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critical ill,mechanical ventilation,monitor

Richard J Nies, Carsten Müller, Roman Pfister, Philipp S Binder, Nicole Nosseir, Felix S Nettersheim, Kathrin Kuhr, Martin H J Wiesen, Matthias Kochanek, Guido Michels
Background: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures...
2018: Journal of Intensive Care
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Anoopindar K Bhalla, Robinder G Khemani, Justin C Hotz, Rica P Morzov, Christopher Jl Newth
BACKGROUND: Widespread use of transcutaneous P CO2 ( P tcCO2 ) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of P tcCO2 with that of P aCO2 measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy. METHODS: We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring...
September 25, 2018: Respiratory Care
Sandra N Stapel, Peter J M Weijs, Armand R J Girbes, Heleen M Oudemans-van Straaten
BACKGROUND & AIMS: Indirect calorimetry is recommended to measure energy expenditure (EE) in critically ill, mechanically ventilated patients. The most validated system, the Deltatrac® (Datex-Ohmeda, Helsinki, Finland) is no longer in production. We tested the agreement of a new breath-by-breath metabolic monitor E-sCOVX® (GE healthcare, Helsinki, Finland), with the Deltatrac. We also compared the performance of the E-sCOVX to commonly used predictive equations. METHODS: We included mechanically ventilated patients eligible to undergo indirect calorimetry...
September 6, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Nadja C Carvalho, Leonardo L Portes, Alessandro Beda, Lucinara M S Tallarico, Luis A Aguirre
Inappropriate patient-ventilator interactions' (PVI) quality is associated with adverse clinical consequences, such as patient anxiety/fear and increased need of sedative and paralytic agents. Thus, technological devices/tools to support the recognition and monitoring of different PVI quality are of great interest. In the present study, we investigate two tools based on a recent landmark study which applied recurrence plots (RPs) and recurrence quantification analysis (RQA) techniques in non-invasive mechanical ventilation...
August 2018: Chaos
Riaz Aziz, Soledad Colombe, Gibonce Mwakisambwe, Solomon Ndezi, Jim Todd, Samuel Kalluvya, Halinder S Mangat, Reed Magleby, Arndt Koebler, Bernard Kenemo, Robert N Peck, Jennifer A Downs
BACKGROUND: Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]...
August 2018: PLoS Neglected Tropical Diseases
Igor Barjaktarevic, William E Toppen, Scott Hu, Elizabeth Aquije Montoya, Stephanie Ong, Russell Buhr, Ian J David, Tisha Wang, Talayeh Rezayat, Steven Y Chang, David Elashoff, Daniela Markovic, David Berlin, Maxime Cannesson
OBJECTIVES: Adequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used...
November 2018: Critical Care Medicine
Hongmin Zhang, Xiaoting Wang, Xiukai Chen, Qing Zhang, Dawei Liu
BACKGROUND: The tricuspid annular plane systolic excursion (TAPSE) is commonly recommended for estimating the right ventricular systolic function. The central venous pressure (CVP), which is determined by venous return and right heart function, was found to be associated with right ventricular outflow fractional shortening. This study thus aimed to investigate the relationship between the TAPSE and CVP in mechanically ventilated critically ill patients. METHODS: This is a prospective observational study...
August 7, 2018: Cardiovascular Ultrasound
Vera Joskova, Anna Patkova, Eduard Havel, Simona Najpaverova, Daniela Uramova, Miroslav Kovarik, Zdenek Zadak, Miloslav Hronek
OBJECTIVE: Loss of muscle mass in critically ill patients is associated with serious consequences, such as prolonged mechanical ventilation, intensive care unit confinement, and higher mortality. Thus, monitoring muscle mass, and especially its decline, should provide a useful indicator of morbidity and mortality. Performing evaluations according only to body mass index is imperfect, therefore the aim of this article was to evaluate appropriate methods for muscle mass loss determination in ICU patients...
August 22, 2018: Journal of Rehabilitation Medicine
Anthony Gan, Avi Cohen, Laren Tan
Percutaneous dilatational tracheostomy is a minimally invasive procedure performed for those who require prolonged mechanical ventilation. It is a procedure that is performed routinely at the bedside in the intensive care unit. Complications nonetheless still occur, and as a result, several technique modifications have been employed. At Loma Linda University Medical Center, we have implemented a novel technique using augmented reality during percutaneous dilatational tracheostomy placement in an attempt to minimize such complications...
August 5, 2018: Journal of Intensive Care Medicine
Davina Wildemeersch, Jens Gios, Philippe G Jorens, Guy H Hans
The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and long-term consequences of unresolved pain or excessive analgosedation, adequate nociceptive monitoring remains challenging in non-communicative, critically ill adults. In the intensive care unit (ICU), routine nociceptive evaluation is carried out by the attending nurse using the Behavior Pain Scale (BPS) in mechanically ventilated patients. This assessment is limited by medication use (e...
July 4, 2018: Journal of Visualized Experiments: JoVE
Marlina E Lovett, Zubin S Shah, Melissa Moore-Clingenpeel, Eric Sribnick, Adam Ostendorf, Melissa G Chung, Jeffrey Leonard, Nicole F O'Brien
OBJECTIVE Focal intracranial infections such as intraparenchymal abscesses or localized infections in the epidural or subdural spaces are relatively rare infections associated with both morbidity and mortality in children. Although children with these infections frequently require surgical intervention, there is a paucity of literature describing the critical care resources required to manage these cases. This retrospective chart review was performed to evaluate the resources necessary to care for critically ill children with focal intracranial infections at the authors' institution...
July 13, 2018: Journal of Neurosurgery. Pediatrics
Candelaria de Haro, Josefina López-Aguilar, Rudys Magrans, Jaume Montanya, Sol Fernández-Gonzalo, Marc Turon, Gemma Gomà, Encarna Chacón, Guillermo M Albaiceta, Rafael Fernández, Carles Subirà, Umberto Lucangelo, Gastón Murias, Montserrat Rué, Robert M Kacmarek, Lluís Blanch
OBJECTIVES: Double cycling generates larger than expected tidal volumes that contribute to lung injury. We analyzed the incidence, mechanisms, and physiologic implications of double cycling during volume- and pressure-targeted mechanical ventilation in critically ill patients. DESIGN: Prospective, observational study. SETTING: Three general ICUs in Spain. PATIENTS: Sixty-seven continuously monitored adult patients undergoing volume control-continuous mandatory ventilation with constant flow, volume control-continuous mandatory ventilation with decelerated flow, or pressure control-continuous mandatory mechanical ventilation for longer than 24 hours...
September 2018: Critical Care Medicine
Franco Díaz, María José Nuñez, Pablo Pino, Benjamín Erranz, Pablo Cruces
BACKGROUND: Fluid overload (FO) is associated with unfavorable outcomes in critically ill children. Clinicians are encouraged to avoid FO; however, strategies to avoid FO are not well-described in pediatrics. Our aim was to implement a bundle strategy to prevent FO in children with sepsis and pARDS and to compare the outcomes with a historical cohort. METHODS: A quality improvement initiative, known as preemptive fluid strategy (PFS) was implemented to prevent early FO, in a 12-bed general PICU...
June 26, 2018: BMC Pediatrics
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
Fady M El Gendy, Muhammad S El-Mekkawy, Nagwan Y Saleh, Mona Salah El-Din Habib, Faten Ezzelarab Younis
PURPOSE: To assess the value of Presepsin and Pentraxin3 measurement in critically ill children. MATERIALS AND METHODS: Prospective observational study conducted on 80 children admitted into Pediatric Intensive Care Unit (PICU) and 80 healthy controls. Patients were evaluated for presence of sepsis. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM2) were calculated. Serum Presepsin and Pentraxin3 were measured within 24 h of admission...
June 3, 2018: Journal of Critical Care
Katarzyna Kotfis, Annachiara Marra, Eugene Wesley Ely
ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies...
2018: Anaesthesiology Intensive Therapy
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients...
May 10, 2018: Cochrane Database of Systematic Reviews
Antoine Vieillard-Baron, R Naeije, F Haddad, H J Bogaard, T M Bull, N Fletcher, T Lahm, S Magder, S Orde, G Schmidt, M R Pinsky
INTRODUCTION: This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. RESULTS: The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation...
May 9, 2018: Intensive Care Medicine
Annia Schreiber, Fatma Yıldırım, Giovanni Ferrari, Andrea Antonelli, Pablo Bayoumy Delis, Murat Gündüz, Marcin Karcz, Peter Papadakos, Roberto Cosentini, Yalım Dikmen, Antonio M Esquinas
There is limited literature on non-invasive mechanical ventilation (NIMV) in patients with polytrauma-related acute respiratory failure (ARF). Despite an increasing worldwide application, there is still scarce evidence of significant NIMV benefits in this specific setting, and no clear recommendations are provided. We performed a systematic review, and a search of clinical databases including MEDLINE and EMBASE was conducted from the beginning of 1990 until today. Although the benefits in reducing the intubation rate, morbidity and mortality are unclear, NIMV may be useful and does not appear to be associated with harm when applied in properly selected patients with moderate ARF at an earlier stage of injury by experienced teams and in appropriate settings under strict monitoring...
April 2018: Turkish Journal of Anaesthesiology and Reanimation
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