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https://www.readbyqxmd.com/read/29793015/right-atrial-anomalous-muscle-bundle-presenting-with-acute-superior-vena-cava-syndrome-and-pulmonary-embolism-surgical-management
#1
Jeko M Madjarov, Michael G Katz, Sophia Madjarova, Svetozar Madzharov, Frank R Arko, David W Miller, Francis Robicsek
BACKGROUND: An anomalous muscle bundle crossing the right atrial cavity represents a pathological finding with unproved clinical significance. This congenital anomaly may be difficult to recognize via echocardiography and could be confused with other intra-cavitary lesions. METHODS: We report a case of a 53-year-old female presented to the cardio-vascular service with acute superior vena cava syndrome and sub-massive pulmonary embolism. RESULTS: The patient underwent venography confirming superior vena cava stenosis...
May 21, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29792537/recognizing-quantifying-and-managing-patient-ventilator-asynchrony-in-invasive-and-noninvasive-ventilation
#2
Eugenio Garofalo, Andrea Bruni, Corrado Pelaia, Luisa Liparota, Nicola Lombardo, Federico Longhini, Paolo Navalesi
Patient-ventilator asynchrony may occur with modes of partial ventilatory support. Because this problem is associated with worsened outcomes, identifying and managing asynchronies has been recognized as a relevant clinical problem during both invasive and non-invasive (NIV) mechanical ventilation. Areas covered: In this review article, we first describe the different forms of patient-ventilator asynchrony and how they are classified and quantified. Then, we show how these asynchronies can be recognized, considering the techniques used to properly detect asynchronies, by either ventilator waveform observation, or through systems based on more complexes mathematical algorithms, by means of adjunctive signals, such as the electrical activity of the diaphragm or esophageal pressure...
May 24, 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/29792513/cardiogenic-shock-complicating-peripartum-cardiomyopathy-importance-of-early-left-ventricular-unloading-and-bromocriptine-therapy
#3
Jan-Thorben Sieweke, Tobias Jonathan Pfeffer, Dominik Berliner, Tobias König, Maximiliane Hallbaum, L Christian Napp, Jörn Tongers, Christian Kühn, Jan D Schmitto, Denise Hilfiker-Kleiner, Andreas Schäfer, Johann Bauersachs
INTRODUCTION: Acute peripartum cardiomyopathy complicated by cardiogenic shock is a rare but life-threatening disease. A prolactin fragment is considered causal for the pathogenesis of peripartum cardiomyopathy. This analysis sought to investigate the role of early percutaneous mechanical circulatory support with micro-axial flow-pumps and/or veno-arterial extracorporeal membrane oxygenation in combination with the prolactin inhibitor bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy...
May 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29792168/trends-in-the-incidence-and-associated-factors-of-late-onset-sepsis-associated-with-improved-survival-in-extremely-preterm-infants-born-at-23-26-weeks-gestation-a-retrospective-study
#4
Jin Kyu Kim, Yun Sil Chang, Sein Sung, So Yoon Ahn, Won Soon Park
BACKGROUND: To investigate the trends in the incidence and associated factors of late-onset sepsis (LOS) associated with improved survival in extremely preterm infants. METHODS: Medical records of 364 infants who were born at 23-26 weeks' gestation from 2000 to 2005 (period I, n = 124) and from 2006 to 2011 (period II, n = 240) were retrospectively reviewed. The infants were stratified into subgroups of 23-24 and 25-26 weeks' gestation within each period, and survival, LOS rate, and clinical characteristics were analyzed...
May 23, 2018: BMC Pediatrics
https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#5
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat
BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2 ) to the fraction of inspired oxygen (Fio2 ) of less than 50 mm Hg for more than 3 hours; a Pao2 :Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29791584/risk-factors-for-early-onset-ventilator-associated-pneumonia-in-aneurysmal-subarachnoid-hemorrhage-patients
#6
J B Cui, Q Q Chen, T T Liu, S J Li
This study aimed to investigate the risk factors related to ventilator-acquired pneumonia (VAP) in aneurysmal subarachnoid hemorrhage (SAH) patients. From January 2011 to December 2015, a single-center retrospective study including 200 SAH patients requiring mechanical ventilation (MV) ≥48 h was performed. The clinical data of these patients were collected and analyzed. The age range of the patients were 41-63 and 72 (36%) were male. The Glasgow coma scale score range was 5-15 and the Simplified Acute Physiology Score II range was 31-52...
2018: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/29791547/predictors-of-mortality-among-intensive-care-unit-patients-coinfected-with-tuberculosis-and-hiv
#7
Marcia Danielle Ferreira, Cynthia Pessoa das Neves, Alexandra Brito de Souza, Francisco Beraldi-Magalhães, Giovanni Battista Migliori, Afrânio Lineu Kritski, Marcelo Cordeiro-Santos
OBJECTIVE: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. METHODS: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model...
April 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29791518/multi-operational-selective-computer-assisted-targeting-of-hepatocellular-carcinoma-evaluation-of-a-novel-approach-for-navigated-tumor-ablation
#8
Pascale Tinguely, Marius Schwalbe, Torsten Fuss, Dominik P Guensch, Andreas Kohler, Iris Baumgartner, Stefan Weber, Daniel Candinas
OBJECTIVE: To facilitate precise local ablation of hepatocellular carcinoma (HCC) in a setting of combined ablation and transarterial chemoembolization (TACE), we evaluated accuracy and efficiency of a novel technique for navigated positioning of ablation probes using intrahepatic tumor referencing and electromagnetic (EM) guidance, in a porcine model. METHODS: An angiographic wire with integrated EM reference sensor at its tip was inserted via a transarterial femoral access and positioned in the vicinity of artificial liver tumors...
2018: PloS One
https://www.readbyqxmd.com/read/29790677/predicting-healthcare-outcomes-in-prematurely-born-infants-using-cluster-analysis
#9
Victoria MacBean, Alan Lunt, Simon B Drysdale, Muska N Yarzi, Gerrard F Rafferty, Anne Greenough
AIMS: Prematurely born infants are at high risk of respiratory morbidity following neonatal unit discharge, though prediction of outcomes is challenging. We have tested the hypothesis that cluster analysis would identify discrete groups of prematurely born infants with differing respiratory outcomes during infancy. METHODS: A total of 168 infants (median (IQR) gestational age 33 (31-34) weeks) were recruited in the neonatal period from consecutive births in a tertiary neonatal unit...
May 23, 2018: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29790382/towards-respiratory-gated-retrograde-intrarenal-surgery-a-prospective-randomized-controlled-study
#10
Vasileios Kourmpetis, Snir Dekalo, Tomer Nir, Nadav Levy, Yuval Bar-Yosef, Avi Beri, Ofer Yossepowitch, Mario Sofer
INTRODUCTION: We set out to investigate whether general anesthesia with low ventilation (LV, respiratory rate ≤8/min and tidal volume <500 ml) could reduce renal mobility and thereby facilitate improved retrograde intrarenal surgery (RIRS) compared to general anesthesia with standard ventilation (SV). MATERIALS AND METHODS: All 60 consecutive patients who presented for RIRS in our department from September 1, 2017 to December 31, 2017 were prospectively randomized 1:1 into one group that was selected to receive SV and another that received LV...
May 23, 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29790144/-prone-position-and-nursing-care
#11
Shu-Ju Lu, Shiao-Pei Wang
Acute respiratory distress syndrome (ARDS) is a life-threatening disease, as acute inflammation in the lungs typically leads to hypoxia and symptoms of dyspnea. The treatment modalities of ARDS include mechanical ventilation, corticosteroid, extracorporeal membranous oxygenation, inhaled nitrogen oxide, and the prone position. Among these, the prone position is supported by evidence showing significantly reduced mortality in patients that adopt this modality. Lying in the prone position reduces atelectatic lung volumes by recruitment of dependent parts and facilitates normal regulation of alveolar ventilation, giving better-matched ventilation perfusion and, thus, improved oxygenation...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29790141/-using-trm-to-enhance-the-accuracy-of-ventilator-associated-pneumonia-preventive-measures-implemented-by-neonatal-intensive-care-unit-medical-staffs
#12
Yu-Ting Huang, Chao-Ya Huang, Hsiu-Ya Su, Chen-Te Ma
BACKGROUND & PROBLEMS: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the neonatal intensive care unit (NICU). The average VAP infection density was 4.7‰ in our unit between June and August 2015. The results of a status survey indicated that in-service education lacked specialization, leading to inadequate awareness among staffs regarding the proper care of newborns with VAP and a lack of related care guides. This, in turn, resulted in inconsistencies in care measures for newborns with VAP...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29789798/the-relation-between-sarcopenia-and-mortality-in-patients-at-intensive-care-unit
#13
Mehmet Toptas, Mazhar Yalcin, İbrahim Akkoc, Eren Demir, Cagatay Metin, Yildiray Savas, Muhsin Kalyoncuoglu, Mehmet Mustafa Can
Background and Aim: Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). Materials and Method: The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29789465/efficacy-safety-and-usability-of-remifentanil-as-premedication-for-insure-in-preterm-neonates
#14
Hadiyah Y Audil, Sara Tse, Chad Pezzano, Amy Mitchell-van Steele, Joaquim M B Pinheiro
Background : We previously reported a 67% extubation failure with INSURE (Intubation, Surfactant, Extubation) using morphine as analgosedative premedication. Remifentanil, a rapid- and short-acting narcotic, might be ideal for INSURE, but efficacy and safety data for this indication are limited. Objectives : To assess whether remifentanil premedication increases extubation success rates compared with morphine, and to evaluate remifentanil's safety and usability in a teaching hospital context. Methods : Retrospective review of remifentanil orders for premedication, at a large teaching hospital neonatal intensive care unit (NICU)...
May 22, 2018: Children
https://www.readbyqxmd.com/read/29789414/development-of-personalized-fitting-device-with-3-dimensional-solution-for-prevention-of-niv-oronasal-mask-related-pressure-ulcers
#15
Maiko Shikama, Gojiro Nakagami, Hiroshi Noguchi, Taketoshi Mori, Hiromi Sanada
BACKGROUND: Pressure ulcers related to oronasal masks used with noninvasive ventilation (NIV), along with patient discomfort, occur due to improper fit of the mask. We developed a personalized fitting device using a 3-dimensional (3D) scanning solution to prevent the formation of NIV mask-related pressure ulcers. This study aimed to evaluate the effectiveness of the proposed personalized fitting device. METHODS: We conducted a randomized crossover experimental study of 20 healthy participants to study the use of this personalized fitting device between the face and an NIV mask designed with 3D solutions...
May 22, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29789411/heliox-adjunct-therapy-for-neonates-with-congenital-diaphragmatic-hernia
#16
Audra C Wise, Mallory A Boutin, Ellen M Knodel, James A Proudfoot, Brian P Lane, Marva L Evans, Denise M Suttner, Amy L Kimball
BACKGROUND: Congenital diaphragmatic hernia remains a complex disease with significant morbidity and mortality. Hypercarbia is a common derangement in this population, which often requires escalating ventilator support. By decreasing airway turbulence and enhancing CO2 removal, inhaled helium-oxygen mixture (heliox) has the potential to improve ventilation and thereby decrease ventilator support and its associated lung injury. METHODS: Retrospective cohort review of all neonates with congenital diaphragmatic hernia treated at Rady Children's Hospital San Diego during 2011-2015...
May 22, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29789134/fluoroscopy-guided-removal-of-individualised-airway-covered-stents-for-airway-fistulas
#17
Y Bi, H Chen, J Li, P Fu, J Ren, X Han, G Wu
AIM: To report the techniques and complications associated with fluoroscopy-guided removal of individual covered stents for airway fistula disease over a 6-year period. MATERIALS AND METHODS: A retrospective analysis was conducted of 85 patients, 72 male and 13 female, who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Patients ranged in age from 15 to 81 years (mean, 54.9±12.3 years). Before removal, 90 stents had been placed for airway fistula disease...
May 19, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29788919/prediction-of-fluid-responsiveness-in-mechanically-ventilated-cardiac-surgical-patients-the-performance-of-seven-different-functional-hemodynamic-parameters
#18
Michael T Ganter, Martin Geisen, Sonja Hartnack, Omer Dzemali, Christoph K Hofer
BACKGROUND: Functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients. Today, different minimally- and non-invasive hemodynamic monitoring systems measure functional hemodynamic parameters. Although some of these parameters are described by the same name, they differ in their measurement technique and thus may provide different results. We aimed to test the performance of seven functional hemodynamic parameters simultaneously in the same clinical setting...
May 22, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29788897/biofilm-destruction-on-endotracheal-tube-associated-pneumonia-by-photodynamic-inactivation
#19
Kate Cristina Blanco, Amanda C Zangirolami, Natalia M Inada, Vanderlei S Bagnato
Hospital infections is a public health problem that can occur with the use of catheters and endotracheal tubes (ETT). Pathogenic microorganisms may adhere to surfaces of these materials forming biofilm. Microbial biofilms presents an extracellular polymer matrix that promotes resistance of microorganisms to factors such as pH, temperature and drugs. The ETT is used to assist a patient with compromised breathing function. ETT biofilm may cause ventilator-associated pneumonia. Pseudomonas aeruginosa and Staphylococcus aureus pneumonia is associated with a 21-fold increase in risk for mechanical ventilation...
May 22, 2018: Infectious Disorders Drug Targets
https://www.readbyqxmd.com/read/29788796/off-hours-admissions-and-mortality-in-picu-without-24-hour-onsite-intensivist-coverage
#20
Farah Chedly Thabet, Faisal Ahmed alHaffaf, Iheb Mohamed Bougmiza, Hend Ali Bafaqih, May Said Chehab, Sulaiman Abdulkareem alMohaimeed
OBJECTIVE: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. DESIGN: Prospective cohort study. SETTING: A 34-bed tertiary PICU. PATIENTS: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. MEASUREMENTS AND MAIN RESULTS: A total of 1254 patients were nonelectively admitted to the PICU...
January 1, 2018: Journal of Intensive Care Medicine
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