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Exchange Extubation

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https://www.readbyqxmd.com/read/30374754/work-of-breathing-during-hhhfnc-and-synchronised-nippv-following-extubation
#1
Elinor Charles, Katie A Hunt, Gerrard F Rafferty, Janet L Peacock, Anne Greenough
Our aim was to compare the work of breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24-31) weeks and post-natal age of 7 (range 2-50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation. They were studied for 2 h on one mode and then switched to the other modality and studied for a further 2-h period...
October 30, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/30285939/whole-blood-exchange-transfusion-as-a-promising-treatment-of-aluminium-phosphide-poisoning
#2
Nasim Zamani, Hossein Hassanian-Moghaddam, Sakine Ebrahimi
A 37-year-old male was referred to us about one hour after deliberate ingestion of two 3-gram aluminium phosphide (ALP) tablets. Three hours after admission, his blood pressure dropped to 85/55 mmHg, his heart rate increased to 120 bpm, O2 saturation dropped to 82 %, and the electrocardiogram showed junctional rhythm. We started whole blood exchange, and gross haematuria and jaundice ensued. However, his blood pressure increased, arrhythmia resolved itself, and he was extubated two days after the transfusion was completed...
September 1, 2018: Arhiv za Higijenu Rada i Toksikologiju
https://www.readbyqxmd.com/read/30278459/comparison-of-bubble-cpap-devices-using-ram-cannula-for-extubation-failure-in-very-low-birth-weight-infants-randomized-and-cohort-studies
#3
Colleen C Claassen, Noah H Hillman, Kimberly Brown, Howard L Williams, Marya L Strand
INTRODUCTION: Bubble continuous positive airway pressure (bCPAP) generates a variable pressure due to bubble size and frequency, and these pressure oscillations may contribute to lung recruitment and gas exchange. Single-outlet bCPAP devices generate larger pressure fluctuation than bCPAP devices with diffusers, but clinical efficacy is unclear. Our hypothesis was that a single-outlet bCPAP device (B&B Bubbler©) would decrease extubation failure and improve oxygenation compared with a bCPAP device with a diffuser (BabiPlus©)...
October 2, 2018: Neonatology
https://www.readbyqxmd.com/read/30176526/ultrasound-guided-percutaneous-dilatational-tracheostomy-using-a-saline-filled-endotracheal-tube-cuff-as-an-ultrasonographic-puncture-target-a-feasibility-study
#4
Chien-Hung Lin, Shun-Mao Yang, Xu-Heng Chiang, Jen-Hao Chuang, Huan-Jang Ko, Pei-Ming Huang
PURPOSE: The saline-filled endotracheal tube (ETT) cuff can be easily identified under cervical ultrasound and can serve as an ideal puncture target during percutaneous dilatational tracheostomy (PDT). The authors present their initial experience with this novel technique. MATERIALS AND METHODS: The records of 38 consecutive critically ill patients who underwent saline-filled cuff puncture PDT between October 2016 and December 2017 were retrospectively reviewed...
August 18, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30176288/effects-of-two-different-ventilation-strategies-on-respiratory-mechanics-during-robotic-gynecological-surgery
#5
Giorgia Spinazzola, Giuliano Ferrone, Flora Cipriani, Cosimo Tommaso Caputo, Marco Rossi, Giorgio Conti
It is unknown which is the best ventilatory approach in patients scheduled for gynecological robotic surgery in Deep Trendelenburg position in terms of respiratory mechanics. 40 patients were enrolled: 20 patients received a standard ventilation and 20 patients received a protective ventilation. Gas exchanges, respiratory mechanics and hemodynamic parameters were recorded. No significant differences were found between the two groups in terms of respiratory mechanics. In both groups, there was a significant reduction of static compliance between Baseline and Extubation Time (p < 0...
August 31, 2018: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/30071876/high-flow-nasal-cannula-oxygen-therapy-decreases-postextubation-neuroventilatory-drive-and-work-of-breathing-in-patients-with-chronic-obstructive-pulmonary-disease
#6
Rosa Di Mussi, Savino Spadaro, Tania Stripoli, Carlo Alberto Volta, Paolo Trerotoli, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore Grasso
BACKGROUND: The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. METHODS: This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies...
August 2, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29886847/cytomegalovirus-reactivation-in-a-critically-ill-patient-a-case-report
#7
Demet Demirkol, Umay Kavgacı, Burcu Babaoğlu, Serhan Tanju, Banu Oflaz Sözmen, Suda Tekin
BACKGROUND: The aim of this case report is to discuss diagnostic workup and clinical management of cytomegalovirus reactivation in a critically ill immunocompetent pediatric patient. CASE PRESENTATION: A 2-year-old white boy who had no medical history presented with respiratory distress and fever. His Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores were 20 and 11, respectively. Our preliminary diagnosis was multiple organ dysfunction secondary to sepsis...
June 11, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29843263/successful-exchange-transfusion-in-extremely-preterm-infant-after-symptomatic-lipid-overdose
#8
M J Rodríguez-Castaño, B Iglesias, L Arruza
BACKGROUND: Complications of intravenous lipid administration are relatively uncommon. However, inadvertent rapid infusion of intravenous fat emulsion (IVFE) is an inherent risk when fats are infused separately from the dextrose-amino acid solution. CASE REPORT: Extremely preterm infant, born at 25 weeks and 6 days of gestational age weighing 920 g, who inadvertently received a massive overdose of IVFE due to a device failure. He developed lethargy, apnea, metabolic acidosis and hemodynamic instability requiring mechanical ventilation and inotropic support...
2018: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/29794728/acute-noncardiogenic-pulmonary-edema-after-neostigmine-administration-during-the-recovery-period-of-general-anesthesia-a-case-report
#9
Wenjing Zhang, Cong Ning, Guoqing Zhao, Zhenbo Su
RATIONALE: Acute non-cardiogenic pulmonary edema (ANPE) is a rare but challenging complication which occurs during the perioperative period, mainly before and after the extubation in the course of the recovery period of general anesthesia. It is characterized by increased fluid in extravascular pulmonary spaces, preventing gas exchange and further resulting in respiratory failure. PATIENT CONCERNS: A 12-year-old boy who had undergone island skin flap in the right upper limb and who developed a unilateral pulmonary edema after the administration of neostigmine during the recovery period of general anesthesia...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29757757/use-of-an-airway-exchange-catheter-assisted-extubation-with-continuous-end-tidal-carbon-dioxide-monitoring-in-a-pediatric-patient-with-a-known-difficult-airway-a-case-report
#10
Courtney C Yegian, Lana M Volz, Richard E Galgon
Tracheal extubation in children with known difficult airways is associated with an increased risk of adverse events. Currently, there is no reliable measure to predict the need for emergent reintubation due to airway inadequacy. Airway exchange catheter-assisted extubation has been shown to be a useful adjunct in decreasing the risk of adverse events due to failed extubation. We report a case of using an airway exchange catheter-assisted extubation with continuous end-tidal carbon dioxide monitoring for a pediatric patient with a known difficult airway...
November 1, 2018: A&A practice
https://www.readbyqxmd.com/read/29756063/the-carrico-index-is-the-parameter-that-guides-the-requirement-of-oxygen-in-the-postoperative-period-in-patients-undergoing-head-and-neck-surgery-under-general-anaesthesia-a-cross-sectional-study
#11
Parnandi Bhaskar Rao, Manaswini Mangaraj, Preetam Mahajan, Swagata Tripathy, Neha Singh, Thenmozhi Mani, Sukdev Nayak
Background & aims: Altered lung function and consequent decrease in oxygenation has been linked to the duration of anaesthesia. This necessitates oxygen monitoring and supplementation in the perioperative period. But, evidence is lacking regarding the parameter that guides best the oxygen supplementation in the postoperative period and the parameter that correlates best with the duration of anaesthesia. Methods: Adult patients scheduled for head & neck surgery under general anaesthesia were recruited...
April 2018: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29661436/model-for-end-stage-liver-disease-score-before-hepatic-transplantation-and-root-mean-square-of-the-diaphragmatic-domes-affect-postoperative-extubation-time
#12
R P Duarte, A M O da Silva, R M Tonella, L S R Ratti, I F S F Boin
INTRODUCTION: The liver transplantation procedure, in addition to its prolonged surgical time, also predisposes to complications such as changes in respiratory mechanics, lung volumes, and gas exchange. OBJECTIVE: This study aims to verify if clinical factors related to the recipient, namely immediate pretransplant Model for End-Stage Liver Disease (MELD) score, surgical time, and root square metric (RMS) of the diaphragmatic domes, affect the extubation time after liver transplantation...
April 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29543641/percutaneous-dilatational-tracheostomy-using-tube-exchanger
#13
Ohad Ronen, Alexander Gurevich, Shimon Ivry, Edward Altman, Evgeni Kukuev
We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope)...
March 14, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29137579/assessment-of-the-reliability-of-intubation-and-ease-of-use-of-the-cook-staged-extubation-set-an-observational-study
#14
C Furyk, M L Walsh, I Kaliaperumal, S Bentley, C Hattingh
The Staged Extubation Set has recently been introduced by Cook Medical for the management of difficult airway patients who potentially require reintubation; however, its reliability for intubation and ease of use is not reported in the literature. The set contains a wire and reintubation catheter with a central lumen for the wire and oxygenation if required. Reintubation is by a two-stage Seldinger-like technique. After induction of general anaesthesia, 23 low-risk elective surgical patients had the Staged Extubation Wire from the Cook set inserted into their trachea under direct laryngoscopy...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29090253/fiberoptic-bronchoscope-and-c-mac-video-laryngoscope-assisted-nasal-oral-tube-exchange-two-case-reports
#15
Sungmi Ji, Jaegyok Song, Seok Kon Kim, Moon-Young Kim, Sangyun Kim
In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device...
September 2017: Journal of dental anesthesia and pain medicine
https://www.readbyqxmd.com/read/28977202/effect-of-different-levels-of-peep-on-oxygenation-during-non-invasive-ventilation-in-patients-submitted-to-cabg-surgery-randomized-clinical-trial
#16
RANDOMIZED CONTROLLED TRIAL
André Luiz Lisboa Cordeiro, Caroline Aparecida Gruska, Pâmella Ysla, Amanda Queiroz, Sarah Carvalho de Oliveira Nogueira, Maria Clara Leite, Bruno Freitas, André Raimundo Guimarães
INTRODUCTION: During and after coronary artery bypass grafting, a decline in multifactor lung function is observed. Due to this fact, some patients may benefit from non-invasive ventilation after extubation targeting lung expansion and consequently improved oxygenation. OBJECTIVE: To test the hypothesis that higher levels of positive end expiration pressure during non-invasive ventilation improves oxygenation in patients undergoing coronary artery bypass grafting...
July 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28716018/prediction-of-extubation-readiness-in-extremely-preterm-infants-by-the-automated-analysis-of-cardiorespiratory-behavior-study-protocol
#17
MULTICENTER STUDY
Wissam Shalish, Lara J Kanbar, Smita Rao, Carlos A Robles-Rubio, Lajos Kovacs, Sanjay Chawla, Martin Keszler, Doina Precup, Karen Brown, Robert E Kearney, Guilherme M Sant'Anna
BACKGROUND: Extremely preterm infants (≤ 28 weeks gestation) commonly require endotracheal intubation and mechanical ventilation (MV) to maintain adequate oxygenation and gas exchange. Given that MV is independently associated with important adverse outcomes, efforts should be made to limit its duration. However, current methods for determining extubation readiness are inaccurate and a significant number of infants fail extubation and require reintubation, an intervention that may be associated with increased morbidities...
July 17, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#18
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/28169983/effect-of-preoperative-inspiratory-muscle-training-on-alveolar-arterial-oxygen-gradients-after-coronary-artery-bypass-surgery
#19
RANDOMIZED CONTROLLED TRIAL
Khalid Turky, Amera M Abdelaziz Afify
PURPOSE: Gas exchange abnormalities and inspiratory muscle dysfunction are common postoperative pulmonary complications after cardiac surgery. The aim of this study was to investigate the changes in the alveolar arterial oxygen gradients and inspiratory muscle power after preoperative inspiratory muscle training (IMT) followed by postoperative IMT and early mobilization after coronary artery bypass graft surgery. METHODS: Patients were randomly assigned to the intervention group (n = 20) or the usual care group (n = 20)...
July 2017: Journal of Cardiopulmonary Rehabilitation and Prevention
https://www.readbyqxmd.com/read/28084083/off-pump-grafting-does-not-reduce-postoperative-pulmonary-dysfunction
#20
RANDOMIZED CONTROLLED TRIAL
Mohammad Bashar Izzat, Farouk Almohammad, Ahmad Fahed Raslan
Objectives Pulmonary dysfunction is a recognized postoperative complication that may be linked to use of cardiopulmonary bypass. The off-pump technique of coronary artery bypass aims to avoid some of the complications that may be related to cardiopulmonary bypass. In this study, we compared the influence of on-pump or off-pump coronary artery bypass on pulmonary gas exchange following routine surgery. Methods Fifty patients (mean age 60.4 ± 8.4 years) with no preexisting lung disease and good left ventricular function undergoing primary coronary artery bypass grafting were prospectively randomized to undergo surgery with or without cardiopulmonary bypass...
February 2017: Asian Cardiovascular & Thoracic Annals
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