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Mechanical ventilator

Chung-Sheng Shi, Tzu-Hsiung Huang, Chin-Kuo Lin, Jhy-Ming Li, Mei-Hsin Chen, Mei-Ling Tsai, Chih-Ching Chang
BACKGROUND: Mechanical ventilation is a life-saving procedure for patients with acute respiratory failure, although it may cause pulmonary vascular inflammation and leakage, leading to ventilator-induced lung injury (VILI). Ly6C+high monocytes are involved in the pathogenesis of VILI. In this study, we investigated whether pulmonary infiltrated Ly6C+high monocytes produce vascular endothelial growth factor (VEGF) and contribute to VILI. METHODS: A clinically relevant two-hit mouse model of VILI, with intravenous lipopolysaccharide (LPS, 20 ng/mouse) immediately before high tidal volume (HTV, 20 mL/kg) ventilation (LPS+HTV), was established...
2016: PloS One
Marlon E F Wilsterman, Pauline de Jager, Robert Blokpoel, Inez Frerichs, Sandra K Dijkstra, Marcel J I J Albers, Johannes G M Burgerhof, Dick G Markhorst, Martin C J Kneyber
BACKGROUND: Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V T toward non-dependent lung zones...
December 2016: Annals of Intensive Care
Adrien Contejean, Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Rebecca Hamidfar, Michael Darmon, Mercé Jourdain, Anne Renault, Benoît Schlemmer, Elie Azoulay
BACKGROUND: Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. METHODS: This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders...
December 2016: Annals of Intensive Care
Patrick Kellner, Mattia Müller, Tobias Piegeler, Philipp Eugster, Christa Booy, Martin Schläpfer, Beatrice Beck-Schimmer
BACKGROUND: Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required. In such patients, usually the first choice an intravenously administered drug. However, growing evidence suggests that volatile anesthetics such as sevoflurane are a valuable alternative. In this study, we evaluate pulmonary and systemic effects of long-term (24-hour) sedation with sevoflurane compared with propofol in an in vivo animal model of ALI. METHODS: Adult male Wistar rats were subjected to ALI by intratracheal lipopolysaccharide (LPS) application, mechanically ventilated and sedated for varying intervals up to 24 hours with either sevoflurane or propofol...
October 24, 2016: Anesthesia and Analgesia
Changsheng Zhang, Massimiliano Pirrone, David A E Imber, Jeanne B Ackman, Jacopo Fumagalli, Robert M Kacmarek, Lorenzo Berra
Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation...
October 24, 2016: A & A Case Reports
Si Guo, JingJing Xu, YanShuan Wei, JunHong Xu, Yi Li, Rui Xue
BACKGROUND: Klebsiella pneumoniae is a prominent nosocomial pathogen that accounts for up to 10 % of all hospital-acquired infections. It is a frequent cause of ventilator-associated pneumonia (VAP). The purpose of this study was to investigate the clinical characteristics of K. pneumoniae-associated VAP and the molecular characteristics of K. pneumoniae strains. METHODS: We retrospectively reviewed 70 mechanically ventilated patients with K. pneumoniae isolated...
October 26, 2016: BMC Infectious Diseases
L Battista
Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day...
September 2016: Review of Scientific Instruments
M Lima Serrano, M I González Méndez, F M Carrasco Cebollero, J S Lima Rodríguez
INTRODUCTION: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. METHODOLOGY: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors...
October 22, 2016: Medicina Intensiva
Michael P O'Leary, Jessica A Keeley, Arthur Yule, Caitlyn Suruki, David S Plurad, Ashkan Moazzez, Angela L Neville, Brant A Putnam, Dennis Y Kim
BACKGROUND: The objectives of this study were to examine the incidence and severity of early acute respiratory distress syndrome (ARDS) according to the Berlin Definition and to identify risk factors associated with the development of early post-traumatic ARDS. METHODS: A 2.5-year retrospective database of adult trauma patients who required mechanical ventilation for greater than 48 hours at a level 1 trauma center was analyzed for variables predictive of early (<48 hours after injury), mild, moderate, and severe ARDS and in-hospital mortality...
September 30, 2016: American Journal of Surgery
Kyle Mock, Jessica Keeley, Ashkan Moazzez, David S Plurad, Brant Putnam, Dennis Y Kim
The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit...
October 2016: American Surgeon
Amanda C Capino, Jamie L Miller, Peter N Johnson
The need for sedation and analgesia and treatment of iatrogenic drug withdrawal is common in critically ill children. First-line therapy typically includes opioid agonists. However, clonidine, a central alpha2 agonist, has been suggested as a treatment option for sedation and analgesia and iatrogenic drug withdrawal. Therefore, we conducted a literature search to identify articles evaluating the use of enteral and transdermal clonidine in critically ill infants and children for sedation and analgesia and treatment of iatrogenic drug withdrawal...
October 25, 2016: Pharmacotherapy
Maria Clara Alencar, Flavio F Arbex, Aline Souza, Adriana Mazzuco, Priscila A Sperandio, Alcides Rocha, Daniel M Hirai, Frederico Mancuso, Danilo C Berton, Audrey Borghi-Silva, Dirceu Almeida, Denis E OʼDonnel, J Alberto Neder
PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(Equation is included in full-text article.)E]-carbon dioxide output [(Equation is included in full-text article.)CO2] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% ± 17% predicted, ejection fraction = 35% ± 6%) were prospectively followed up during 412 ± 261 days for major cardiac events...
November 2016: Journal of Cardiopulmonary Rehabilitation and Prevention
Ryan M J Ivie, Emily A Vail, Hannah Wunsch, Monica P Goldklang, Robert Fowler, Vivek K Moitra
OBJECTIVE: We conducted this study to determine the generalizability of information gained from randomized controlled trials in critically ill patients by assessing the incidence of eligibility for each trial. DESIGN: Prospective, observational cohort study. We identified the 15 most highly cited randomized controlled trials in critical care medicine published between 1998 and 2008. We examined the inclusion and exclusion criteria for each randomized controlled trial and then assessed the eligibility of each patient admitted to a study ICU for each randomized controlled trial and calculated rates of potential trial eligibility in the cohort...
October 24, 2016: Critical Care Medicine
C Y Cheung, M L Pong, S F Au Yeung, K F Chau
INTRODUCTION: The number of actual donors per million population is the most commonly used metric to measure organ donation rates worldwide. It is deemed inadequate, however, because it does not take into account the potential donor pool. The aim of this study was to determine the true potential for solid organ donation from deceased brain-dead donors and the reasons for non-donation from potential donors in the Chinese community. METHODS: Medical records of all hospital deaths between 1 January and 31 December 2014 at a large regional hospital in Hong Kong were reviewed...
October 24, 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Fang Hua, Huixu Xie, Helen V Worthington, Susan Furness, Qi Zhang, Chunjie Li
BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs)...
October 25, 2016: Cochrane Database of Systematic Reviews
Pierre Bou-Khalil, Salah Zeineldine, Robert Chatburn, Chakib Ayyoub, Farouk Elkhatib, Imad Bou-Akl, Mohamad El-Khatib
Simple and accurate expressions describing the PaO2-FiO2 relationship in mechanically ventilated patients are lacking. The current study aims to validate a novel mathematical expression for accurate prediction of the fraction of inspired oxygen that will result in a targeted arterial oxygen tension in non-smoking and smoking patients receiving mechanical ventilation following open heart surgeries. One hundred PaO2-FiO2 data pairs were obtained from 25 non-smoking patients mechanically ventilated following open heart surgeries...
October 24, 2016: Journal of Clinical Monitoring and Computing
Katerina Vaporidi, Dimitris Babalis, Achilleas Chytas, Emmanuel Lilitsis, Eumorfia Kondili, Vasilis Amargianitakis, Ioanna Chouvarda, Nicos Maglaveras, Dimitris Georgopoulos
PURPOSE: The aim of this study was to investigate the role of ineffective efforts (IEs), specifically clusters of IEs, during mechanical ventilation on the outcome of critically ill patients. METHODS: In a prospective observational study, 24-h recordings were obtained in 110 patients on the 1st day of assisted ventilation (pressure support or proportional assist), using a prototype monitor validated to identify IEs. Patients remaining on assisted ventilation were studied again on the 3rd day (n = 37) and on the 6th day (n = 13)...
October 24, 2016: Intensive Care Medicine
P Deltell Colomer, N Albertos Mira-Marcelí, N Gallego Mellado, M E Kuan Argüello, M F Bordallo Vázquez, J Mira Navarro, J Gonzálvez Piñera
INTRODUCTION: In more than 50% of the necrotizing enterocolitis that underwent surgery will require an ileostomy. The optimal time to reestablish intestinal transit still is a controversial subject. Many times ileostomies cause medical issues that require early intestinal reconstruction. Our objective is to compare the early closure against late close, being the shift point 35 days according to other published research. MATERIAL AND METHODS: Retrospective study off all patients that in the last 10 years have had an episode of necrotizing enterocolitis which required an intestinal derivation like ileostomy...
January 15, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Jun Takei, Ran Takei, Satoshi Nozuma, Keiichi Nakahara, Osamu Watanabe, Hiroshi Takashima
A 40-year-old man presented with a series of generalized tonic-clonic seizures after febrile illness. He developed status epilepticus and required mechanical ventilation with anesthetics. Steroid pulse, intravenous immunoglobulin, and immunoadsorption therapy were administrated, and the status epilepticus improved; however, drug-resistant seizures remained. Despite the use of several antiepileptic drugs, seizures frequently occurred. Additional administration of potassium bromide resulted in significant suppression of seizures...
October 21, 2016: Rinshō Shinkeigaku, Clinical Neurology
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
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