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Ventilator management

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https://www.readbyqxmd.com/read/28432405/-extracorporeal-membrane-oxygenation-system-selection-contra-indications-and-management
#1
T Staudinger
There are a large number of extracorporeal membrane oxygenation (ECMO) systems and configurations. Thorough planning and evaluation of specific therapeutic needs are necessary to tailor ECMO therapy to the individual patient situation. Indications tend towards lowering the threshold towards respiratory ECMO. Patients with severe acute respiratory distress syndrome (ARDS) not improving to optimization of ventilation and supportive therapeutic measures potentially qualify for ECMO. Contraindications are relative and have to be considered in the light of the individual risk-benefit ratio...
April 21, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28431383/protocolized-hyperventilation-enhances-electroconvulsive-therapy
#2
Aida de Arriba-Arnau, Antonia Dalmau, Virginia Soria, Neus Salvat-Pujol, Carmina Ribes, Ana Sánchez-Allueva, José Manuel Menchón, Mikel Urretavizcaya
BACKGROUND: Hyperventilation is recommended in electroconvulsive therapy (ECT) to enhance seizures and to increase patients' safety. However, more evidence is needed regarding its effects and the optimum method of application. METHODS: This prospective study involving 21 subjects compared two procedures, protocolized hyperventilation (PHV) and hyperventilation as usual (HVau), applied to the same patient in two consecutive sessions. Transcutaneous partial pressure of carbon dioxide (TcPCO2) was measured throughout all sessions...
April 13, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28430760/resuscitative-endovascular-balloon-occlusion-of-the-aorta-or-resuscitative-thoracotomy-with-aortic-clamping-for-noncompressible-torso-hemorrhage-a-retrospective-nationwide-study
#3
Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28428229/withdrawal-of-invasive-ventilation-in-a-patient-with-motor-neurone-disease-and-total-locked-in-syndrome
#4
Aoife Gleeson, Faye Johnson
Withdrawing invasive ventilation from a person with motor neurone disease who lacks the relevant mental capacity raises ethical issues such as the withdrawal of life-sustaining treatment and establishing best interests. There is little available information on providing optimal symptom management to these patients during the withdrawal process. We describe a man with motor neurone disease who also had total locked-in syndrome at the time of ventilation withdrawal, and we document the legal, ethical, emotional and symptom control issues encountered in supporting him...
April 20, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28428012/-retrospective-study-of-children-referred-from-paediatric-intensive-care-to-palliative-care-why-and-for-what
#5
Alberto García-Salido, Paula Santos-Herranz, Verónica Puertas-Martín, María Ángeles García-Teresa, Ricardo Martino-Alba, Ana Serrano-González
INTRODUCTION: The creation of paediatric palliative care units (PPCU) could optimise the management of children with palliative focus after admission to a paediatric intensive care unit (PICU). This study describes the clinical and epidemiological characteristics of children referred from PICU to the UCPP of the Autonomous Community of Madrid (CAM). The overall treatment, relapses, re-admissions, and deaths, if occurred, are described. PATIENTS AND METHOD: A retrospective review was performed using the medical records from children transferred from the CAM paediatric intensive care units to the paediatric palliative care unit (1 March 2008-31 January 2015)...
April 17, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28427745/how-to-approach-the-acute-respiratory-distress-syndrome-prevention-plan-and-prudence
#6
REVIEW
Younsuck Koh
The acute respiratory distress syndrome (ARDS) is typically manifested by refractory hypoxemia with high mortality. A correct diagnosis is the first step to achieve better outcomes. An early intervention to manage modifiable risk factors of ARDS development and the avoidance of aggravating factors that increase disease severity and progression should be carefully addressed. A management plan is necessary at an early stage of ARDS to determine the level of intensive care. It should be carefully decided which therapeutic measures should be performed depending on the patient׳s underlying clinical condition...
May 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28427368/complications-of-miliary-tuberculosis-low-mortality-and-predictive-biomarkers-from-a-uk-cohort
#7
Jonathan Underwood, Fiona Cresswell, Alex P Salam, Alex J Keeley, Charles Cleland, Laurence John, Robert N Davidson
BACKGROUND: Untreated, miliary tuberculosis (TB) has a mortality approaching 100%. As it is uncommon there is little specific data to guide its management. We report detailed data from a UK cohort of patients with miliary tuberculosis and the associations and predictive ability of admission blood tests with clinical outcomes. METHODS: Routinely collected demographic, clinical, blood, imaging, histopathological and microbiological data were assessed for all patients with miliary TB identified from the London TB register from 2008 to 2012 from Northwest London Hospitals NHS Trust...
April 20, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#8
James L Hungerford, Nicole O'Brien, Melissa Moore-Clingenpeel, Eric A Sribnick, Cheryl Sargel, Mark Hall, Jeffrey R Leonard, Joseph D Tobias
OBJECTIVE: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 2...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28424322/kaposi-sarcoma-inflammatory-cytokine-syndrome-kics-a-rare-but-potentially-treatable-condition
#9
Michael Karass, Emily Grossniklaus, Talal Seoud, Sanjay Jain, Daniel A Goldstein
Kaposi sarcoma inflammatory cytokine syndrome (KICS) is a newly-described condition affecting individuals who are HIV-positive and are infected with human herpesvirus 8 (HHV-8). This is a syndrome that in some ways mimics severe sepsis with associated acute respiratory distress syndrome, possibly requiring a ventilator and vasopressor support. However, unlike severe sepsis, antibiotics provide no benefit. Management of KICS has not been fully elucidated because of its high mortality rate. However, the syndrome has been successfully treated in some cases with immunomodulatory therapy...
April 19, 2017: Oncologist
https://www.readbyqxmd.com/read/28421191/prospective-multicentre-study-on-the-epidemiology-and-current-therapeutic-management-of-severe-bronchiolitis-in-spain
#10
Jose C Flores-González, Juan Mayordomo-Colunga, Iolanda Jordan, Alicia Miras-Veiga, Cristina Montero-Valladares, Marta Olmedilla-Jodar, Andrés J Alcaraz-Romero, Miren Eizmendi-Bereciartua, Francisco Fernández-Carrión, Carmen Santiago-Gutierrez, Esther Aleo-Luján, Sonia Pérez-Quesada, Cristina Yun-Castilla, Carmen Martín, Álvaro Navarro-Mingorance, Concha Goñi-Orayen
Objective. To determine the epidemiology and therapeutic management of patients with severe acute bronchiolitis (AB) admitted to paediatric intensive care units (PICUs) in Spain. Design. Descriptive, prospective, multicentre study. Setting. Sixteen Spanish PICUs. Patients. Patients with severe AB who required admission to any of the participating PICUs over 1 year. Interventions. Both epidemiological variables and medical treatment received were recorded. Results. A total of 262 patients were recruited; 143 were male (54...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28421173/cerebral-autoregulation-brain-injury-and-the-transitioning-premature-infant
#11
REVIEW
Zachary A Vesoulis, Amit M Mathur
Improvements in clinical management of the preterm infant have reduced the rates of the two most common forms of brain injury, such as severe intraventricular hemorrhage and white matter injury, both of which are contributory factors in the development of cerebral palsy. Nonetheless, they remain a persistent challenge and are associated with a significant increase in the risk of adverse neurodevelopment outcomes. Repeated episodes of ischemia-reperfusion represent a common pathway for both forms of injury, arising from discordance between systemic blood flow and the innate regulation of cerebral blood flow in the germinal matrix and periventricular white matter...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28420689/-the-year-of-first-aid-effectiveness-of-a-3-day-first-aid-programme-for-7-14-year-old-primary-school-children
#12
Balint Banfai, Emese Pek, Attila Pandur, Henrietta Csonka, Jozsef Betlehem
AIM OF THE STUDY: Bystanders can play an important role in the event of sudden injury or illness. Our aim was to evaluate the effects of a 3-day first aid course for all primary school age groups (7-14 years old). METHODS: 582 school children were involved in the study. Training consisted of three sessions with transfer of theoretical knowledge and practical skills about first aid. The following most urgent situations were addressed in our study: adult basic life support (BLS), using an automated external defibrillator (AED), handling an unconscious patient, managing bleeding and calling the ambulance...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28420471/-mixed-venous-arterial-carbon-dioxide-difference-combined-with-passive-leg-raising-in-guiding-volume-management-for-patients-post-off-pump-coronary-artery-bypass-grafting
#13
Likun Huo, Peijun Li, Chang Xie, Chenglei Yan, Jie Li
OBJECTIVE: To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG). METHODS: Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28420300/epinephrine-induced-pulmonary-edema-during-hip-arthroscopy-a-report-of-two-cases-and-a-review-of-the-literature
#14
Nicole S Belkin, Ryan M Degen, Gregory A Liguori, Bryan T Kelly
OBJECTIVES: Hip arthroscopy utilization has significantly increased in recent years. While it is a relatively safe procedure, it is not without risk. Life-threatening complications, albeit rare, can potentially occur and must be appropriately recognized and treated. We describe 2 cases in which patients' undergoing hip arthroscopy developed pulmonary edema and their respective courses of treatment. METHODS: Both patients were being treated for symptomatic femoroacetabular impingement (FAI), with labral tears, requiring operative management after a failed trial of conservative management...
April 18, 2017: Physician and Sportsmedicine
https://www.readbyqxmd.com/read/28419746/factors-for-postoperative-complications-following-pressure-ulcer-operation-stepwise-multiple-logistic-regression-analysis
#15
Hyun Ho Han, Jun Gul Ko, Jong Won Rhie
Patients with pressure ulcers are generally older, have a long hospital stay and often have a variety of comorbidities. The decision to perform surgery for pressure ulcer management can be difficult because of concerns about the risk of postoperative complications. The aim of this study was to analyse the relationship between comorbid conditions and surgical outcomes in order to guide patient selection for pressure ulcer surgery. In 57 patients, data on age, defect size, operating time, hospital stay, body mass index, surgical site, mobility state, cardiac ischaemic history, diabetes, renal failure, ventilator dependency, tracheostomy state, use of haemodilution therapy and cancer were evaluated using stepwise multiple logistic regression analysis to determine the relationships between variables...
April 17, 2017: International Wound Journal
https://www.readbyqxmd.com/read/28417889/monitoring-for-the-oral-and-maxillofacial-surgeon
#16
REVIEW
Robert C Bosack
Parenteral medications are titrated in the oral and maxillofacial surgery office to achieve moderate sedation, deep sedation, or general anesthesia while continuously maintaining spontaneous ventilation with an open airway. After initial drug administration, the provider assesses and interprets both the level of anesthesia and the presence/severity of adverse side effects, both of which guide further drug titration, cessation, reversal, or medical management. This assessment is called monitoring, which guides the conduct of anesthesia delivery and becomes the essence of this art...
May 2017: Oral and Maxillofacial Surgery Clinics of North America
https://www.readbyqxmd.com/read/28416020/patient-and-family-centered-performance-measures-focused-on-actionable-processes-of-care-for-persistent-and-chronic-critical-illness-protocol-for-a-systematic-review
#17
Louise Rose, Laura Istanboulian, Laura Allum, Lisa Burry, Craig Dale, Nicholas Hart, Claire Kydonaki, Pam Ramsay, Natalie Pattison, Bronwen Connolly
BACKGROUND: Approximately 5 to 10% of critically ill patients transition from acute critical illness to a state of persistent and in some cases chronic critical illness. These patients have unique and complex needs that require a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, discharge planning, and in some cases, end-of-life care. However, existing indicators and measures of care quality, and tools such as checklists, that foster implementation of best practices, may not be sufficiently inclusive in terms of actionable processes of care relevant to these patients...
April 17, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28413621/recent-advances-in-pediatric-ventilatory-assistance
#18
REVIEW
Nicolas Nardi, Guillaume Mortamet, Laurence Ducharme-Crevier, Guillaume Emeriaud, Philippe Jouvet
In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance...
2017: F1000Research
https://www.readbyqxmd.com/read/28413485/therapeutic-efficacy-of-phentolamine-in-the-management-of-severe-hand-foot-and-mouth-disease-combined-with-pulmonary-edema
#19
Zhixin Yan, Yaokai Shang, Fengxian Li, Fei Xie, Huili Qian, Youqi Zhang, Bin Yue
The aim of this study was to examine the effects of phentolamine on severe hand, foot and mouth disease (HFMD) combined with pulmonary edema (PE). From May 2008 to December 2012, 53 children with severe HFMD plus PE were enrolled in the treatment group, receiving phentolamine intravenously at a loading dose of 5 µg/kg/min. The control group comprised 52 children with the same disease who did not receive phentolamine infusion. Data concerning creatine kinase (CK), CK-MB, cardiac troponin I (cTnI), heart rate, systolic blood pressure (SBP) and the duration of ventilation dependence and hospitalization were collected...
April 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28412131/screening-nasal-swabs-for-methicillin-resistant-staphylococcus-aureus-a-regional-burn-center-s-experience
#20
Shawn Tejiram, Laura S Johnson, Mihriye Mete, Sameer Desale, Kimberly Johnson, Jenny Zhang, Lauren T Moffatt, Jeffrey W Shupp
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that can result in substantial morbidity and mortality. Early detection of MRSA colonization by screening nasal swabs may be important in the management of burn-injured patients. However, studies examining its use in this population are limited. The aim of this study was to study the utility of admission MRSA screening nasal swabs and determine if being positive for MRSA on admission impacted outcomes. MATERIALS AND METHODS: A retrospective review was conducted of burn patients who presented to a single regional burn center between June 2012 and December 2014...
April 12, 2017: Burns: Journal of the International Society for Burn Injuries
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