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https://www.readbyqxmd.com/read/29239751/feasibility-of-single-vs-two-physician-procedural-sedation-in-a-small-community-emergency-department
#1
Clayton P Josephy, David R Vinson
OBJECTIVE: Sedation is commonly required for painful procedures in the emergency department (ED). Some facilities mandate two physicians be present for deep sedation cases. Evidence is lacking, however, that a two-physician approach improves safety outcomes. We report our experience on the feasibility of replacing a two-physician ED procedural sedation policy with a single-physician policy in a small, single-coverage community ED. METHODS: This is a retrospective, before/after, single-center observational study of prospectively collected data from January 2013 through December 2016...
November 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29230684/imipenem-relebactam-and-meropenem-vaborbactam-two-novel-carbapenem-%C3%AE-lactamase-inhibitor-combinations
#2
REVIEW
George G Zhanel, Courtney K Lawrence, Heather Adam, Frank Schweizer, Sheryl Zelenitsky, Michael Zhanel, Philippe R S Lagacé-Wiens, Andrew Walkty, Andrew Denisuik, Alyssa Golden, Alfred S Gin, Daryl J Hoban, Joseph P Lynch, James A Karlowsky
Relebactam (formerly known as MK-7655) is a non-β-lactam, bicyclic diazabicyclooctane, β-lactamase inhibitor that is structurally related to avibactam, differing by the addition of a piperidine ring to the 2-position carbonyl group. Vaborbactam (formerly known as RPX7009) is a non-β-lactam, cyclic, boronic acid-based, β-lactamase inhibitor. The structure of vaborbactam is unlike any other currently marketed β-lactamase inhibitor. Both inhibitors display activity against Ambler class A [including extended-spectrum β-lactamases (ESBLs), Klebsiella pneumoniae carbapenemases (KPCs)] and class C β-lactamases (AmpC)...
December 12, 2017: Drugs
https://www.readbyqxmd.com/read/29229259/effects-of-positive-airway-pressure-and-mechanical-ventilation-of-the-lungs-during-cardiopulmonary-bypass-on-pulmonary-adverse-events-after-cardiac-surgery-a-systematic-review-and-meta-analysis
#3
Yi-Chia Wang, Chi-Hsiang Huang, Yu-Kang Tu
OBJECTIVE: To investigate whether different ventilation strategies during cardiopulmonary bypass (CPB) can improve outcomes in adult cardiac surgery patients. DESIGN: Systematic review of randomized controlled trials with meta-analyses. SETTING: Clinical trials for human studies up to July 2016 were obtained from electronic databases (Medline, Embase, PubMed, and the Cochrane Central Register of Controlled Trials) and reference lists of relevant randomized trials and review articles...
September 14, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29229100/sleep-related-respiratory-events-during-non-invasive-ventilation-of-patients-with-chronic-hypoventilation
#4
Sigurd Aarrestad, Magnus Qvarfort, Anne Louise Kleiven, Elin Tollefsen, Ole Henning Skjønsberg, Jean-Paul Janssens
BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in the treatment of patients with chronic hypercapnic respiratory failure (CRF). Residual sleep related respiratory events under NIV such as obstructive or central apnea/hypopnea (AH), or patient-ventilator asynchrony (PVA), may compromise treatment efficacy and/or comfort. AIMS OF STUDY: 1/to quantify the frequency and describe the types of both AH and PVA in a large group of stable patients with CRF during night-time NIV; 2/to analyze the influence of these events on overnight pulse oximetry and transcutaneous CO2 and 3/to assess interrater agreement in identifying and quantifying AH and PVA...
November 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/29226131/risk-factors-of-delirium-in-sequential-sedation-patients-in-intensive-care-units
#5
Jie Yang, Yongfang Zhou, Yan Kang, Binbin Xu, Peng Wang, Yinxia Lv, Zhen Wang
Background: Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients. Methods: A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors...
2017: BioMed Research International
https://www.readbyqxmd.com/read/29224973/residual-pulmonary-embolism-as-a-predictor-for-recurrence-after-a-first-unprovoked-episode-results-from-the-reverse-cohort-study
#6
Tony Wan, Marc Rodger, Wanzhen Zeng, Philippe Robin, Marc Righini, Michael J Kovacs, Melanie Tan, Marc Carrier, Susan R Kahn, Philip S Wells, David R Anderson, Isabelle Chagnon, Susan Solymoss, Mark Crowther, Richard H White, Linda Vickars, Sadri Bazarjani, Grégoire Le Gal
BACKGROUND: The optimal duration of oral anticoagulant therapy after a first, unprovoked venous thromboembolism is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. Risk stratification tools may assist in decision making. OBJECTIVES: We sought to determine the relationship between residual pulmonary embolism assessed by baseline ventilation-perfusion scan after completion of 5-7months of oral anticoagulant therapy and the risk of recurrent venous thromboembolism in patients with the first episode of unprovoked pulmonary embolism...
December 7, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29202254/incidence-correlates-and-outcomes-associated-with-falls-in-the-intensive-care-unit-a-retrospective-cohort-study
#7
Drayton Trumble, Michael A Meier, Maryellen Doody, Xiaoming Wang, Sean M Bagshaw
BACKGROUND: Falls among hospitalised patients contribute to avoidable morbidity and prolonged hospital stay. We aimed to describe the incidence, circumstances and outcomes associated with patient falls occurring in intensive care units. METHODS: Retrospective cohort study of adult admissions to an academic, tertiary ICU in Edmonton, Canada between 1 January 2013 and 30 April 2016. Fall events were ascertained by interrogation of an electronic health record. Each fall was independently adjudicated by two intensivists to confirm that a fall did occur, and to determine if the fall was potentially avoidable...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29200833/positive-airway-pressure-adherence-and-subthreshold-adherence-in-posttraumatic-stress-disorder-patients-with-comorbid-sleep-apnea
#8
Barry J Krakow, Jessica J Obando, Victor A Ulibarri, Natalia D McIver
Study objectives: Patients with comorbid posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) manifest low adherence to continuous positive airway pressure (CPAP) due to fixed, pressure-induced expiratory pressure intolerance (EPI), a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV]) may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/29197374/prevalence-and-associated-factors-of-strabismus-in-former-preterm-and-full-term-infants-between-4-and-10%C3%A2-years-of-age
#9
Achim Fieß, Ruth Kölb-Keerl, Alexander K Schuster, Markus Knuf, Bernd Kirchhof, Philipp S Muether, Jacqueline Bauer
BACKGROUND: Limited data exist collating most of the associated factors for strabismus in one analysis. The aim of this study was to assess the prevalence of strabismus and to analyse associated factors in former preterm and full-term infants. METHODS: In this cross-sectional study, 239 former preterm infants with gestational age (GA) ≤ 32 weeks and 264 former full-term born infants with GA ≥ 37 weeks underwent detailed ophthalmologic examination in the age of 4-10 years and perinatal data assessment for risk factor analysis...
December 2, 2017: BMC Ophthalmology
https://www.readbyqxmd.com/read/29196698/high-pressure-versus-low-pressure-home-non-invasive-positive-pressure-ventilation-with-built-in-software-in-patients-with-stable-hypercapnic-copd-a-pilot-study
#10
Rongchang Chen, Lili Guan, Weiliang Wu, Xiaoying Li, Xin Chen, Bingpeng Guo, Yating Huo, Jiawen Xu, Yuqiong Yang, Luqian Zhou
High-pressure non-invasive positive pressure ventilation (NPPV) is a new strategy targeted at maximally reducing arterial carbon dioxide. However, high inspiratory positive airway pressure (IPAP) might cause respiratory adverse events likely to diminish the benefit of NPPV. In the setting of ventilatory support, monitoring NPPV efficacy and resolving problems promptly are critical. This study assessed the treatment effect of high and low-pressure NPPV in chronic hypercapnic COPD using home ventilator with built-in software...
December 1, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29189639/effects-of-closed-endotracheal-suctioning-on-systemic-and-cerebral-oxygenation-and-hemodynamics-in-children
#11
Madhuradhar Chegondi, Teshaun Francis, Wei-Chiang Lin, Sayed Naqvi, Andre Raszynski, Balagangadhar R Totapally
OBJECTIVES: To evaluate the effects of closed endotracheal tube suctioning on systemic oxygen saturation, cerebral regional oxygen saturation, and somatic regional (renal) oxygen saturation and hemodynamic variables in children. DESIGN: Prospective observational. SETTING: A tertiary care PICU. SUBJECTS: Children aged 0-18 years, requiring invasive mechanical ventilation and with an arterial line. INTERVENTIONS: Closed endotracheal suction...
November 16, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29186145/respective-impact-of-implementation-of-prevention-strategies-colonization-with-multiresistant-bacteria-and-antimicrobial-use-on-the-risk-of-early-and-late-onset-vap-an-analysis-of-the-outcomerea-network
#12
Wafa Ibn Saied, Bertrand Souweine, Maité Garrouste-Orgeas, Stéphane Ruckly, Michael Darmon, Sébastien Bailly, Yves Cohen, Elie Azoulay, Carole Schwebel, Aguila Radjou, Hatem Kallel, Christophe Adrie, Anne-Sylvie Dumenil, Laurent Argaud, Guillaume Marcotte, Samir Jamali, Laurent Papazian, Dany Goldgran-Toledano, Lila Bouadma, Jean-Francois Timsit
RATIONALE: The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator-associated pneumonia (VAP) are still debated. OBJECTIVES: To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. METHODS: 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016)...
2017: PloS One
https://www.readbyqxmd.com/read/29182729/effects-of-opioids-given-to-facilitate-mechanical-ventilation-on-sleep-apnea-after-extubation-in-the-intensive-care-unit
#13
Fanny P Timm, Sebastian Zaremba, Stephanie D Grabitz, Hassan N Farhan, Stefanie Zaremba, Elizabeth Siliski, Christina H Shin, Sandra Muse, Sabine Friedrich, James E Mojica, Tobias Kurth, Satya-Krishna Ramachandran, Matthias Eikermann
Study Objectives: Following extubation in the intensive care unit (ICU), upper airway (UA) edema and respiratory depressants may promote UA dysfunction. We tested the hypothesis that opioids increase the risk of sleep apnea early after extubation. Methods: 56 ICU patients underwent polysomnography the night after extubation. Airflow limitation during wakefulness was identified using bedside spirometry. Correlation and ordinal regression analyses were used to quantify effects of pre-extubation opioid dose on post-extubation Apnea-Hypopnea-Index (AHI) and severity of sleep apnea and whether or not inspiratory airway obstruction (ratio of maximum expiratory and inspiratory flow at 50% of vital capacity (MEF50/MIF50)≥1) during wakefulness predicts airway obstruction during sleep...
November 22, 2017: Sleep
https://www.readbyqxmd.com/read/29181534/association-between-decline-in-slow-vital-capacity-and-respiratory-insufficiency-use-of-assisted-ventilation-tracheostomy-or-death-in-patients-with-amyotrophic-lateral-sclerosis
#14
Jinsy A Andrews, Lisa Meng, Sarah F Kulke, Stacy A Rudnicki, Andrew A Wolff, Michael E Bozik, Fady I Malik, Jeremy M Shefner
Importance: The prognostic value of slow vital capacity (SVC) in relation to respiratory function decline and disease progression in patients with amyotrophic lateral sclerosis (ALS) is not well understood. Objective: To investigate the rate of decline in percentage predicted SVC and its association with respiratory-related clinical events and mortality in patients with ALS. Design, Setting, and Participants: This retrospective study included 893 placebo-treated patients from 2 large clinical trials (EMPOWER and BENEFIT-ALS, conducted from March 28, 2011, to November 1, 2012, and from October 23, 2012, to March 21, 2014, respectively) and an ALS trial database (PRO-ACT, containing studies completed between 1990 and 2010) to investigate the rate of decline in SVC...
November 27, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/29178963/chloral-hydrate-enteral-infusion-for-sedation-in-ventilated-children-the-chosen-pilot-study
#15
Ari R Joffe, Jessica Hogan, Cathy Sheppard, Gerda Tawfik, Jonathan P Duff, Gonzalo Garcia Guerra
BACKGROUND: We aimed to test a novel method of delivery of chloral hydrate (CH) sedation in ventilated critically ill young children. METHODS: Children < 12 years old, within 72 hours of admission, who were ventilated, receiving enteral tube-feeds, with intermittent CH ordered were enrolled after signed consent. Patients received a CH loading-dose of 10 mg/kg enterally, then a syringe-pump enteral infusion at 5 mg/kg/hour, increasing to a maximum of 9 mg/kg/hour...
November 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29174079/laryngeal-mask-airway-for-surfactant-administration-in-neonates-a-randomized-controlled-trial
#16
Kari D Roberts, Roland Brown, Andrea L Lampland, Tina A Leone, Kyle D Rudser, Neil N Finer, Wade D Rich, T Allen Merritt, Adam J Czynski, Julie M Kessel, Sajani M Tipnis, Erin C Stepka, Mark C Mammel
OBJECTIVE: To determine if preterm infants with moderate respiratory distress syndrome on continuous positive airway pressure (CPAP) who received surfactant via a laryngeal mask airway (LMA) would have a decreased rate of intubation and mechanical ventilation compared with those on CPAP who did not receive surfactant. STUDY DESIGN: In this prospective, multicenter, randomized controlled trial, 103 premature infants 280/7-356/7 weeks gestation, ≥1250 g and ≤36 hours old on CPAP requiring fraction of inspired oxygen 0...
November 21, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29161935/extended-versus-short-course-corticosteroid-taper-regimens-in-the-management-of-chronic-obstructive-pulmonary-disease-exacerbations-in-critically-ill-patients
#17
Teresa Poon, Daryl Glick Paris, Samuel L Aitken, Paru Patrawalla, Eric Bondarsky, Jerry Altshuler
BACKGROUND: Previous literature has suggested that a short course of corticosteroids is similarly effective as an extended course for managing an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, there are limited data regarding the optimal corticosteroid regimen in critically ill patients and the dosing strategies remain highly variable in this population. METHODS: This retrospective cohort study evaluated patients with AECOPD admitted to the intensive care unit within a 2-year period...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29159491/-algorithm-for-securing-an-unexpected-difficult-airway-user-analysis-on-a-simulator
#18
T Ott, K Truschinski, M Kriege, M Naß, S Herrmann, V Ott, S Sellin
BACKGROUND: Critical incidents in difficult airway management are still a main contributory factor for perioperative morbidity and mortality. Many national associations have developed algorithms for management of these time critical events. For implementation of these algorithms the provision of technical requirements and procedure-related training are essential. Severe airway incidents are rare events and clinical experience of the individual operators is limited; therefore, simulation is an adequate instrument for training and evaluating difficult airway algorithms...
November 20, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29158181/effects-of-noninvasive-ventilation-with-bilevel-positive-airway-pressure-on-exercise-tolerance-and-dyspnea-in-heart-failure-patients
#19
Mansueto Gomes Neto, Laís Fernanda Gama Duarte, Erenaldo de Sousa Rodrigues-Jr, Hugo Souza Bittencourt, Noélia Gonçalves Dos Santos, Bruno Costa David, Eugênia da Silva Lima, Helena França Correia Dos Reis
BACKGROUND: Heart failure (HF) is a syndrome that results in inadequate blood supply, leading to a number of structural and functional changes. Noninvasive ventilatory support (NIVS) is used as an adjuvant treatment to improve the functional capacity of these patients. OBJECTIVE: To investigate the effect of NIVS with bilevel positive airway pressure ventilation (BiPAP) on exercise tolerance and dyspnea in HF patients. METHODS: Forty patients with New York Heart Association class I/II/III HF were randomly assigned either to a NIVS group (n=20) or a control group (n=20)...
November 17, 2017: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/29157044/prenatal-complications-are-associated-with-the-postnatal-airway-host-response-and-microbiota-in-intubated-preterm-infants
#20
Brandie D Wagner, Marci K Sontag, J Kirk Harris, Joshua I Miller, Lindsey Morrow, Charles E Robertson, Mark J Stephens, Brenda B Poindexter, Steven H Abman, Peter M Mourani
PURPOSE: To prospectively examine the relationship between prenatal events, postnatal airway host response and microbiota, and clinical outcomes. MATERIALS AND METHODS: Tracheal aspirates collected at 7 days of age from 71 mechanically ventilated infants (median gestational age (GA), 25 weeks [range 23-28]) were simultaneously processed for a 12-plex protein assay and bacterial identification by 16S rRNA sequencing. Phenotypes were determined by unsupervised clustering of the protein analytes...
November 20, 2017: Journal of Maternal-fetal & Neonatal Medicine
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