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https://www.readbyqxmd.com/read/30343318/a-multicenter-randomized-controlled-trial-of-a-3-l-kg-min-versus-2-l-kg-min-high-flow-nasal-cannula-flow-rate-in-young-infants-with-severe-viral-bronchiolitis-tramontane-2
#1
Christophe Milési, Anne-Florence Pierre, Anna Deho, Robin Pouyau, Jean-Michel Liet, Camille Guillot, Anne-Sophie Guilbert, Jérôme Rambaud, Astrid Millet, Mickael Afanetti, Julie Guichoux, Mathieu Genuini, Thierry Mansir, Jean Bergounioux, Fabrice Michel, Marie-Odile Marcoux, Julien Baleine, Sabine Durand, Philippe Durand, Stéphane Dauger, Etienne Javouhey, Stéphane Leteurtre, Olivier Brissaud, Sylvain Renolleau, Aurélie Portefaix, Aymeric Douillard, Gilles Cambonie
PURPOSE: High-flow nasal cannula (HFNC) therapy is increasingly proposed as first-line respiratory support for infants with acute viral bronchiolitis (AVB). Most teams use 2 L/kg/min, but no study compared different flow rates in this setting. We hypothesized that 3 L/kg/min would be more efficient for the initial management of these patients. METHODS: A randomized controlled trial was performed in 16 pediatric intensive care units (PICUs) to compare these two flow rates in infants up to 6 months old with moderate to severe AVB and treated with HFNC...
October 21, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/30343313/small-volume-resuscitation-with-20-albumin-in-intensive-care-physiological-effects-the-swipe-randomised-clinical-trial
#2
Johan Mårtensson, Shailesh Bihari, Jonathan Bannard-Smith, Neil J Glassford, Patryck Lloyd-Donald, Luca Cioccari, Nora Luethi, Aiko Tanaka, Marco Crisman, Nicolas Rey de Castro, Marcus Ottochian, Agnes Huang, Maria Cronhjort, Andrew D Bersten, Shivesh Prakash, Michael Bailey, Glenn M Eastwood, Rinaldo Bellomo
PURPOSE: We set out to assess the resuscitation fluid requirements and physiological and clinical responses of intensive care unit (ICU) patients resuscitated with 20% albumin versus 4-5% albumin. METHODS: We performed a randomised controlled trial in 321 adult patients requiring fluid resuscitation within 48 h of admission to three ICUs in Australia and the UK. RESULTS: The cumulative volume of resuscitation fluid at 48 h (primary outcome) was lower in the 20% albumin group than in the 4-5% albumin group [median difference - 600 ml, 95% confidence interval (CI) - 800 to - 400; P < 0...
October 21, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/30341870/snake-bite-envenomation-in-a-tertiary-care-centre
#3
Rupal Padhiyar, Swati Chavan, Swapnil Dhampalwar, Trupti Trivedi, Nivedita Moulick
Background: In India, it is estimated that up to 20,000 people die annually from snake bites. The present study was carried to out to estimate the snake bite related epidemiology, predictors of severity, relationship between type of snake, clinical severity, complications, outcome and usage pattern of polyvalent anti snake venom (ASV) in a tertiary care center. Methods: All indoor patients admitted in our institute with definitive history of bite by a snake, with or without presence of fang marks, Evidence of cellulitis, acute onset of neurotoxicity or bleeding diathesis were serially recruited in the study...
March 2018: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/30340932/pda-tolerate-trial-an-exploratory-randomized-controlled-trial-of-treatment-of-moderate-to-large-patent-ductus-arteriosus-at-1-week-of-age
#4
Ronald I Clyman, Melissa Liebowitz, Joseph Kaempf, Omer Erdeve, Ali Bulbul, Stellan Håkansson, Johanna Lindqvist, Aijaz Farooqi, Anup Katheria, Jason Sauberan, Jaideep Singh, Kelly Nelson, Andrea Wickremasinghe, Lawrence Dong, Denise C Hassinger, Susan W Aucott, Madoka Hayashi, Anne Marie Heuchan, William A Carey, Matthew Derrick, Erika Fernandez, Meera Sankar, Tina Leone, Jorge Perez, Arturo Serize
OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial...
October 16, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/30338638/outcome-of-children-with-rhinovirus-detection-prior-to-allogeneic-hematopoietic-cell-transplant
#5
Clayton Mowrer, Brian R Lee, Rakesh Goyal, Rangaraj Selvarangan, Jennifer E Schuster
Rhinoviruses are commonly detected in symptomatic and asymptomatic children prior to HCT. Unlike pre-HCT detection of other respiratory viruses, it is not known whether RV detection, with or without clinical symptoms, is associated with worse outcomes in children post-HCT. In a retrospective study of children undergoing allogeneic HCT from January 2009 to February 2015, 91 children underwent allogeneic HCT, and 62 children had RPP testing within 30 days pre-HCT. Fifty-six (90%) children had either no pathogen (n = 34, 55%) or single RV detection (n = 22, 35%), which was the most common pathogen identified...
October 19, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/30338260/epidural-analgesia-with-surgical-stabilization-of-flail-chest-following-blunt-thoracic-trauma-in-patients-with-multiple-trauma
#6
Darko Aleksa Golic, Dragan Svraka, Nataša Keleman, Snjezana Petrovic
Flail chest, often defined as the fracture of three or more ribs in two or more places, represents the most severe form of rib fractures. Conservative treatment, consisting of respiratory assistance with endotracheal intubation and mechanical ventilation (internal pneumatic stabilization) and pain control, are the current treatments of choice in the majority of patients with multiple rib fractures. However, the use of mechanical ventilation may create complications. In selected patients, operative fixation of fractured ribs within 72 h post injury may lead to better outcomes...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/30338259/enhanced-recovery-in-surgical-intensive-care-a-review
#7
REVIEW
Gordana Jovanović, Dea Karaba Jakovljević, Mirka Lukić-Šarkanović
Patients are admitted to the surgical intensive care (SICU) unit after emergency and elective surgery. After elective surgery, for further support, or to manage coexisting comorbidities. The implementation of the ERAS (Enhanced recovery after surgery) protocols in surgery should decrease the need for ICU beds, but there will always be unpredicted complications after surgery. These will require individual management. What we can do for our surgical patients in ICU to further enhance their recovery? To promote early enhanced recovery in surgical intensive care-SICU, three areas need to be addressed, sedation, analgesia, and delirium...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/30336946/selecting-the-best-ventilator-hyperinflation-technique-based-on-physiologic-markers-a-randomized-controlled-crossover-study
#8
Beatriz S Ribeiro, Agnaldo J Lopes, Sara L S Menezes, Fernando S Guimarães
BACKGROUND: Ventilator hyperinflation (VHI) is effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated subjects; however, there are no recommendations for the best ventilator settings to perform the technique. OBJECTIVE: To compare six modes of VHI, concerning physiological markers of efficacy and safety criteria to support the selection of optimal settings. METHODS: Thirty mechanically ventilated patients underwent six modes of VHI in a randomized order...
October 15, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/30336847/remote-ischaemic-conditioning-for-prevention-of-acute-kidney-injury-after-valvular-heart-surgery-a-randomised-controlled-trial
#9
J W Song, W K Lee, S Lee, J K Shim, H J Kim, Y L Kwak
BACKGROUND: Repeated remote ischaemic conditioning (RIC) during weaning from cardiopulmonary bypass and in the early postoperative period may confer protection against acute kidney injury (AKI). We evaluated the effect of repeated RIC on the incidence of AKI in patients undergoing valvular heart surgery. METHODS: Patients were randomised into either the RIC (n=120) or control (n=124) group. A pneumatic tourniquet was placed on each patient's thigh. Upon removal of the aortic cross-clamp, three cycles of inflation for 5 min at 250 mm Hg (with 5 min intervals) were applied in the RIC group...
November 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/30334625/the-infant-with-severe-bronchiolitis-from-hfnc-to-cpap-and-mechanical-ventilation
#10
Andrea Wolfler, Gianfranco Raimondi, Cecilia Pagan de Paganis, Elena Zoia
INTRODUCTION: Bronchiolitis is one of the most frequent reasons for PICU admission in children less than 1 year of age. It causes a wide spectrum of clinical scenarios from mild to severe respiratory failure and supportive therapy range from HFNC to nonconventional ventilation and ECMO in the most severe forms. Aim of this article is to review the available ventilation mode in children with bronchiolitis and the scientific evidence. EVIDENCE ACQUISITION: The main medical databases were explored to search for clinical trials that address management strategies for respiratory support of infants with RSV infection...
October 18, 2018: Minerva Pediatrica
https://www.readbyqxmd.com/read/30328936/cardiorespiratory-and-metabolic-determinants-during-moderate-and-high-resistance-exercise-intensities-until-exhaustion-using-dynamic-leg-press-comparison-with-critical-load
#11
V M Arakelian, C L Goulart, R G Mendes, F C Caruso, V Baldissera, R Arena, A Borghi-Silva
The objective of this study was to assess cardiovascular, respiratory, and metabolic responses during a commonly used dynamic leg press resistance exercise until exhaustion (TEx) at different intensities and compare with critical load (CL). This was a prospective, cross-sectional, controlled, and crossover study. Twelve healthy young men (23±2.5 years old) participated. The subjects carried out three bouts of resistance exercise in different percentages of 1 repetition maximum (60, 75, and 90% 1RM) until TEx...
October 11, 2018: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/30327772/efficacy-of-manual-ventilation-techniques-during-cardiopulmonary-resuscitation-in-dogs
#12
Kate Hopper, Marlis L Rezende, Angela Borchers, Steven E Epstein
The efficacy of ventilation of dogs during cardiopulmonary resuscitation (CPR) with a tight fitting face mask or mouth-to-nose rescue breathing has not been evaluated. Twenty-four purpose bred research dogs: Dogs were randomized to be ventilated by cuffed orotracheal tube, tight fitting face mask, mouth-to-nose breathing or compressions only during CPR ( n = 6 in all groups). Orotracheal tube and face mask ventilation was performed on room air. Chest compressions were performed during the experimental procedure...
2018: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/30327770/prolonged-recovery-from-general-anesthesia-possibly-related-to-persistent-hypoxemia-in-a-draft-horse
#13
Julien Dupont, Didier Serteyn, Charlotte Sandersen
Horses are susceptible to developing large areas of pulmonary atelectasis during recumbency and anesthesia. The subsequent pulmonary shunt is responsible for significant impairment of oxygenation. Since ventilation perfusion mismatch persists into the post-operative period, hypoxemia remains an important concern in the recovery stall. This case report describes the diagnosis and supportive therapy of persistent hypoxemia in a 914 kg draft horse after isoflurane anesthesia. It highlights how challenging it can be to deal with hypoxemia after disconnection from the anesthesia machine and how life-threatening it can become if refractory to treatment...
2018: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/30326893/high-flow-nasal-cannula-in-adults-with-acute-respiratory-failure-and-after-extubation-a-systematic-review-and-meta-analysis
#14
REVIEW
Zhiheng Xu, Yimin Li, Jianmeng Zhou, Xi Li, Yongbo Huang, Xiaoqing Liu, Karen E A Burns, Nanshan Zhong, Haibo Zhang
BACKGROUND: High-flow nasal cannula (HFNC) can be used as an initial support strategy for patients with acute respiratory failure (ARF) and after extubation. However, no clear evidence exists to support or oppose HFNC use in clinical practice. We summarized the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on important outcomes including treatment failure and intubation/reintubation rates in adult patients with ARF and after extubation...
October 16, 2018: Respiratory Research
https://www.readbyqxmd.com/read/30326162/interventions-for-preventing-and-treating-cardiac-complications-in-duchenne-and-becker-muscular-dystrophy-and-x-linked-dilated-cardiomyopathy
#15
REVIEW
John P Bourke, Teofila Bueser, Rosaline Quinlivan
BACKGROUND: The dystrophinopathies include Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD), and X-linked dilated cardiomyopathy (XLDCM). In recent years, co-ordinated multidisciplinary management for these diseases has improved the quality of care, with early corticosteroid use prolonging independent ambulation, and the routine use of non-invasive ventilation signficantly increasing survival. The next target to improve outcomes is optimising treatments to delay the onset or slow the progression of cardiac involvement and so prolong survival further...
October 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30325851/use-of-chlorhexidine-to-prevent-ventilator-associated-pneumonia-in-a-long-term-care-setting-a-retrospective-medical-record-review
#16
Margaret K McCue, Glen A Palmer
BACKGROUND: The purpose of this study was to explore the use of the oral decontamination solution chlorhexidine (CHX) to reduce ventilator-associated pneumonia (VAP) in a long-term ventilator care setting over time. Most of the research in this area has been conducted in acute and intensive care settings. METHODS: This study was a retrospective medical record review conducted in a long-term care facility with a dedicated ventilator unit. Veterans records (N = 12) were accessed for this study...
October 15, 2018: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/30317708/-minimally-invasive-approach-vs-full-sternotomy-for-aortic-valve-and-ascending-aorta-replacement-results-from-our-center
#17
Tiago R Velho, Hugo Duarte Ferreira, Catarina Carvalheiro, André Sena, Nádia Juqueira, Nuno Guerra, Javier Gallego, Ângelo Nobre
BACKGROUND: Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS: Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/30317536/use-of-noninvasive-mechanical-ventilation-with-pressure-support-guaranteed-with-average-volume-in-de-novo-hypoxaemic-respiratory-failure-a-pilot-study
#18
Killen Harold Briones-Claudett, Antonio Esquinas Rodriguez, Mónica H Briones-Claudett, Miguel Puga-Tejada, Mariuxi Del Pilar Cabrera Baños, Christian Roberto Pazmiño Dueñas, Carlos Israel Torres Herrera, Michelle Grunauer
BACKGROUND: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novohypoxaemicrespiratory failure. METHODS: This is a prospective study that includes subjects with de novohypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO₂/FiO₂, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador...
October 14, 2018: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/30317049/an-open-loop-physiological-model-based-decision-support-system-can-reduce-pressure-support-while-acting-to-preserve-respiratory-muscle-function
#19
Savino Spadaro, Dan Stieper Karbing, Francesca Dalla Corte, Tommaso Mauri, Federico Moro, Antonio Gioia, Carlo Alberto Volta, Stephen Edward Rees
PURPOSE: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2 . MATERIALS: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured...
October 5, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30316913/too-many-patients%C3%A2-a-framework-to-guide-statewide-allocation-of-scarce-mechanical-ventilation-during-disasters
#20
REVIEW
Elizabeth Lee Daugherty Biddison, Ruth Faden, Howard S Gwon, Darren P Mareiniss, Alan C Regenberg, Monica Schoch-Spana, Jack Schwartz, Eric S Toner
The threat of a catastrophic public health emergency causing life threatening illness or injury on a massive scale has prompted extensive federal, state, and local preparedness efforts. Modeling studies suggest that an influenza pandemic similar to that of 1918 would require ICU and mechanical ventilation capacity that is significantly greater than what is available. Several groups have published recommendations for allocating life-support measures during a public health emergency. Because there are multiple ethically permissible approaches to allocating scarce life-sustaining resources and because the public will bear the consequences of these decisions, knowledge of public perspectives and moral points of reference on these issues is critical...
October 11, 2018: Chest
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