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emergency mechanical ventilation

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https://www.readbyqxmd.com/read/29041985/simplified-prognostic-model-for-critically-ill-patients-in-resource-limited-settings-in-south-asia
#1
Rashan Haniffa, Mavuto Mukaka, Sithum Bandara Munasinghe, Ambepitiyawaduge Pubudu De Silva, Kosala Saroj Amarasiri Jayasinghe, Abi Beane, Nicolette de Keizer, Arjen M Dondorp
BACKGROUND: Current critical care prognostic models are predominantly developed in high-income countries (HICs) and may not be feasible in intensive care units (ICUs) in lower- and middle-income countries (LMICs). Existing prognostic models cannot be applied without validation in LMICs as the different disease profiles, resource availability, and heterogeneity of the population may limit the transferability of such scores. A major shortcoming in using such models in LMICs is the unavailability of required measurements...
October 17, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29038045/effects-of-procalcitonin-guided-treatment-on-antibiotic-use-and-need-for-mechanical-ventilation-in-patients-with-acute-asthma-exacerbation-meta-analysis-of-randomized-controlled-trials
#2
Wanis H Ibrahim, Kamran Mushtaq, Tasleem Raza, Anand Kartha, Ahmed O Saleh, Rayaz A Malik
OBJECTIVE: The primary outcome was to determine whether serum procalcitonin-guided antibiotic therapy can reduce antibiotic exposure in patients with an acute exacerbation of asthma presenting to the primary care facility, emergency department or during hospital admission. The secondary outcome was the need for mechanical ventilation. METHODS: In this meta-analysis, we performed extensive literature search for randomized controlled clinical trials (published in English) that compared serum procalcitonin-guided antibiotic therapy versus antibiotic use according to physician's discretion for adult participants with mild, moderate or severe acute asthma exacerbations...
October 13, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29037430/total-spinal-block-after-local-anesthetic-administration-through-the-wrong-access-port-of-a-spinal-infusion-pump
#3
Sensar
We present a case reported on the SENSAR database. A patient with a spinal infusion pump was admitted for reservoir refill. On administration of 22ml of 0.75% bupivacaine the patient suffered a total spinal block with widespread loss strength and respiratory arrest. The patient required emergency orotracheal intubation, mechanical ventilation and admission to ICU, where extubation was achieved within two hours without incidences. At a later stage it was stated that the local anaesthetic had been administered via the access port for bolus or contrast administration instead of via the access to the reservoir...
October 13, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29036955/-comparision-of-risk-factors-and-pathogens-in-patients-with-early-and-late-onset-ventilator-associated-pneumonia-in-intensive-care-unit
#4
Y J Liang, Z L Li, L Wang, B Y Liu, R Y Ding, X C Ma
Objective: To compare risk factors and bacterial etiology in patients with early-onset versus late-onset ventilator-associated pneumonia (VAP) in intensive care unit (ICU). Methods: This prospective cohort study enrolled mechanically ventilated patients hospitalized for more than 48 hours in the first affiliated hospital, China Medical University from Jan 2012 to Jun 2016. Subjects were classified by ventilator status: early-onset VAP (< 5 d ventilation, E-VAP) or late-onset VAP (≥ 5 d ventilation, L-VAP)...
October 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29035976/the-impact-of-obesity-on-mortality-and-other-outcomes-in-patients-with-nonvariceal-upper-gastrointestinal-hemorrhage-in-the-united-states
#5
Marwan S Abougergi, Heather Peluso, Chebli Mrad, John R Saltzman
GOALS: To quantify in patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH) the relationship between obesity and mortality, disease severity, treatment modalities, and resource utilization. BACKGROUND: NVUGIH is the most common gastrointestinal emergency. STUDY: Adults with a principal diagnosis of NVUGIH were selected from the 2014 National Inpatient Sample. The primary outcome was in-hospital mortality. Secondary outcomes were hemorrhagic shock, prolonged mechanical ventilation (PMV), upper endoscopy [esophagogastroduodenoscopy (EGD)], radiologic treatment, surgery, length of hospital stay (LOS), and total hospitalization costs and charges...
October 13, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/29035402/respiratory-parameters-at-varied-altitudes-in-intermittent-mining-work
#6
Alessandro Bacaloni, Margarita Cecilia Zamora Saà, Federica Sinibaldi, Alessia Steffanina, Susanna Insogna
OBJECTIVES: Workers in the mining industry in altitude are subjected to several risk factors, e.g., airborne silica and low barometric pressure. The aim of this study has been to assess the risks for this work category, evaluating single risk factors as airborne silica, altitude and work shift, and relating them with cardiovascular and ventilatory parameters. MATERIAL AND METHODS: Healthy miners employed in a mining company, Chile, working at varied altitudes, and subjected to unusual work shifts, were evaluated...
October 13, 2017: International Journal of Occupational Medicine and Environmental Health
https://www.readbyqxmd.com/read/29034967/evaluation-of-a-method-for-isocapnic-hyperventilation-a-clinical-pilot-trial
#7
K Hallén, P Jildenstål, O Stenqvist, S-E Ricksten, S Lindgren
BACKGROUND: Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO2 . In a clinical trial on patients undergoing long-duration sevoflurane anaesthesia for major ear-nose-throat (ENT) surgery, we evaluated the utility of a technique for CO2 delivery (DCO2 ) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia. METHODS: Fifteen adult ASA 1-3 patients were included...
October 16, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29033344/a-prospective-study-of-ketamine-as-primary-therapy-for-prehospital-profound-agitation
#8
Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, Jeffrey D Ho
OBJECTIVE: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. METHODS: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29028076/intestinal-probiotics-in-relieving-clinical-symptoms-of-severe-hand-foot-and-mouth-disease-and-potential-mechanism-analysis
#9
F Zhu, Z Jiang, H-W Li
OBJECTIVE: In this prospective cohort study, the efficacy and action mechanism of an intestinal probiotic formulation, Golden Bifid, in severe hand, foot, and mouth disease (HFMD) were determined in 63 consecutively admitted patients successfully treated in the Pediatrics Emergency Department of our hospital. PATIENTS AND METHODS: All patients had a persistent fever; 43 patients had rashes on hands, feet, crissum, and hips; and 45 patients had neurological signs and symptoms...
September 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29023260/dysphagia-in-mechanically-ventilated-icu-patients-dynamics-a-prospective-observational-trial
#10
Joerg C Schefold, David Berger, Patrick Zürcher, Michael Lensch, Andrea Perren, Stephan M Jakob, Ilkka Parviainen, Jukka Takala
OBJECTIVES: Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN: Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS: ICU of a tertiary care academic center...
October 11, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29018832/pharyngeal-myiasis-caused-by-sheep-botfly-oestrus-ovis-diptera-oestridae-larva-tabriz-east-azarbaijan-province-iran-a-case-report
#11
Teimour Hazratian, Ali Tagizadeh, Mohammad Chaichi, Madineh Abbasi
Myiasis is caused by the larvae of flies infesting animal or human tissues and organs. This report aims to present a case of pharyngeal myiasis caused by the larvae of Oestrus ovis (Diptera: Oestridae). A 55-yr old drug addict living in the Shahindeje village of Western Azerbaijan Province, northwestern Iran was referred to the Emam Reza Hospital in Tabriz, having a medical history of Chronic Obstructive Pulmonary Disease (COPD) and hospitalized due to respiratory distress, 20 days ago. He was intubated with a mechanical ventilator (MV) because of his respiratory distress condition...
March 2017: Journal of Arthropod-borne Diseases
https://www.readbyqxmd.com/read/28994630/clinical-presentations-treatments-and-risk-factors-for-mortality-in-cats-with-tick-paralysis-caused-by-ixodes-holocyclus-2077-cases-2008-2016
#12
Ellie Leister, John Morton, Rick Atwell, Rob Webster
Objectives The objective of this study was to describe seasonality, demographics, presentations, treatments, complications and outcomes for cats with Ixodes holocyclus causing tick paralysis, and to identify risk factors for mortality. Methods This was a retrospective single cohort study with 2077 cases occurring between 2008 and 2016, and presenting to one of four emergency clinics in south-eastern Queensland, Australia. Case mortality at 5 days post-presentation could be determined for 1742 cases, and potential risk factors for mortality were assessed using random-effects logistic regression...
October 1, 2017: Journal of Feline Medicine and Surgery
https://www.readbyqxmd.com/read/28993038/capnography-in-the-emergency-department-a-review-of-uses-waveforms-and-limitations
#13
Brit Long, Alex Koyfman, Michael A Vivirito
BACKGROUND: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. OBJECTIVE OF THE REVIEW: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DISCUSSION: Capnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients...
October 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28991116/incidence-and-operative-factors-associated-with-discretional-postoperative-mechanical-ventilation-after-general-surgery
#14
Juliet J Ray, Meredith Degnan, Krishnamurti A Rao, Jonathan P Meizoso, Charles A Karcutskie, Danielle B Horn, Luis Rodriguez, Richard P Dutton, Carl I Schulman, Roman Dudaryk
BACKGROUND: Mechanical ventilation after general surgery is associated with worse outcomes, prolonged hospital stay, and increased health care cost. Postoperatively, patients admitted to the intensive care unit (ICU) may be categorized into 1 of 3 groups: extubated patients (EXT), patients with objective medical indications to remain ventilated (MED), and patients not meeting these criteria, called "discretional postoperative mechanical ventilation" (DPMV). The objectives of this study were to determine the incidence of DPMV in general surgery patients and identify the associated operative factors...
October 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28984091/repeated-alveolar-recruitment-maneuvers-with-and-without-positive-end-expiratory-pressure-during-bariatric-surgery-a-randomized-trial
#15
Ke Wei, Su Min, Jun Cao, Xuechao Hao, Jie Deng
BACKGROUND: Positive end-expiratory pressure (PEEP) is considered essential in protective ventilation, while may lead to hemodynamic impairment. In the present study, we investigated the effect of repeated alveolar recruitment maneuvers (ARMs) with or without additional PEEP on the arterial oxygenation of obese patients who were undergoing bariatric surgery. METHODS: Thirty-six obese adult patients with body mass index (BMI) >40 kg/m2 who were scheduled for laparoscopic sleeve gastrectomy were randomly allocated into three groups: (1) control group, no intraoperative ARMs; (2) ARM+ZEEP group, repeated ARMs every 30 minutes without extra PEEP; or (3) ARM+PEEP group, ARMs followed by 8 cm H2O of PEEP from the onset of pneumoperitoneum...
October 4, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28983829/mechanical-ventilation-during-resuscitation-how-manual-chest-compressions-affect-a-ventilator-s-function
#16
Tillmann Speer, Wolfgang Dersch, Björn Kleine, Christian Neuhaus, Clemens Kill
INTRODUCTION: Guidelines for resuscitation recommend positive-pressure ventilation with a fixed ventilation rate as provided by an automated transport ventilator during cardiopulmonary resuscitation (CPR) with a secured airway. We investigated the influence of manual chest compressions (CC) on the accuracy of ventilator presets and the quality of CC with intermittent positive-pressure ventilation (IPPV), bilevel ventilation (BiLevel), and the novel ventilation mode chest compression synchronized ventilation (CCSV) in a simulation model...
October 5, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28979537/tension-pneumomediastinum-a-literal-form-of-chest-tightness
#17
David J Clancy, Andrew S Lane, Peter W Flynn, Ian M Seppelt
Tension pneumomediastinum is a rare and life-threatening complication of mediastinal emphysema which can occur with mechanical ventilation. We present a case of tension mediastinum associated with mechanical ventilation in a patient with Acute Respiratory Distress Syndrome due to Pneumocystis jirovecii pneumonia. We discuss the mechanism and pathophysiology of tension pneumomediastinum, the potential association with Pneumocystis jirovecii pneumonia and recruitment manouvres, and its definitive emergency treatment...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28974998/successful-use-of-ketamine-for-central-neurogenic-hyperventilation-a-case-report
#18
G Morgan Jones, Adam L Wiss, Nitin Goyal, Jason J Chang
This report describes the use of ketamine in a patient with central neurogenic hyperventilation following intracerebral hemorrhage. A 41-year-old man was admitted with right thalamic intracerebral hemorrhage with intraventricular extension requiring emergent external ventricular drain placement. After aggressive management of his neurologic status and other associated complications, the patient subacutely developed an altered respiratory pattern characterized by shallow, rapid breaths. After the use of multiple sedative agents to control respiratory drive had failed, a single 2 mg/kg bolus dose of intravenous ketamine was administered...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28971864/risk-factors-for-colonization-or-infection-with-carbapenem-resistant-enterobacteriaceae-in-children-a-multicenter-study
#19
Kathleen Chiotos, Pranita D Tamma, Kelly B Flett, Matthew Naumann, Manjiree V Karandikar, Warren B Bilker, Theoklis Zaoutis, Jennifer H Han
Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly identified in children in the United States, but data on the epidemiology of CRE in this population are limited. The objectives of this study were to characterize risk factors for colonization or infection with CRE and describe the microbiologic characteristics of pediatric CRE isolates. We performed a multicenter matched case-control study from January 2011 to October 2015 at three tertiary care pediatric centers. Case patients were hospitalized children with CRE isolated from clinical cultures and were matched in a 2:1 ratio to control patients with carbapenem-susceptible Enterobacteriaceae (CSE)...
October 2, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28968051/gps-have-key-role-in-improving-outcomes-in-acute-asthma
#20
Helen L Grover, Bernard G Higgins
Asthma deaths in the UK remain among the highest in Europe. The 2014 National Review of Asthma Deaths looked at detailed data over a 12-month period assessing 195 patients who died from asthma and highlighted the avoidable factors in patient deaths. Although faults were found in secondary care, many of the problems related to poor management of patients in the community, both in terms of regular surveillance and assessment and treatment at the onset of attacks. Features which indicate a high risk of severe attacks include: previous admission to intensive care, particularly if requiring mechanical ventilation; previous admission with asthma especially in the past year or repeated emergency admissions; history of worsening asthma in January or February; use of three or more classes of asthma medication; heavy use of beta-2 agonists; anxiety traits; and marital stress...
November 2016: Practitioner
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