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Respiratory Mechanical Ventilation

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https://www.readbyqxmd.com/read/28734692/respiratory-arrest-at-the-onset-of-idiopathic-childhood-occipital-epilepsy-of-gastaut
#1
Keiko Funata, Tatsuhiko Shike, Toshiki Takenouchi, Yukio Yamashita, Takao Takahashi
Occipital lobe epilepsy of childhood includes two entities: Panayiotopoulos syndrome in pre-school children, and idiopathic childhood occipital epilepsy of Gastaut (ICOEG) in school-age children. The typical initial manifestation of the former is vomiting, and that of the latter is visual hallucinations. Ictal cardiopulmonary arrest at initial presentation has been reported for Panayiotopoulos syndrome, but not for ICOEG. We document a 7-year-old previously healthy girl who experienced an acute elemental visual hallucination of seeing insects, followed by a new-onset generalized seizure...
July 19, 2017: Brain & Development
https://www.readbyqxmd.com/read/28733094/isolated-non-cardiogenic-pulmonary-edema-a-rare-complication-of-mdma-toxicity
#2
Astrid Haaland, Elliot Warman, Illya Pushkar, Antonios Likourezos, Matt S Friedman
This is a case of a 19-year-old male who presented to the medical tent at an outdoor electronic dance music festival (EDMF) due to an altered mental state in the setting of acute 3,4-methylenedioxymethamphetamine (MDMA) intoxication. He was noted to be in severe respiratory distress, required endotracheal intubation in the field and subsequently developed Acute Respiratory Distress Syndrome (ARDS) without other acute organ dysfunction. He was hospitalized for 5days requiring endotracheal intubation and mechanical ventilation...
June 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28731651/fluid-balance-and-length-of-mechanical-ventilation-in-children-admitted-to-a-single-pediatric-intensive-care-unit
#3
Solange Vidal, Augusto Pérez, Pablo Eulmesekian
INTRODUCTION: Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU). METHODS: Retrospective cohort of patients in the PICU of Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012...
August 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28730574/mechanical-ventilation-guided-by-electrical-impedance-tomography-in-pediatric-acute-respiratory-distress-syndrome
#4
Jeffrey Dmytrowich, Tanya Holt, Karen Schmid, Gregory Hansen
Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS...
July 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28727576/severe-respiratory-failure-extracorporeal-membrane-oxygenation-and-intracranial-hemorrhage
#5
Christopher J A Lockie, Stuart A Gillon, Nicholas A Barrett, Daniel Taylor, Asif Mazumder, Kaggere Paramesh, Katie Rowland, Kathleen Daly, Luigi Camporota, Christopher I S Meadows, Guy W Glover, Nicholas Ioannou, Christopher J Langrish, Stephen Tricklebank, Andrew Retter, Duncan L A Wyncoll
OBJECTIVES: For patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage...
July 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28725223/gas-exchange-disturbances-regulate-alveolar-fluid-clearance-during-acute-lung-injury
#6
REVIEW
István Vadász, Jacob I Sznajder
Disruption of the alveolar-capillary barrier and accumulation of pulmonary edema, if not resolved, result in poor alveolar gas exchange leading to hypoxia and hypercapnia, which are hallmarks of acute lung injury and the acute respiratory distress syndrome (ARDS). Alveolar fluid clearance (AFC) is a major function of the alveolar epithelium and is mediated by the concerted action of apically-located Na(+) channels [epithelial Na(+) channel (ENaC)] and the basolateral Na,K-ATPase driving vectorial Na(+) transport...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28724778/eupnea-tachypnea-and-autoresuscitation-in-a-closed-loop-respiratory-control-model
#7
Casey O Diekman, Peter J Thomas, Christopher G Wilson
How sensory information influences the dynamics of rhythm generation varies across systems, and general principles for understanding this aspect of motor control are lacking. Determining the origin of respiratory rhythm generation is challenging because the mechanisms in a central circuit considered in isolation may be different than those in the intact organism. We analyze a closed-loop respiratory control model incorporating a central pattern generator (CPG), the Butera-Rinzel-Smith (BRS) model, together with lung mechanics, oxygen handling, and chemosensory components...
July 19, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28721821/current-perspectives-for-the-use-of-gonane-progesteronergic-drugs-in-the-treatment-of-central-hypoventilation-syndromes
#8
Camille Loiseau, Florence Cayetanot, Fanny Joubert, Anne-Sophie Perrin-Terrin, Philippe Cardot, Marie-Noëlle Fiamma, Alain Frugiere, Christian Straus, Laurence Bodineau
BACKGROUND: Central alveolar hypoventilation syndromes (CHS) encompass neurorespiratory diseases resulting from congenital or acquired neurological disorders. Hypercapnia, acidosis, and hypoxemia resulting from CHS negatively affect physiological functions and can be life-threatening. To date, the absence of pharmacological treatment implies that the patients must receive assisted ventilation throughout their lives. OBJECTIVE: To highlight the relevance of determining conditions in which using gonane synthetic progestins could be of potential clinical interest for the treatment of CHS...
July 19, 2017: Current Neuropharmacology
https://www.readbyqxmd.com/read/28721327/two-catastrophes-in-one-patient-drug-reaction-with-eosinophilia-and-systemic-symptoms-and-toxic-shock-syndrome
#9
Moayed Ibrahim, Diana L Nunley
A 70-year-old, immunocompromised patient presented to the emergency room (ER) five weeks after she was started on clopidogrel. She complained of skin eruption, mouth ulcers, fatigue, and myalgia over the past two weeks. Labs showed severe hyponatremia, acute kidney injury, rhabdomyolysis, hyperkalemia, and elevated liver enzymes. She was treated with steroids and discharged after her condition improved. However, a month later, she returned to the ER, complaining of nausea, vomiting, diarrhea, dizziness, chills, and shortness of breath over the past two days...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28720673/challenges-with-implementation-of-a-respiratory-therapist-driven-protocol-of-spontaneous-breathing-trials-in-the-pediatric-icu
#10
Conrad Krawiec, Dale Carl, Christy Stetter, Lan Kong, Gary D Ceneviva, Neal J Thomas
BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28720671/the-impact-of-ventilator-associated-events-in-critically-ill-subjects-with-prolonged-mechanical-ventilation
#11
Hidetsugu Kobayashi, Shigehiko Uchino, Masanori Takinami, Shoichi Uezono
BACKGROUND: The Centers for Disease Control and Prevention recently released a surveillance definition for respiratory complications in ventilated patients, ventilator-associated events (VAE), to replace ventilator-associated pneumonia (VAP). VAE consists of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible VAP. A duration of mechanical ventilation of at least 4 d is required to diagnose VAE. However, the observed duration of mechanical ventilation was < 4 d in many previous studies...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28720600/is-the-mechanism-of-re-expansion-pulmonary-oedema-in-a-heart-lung-interaction
#12
Candy Masego Mokotedi, Martin Balik
The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension...
July 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28719228/successful-use-of-noninvasive-ventilation-in-chronic-obstructive-pulmonary-disease-how-do-high-performing-hospitals-do-it
#13
Kimberly A Fisher, Kathleen M Mazor, Sarah Goff, Mihaela S Stefan, Penelope S Pekow, Lauren A Williams, Vida Rastegar, Michael B Rothberg, Nicholas S Hill, Peter K Lindenauer
RATIONALE: Noninvasive ventilation (NIV) is a cornerstone of treatment for patients with severe exacerbations of chronic obstructive pulmonary disease (COPD) where it has been shown to reduce the need for intubation, hospital length of stay, and mortality. Despite high quality evidence and strong recommendations in clinical guidelines, use of NIV varies widely across hospitals. OBJECTIVE: To identify approaches used by hospitals which have been successful in implementing NIV to treat patients with severe exacerbations of COPD...
July 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28717524/anasarca-fever-thrombocytopenia-organomegaly-and-multiorgan-failure-in-a-24-year-old-pregnant-woman
#14
Guillaume Morel, Joy Mootien, Philippe Guiot, Khaldoun Kuteifan
TAFRO syndrome is a distinct idiopathic multicentric Castleman disease characterized by the association of thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. We report the first case occurring in a Caucasian pregnant woman. At 34 weeks of gestation, our patient presented with all clinical and biological symptoms compatible with a TAFRO syndrome. Tough quick cesarean section was performed as symptoms got worse with onset of multiorgan failure requiring mechanical ventilation for acute respiratory distress, continuous renal replacement, and vasopressors...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28717088/long-term-effects-of-intravenous-cyclophosphamide-in-combination-with-mesna-provided-intravenously-and-via-bladder-perfusion-in-a-patient-with-severe-multifocal-motor-neuropathy
#15
Eri Iwasawa, Takuya Ohkubo, Tadashi Kanouchi, Takashi Kanda, Hidehiro Mizusawa, Takanori Yokota
A 25-year-old woman presenting with progressive muscle weakness in the distal extremities in the absence of sensory involvement for 2 years was diagnosed with multifocal motor neuropathy (MMN). Her disease was difficult to manage with various immunosuppressants, and the muscle weakness eventually progressed to involve the respiratory muscles, necessitating mechanical ventilation. Intravenous cyclophosphamide (CY) dramatically improved her symptoms, and she has since maintained her ambulatory status for 18 years with intermittent CY therapy...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28716451/multidrug-resistant-pseudomonas-aeruginosa-lower-respiratory-tract-infections-in-the-intensive-care-unit-prevalence-and-risk-factors
#16
Trang D Trinh, Evan J Zasowski, Kimberly C Claeys, Abdalhamid M Lagnf, Shravya Kidambi, Susan L Davis, Michael J Rybak
Intensive care unit (ICU) admission is a risk for multidrug-resistant (MDR) Pseudomonas aeruginosa, but factors specific to critically ill pneumonia patients are not fully characterized. Objective was to determine risk factors associated with MDR P. aeruginosa pneumonia among ICU patients. This was a retrospective case-control study of P. aeruginosa pneumonia in the ICU; cystic fibrosis and colonizers were excluded. Risk factors included comorbid conditions and prior healthcare exposure (anti-pseudomonal antibiotics, hospitalizations, nursing home, P...
June 19, 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/28711861/healthcare-infrastructure-capacity-to-respond-to-severe-acute-respiratory-infection-sari-and-sepsis-in-vietnam-a-low-middle-income-country
#17
Vu Quoc Dat, Nguyen Thanh Long, Kim Bao Giang, Pham Bich Diep, Ta Hoang Giang, Janet V Diaz
PURPOSE: This study investigated the availability of relevant structural and human resources needed for the clinical management of patients with severe acute respiratory infections and sepsis in critical care units in Vietnam. MATERIAL AND METHODS: A questionnaire survey was conducted by purposive sampling of 128 hospitals (36% of total hospitals in surveyed provinces), including 25 provincial and 103 district level hospitals, from 20 provinces in Vietnam. Data on availability of hospital characteristics, structural resources and health care workers was then analyzed...
July 10, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28710027/admission-lactate-predicts-poor-prognosis-independently-of-the-crb-curb-65-scores-in-community-acquired-pneumonia
#18
Frederik S Frenzen, Ulrike Kutschan, Nils Meiswinkel, Bernhard Schulte-Hubbert, Santiago Ewig, Martin Kolditz
OBJECTIVES: Community-acquired pneumonia (CAP) is associated with a high risk of respiratory failure or septic organ dysfunction. Lactate is an established early marker of prognosis and sepsis severity, but few data exist in patients with CAP. METHODS: We performed a retrospective cohort study of consecutive adult CAP patients without treatment restrictions or direct ICU admission. Lactate was measured as point of care test within the capillary admission blood gas analysis and its prognostic value was compared to the CRB/CURB-65 criteria by multivariate and ROC curve analysis...
July 11, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28709948/mechanical-ventilation-strategies
#19
REVIEW
Martin Keszler
Although only a small proportion of full term and late preterm infants require invasive respiratory support, they are not immune from ventilator-associated lung injury. The process of lung damage from mechanical ventilation is multifactorial and cannot be linked to any single variable. Atelectrauma and volutrauma have been identified as the most important and potentially preventable elements of lung injury. Respiratory support strategies for full term and late preterm infants have not been as thoroughly studied as those for preterm infants; consequently, a strong evidence base on which to make recommendations is lacking...
July 11, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28708679/transpulmonary-pressure-describes-lung-morphology-during-decremental-positive-end-expiratory-pressure-trials-in-obesity
#20
Jacopo Fumagalli, Lorenzo Berra, Changsheng Zhang, Massimiliano Pirrone, Roberta R De Santis Santiago, Susimeire Gomes, Federico Magni, Glaucia A B Dos Santos, Desmond Bennett, Vinicius Torsani, Daniel Fisher, Caio Morais, Marcelo B P Amato, Robert M Kacmarek
OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil)...
August 2017: Critical Care Medicine
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