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Exchange Extubation

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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
#1
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
#2
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
#3
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
#4
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
#5
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...
May 11, 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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/28009154/high-flow-nasal-cannula-oxygen-therapy-work-in-progress-in-respiratory-critical-care
#16
REVIEW
Annia Schreiber, Fabiano DI Marco, Fulvio Braido, Paolo Solidoro
After a planned extubation, the re-occurrence of acute respiratory distress needing the restoration of invasive mechanical support is a severe phenomenon associated with several important consequences, including increased morbidity, Intensive Care Unit mortality, and an enormous financial burden. So far, the most commonly used techniques to ameliorate gas exchange in the postextubation period were low-flow oxygen therapy and non-invasive ventilation (NIV). High flows through nasal cannulae (HFNC) is a system which allows increased CO2 wash-out of anatomical dead space, positive nasopharyngeal pressure, a relatively constant FiO2, and an improvement of mucociliary function...
December 2016: Minerva Medica
https://www.readbyqxmd.com/read/27856933/predictors-of-extubation-outcomes-following-myasthenic-crisis
#17
Zhenguo Liu, Shiyuan Yao, Qian Zhou, Zhensheng Deng, Jianyong Zou, Huiyu Feng, Hua Zhu, Chao Cheng
Objective Myasthenic crisis (MC) is considered the most severe adverse event in patients with myasthenia gravis. The present retrospective study was performed to evaluate the predictors of clinical outcomes in patients with MC. Methods The medical charts of 33 patients (19 women, 14 men) with 76 MC attacks from 2002 to 2014 were retrospectively reviewed. Early extubation (≤7 days) and prolonged ventilation (>15 days) during the MC were used to assess patient outcomes. Results Among the 33 patients, 24 (72...
December 2016: Journal of International Medical Research
https://www.readbyqxmd.com/read/27837750/continuous-positive-airway-pressure-to-bubble-or-not-to-bubble
#18
REVIEW
Samir Gupta, Steven M Donn
Continuous positive airway pressure (CPAP) systems can be broadly grouped into continuous flow or variable flow devices. Bubble CPAP (bCPAP) is a continuous flow device and has physiologic properties that could facilitate gas exchange. Its efficacy has been reported to be similar to variable flow CPAP systems when used as a primary mode of respiratory support. Post-extubation bCPAP is reported to significantly reduce extubation failure rates among preterm infants ventilated for less than 2 week when compared to Infant flow driver CPAP (variable flow)...
December 2016: Clinics in Perinatology
https://www.readbyqxmd.com/read/27783213/a-prospective-randomized-study-of-inhaled-prostacyclin-versus-nitric-oxide-in-patients-with-residual-pulmonary-hypertension-after-pulmonary-endarterectomy
#19
RANDOMIZED CONTROLLED TRIAL
Shinichiro Abe, Keiichi Ishida, Masahisa Masuda, Hideki Ueda, Hiroki Kohno, Kaoru Matsuura, Yusaku Tamura, Michiko Watanabe, Goro Matsumiya
OBJECTIVES: Pulmonary endarterectomy (PEA) is an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative residual hypertension leads to in-hospital mortality. Inhaled epoprostenol sodium (PGI2 ) and NO are administered for pulmonary hypertension after cardiothoracic surgery. This prospective study provides the first comparative evaluation of the effects of inhaled PGI2 and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange in patients developing residual pulmonary hypertension after PEA...
March 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27775982/evaluating-pre-burn-center-intubation-practices-an-update
#20
COMPARATIVE STUDY
Anthony R Cai, Erica I Hodgman, Puneet B Kumar, Alvand J Sehat, Alexander L Eastman, Steven E Wolf
A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate...
January 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
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