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https://www.readbyqxmd.com/read/28711381/effectiveness-assessment-of-a-guideline-based-protocol-for-ventilatory-support-management-of-copd-exacerbations-in-an-emergency-department
#1
Franciele Plachi, Fernando Nataniel Vieira, Danilo Cortozi Berton, Marli Knorst, Alexandre Simões Dias, Fernanda Machado Balzan
OBJECTIVES: To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a "real-life" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation. METHODS: Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation)...
July 5, 2017: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/28709948/mechanical-ventilation-strategies
#2
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/28704835/high-prevalence-of-pulmonary-hypertension-complicates-the-care-of-infants-with-omphalocele
#3
Shandee Hutson, Joanne Baerg, Douglas Deming, Shawn D St Peter, Andrew Hopper, Donna A Goff
BACKGROUND: Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. OBJECTIVES: To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele...
July 14, 2017: Neonatology
https://www.readbyqxmd.com/read/28702694/mortality-and-morbidity-in-oesophageal-atresia
#4
Robert T Peters, Hany Ragab, Malachy O Columb, James Bruce, Ralph J MacKinnon, Ross J Craigie
BACKGROUND: Several classification systems exist to predict mortality in oesophageal atresia, the most widely quoted of these being over 20 years old. No classification system exists to predict morbidity. We sought to test whether these classification systems remain relevant and to determine whether they can be useful to predict morbidity. In addition, we aimed to identify independent risk factors for predicting mortality and morbidity. METHODS: Neonates presenting with oesophageal atresia over a 20-year period (1990-2010) were retrospectively reviewed...
July 12, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28701597/randomized-comparative-study-of-intravenous-infusion-of-three-different-fixed-doses-of-milrinone-in-pediatric-patients-with-pulmonary-hypertension-undergoing-open-heart-surgery
#5
Neeraj Kumar Barnwal, Sanjeeta Rajendra Umbarkar, Manjula Sudeep Sarkar, Raylene J Dias
BACKGROUND: Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. METHODOLOGY: Patients were randomized into three groups...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28698268/effects-of-volume-guaranteed-ventilation-combined-with-two-different-modes-in-preterm-infants
#6
Sezin Unal, Ebru Ergenekon, Selma Aktas, Nilgun Altuntas, Serdar Beken, Ebru Kazanci, Ferit Kulali, Ozlem Gulbahar, Ibrahim M Hirfanoglu, Esra Onal, Canan Turkyilmaz, Esin Koc, Yildiz Atalay
BACKGROUND: Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes...
July 11, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28685656/a-combined-technique-using-a-muscular-flap-and-endobronchial-stent-to-repair-complex-broncho-oesophageal-fistulae-supported-by-ecmo
#7
Jean-Marc Baste, Laura Haddad, Guillaume Philouze
INTRODUCTION: Certain broncho-oesophageal fistulae require surgical repair. Herein, we describe an innovative surgical technique combining intercostal flap and endobronchial stenting. CASE REPORTS: Two patients, each with a with complex broncho-oesophageal fistula 2 years after radio-chemotherapy, were hospitalised for severe respiratory infection and extension of the fistula despite previous endoscopic treatment. The first patient presented with respiratory distress (ARDS)...
July 7, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#8
Federico Longhini, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: Noninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony...
July 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28673877/remifentanil-effects-on-respiratory-drive-and-timing-during-pressure-support-ventilation-and-neurally-adjusted-ventilatory-assist
#9
Roberta Costa, Paolo Navalesi, Gianmaria Cammarota, Federico Longhini, Giorgia Spinazzola, Flora Cipriani, Giuliano Ferrone, Olimpia Festa, Massimo Antonelli, Giorgio Conti
We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg(-1)·min(-)1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI)...
July 1, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28668914/safety-and-acceptability-of-patient-administered-sedatives-during-mechanical-ventilation
#10
Linda L Chlan, Debra J Skaar, Mary F Tracy, Sarah M Hayes, Breanna D Hetland, Kay Savik, Craig R Weinert
BACKGROUND: Safety and acceptability of sedative self-administration by patients receiving mechanical ventilation is unknown. OBJECTIVES: To determine if self-administration of dexmedetomidine by patients is safe and acceptable for self-management of anxiety during ventilatory support. METHODS: In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dexmedetomidine and 20 to usual care. Dexmedetomidine was administered via standard pumps for patient-controlled analgesia, with a basal infusion (0...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28658025/determinants-of-receiving-palliative-care-and-ventilator-withdrawal-among-patients-with-prolonged-mechanical-ventilation
#11
Yang-Ching Chen, Hsien-Yu Fan, J Randall Curtis, Oscar Kuang-Sheng Lee, Chih-Kuang Liu, Sheng-Jean Huang
OBJECTIVES: Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. DESIGN: Cross-sectional study. SETTING: Five different hospitals of Taipei City Hospital system...
June 27, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28630772/severe-rhabdomyolysis-due-to-presumed-drug-interactions-between-atorvastatin-with-amlodipine-and-ticagrelor
#12
Iouri Banakh, Kavi Haji, Ross Kung, Sachin Gupta, Ravindranath Tiruvoipati
Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28628748/does-young-age-really-put-the-heart-at-risk
#13
Michael P Belanger, Luke Yang Tan, Carin Wittnich
Despite significant advances in the management and treatment of heart disease in children, there continue to be patients who have worse outcomes than might be expected. A number of risk factors that could be responsible have been identified. Evidence based findings will be reviewed including whether young age and/or reduced body weight exacerbate these responses. For example, newborn children undergoing congenital cardiac surgery are known to have worse outcomes than older children. Evidence exists that newborn hearts do not tolerate ischemia as well as adults; developing irreversible injury sooner and exhibiting at risk metabolic profiles...
June 19, 2017: Canadian Journal of Physiology and Pharmacology
https://www.readbyqxmd.com/read/28623885/monitoring-the-electric-activity-of-the-diaphragm-during-noninvasive-positive-pressure-ventilation-a-case-report
#14
Fabia Diniz-Silva, Anna Miethke-Morais, Adriano M Alencar, Henrique T Moriya, Pedro Caruso, Eduardo L V Costa, Juliana C Ferreira
BACKGROUND: In patients with post-extubation respiratory distress, delayed reintubation may worsen clinical outcomes. Objective measures of extubation failure at the bedside are lacking, therefore clinical parameters are currently used to guide the need of reintubation. Electrical activity of the diaphragm (EAdi) provides clinicians with valuable, objective information about respiratory drive and could be used to monitor respiratory effort. CASE PRESENTATION: We describe the case of a patient with Chronic Obstructive Pulmonary Disease (COPD), from whom we recorded EAdi during four different ventilatory conditions: 1) invasive mechanical ventilation, 2) spontaneous breathing trial (SBT), 3) unassisted spontaneous breathing, and 4) Noninvasive Positive Pressure Ventilation (NPPV)...
June 17, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28616212/hypophosphatemia-in-critically-ill-patients-with-acute-kidney-injury-treated-with-hemodialysis-is-associated-with-adverse-events
#15
Cynthia Lim, Han Khim Tan, Manish Kaushik
Background. Hypophosphatemia in critically ill patients may be exacerbated by renal replacement therapy (RRT). We aimed to identify risk factors and adverse outcomes associated with hypophosphatemia in intensive care patients treated with RRT for acute kidney injury (AKI). Methods. This was a secondary analysis of data from a single-center prospective cohort study of medical and surgical intensive care patients with RRT for AKI between 18 December 2010 and 3 April 2013. Demographic, comorbidity, laboratory and RRT data were retrieved from patient case notes and electronic medical records...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28608135/can-proportional-ventilation-modes-facilitate-exercise-in-critically-ill-patients-a-physiological-cross-over-study-pressure-support-versus-proportional-ventilation-during-lower-limb-exercise-in-ventilated-critically-ill-patients
#16
Evangelia Akoumianaki, Nicolas Dousse, Aissam Lyazidi, Jean-Claude Lefebvre, Severine Graf, Ricardo Luiz Cordioli, Nathalie Rey, Jean-Christophe Marie Richard, Laurent Brochard
BACKGROUND: Early exercise of critically ill patients may have beneficial effects on muscle strength, mass and systemic inflammation. During pressure support ventilation (PSV), a mismatch between demand and assist could increase work of breathing and limit exercise. A better exercise tolerance is possible with a proportional mode of ventilation (Proportional Assist Ventilation, PAV+ and Neurally Adjusted Ventilatory Assist, NAVA). We examined whether, in critically ill patients, PSV and proportional ventilation have different effects on respiratory muscles unloading and work efficiency during exercise...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28604599/nutritional-challenges-in-duchenne-muscular-dystrophy
#17
REVIEW
Simona Salera, Francesca Menni, Maurizio Moggio, Sophie Guez, Monica Sciacco, Susanna Esposito
Neuromuscular diseases (NMDs) represent a heterogeneous group of acquired or inherited conditions. Nutritional complications are frequent in NMDs, but they are sometimes underestimated. With the prolongation of survival in patients with NMDs, there are several nutritional aspects that are important to consider, including the deleterious effects of overnutrition on glucose metabolism, mobility, and respiratory and cardiologic functions; the impact of hyponutrition on muscle and ventilatory function; constipation and other gastrointestinal complications; chewing/swallowing difficulties with an increased risk of aspiration that predisposes to infectious diseases and respiratory complications; as well as osteoporosis with an associated increased risk of fractures...
June 10, 2017: Nutrients
https://www.readbyqxmd.com/read/28602381/variability-of-care-in-infants-with-severe-bronchiolitis-less-invasive-respiratory-management-leads-to-similar-outcomes
#18
Sandrine Essouri, Florent Baudin, Laurent Chevret, Mélanie Vincent, Guillaume Emeriaud, Philippe Jouvet
OBJECTIVE: To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations. STUDY DESIGN: This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included...
June 8, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28598946/dexmedetomidine-for-sedation-during-noninvasive-ventilation-in-pediatric-patients
#19
Rasika Venkatraman, James L Hungerford, Mark W Hall, Melissa Moore-Clingenpeel, Joseph D Tobias
OBJECTIVES: To describe the use of dexmedetomidine for sedation in a large cohort of nonintubated children with acute respiratory insufficiency receiving noninvasive ventilatory support. DESIGN: Single-center, retrospective, observational cohort study. SETTING: A large quaternary-care PICU. PATIENTS: The study cohort included 202 children receiving noninvasive ventilatory and a dexmedetomidine infusion within 48 hours of PICU admission over a 6-month period...
June 8, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28589528/functional-evaluation-in-obese-patients-before-and-after-sleeve-gastrectomy
#20
Daniel Neunhaeuserer, Andrea Gasperetti, Francesco Savalla, Stefano Gobbo, Valentina Bullo, Marco Bergamin, Mirto Foletto, Roberto Vettor, Marco Zaccaria, Andrea Ermolao
BACKGROUND: Although sleeve gastrectomy (SG) has become an important treatment option in severe obesity, cardiorespiratory and muscle function after SG has not adequately been investigated. METHODS: This is an observational study in 26 obese patients (BMI 45.2 ± 5.8 kg/m(2)), comparing physical function before and after 6 months from SG. All available patients listed for SG were here included. Incremental cardiopulmonary exercise tests, standardized strength tests, and balance analysis were performed...
June 6, 2017: Obesity Surgery
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