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Permissive hypercapnia

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https://www.readbyqxmd.com/read/29144241/shifting-risks-and-conflicting-outcomes-ecmo-for-neonates-with-congenital-diaphragmatic-hernia-in-the-modern-era
#1
Joseph W Turek, Joseph R Nellis, Brenton G Sherwood, Meera Kotagal, Andrew L Mesher, Ravi R Thiagarajan, Sonali S Patel, Jeffrey R Avansino, Peter T Rycus, D Michael McMullan, Thomas V Brogan
OBJECTIVES: To update previously described trends for neonates with congenital diaphragmatic hernia (CDH) receiving ECMO with changes in recommendations for care, and to determine how recent advancements in respiratory care have affected this patient population. STUDY DESIGN: This study is a retrospective review of more than 2500 neonates with CDH who received ECMO listed in the Extracorporeal Life Support Organization (ELSO) registry. Cochran-Armitage and multivariate regression analyses were used to analyze changes in the patient population over time and in mortality-related risk factors...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29105540/mechanically-ventilating-the-severe-asthmatic
#2
Abdullah E Laher, Sean K Buchanan
The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29078756/effects-of-lung-protective-mechanical-ventilation-associated-with-permissive-respiratory-acidosis-on-regional-extra-pulmonary-blood-flow-in-experimental-ards
#3
Rudolf Hering, Stefan Kreyer, Christian Putensen
BACKGROUND: Lung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS...
October 27, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28828555/efficacy-of-co2-insufflation-during-thoracoscopic-esophagectomy-in-the-left-lateral-position
#4
Itasu Ninomiya, Koichi Okamoto, Sachio Fushida, Katsunobu Oyama, Jun Kinoshita, Hiroyuki Takamura, Hidehiro Tajima, Isamu Makino, Tomoharu Miyashita, Tetsuo Ohta
OBJECTIVE: Thoracoscopic esophagectomy (TE) is widely performed as a minimally invasive technique in the management of esophageal cancer. The aim of this study was to estimate the efficacy of intrathoracic carbon dioxide (CO2) insufflation during TE in the left lateral position. METHODS: From January 2010 to April 2016, 58 patients with esophageal cancer underwent TE without intrathoracic CO2 insufflation (Group N) and 37 patients with esophageal cancer underwent TE with intrathoracic CO2 insufflation (Group C)...
August 21, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28643877/cerebral-haemodynamic-response-to-somatosensory-stimulation-in-neonatal-lambs
#5
Shinji Nakamura, David W Walker, Flora Y Wong
KEY POINTS: Cerebral haemodynamic response to neural stimulation has been extensively studied in adults, but little is known about cerebral haemodynamic response in the fetal and neonatal brain. The present study describes the cerebral haemodynamic response measured by near infrared spectroscopy to somatosensory stimulation in newborn lambs, in comparison to recent findings in fetal sheep. The cerebral haemodynamic responses in the newborn lamb brain can involve an increase in oxyhaemoglobin (oxyHb), or a decrease of oxyHb suggestive of reduced perfusion and oxygenation...
September 1, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28632754/permissive-hypercapnia-for-severe-acute-respiratory-distress-syndrome-in-immunocompromised-children-a-single-center-experience
#6
Hans Fuchs, Nicola Rossmann, Manuel B Schmid, Manfred Hoenig, Ulrich Thome, Benjamin Mayer, Daniel Klotz, Helmut D Hummler
BACKGROUND: Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg. METHODS: Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort...
2017: PloS One
https://www.readbyqxmd.com/read/28561251/management-of-acute-respiratory-failure-in-pregnancy
#7
Stephen E Lapinsky
Respiratory failure affects up to 1 in 500 pregnancies, more commonly in the postpartum period. The causes of respiratory failure include several pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism, and peripartum cardiomyopathy. Pregnancy may also increase the risk or severity of other conditions, such as asthma, thromboembolism, viral pneumonitis, and gastric acid aspiration. Changes to maternal respiratory physiology and the presence of a fetus may affect the assessment and management of these patients...
April 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#8
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
June 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28130958/a-definition-of-gentle-ventilation-in-congenital-diaphragmatic-hernia-a-survey-of-neonatologists-and-pediatric-surgeons
#9
Christiana Farkouh-Karoleski, Tasnim Najaf, Julia Wynn, Gudrun Aspelund, Wendy K Chung, Charles J Stolar, George B Mychaliska, Brad W Warner, Amy J Wagner, Robert A Cusick, Foong-Yen Lim, David T Schindel, Douglas Potoka, Kenneth Azarow, C Michael Cotten, Anthony Hesketh, Samuel Soffer, Timothy Crombleholme, Howard Needelman
Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers' GV practices in the neonatal management of CDH...
January 28, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28121055/permissive-hypercapnia-in-extremely-low-birthweight-infants-how-far-should-we-go
#10
Hesham Abdel-Hady, Basma Shouman
No abstract text is available yet for this article.
June 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/27999775/protective-ventilation-improves-gas-exchange-reduces-incidence-of-atelectases-and-affects-metabolic-response-in-major-pancreatoduodenal-surgery
#11
Vsevolod V Kuzkov, Ludmila N Rodionova, Yana Y Ilyina, Aleksey A Ushakov, Maria M Sokolova, Eugenia V Fot, Boris L Duberman, Mikhail Y Kirov
BACKGROUND: Protective perioperative ventilation has been shown to improve outcomes and reduce the incidence of postoperative pulmonary complications. The goal of this study was to assess the effects of ventilation with low tidal volume (VT) either alone or in a combination with moderate permissive hypercapnia in major pancreatoduodenal interventions. MATERIALS AND METHODS: Sixty adult patients scheduled for elective pancreatoduodenal surgery with duration >2 h were enrolled into a prospective single-center study...
2016: Frontiers in Medicine
https://www.readbyqxmd.com/read/27881376/question-2-is-permissive-hypercapnia-beneficial-to-preterm-infants
#12
Murwan Omer, Eleanor J Molloy
No abstract text is available yet for this article.
January 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27876355/lung-protective-ventilatory-strategies-in-intubated-preterm-neonates-with-rds
#13
REVIEW
F Reiterer, B Schwaberger, T Freidl, G Schmölzer, G Pichler, B Urlesberger
This article provides a narrative review of lung-protective ventilatory strategies (LPVS) in intubated preterm infants with RDS. A description of strategies is followed by results on short-and long-term respiratory and neurodevelopmental outcomes. Strategies will include patient-triggered or synchronized ventilation, volume targeted ventilation, the technique of intubation, surfactant administration and rapid extubation to NCPAP (INSURE), the open lung concept, strategies of high-frequency ventilation, and permissive hypercapnia...
June 2017: Paediatric Respiratory Reviews
https://www.readbyqxmd.com/read/27758969/extracorporeal-membrane-oxygenation-support-for-life-threatening-acute-severe-status-asthmaticus
#14
Gabriella Di Lascio, Edvin Prifti, Elmi Messai, Adriano Peris, Guy Harmelin, Roland Xhaxho, Albana Fico, Guido Sani, Massimo Bonacchi
INTRODUCTION: Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure due to asthma that is unresponsive to standard therapeutic measures. We used extracorporeal membrane oxygenation (ECMO) to treat patients with near-fatal status asthamticus who did not respond to aggressive medical therapies and mechanical ventilation under controlled permissive hypercapnia. MATERIALS AND METHODS: Between January 2011 and October 2015, we treated 16 adult patients with status asthmaticus (8 women, 8 men, mean age: 50...
March 2017: Perfusion
https://www.readbyqxmd.com/read/27635737/mechanical-ventilation-in-neurocritical-care-patients-a-systematic-literature-review
#15
REVIEW
Beatrice Borsellino, Marcus J Schultz, Marcelo Gama de Abreu, Chiara Robba, Federico Bilotta
INTRODUCTION: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers...
October 2016: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/27512467/acute-respiratory-failure-in-pregnancy
#16
REVIEW
Stephen E Lapinsky
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient...
September 2015: Obstetric Medicine
https://www.readbyqxmd.com/read/27386763/intensive-care-and-pregnancy-epidemiology-and-general-principles-of-management-of-obstetrics-icu-patients-during-pregnancy
#17
REVIEW
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27386250/effects-of-permissive-hypercapnia-on-pulmonary-and-neurodevelopmental-sequelae-in-extremely-low-birth-weight-infants-a-meta-analysis
#18
REVIEW
Jianglin Ma, Hui Ye
OBJECTIVES: To perform a systematic review and meta-analysis of the efficacy and safety of permissive hypercapnia in extremely low birth weight infants. METHODS: A systematic search of MEDLINE, EMBASE, the Cochrane Database of randomized trials. Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted. RESULTS: Four studies that enrolled a total of 693 participants were selected...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27216321/a-47-year-old-woman-with-hypercapnia-and-altered-mental-status
#19
Brian Bellucci, Renli Qiao
Permissive hypercapnia is a commonly used ventilator strategy in attempt to improve refractory hypoxemia. The rationale of such practice is based on the assumption that hypercapnia, although associated with altered mental status, is well tolerated. Here we report a case in which the altered mental status caused by hypercapnia is underlined by a life-threatening mechanism. The case indicates the severity of hypercapnia may have been mistakenly overlooked in the past. This article is protected by copyright. All rights reserved...
May 23, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/26955891/lung-ventilation-strategies-for-acute-respiratory-distress-syndrome-a-systematic-review-and-network-meta-analysis
#20
REVIEW
Changsong Wang, Xiaoyang Wang, Chunjie Chi, Libo Guo, Lei Guo, Nana Zhao, Weiwei Wang, Xin Pi, Bo Sun, Ailing Lian, Jinghui Shi, Enyou Li
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0...
March 9, 2016: Scientific Reports
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