) would increase survival and quality of life. We included 38 review articles. From these papers, results and ethical implications of initiating and mainly withdrawing respiratory support were analyzed...
May 2018: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
https://www.readbyqxmd.com/read/29777224/progression-of-whole-blood-transcriptional-signatures-from-interferon-induced-to-neutrophil-associated-patterns-in-severe-influenza
#15
Jake Dunning, Simon Blankley, Long T Hoang, Mike Cox, Christine M Graham, Philip L James, Chloe I Bloom, Damien Chaussabel, Jacques Banchereau, Stephen J Brett, Miriam F Moffatt, Anne O'Garra, Peter J M Openshaw
Transcriptional profiles and host-response biomarkers are used increasingly to investigate the severity, subtype and pathogenesis of disease. We now describe whole-blood mRNA signatures and concentrations of local and systemic immunological mediators in 131 adults hospitalized with influenza, from whom extensive clinical and investigational data were obtained by MOSAIC investigators. Signatures reflective of interferon-related antiviral pathways were common up to day 4 of symptoms in patients who did not require mechanical ventilator support; in those who needed mechanical ventilation, an inflammatory, activated-neutrophil and cell-stress or death ('bacterial') pattern was seen, even early in disease...
May 18, 2018: Nature Immunology
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
#16
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
#17
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/29775966/an-enigmatic-case-presentation-of-budd-chiari-syndrome-with-pulmonary-embolism-an-unusual-syndrome-with-an-uncommon-complication
#18
A M Al-Sharydah, A H Al-Abdulwahhab, H A Abu AlOla
INTRODUCTION: In patients with a hypercoagulable state, such as patients with pulmonary embolism and/or Budd-Chiari syndrome, the complications from multiple gene mutations are more numerous than those from a single mutation. The authors present a woman with no major prior medical history who presented with pulmonary embolism and Budd-Chiari syndrome; this enigmatic co-occurrence has never been solely reported without underlying aetiology in a patient without prior medical conditions...
May 3, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29775671/variable-ventilation-decreases-airway-responsiveness-and-improves-ventilation-efficiency-in-a-rat-model-of-asthma
#19
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/29775603/genetic-and-extracardiac-anomalies-are-associated-with-inferior-single-ventricle-palliation-outcomes
#20
Bahaaldin Alsoufi, Courtney McCracken, Matthew Oster, Subhadra Shashidharan, Kirk Kanter
BACKGROUND: We aim to examine the effect of genetic syndromes and extracardiac anomalies (GS/EC) on single ventricle (SV) palliation with focus on hospital death, interstage mortality, and progression towards subsequent palliation stages. METHODS: 530 neonates with SV underwent first-stage palliation: Norwood (n=284,53%), shunt (n=173,33%), band (n=73,14%). Outcomes were compared between those with GS/EC (n=121,23%) and without GS/EC (n=409,77%). Regression analyses were adjusted for other risk factors (age, gender, prematurity, weight, SV anomaly, first-stage palliation surgery)...
May 15, 2018: Annals of Thoracic Surgery
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