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Mechanical ventilator

Jaime Retamal, Daniel Hurtado, Nicolás Villarroel, Alejandro Bruhn, Guillermo Bugedo, Marcelo Britto Passos Amato, Eduardo Leite Vieira Costa, Göran Hedenstierna, Anders Larsson, João Batista Borges
OBJECTIVE: It is known that ventilator-induced lung injury causes increased pulmonary inflammation. It has been suggested that one of the underlying mechanisms may be strain. The aim of this study was to investigate whether lung regional strain correlates with regional inflammation in a porcine model of acute respiratory distress syndrome. DESIGN: Retrospective analysis of CT images and positron emission tomography images using [F]fluoro-2-deoxy-D-glucose. SETTING: University animal research laboratory...
March 9, 2018: Critical Care Medicine
Neha N Passi, Jim Buckley
Patients with tuberculosis admitted to the intensive care unit represent a small (1-3%) yet significant subset of the global tuberculosis burden. This article reviews current evidence supporting the diagnosis and management of patients with tuberculosis admitted to an intensive care unit from a combination of cohort studies and national and international tuberculosis guidelines. This review considers admission, diagnosis, mechanical ventilation, infection control, treatment and prognosis of patients with tuberculosis admitted to an intensive care unit...
March 2, 2018: British Journal of Hospital Medicine
Talita M Silva, Laiali J Chaar, Reinaldo C Silva, Ana C Takakura, Niels O Câmara, Vagner R Antunes, Thiago S Moreira
NEW FINDINGS: What is the central question of this study? Microglia are presumably the source of inflammatory mediators, which contribute to hypoxia-induced neuroinflammation. However, the relationship between microglia activity during hypoxia and inflammatory responses in specific autonomic brain regions is not well understood. Therefore, we hypothesize that acute hypoxia (AH) initiates an immune response in the central nervous system elicited by an increased expression of inflammatory mediators in specific brain areas related to autonomic control...
March 12, 2018: Experimental Physiology
Christie L Glau, Thomas W Conlon, Adam S Himebauch, Donald L Boyer, Samuel A Rosenblatt, Akira Nishisaki
High-frequency oscillatory ventilation (HFOV) is a mode of mechanical ventilation used in severe pediatric respiratory failure. Thoracic ultrasound (US) is a powerful tool for diagnosing acute pathophysiologic conditions during spontaneous respiration and conventional noninvasive and invasive mechanical ventilation. High-frequency oscillatory ventilation differs from conventional modes of ventilation in that it does not primarily use bulk flow delivery for gas exchange but, rather, a number of alternative mechanisms as the result of pressure variations oscillating around a constant distending pressure...
March 12, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Sibel Kara, Nazan Sen, Ebru Kursun, Hakan Yabanoğlu, Sedat Yıldırım, Şule Akçay, Mehmet Haberal
OBJECTIVES: Pulmonary infections are a significant cause of morbidity and mortality in solid-organ transplant recipients despite enhanced facilities for perioperative care. The aim of this study was to evaluate the demographic characteristics, clinical course, and outcomes of renal transplant recipients with pneumonia. MATERIALS AND METHODS: The medical records of all renal transplant recipients from January 2010 to December 2014 were retrospectively reviewed, and patients diagnosed with pneumonia according to Centers for Disease Control and Prevention criteria were evaluated...
March 2018: Experimental and Clinical Transplantation
I Cundrle, P Suk, V Sramek, Z Lacinova, M Haluzik
Physiologically, leptin concentration is controlled by circadian rhythm. However, in critically ill patients, circadian rhythm is disrupted. Thus we hypothesized that circadian leptin concentration changes are not preserved in critically ill patients. Ten consecutive critically ill heart failure patients with the clinical indication for mechanical ventilation and sedation were included into our study. Plasma leptin concentration was measured every 4 h during the first day (0-24 h) and during the third day (48-72 h) after admission...
March 12, 2018: Physiological Research
Ajith Ananthakrishna Pillai, Chandramohan Ramasamy, Saranya Gousy V, Harichandrakumar Kottyath
BACKGROUND: Mitral stenosis may present with decompensated heart failure during pregnancy. Many patients do have advanced sub valve disease and present late with decompensated state. The outcomes of balloon mitral valvuloplasty (BMV) in such advanced sub valve disease with severe heart failure in pregnancy has not been specifically studied till now. METHODS: A descriptive study looking at the immediate and long-term outcomes of pregnant patients with MS who presented with severe heart failure and sub valve disease who had undergone BMV...
March 11, 2018: Journal of Interventional Cardiology
Qing Zhang, Xiaoting Wang, Longxiang Su, Hongmin Zhang, Wenzhao Chai, Yangong Chao, Wei He, Dawei Liu
PURPOSE: To explore the relationship between the shape of the inferior vena cava (IVC) lumen and central venous pressure (CVP). METHODS: In 60 patients undergoing mechanical ventilation and CVP monitoring in the Intensive Care Unit of Peking Union Medical College Hospital from July to October 2016, we measured with B-mode ultrasonography the transverse maximum (MXD) and minimum diameter (MID) of the IVC at end expiration, and calculated the diameter ratio (DR) as MXD/MID...
March 12, 2018: Journal of Clinical Ultrasound: JCU
Tanmay Pal, Pranab Kumar Dutta, Srinivasu Maka
Periodic Breathing (PB) is a diseased condition of the cardiorespiratory system, and mathematically it is modelled as an oscillation. Modeling approaches replicate periodic oscillation in the minute ventilation due to a higher than normal gain of the feedback signals from the chemoreceptors coupled with a longer than normal latency in feedback, and do not consider the waxing-waning pattern of the oronasal airflow. In this work, a noted regulation model is extended by integrating respiratory mechanics and respiratory Central Pattern Generator (rCPG) model, using modulation-demodulation1 hypothesis...
March 8, 2018: Respiratory Physiology & Neurobiology
Mary M Mitchell, Eric D Hansen, Tuo-Yen Tseng, Meng Shen, Cynda Rushton, Tom Smith, Nancy Hutton, Jennifer Wolfe, Lee Bone, Jeanne Keruly, Lawrence Wissow, Amy R Knowlton
CONTEXT & OBJECTIVE: Advance care planning (ACP) rates remain low, especially among people who are HIV positive, disadvantaged, and African American. While ACP can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. METHODS: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, MD, who had histories of illicit drug use...
March 8, 2018: Journal of Pain and Symptom Management
Tymoteusz Żera, Jacek Przybylski, Tomasz Grygorowicz, Kaja Kasarełło, Martyna Podobińska, Dagmara Mirowska-Guzel, Agnieszka Cudnoch-Jędrzejewska
Vasopressin (AVP) maintains body homeostasis by regulating water balance, cardiovascular system and stress response. AVP inhibits breathing through central vasopressin 1a receptors (V1aRs). Chemoreceptors within carotid bodies (CBs) detect chemical and hormonal signals in the bloodstream and provide sensory input to respiratory and cardiovascular centers of the brainstem. In the study we investigated if CBs contain V1aRs and how the receptors are involved in the regulation of ventilation by AVP. We first immunostained CBs for V1aRs and tyrosine hydroxylase, a marker of chemoreceptor type I (glomus) cells...
March 7, 2018: Peptides
Samuel Wittekind, Wayne Mays, Yvette Gerdes, Sandra Knecht, John Hambrook, William Border, John Lynn Jefferies
Patients with a Fontan circulation have impaired exercise capacity. Cardiac rehabilitation (CR) has shown promise in enhancing peak exercise parameters in this population, but an improvement in submaximal exercise has not been consistently demonstrated. We assessed the hypothesis that participation in CR will be associated with more efficient oxygen extraction and ventilation during submaximal exercise. In this prospective study, pediatric Fontans completed two 60 min CR sessions per week for 12 weeks. Cardiopulmonary exercise testing and stress echocardiography were performed at baseline and last CR session, and then compared with a paired sample t test...
March 9, 2018: Pediatric Cardiology
Keamogetswe Molokoane-Mokgoro, Lara Nicole Goldstein, Mike Wells
INTRODUCTION: Ultrasound assessment of the inferior vena cava (IVC) has gained favour in aiding fluid management decisions for controlled, mechanically ventilated patients as well as in non-mechanically ventilated, spontaneously breathing patients. Its utility in spontaneously breathing patients during positive pressure non-invasive ventilation has not yet been determined. The use of the axillary vein, as an alternative option to the IVC due to its ease of accessibility and independence from intra-abdominal pressure, has also not been evaluated...
March 9, 2018: Emergency Medicine Journal: EMJ
Arjun Gupta, Avash Das, Raseen Tariq, Nizar Bhulani, Naveen Premnath, Dipesh Solanky, Ryan D Frank, David Johnson, Sahil Khanna, Muhammad S Beg
Background: There has been an overall decline in intensive care unit mortality over the past 2 decades, including in patients undergoing intubation and mechanical ventilation (MV). Whether this decline extends to patients with metastatic cancer remains unknown. We analyzed the outcomes of patients with metastatic cancer undergoing intubation/MV using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Methods: Diagnosis and procedure codes were used to identify patients with metastatic cancer who underwent intubation/MV...
March 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Alan Leviton, Stephen R Hooper, Scott J Hunter, Megan N Scott, Elizabeth N Allred, Robert M Joseph, T Michael O'Shea, Karl Kuban
BACKGROUND: The incidence of attention deficit hyperactivity disorder is higher among children born very preterm than among children who are mature at birth. METHODS: We studied 583 ten-year-old children who were born before 28 weeks of gestation whose IQ was above 84 and had a parent-completed Child Symptom Inventory-4, which allowed classification of the child as having or not having symptoms of attention deficit hyperactivity disorder. For 422 children, we also had a teacher report, and for 583 children, we also had a parent report of whether or not a physician made an attention deficit hyperactivity disorder diagnosis...
December 21, 2017: Pediatric Neurology
Peter D Sottile, David Albers, Marc M Moss
BACKGROUND: Neuromuscular blockade (NMB) is a therapy for acute respiratory distress syndrome (ARDS). However, the mechanism by which NMB may improve outcome for ARDS patients remains unclear. We sought to determine whether NMB attenuates biomarkers of epithelial and endothelial lung injury and systemic inflammation in ARDS patients, and whether the association is dependent on tidal volume size and the initial degree of hypoxemia. METHODS: We performed a secondary analysis of patients enrolled in the ARDS network low tidal volume ventilation (ARMA) study...
March 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Verónica Becerra, Daniel Buamscha, Corina Ponce, Carlos Cambaceres, Alejandro Noman, María E Galván, Miriam Lenz
INTRODUCTION: Sedation of patients in pediatric ICU extubated and in weaning of mechanic ventilation is diffcult under regular sedation, because of the tolerance and/or abstinence generated by its sustained use. The objective of this study is to describe the use of Levomepromazine as sedative coadjuvant in these patients. POPULATION AND METHODS: Observational and longitudinal study in intensive care from Juan P. Garrahan Pediatric Hospital. Patients older than 2 years were included, extubated and in weaning of mechanic ventilation with requirements of additional sedation...
November 2017: Vertex: Revista Argentina de Psiquiatriá
S Hoang, A Georget, J Asselineau, A-G Venier, C Leroyer, A M Rogues, R Thiébaut
OBJECTIVE: To assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection. STUDY DESIGN AND SETTING: A French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples...
2018: PloS One
Yang Liu, Weishuai Bian, Ping Liu, Xuefeng Zang, Xuyun Gu, Wei Chen
OBJECTIVES: Dexmedetomidine has been shown to decrease cardiac complications in adults undergoing cardiac surgery. Results from clinical trials of dexmedetomidine on outcomes following paediatric cardiac surgery are controversial. METHODS: We searched EMBASE, PubMed and Cochrane CENTRAL databases for randomized controlled trials comparing the effect of dexmedetomidine versus placebo or other anaesthetic drugs in paediatric patients undergoing cardiac surgery. The primary outcome was the duration of mechanical ventilation...
March 7, 2018: Interactive Cardiovascular and Thoracic Surgery
Abirami Kumaresan, Robert Gerber, Ariel Mueller, Stephen H Loring, Daniel Talmor
BACKGROUND: The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. METHODS: We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade...
March 9, 2018: Anesthesiology
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