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Weaning ventilation

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https://www.readbyqxmd.com/read/29050461/comparison-of-clinical-utility-between-diaphragm-excursion-and-thickening-change-using-ultrasonography-to-predict-extubation-success
#1
Jung-Wan Yoo, Seung Jun Lee, Jong Deog Lee, Ho Cheol Kim
Background/Aims: Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubation success. Methods: This study included patients subjected to extubation trial in the medical or surgical intensive care unit of a university-affiliated hospital from May 2015 through February 2016...
October 19, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29038671/inspiratory-muscle-training-in-the-intensive-care-unit-a-new-perspective
#2
Rodrigo Marques Tonella, Ligia Dos Santos Roceto Ratti, Lilian Elisabete Bernardes Delazari, Carlos Fontes Junior, Paula Lima Da Silva, Aline Ribeiro Da Silva Herran, Daniela Cristina Dos Santos Faez, Ivete Alonso Bredda Saad, Luciana Castilho De Figueiredo, Rui Moreno, Desanka Dragosvac, Antonio Luis Eiras Falcao
BACKGROUND: Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP)...
November 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29038412/-effects-of-high-frequency-jet-ventilation-on-respiratory-failure-after-total-arch-replacement-due-to-acute-aortic-dissection-with-morbid-obesity-report-of-a-case
#3
Motoyuki Kumagai, Junichiro Nishizawa, Kazuhiro Takatoku, Takashi Ohba
A 55-year-old morbidly obese woman [body mass index (BMI) 51.2] developed acute type A aortic dissection, and she also presented with significant hypoxemia and hypercapnia. She underwent a successful emergency total arch replacement, but severe hypoxemia persisted and Pao2/Fio2 lowered to 71.9 mmHg. We therefore applied high frequency jet ventilation (HFJV), which soon improved the hypoxemia without hemodynamic compromise. HFJV was discontinued three days later, when her Pao2/Fio2 improved to 170.0 mmHg. Weaning from the respirator was initiated on postoperative day 13...
October 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29026843/melatonin-supplementation-may-improve-the-outcome-of-patients-with-hemorrhagic-stroke-in-the-intensive-care-unit
#4
Mehrnoush Dianatkhah, Atabak Najafi, Mohammad Sharifzadeh, Arezoo Ahmadi, Hamidreza Sharifnia, Mojtaba Mojtahedzadeh, Farhad Najmeddin, Azadeh Moghaddas
OBJECTIVE: Although mechanical ventilation is frequently a life-saving therapy, its use can result in unwanted side effects. It has been well documented that the choice of sedating agent may influence the duration of mechanical ventilation. Melatonin is a sedative and analgesic agent without any respiratory depressant effect which makes it an attractive adjuvant for sedation in the intubated patients. The aim of this study is to evaluate the effect of melatonin on the duration of mechanical ventilation in patients with hemorrhagic stroke...
July 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/29026677/bedside-ultrasound-in-the-diagnosis-and-treatment-of-children-with-respiratory-difficulty-following-cardiac-surgery
#5
REVIEW
Hussam Kanaan Hamadah, Mohamed Salim Kabbani
Many children frequently fail extubation or require a prolonged period of positive pressure ventilation support after cardiac surgery. Pediatric cardiac Intensive Care Unit (PCICU) ultrasound (US) stands as a simple, basic bedside tool that can be performed by trained intensivists for the diagnosis with immediate implication on therapeutic decisions in multiple scenarios that physicians may face in PCICU. Bedside US is widely available, convenient, and inexpensive. This educational article based mainly on our own experience is highlighting the role of US in detecting the most common causes of respiratory weaning difficulties and extubation failure in postoperative cardiac children through proposed illustration and algorithm...
2017: Journal of Clinical Imaging Science
https://www.readbyqxmd.com/read/29025380/early-tracheostomy-reduces-time-of-mechanical-ventilation-in-respiratory-high-risk-patients-after-liver-transplant
#6
Sebastian Cammann, Kai Timrott, Florian W R Vondran, Harald Schrem, Frank Lehner, Jürgen Klempnauer, Wolfgang Knitsch, Moritz Kleine
OBJECTIVES: Weaning from mechanical ventilation after liver transplant can be demanding. In selected cases, tracheostomy is helpful. The optimal timing for tracheostomy in ventilator-dependent liver transplant recipients is not well known. MATERIALS AND METHODS: We retrospectively analyzed data of 447 patients who had undergone liver transplant in our hospital. Thirty-nine patients who had high risk of prolonged mechanical ventilation according to the Respiratory Risk Score were identified from 95 patients who received tracheostomy after liver transplant...
October 12, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29018041/spontaneous-breathing-trials-and-conservative-sedation-practices-reduce-mechanical-ventilation-duration-in-subjects-with-ards
#7
Richard H Kallet, Hanjing Zhuo, Vivian Yip, Antonio Gomez, Michael S Lipnick
BACKGROUND: Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. METHODS: All ARDS survivors from 2002 to 2016 (N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016)...
October 10, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28994676/does-bilevel-positive-airway-pressure-improve-outcome-of-acute-respiratory-failure-after-open-heart-surgery
#8
Ahmed Said Elgebaly
BACKGROUND: Respiratory failure is of concern in the postoperative period after cardiac surgeries. Invasive ventilation (intermittent positive pressure ventilation [IPPV]) carries the risks and complications of intubation and mechanical ventilation (MV). AIMS: Noninvasive positive pressure ventilation (NIPPV) is an alternative method and as effective as IPPV in treating insufficiency of respiration with less complications and minimal effects on respiratory and hemodynamic parameters next to open-heart surgery...
October 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28990225/feasibility-of-diaphragm-pacing-in-patients-after-bilateral-lung-transplantation
#9
Dries Testelmans, Philippe Nafteux, Sophie Van Cromphaut, Bart Vrijsen, Robin Vos, Paul De Leyn, Herbert Decaluwé, Dirk Van Raemdonck, Geert M Verleden, Bertien Buyse
Recent animal studies and intra-operative studies in humans suggested that phrenic nerve stimulation could attenuate ventilator-induced diaphragm dysfunction. The purpose of the present study is to examine the safety and feasibility of diaphragm pacing during the weaning process after bilateral lung transplantation. Four patients, suffering from chronic pulmonary disease, were included, and diaphragm pacing was evaluated after lung transplantation. Implantation of electrodes at the end of the lung transplant procedure was possible in three of the four patients...
October 9, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28987578/housing-and-management-characteristics-of-calf-automated-feeding-systems-in-the-upper-midwest-united-states
#10
M W Jorgensen, K Janni, A Adams-Progar, H Chester-Jones, J A Salfer, M I Endres
Automated milk feeders are used by dairy producers to manage preweaned calves in group housing, but little is known about how these feeding systems are being used in the United States. To better understand how US dairy producers are operating these systems, this study investigated characteristics of barn design, environment, and management practices on 38 farms in the Upper Midwest United States via a questionnaire and on-farm measurements. Farms using automated feeders ranged in size from 7 to 300 calves on site...
October 4, 2017: Journal of Dairy Science
https://www.readbyqxmd.com/read/28982305/advanced-modes-of-mechanical-ventilation-introduction-for-the-critical-care-pharmacist
#11
Michael J Cawley
Mechanical ventilation continues to be an evolving modality in the critical care environment. Technological advances in microprocessor-controlled ventilation integrated with the complexity of new ventilator modes has provided the multidisciplinary team opportunities to further improve the care of the critically ill ventilator patients. As members of the critical care multidisciplinary team, pharmacists require a basic understanding of both conventional and advanced modes of mechanical ventilation in order to assist in optimizing medication use and ultimately patient health-care outcomes...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28978595/hiv-related-pneumocystis-jirovecii-pneumonia-managed-with-caspofungin-and-veno-venous-extracorporeal-membrane-oxygenation-rescue-therapy
#12
Nathaniel Lee, David Lawrence, Brijesh Patel, Stephane Ledot
Patients with pneumocystis pneumonia have a risk of progressing to acute respiratory failure necessitating admission to intensive care. The case described is of a patient with a newly diagnosed HIV infection presenting with pneumocystis pneumonia. Despite initiating the appropriate pharmacological treatment the patient's clinical condition deteriorated, and required both rescue pharmacological therapy with echinocandins as well as respiratory support with extracorporeal membrane oxygenation therapy. The patient recovered well on ventilator and circulatory support despite a long weaning process complicated by sequelae common to pneumocystis pneumonia...
October 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28977304/children-with-multiple-congenital-defects-what-are-the-limits-between-therapeutic-obstinacy-and-the-treatment-of-uncertain-benefit
#13
Patricia Souza Valle Cardoso Pastura, Marcelo Gerardin Poirot Land
OBJECTIVE: Therapeutic approach of children with multiple malformations poses many dilemmas, making it difficult to build a line between the treatment of uncertain benefit and therapeutic obstinacy. The aim of this paper was to highlight possible sources of uncertainty in the decision-making process, for this group of children. CASE DESCRIPTION: An 11-month-old boy, born with multiple birth defects and abandoned by his parents, has never been discharged home. He has complex congenital heart disease, main left bronchus stenosis and imperforate anus...
January 2017: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
https://www.readbyqxmd.com/read/28977266/potential-clinical-application-of-surface-electromyography-as-indicator-of-neuromuscular-recovery-during-weaning-tests-after-organophosphate-poisoning
#14
Maria Bernarda Salazar Sánchez, Alher Mauricio Hernández Valdivieso, Miguel Ángel Mañanas Villanueva, Andrés Felipe Zuluaga Salazar
This study aimed to explore the usefulness of measuring respiratory muscle activity in mechanically ventilated patients suffering from acute organophosphate poisoning, with a view towards providing complementary information to determine the best time to suspend ventilatory support. Surface electromyography in respiratory muscles (diaphragm, external intercostal and sternocleidomastoid muscles) was recorded in a young man affected by self-poisoning with an unknown amount of parathion to determine the muscle activity level during several weaning attempts from mechanical ventilation...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28977261/assessment-of-weaning-indexes-based-on-diaphragm-activity-in-mechanically-ventilated-subjects-after-cardiovascular-surgery-a-pilot-study
#15
Isabel Cristina Muñoz Ortega, Alher Mauricio Hernández Valdivieso, Joan Francesc Alonso Lopez, Miguel Ángel Mañanas Villanueva, Luis Horacio Atehortúa Lopez
OBJECTIVE: The aim of this pilot study was to evaluate the feasibility of surface electromyographic signal derived indexes for the prediction of weaning outcomes among mechanically ventilated subjects after cardiac surgery. METHODS: A sample of 10 postsurgical adult subjects who received cardiovascular surgery that did not meet the criteria for early extubation were included. Surface electromyographic signals from diaphragm and ventilatory variables were recorded during the weaning process, with the moment determined by the medical staff according to their expertise...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28974646/factors-associated-with-re-intubation-within-14-days-after-ventilator-liberation
#16
Chia-Chen Chu, Chin-Jung Liu, Suh-May Yen, Wen-Yu Chou, Pei-Tseng Kung, Yuh-Show Tsai, Wen-Chen Tsai
BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010...
October 3, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28973363/effect-of-lung-recruitment-and-titrated-positive-end-expiratory-pressure-peep-vs-low-peep-on-mortality-in-patients-with-acute-respiratory-distress-syndrome-a-randomized-clinical-trial
#17
RANDOMIZED CONTROLLED TRIAL
Alexandre Biasi Cavalcanti, Érica Aranha Suzumura, Ligia Nasi Laranjeira, Denise de Moraes Paisani, Lucas Petri Damiani, Helio Penna Guimarães, Edson Renato Romano, Marisa de Moraes Regenga, Luzia Noriko Takahashi Taniguchi, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Flavia Ribeiro Machado, Fredi Alexander Diaz-Quijano, Meton Soares de Alencar Filho, Israel Silva Maia, Eliana Bernardete Caser, Wilson de Oliveira Filho, Marcos de Carvalho Borges, Priscilla de Aquino Martins, Mirna Matsui, Gustavo Adolfo Ospina-Tascón, Thiago Simões Giancursi, Nelson Dario Giraldo-Ramirez, Silvia Regina Rios Vieira, Maria da Graça Pasquotto de Lima Assef, Mohd Shahnaz Hasan, Wojciech Szczeklik, Fernando Rios, Marcelo Britto Passos Amato, Otávio Berwanger, Carlos Roberto Ribeiro de Carvalho
Importance: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. Objective: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. Design, Setting, and Participants: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS...
October 10, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28971493/tocilizumab-for-severe-cytokine-release-syndrome-after-haploidentical-donor-transplantation-in-a-patient-with-refractory-epstein-barr-virus-positive-diffuse-large-b-cell-lymphoma
#18
Hiroshi Ureshino, Toshihiko Ando, Haruna Kizuka, Kana Kusaba, Haruhiko Sano, Atsujiro Nishioka, Hidekazu Itamura, Takero Shindo, Yasushi Kubota, Kensuke Kojima, Shinya Kimura
It has been well documented that patients may develop cytokine-release syndrome (CRS) following the administration of monoclonal antibodies, such as chimeric antigen receptor-modified T cell. Cytokine-release syndrome is a common complication in patients who have received haploidentical donor allogeneic haematopoietic cell transplantation (haplo-HCT). Although severe CRS after haplo-HCT is a potentially life-threatening toxicity, a standard treatment has not been established. Cytokine blockade with tocilizumab, an anti-IL-6 receptor antibody, has been effective for the treatment of patients with CRS after chimeric antigen receptor-modified T-cell treatment and has also improved CRS after haplo-HCT...
October 3, 2017: Hematological Oncology
https://www.readbyqxmd.com/read/28970694/daily-plasma-exchange-in-severe-guillain-barr%C3%A3-syndrome-helps-in-early-weaning-from-ventilator-a-lesson-from-a-case
#19
Arunpreet Kaur, Archana Bajpayee, Nitin Kumar Bajpai, Nikhil Kothari
Intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE) are well-known therapeutic modalities in Guillain-Barré syndrome (GBS). In developing countries like India, where plasma-derived products (IVIG) are not easily available, and affordable TPE is preferred. Here, we reported a case of severe GBS, who was treated with daily plasma exchange (PLEX) rather than recommended alternate day schedule. A 16-year-old male adolescent of severe GBS, i.e., on mechanical ventilator was treated with the plasmapheresis regimen consisted of removal of 1...
July 2017: Asian Journal of Transfusion Science
https://www.readbyqxmd.com/read/28969727/manual-trans-tracheal-high-frequency-positive-pressure-ventilation-for-left-main-bronchus-and-carinal-mass-surgical-resection-in-a-child
#20
Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid
Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A9-year boy, weighing 21 kg, was diagnosed as a case of IMTof left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy...
September 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
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