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Ventilation support

Satvinder Ghotra, Michael Vincer, Victoria M Allen, Naeem Khan
OBJECTIVE: To identify the temporal trends, risk factors and outcomes of cystic white matter injury (WMI) detected by ultrasound in a population-based cohort of very preterm infants (VPI) with a minimal risk of selection bias. STUDY DESIGN: All live-born VPIs between 22 and < 31 weeks gestational age born in Nova Scotia, Canada from 1993 to 2013. RESULTS: Cystic WMI was identified in 87 (7%) out of 1184 eligible infants. The gestational age and mortality adjusted prevalence of cystic WMI decreased over time (p = 0...
December 14, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Marilyn Green Larach, Thomas T Klumpner, Barbara W Brandom, Michelle T Vaughn, Kumar G Belani, Andrew Herlich, Tae W Kim, Janine Limoncelli, Sheila Riazi, Erica L Sivak, John Capacchione, Darlene Mashman, Sachin Kheterpal, Fabian Kooij, Janet Wilczak, Roy Soto, Joshua Berris, Zachary Price, Steven Lins, Peter Coles, John M Harris, Kenneth C Cummings, Mitchell F Berman, Masakatsu Nanamori, Bruce T Adelman, Christopher Wedeven, John LaGorio, Patrick J McCormick, Simon Tom, Michael F Aziz, Traci Coffman, Terri A Ellis, Susan Molina, William Peterson, Sean C Mackey, Wilton A van Klei, Adit A Ginde, Daniel A Biggs, Mark D Neuman, Robert M Craft, Nathan L Pace, William C Paganelli, Marcel E Durieux, Bala J Nair, Jonathan P Wanderer, Scott A Miller, Daniel L Helsten, Zachary A Turnbull, Robert B Schonberger
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene...
January 2019: Anesthesiology
Samiah Al-Zaidy, A Simon Pickard, Kavitha Kotha, Lindsay N Alfano, Linda Lowes, Grace Paul, Kathleen Church, Kelly Lehman, Douglas M Sproule, Omar Dabbous, Benit Maru, Katherine Berry, W David Arnold, John T Kissel, Jerry R Mendell, Richard Shell
BACKGROUND: Spinal Muscular Atrophy type 1 (SMA1) is a rare genetic neuromuscular disease where 75% of SMA1 patients die/require permanent-ventilation by 13.6 months. This study assessed the health outcomes of SMA1 infants treated with AVXS-101 gene replacement therapy. METHODS: Twelve genetically confirmed SMA1 infants with homozygous deletions of the SMN1 gene and two SMN2 gene copies received a one-time intravenous proposed therapeutic dose of AVXS-101 in an open label study conducted between December 2014 and 2017...
December 12, 2018: Pediatric Pulmonology
David W Bearl, Debra A Dodd, Cary Thurm, Matt Hall, Jonathan H Soslow, Brian Feingold, Justin Godown
Right ventricular (RV) failure is a potentially fatal complication following heart transplantation (HTx). Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that is used to decrease pulmonary vascular resistance immediately post-HTx to reduce the risk of RV failure. The aim of this study was to describe utilization patterns, costs, and outcomes associated with post-transplant iNO use in children. All pediatric HTx recipients (2002-2016) were identified from a unique linked PHIS/SRTR dataset. Post-HTx iNO use was determined based on hospital billing data...
December 13, 2018: Pediatric Cardiology
Maiying Fan, Jieying Luo, Hui Wen, Fengling Ning, Min Gao, Xiaotong Han
OBJECTIVE: To evaluate the diaphragm movement index of mechanical ventilation weaning patients by ultrosonography, and to explore its value for weaning. METHODS: Forty patients undergoing invasive mechanical ventilation for at least 48 hours admitted to emergency intensive care unit (EICU) of Hunan Provincial People's Hospital from September 2017 to February 2018 were enrolled. Low level pressure support ventilation (PSV) was used for spontaneous breathing test (SBT), and bedside M-mode ultrasonography was used to assess the diaphragm movement index of the patient within 1 hour of SBT, including the excursion of the diaphragm, diaphragmatic-rapid shallow breathing index (D-RSBI)...
November 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Jing Zhao, Liqin Zhang, Dongquan Zhang, Jinhui Tian, Tianpeng He, Dong Gong, Yuan Yuan
OBJECTIVE: To survey the distribution pattern and subject domain knowledge of the literatures about ventilator-associated pneumonia (VAP). METHODS: Literatures about VAP published until December 2017 were identified in SinoMed database for statistics and analysis. The information of author, organization and province was extracted by BICOMS software for generating co-occurrence matrix, at the same time, the topic words were cluster analyzed by Gcluto software to generate topical visual surface maps and visualization matrices, and the current research hotspots were analyzed...
November 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Semeeh A Omoleke, Olatunji Alabi, Faisal Shuaib, Fiona Braka, Sisay G Tegegne, Gregory C Umeh, Johnson M Ticha, Anthony Onimisin, Peter Nsubuga, Usman Adamu, Kabiru Mohammed, Chima Onoka, Wondimagegnehu Alemu
BACKGROUND: Kebbi State remains the epicentre of the seasonal epidemic meningitis in northwestern Nigeria despite interventions. In this setting, no previous study has been conducted to understand the risk factors of the recurrent meningitis epidemics using qualitative approach. Consequently, this study intends to explore and better understand the environmental, economic and socio-cultural factors of recurrent seasonal epidemic meninigitis using a qualitative approach. METHODS: We conducted in-depth interview (40 IDIs) and focus group discussions (6 FGDs) in two local government areas (LGAs) in Kebbi State, Northwestern Nigeria to understand the environmental, economic and socio-cultural factors of recurrent meningitis outbreaks...
December 13, 2018: BMC Public Health
Ming-Hui Hung, Jin-Shing Chen, Ya-Jung Cheng
PURPOSE OF REVIEW: The current review focuses on precise anesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. RECENT FINDINGS: VATS has become an established and widely used minimally invasive approach with broad implementation on a variety of thoracic operations. In the current environment of enhanced recovery protocols and cost containment, minimally invasive VATS operations suggest adoption of individualized tailored, precise anesthesia...
December 11, 2018: Current Opinion in Anaesthesiology
Allen Brinker, Carmen Cheng, Vicky Chan
Importance: The US Food and Drug Administration (FDA) conducts ongoing public health safety surveillance for drug and therapeutic biologic products. Identifying cases of acute and subacute noninfectious pneumonia supports the public health mission of the FDA. Objective: To identify and analyze postmarketing cases of noninfectious pneumonia associated with ustekinumab use. Design, Setting, and Participants: This retrospective analysis of postmarketing (spontaneous) case reports reviewed the FDA Adverse Event Reporting System (FAERS) and the PubMed databases from September 25, 2009, through November 20, 2017...
December 12, 2018: JAMA Dermatology
Enrico Bulleri, Cristian Fusi, Stefano Bambi, Luigi Pisani
BACKGROUND: Mechanical ventilation is often employed as partial ventilatory support where both the patient and the ventilator work together. The ventilator settings should be adjusted to maintain a harmonious patient-ventilator interaction. However, this balance is often altered by many factors able to generate a patient ventilator asynchrony (PVA). The aims of this review were: to identify PVAs, their typologies and classifications; to describe how and to what extent their occurrence can affect the patients' outcomes; to investigate the levels of nursing skill in detecting PVAs...
December 7, 2018: Acta Bio-medica: Atenei Parmensis
Jun Kataoka, Akira Kuriyama, Yasuhiro Norisue, Shigeki Fujitani
BACKGROUND: Proportional modes (proportional assist ventilation, PAV, and neurally adjusted ventilatory assist, NAVA) could improve patient-ventilator interaction and consequently may be efficient as a weaning mode. The purpose of this systematic review is to examine whether proportional modes improved patient-ventilator interaction and whether they had an impact on the weaning success and length of mechanical ventilation, in comparison with PSV. METHODS: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through May 13, 2018...
December 10, 2018: Annals of Intensive Care
Sona Dave, Anand Nirgude, Pinakin Gujjar, Ritika Sharma
Background and Aims: Atrial fibrillation (AF) is a common postoperative complication after cardiac surgery due to multifactorial causes. The aim of this study was to evaluate the incidence and risk factors of postoperative atrial fibrillation (POAF) after cardiac surgery under cardiopulmonary bypass (CPB). Methods: A total of 150 adult patients undergoing coronary artery bypass graft (CABG) surgery and valvular surgeries were included. They were evaluated with respect to preoperative risk factors [age, use of β-blockers, left ventricular ejection fraction (LVEF), previous myocardial infarction (MI) and diabetes], intraoperative factors (CABG or valvular surgery, duration of CPB and aortic cross clamp time) and postoperative factors (duration of inotropic support and ventilatory support)...
November 2018: Indian Journal of Anaesthesia
Prabisha Amatya, Saruna Ghimire, Karen E Callahan, Binaya Kumar Baral, Krishna C Poudel
BACKGROUND: Menstrual exile, also known as Chhaupadi, is a tradition of "untouchability" in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi...
2018: PloS One
Tom Schepens, Martin Dres, Leo Heunks, Ewan C Goligher
PURPOSE OF REVIEW: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy...
December 5, 2018: Current Opinion in Critical Care
Rebecca Inglis, Emmanuel Ayebale, Marcus J Schultz
PURPOSE OF REVIEW: This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited. RECENT FINDINGS: Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs...
December 5, 2018: Current Opinion in Critical Care
Jeremy R Beitler
PURPOSE OF REVIEW: The most effective strategies for treating the patient with acute respiratory distress syndrome center on minimizing ventilation-induced lung injury (VILI). Yet, current standard-of-care does little to modify mechanical ventilation to patient-specific risk. This review focuses on evaluation of bedside respiratory mechanics, which when interpreted in patient-specific context, affords opportunity to individualize lung-protective ventilation in patients with acute respiratory distress syndrome...
December 5, 2018: Current Opinion in Critical Care
Allison Nackers, Mary Ehlenbach, Michelle M Kelly, Nicole Werner, Gemma Warner, Ryan J Coller
OBJECTIVES: Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. Our objective was to identify predictors of device-complicated ED visits and hospitalizations. METHODS: This single-center retrospective cohort study included patients referred to a Pediatric Complex Care Program between April 1, 2014, and April 30, 2016, assisted by at least 1 medical device...
December 10, 2018: Hospital Pediatrics
Norihisa Shigemura
When encountering early signs of primary graft dysfunction (PGD) at the end of the procedure following lung transplantation in operating rooms, aside from lung protective ventilation strategies, two key players as currently available therapeutic options include inhaled nitric oxide (iNO) and/or extracorporeal membrane oxygenation (ECMO) (1). While iNO plays a unique and relevant therapeutic role in the current clinical lung transplantation, its impact on posttransplant outcomes remains unclear mostly due to a large variety of iNO usage in clinical practice intra-, peri-, and post-operatively among the institutions (2-3)...
December 7, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Dannette A Mitchell, Maureen A Seckel
Acute respiratory distress syndrome continues to have high morbidity and mortality despite more than 50 years of research. The Berlin definition in 2012 established risk stratification based on degree of hypoxemia and the use of positive end-expiratory pressure. The use of prone positioning as a treatment modality has been studied for more than 40 years, with recent studies showing an improvement in oxygenation and decreased mortality. The studies also provide evidence to support the methodology and length of treatment time...
2018: AACN Advanced Critical Care
John J Gallagher
Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes...
2018: AACN Advanced Critical Care
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