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emergency mechanical ventilation

Dr Gian Domenico Giusti, Dr Cecilia Rogari, Dr Alessio Gili, Dr Fulvio Nisi
BACKGROUND: Endotracheal intubation (ETI) for mechanical ventilation has a central role in the Intensive Care Unit (ICU). ETI is one of the main risk factors for the development of ventilator-associated pneumonia (VAP) as its presence reduces the natural defences of the upper airway and allows the micro-suction of secretions in the airways. In order to minimise such complications, it is fundamental to maintain a suitable pressure inside the tube cuff. AIM AND SCOPE: The main objective of the present study is to evaluate the effectiveness and reliability of palpation method, performed with the operators fingers, for detecting the tube cuff pressure...
October 18, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Wei-Cheng Chen, Kuo-Yang Huang, Chih-Wei Yao, Cing-Feng Wu, Shinn-Jye Liang, Chia-Hsiang Li, Chih-Yeh Tu, Hung-Jen Chen
BACKGROUND: Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED. METHOD: This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014...
October 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
P Michel, D Wähnert, M Freistühler, M G Laukoetter, S Rehberg, M J Raschke, P Garcia
BACKGROUND: Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation...
October 19, 2016: Journal of Medical Case Reports
Gennaro D'Amato, Carolina Vitale, Antonio Molino, Anna Stanziola, Alessandro Sanduzzi, Alessandro Vatrella, Mauro Mormile, Maurizia Lanza, Giovanna Calabrese, Leonardo Antonicelli, Maria D'Amato
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma...
2016: Multidisciplinary Respiratory Medicine
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
S Gibiino, A Trappoli, B Balzarro, A R Atti, D De Ronchi
A 71-year-old man developed coma with severe respiratory failure, hypotension, and tachycardia induced by the intentional ingestion of quetiapine fumarate extended release (XR) 20 g. At the time, he had been treated for bipolar depression with venlafaxine 75 mg/day, lamotrigine 100 mg/day, pregabalin 75 mg/day, and quetiapine XR 400 mg/day for approximately 1 year. Comorbidities were hypertension treated with metoprolol, diabetes mellitus type 2 treated with metformin, and benign prostatic hyperplasia treated with silodosin...
December 2015: Drug Saf Case Rep
Chih-Chia Hsieh, Ching-Chi Lee, Hsiang-Chin Hsu, Hsin-I Shih, Chien-Hsin Lu, Chih-Hao Lin
BACKGROUND/PURPOSE: To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). METHODS: This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records...
September 30, 2016: American Journal of Emergency Medicine
Kevin Johnson, Maria Linnaus, David Notrica
BACKGROUND: Airway foreign bodies (FB) are a common medical emergency within the pediatric population. While deaths are not uncommon, the in-hospital mortality rates and correlation with anatomic location of the airway foreign body have not been previously reported. METHODS: The KID database was reviewed for 2003, 2006, 2009, and 2012 for pediatric patients with a discharge diagnosis of airway foreign body using ICD-9 codes (933.1, 934.x). RESULTS: 11,793 patients, ages 0-17, were found to have an airway FB...
October 13, 2016: Pediatric Surgery International
Laveena Munshi, Hayley B Gershengorn, Eddy Fan, Hannah Wunsch, Niall D Ferguson, Therese A Stukel, Gordon D Rubenfeld
RATIONALE: Adoption and de-adoption of adjuvant strategies to mechanical ventilation for acute respiratory failure (ARF), and factors associated with their selection, have not been extensively evaluated. OBJECTIVES: To evaluate change in use of adjuvants to mechanical ventilation for ARF (2008-2013), the impact of landmark publications on adoption and de-adoption, and factors associated with use. METHODS: Changes in use of four adjuvants for ARF from 2008-2013, the impact of landmark publications on use, and factors associated with use were evaluated using the Premier Database...
October 13, 2016: Annals of the American Thoracic Society
Susana Garcia-Gutierrez, José Maria Quintana, Ane Antón-Ladislao, Maria Soledad Gallardo, Esther Pulido, Irene Rilo, Elena Zubillaga, Miren Morillas, José Juan Onaindia, Nekane Murga, Ricardo Palenzuela, José González Ruiz
Our aims were to create and validate a clinical decision rule to assess severity in acute heart failure. We conducted a prospective cohort study of patients with symptoms of acute heart failure who attended the emergency departments (EDs) of three hospitals between April 2011 and April 2013. The following data were collected on arrival to or during the stay in the ED: baseline severity of symptoms; presence of decompensated comorbidities; number of hospital admissions/visits to EDs for acute heart failure during the previous 24 months; triggers of the exacerbation; clinical signs and symptoms; results of ancillary tests requested in the ED; treatments prescribed; and response to the initial treatment in the ED...
October 11, 2016: Internal and Emergency Medicine
Pradeep H Lakshminarayana, Adiba A Geeti, Umer M Darr, David A Kaufman
Dead space fraction (V d/V t) measurement performed using volumetric capnography requires arterial blood gas (ABG) sampling to estimate the partial pressure of carbon dioxide (PaCO2). In recent years, transcutaneous capnography (PtcCO2) has emerged as a noninvasive method of estimating PaCO2. We hypothesized that PtcCO2 can be used as a substitute for PaCO2 in the calculation of V d/V t. In this prospective pilot comparison study, 30 consecutive postcardiac surgery mechanically ventilated patients had V d/V t calculated separately using volumetric capnography by substituting PtcCO2 for PaCO2...
2016: Critical Care Research and Practice
Eric M Wise, Ricky Harika, Fatima Zahir
Amniotic fluid embolism (AFE) is a rare, catastrophic emergency that requires prompt recognition and treatment. Despite early recognition and supportive therapy, the morbidity and mortality remain high. We report a case of AFE after vacuum-assisted vaginal delivery resulting in hemodynamic collapse and subsequent multiorgan failure. Management included mechanical ventilation, extracorporeal membrane oxygenation, and continuous veno-venous hemodialysis. The patient was able to make a full recovery with minimal sequelae...
November 2016: Journal of Clinical Anesthesia
Wayne Varndell, Margaret Fry, Doug Elliott
AIM: This systematic review examined the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND: In the emergency department assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e...
September 29, 2016: Journal of Clinical Nursing
Debra E Weese-Mayer, Casey M Rand, Amy Zhou, Michael S Carroll, Carl E Hunt
The "bedside-to-bench" CCHS research journey has led to increased phenotypic-genotypic knowledge regarding autonomic nervous system (ANS) regulation, and improved clinical outcomes. CCHS is a neurocristopathy characterized by hypoventilation and ANS dysregulation. Initially described in 1970, timely diagnosis and treatment remained problematic until the first large cohort report (1992), delineating clinical presentation and treatment options. A central role of ANS dysregulation (2001) emerged, precipitating evaluation of genes critical to ANS development, and subsequent 2003 identification of PHOX2B as the disease-defining gene for CCHS...
September 27, 2016: Pediatric Research
Y-W Su, C-Y Hsu, Y-W Guo, H-S Chen
AIMS: To evaluate the correlation between the plasma glucose-to-glycated haemoglobin ratio (GAR) and clinical outcome during acute illness. METHODS: This retrospective observational cohort study enrolled 661 patients who visited the emergency department of our hospital between 1 July 2008 and 30 September 2010 with plasma glucose concentrations>500mg/dL. Systolic blood pressure, heart rate, white blood cells, neutrophils, haematocrit, blood urea nitrogen, serum creatinine, liver function and plasma glucose concentration were recorded at the initial presentation to the emergency department...
September 20, 2016: Diabetes & Metabolism
Cliff Reid, Ian Ferguson, Brian Burns, Karel Habig, Mohammed Shareef
BACKGROUND: Life-like end-tidal capnography (ETCO2) waveforms have been demonstrated in recently deceased and fresh-frozen cadavers following tracheal intubation, offering potential for high fidelity airway simulation training. As the mechanism for carbon dioxide production is not fully understood, it is possible that oesophageal intubation may also generate a capnograph. Our aim was to measure ETCO2 levels following (1) oesophageal and (2) tracheal intubation in fresh-frozen cadavers, and to observe the size, shape and duration of any capnographic waveform...
September 23, 2016: Emergency Medicine Journal: EMJ
R de la Espriella-Juan, A Valls-Serral, B Trejo-Velasco, A Berenguer-Jofresa, Ó Fabregat-Andrés, D Perdomo-Londoño, C Albiach-Montañana, J V Vilar-Herrero, D Sanmiguel-Cervera, E Rumiz-Gonzalez, S Morell-Cabedo
OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015...
September 17, 2016: Medicina Intensiva
Raya Brandenburg, Sylvia Brinkman, Nicolette F de Keizer, Jozef Kesecioglu, Jan Meulenbelt, Dylan W de Lange
CONTEXT: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. OBJECTIVE: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality). MATERIALS AND METHODS: We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs...
September 20, 2016: Clinical Toxicology
Badri Prasad Das, Anil Prasad Singh, Ram Badan Singh
INTRODUCTION: Underdevelopment of the lung parenchyma associated with abnormal growth of pulmonary vasculature in neonates with congenital diaphragmatic hernia results in pulmonary hypertension which mandates smooth elective mechanical ventilation in postoperative period, for proper alveolar recruitment and oxygenation, allowing lungs to mature enough for its functional anatomy and physiology. Dexmedetomidine is sympatholytic, reduces pulmonary vascular resistance and exerts sedative and analgesic property to achieve stable hemodynamics during elective ventilation...
June 2016: Anesthesiology and Pain Medicine
Americo Testa, Rosangela Giannuzzi, Valeria De Biasio
BACKGROUND: Myonecrosis can rapidly develop in soft tissue necrotizing infections, often with initial sparing of the skin. Despite the improvements in management of necrotizing soft tissue infections, mortality remains high, according to the location, microbial agents and comorbidities, ranging between 17 and 46 %. A prompt diagnosis represents the greatest challenge for the emergency physician. CASE REPORT: We describe the case of a patient with a history of hypertension and arrhythmia who developed nonclostridial necrotizing fasciitis with extensive myonecrosis, after articular infiltration procedure...
September 2016: Journal of Ultrasound
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