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https://www.readbyqxmd.com/read/28515969/application-of-selective-bronchial-intubation-versus-neurally-adjusted-ventilatory-assist-in-the-management-of-unilateral-pulmonary-interstitial-emphysema-an-illustrative-case-and-the-literature-review
#1
Shing-Yan Robert Lee
In the treatment of left-sided pulmonary interstitial emphysema (PIE) in a 23-week neonate, we used two ventilatory strategies: selective bronchial intubation from day 10 to 15 and neurally adjusted ventilatory assist (NAVA) from day 18 to 26. We compared the effects and adverse effects of these two strategies. On selective bronchial intubation, desaturation was frequent. Fentanyl infusion was required. There was an episode of carbon dioxide retention coupled with hypotension. On NAVA, the neonate was clinically stable without the requirement of sedation...
April 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28506729/-the-role-of-extracorporeal-removal-of-co2-ecco2r-in-the-management-of-respiratory-diseases
#2
J L Diehl, J Boisramé-Helms, A Chardon-Couteau, M Commereuc, J-L Augy, A Sokoloff, N Rivet, P Gaussem, D M Smadja, N Aissaoui
INTRODUCTION: The aim of extracorporeal removal of CO2 (ECCO2R) is to ensure the removal of CO2 without any significant effect on oxygenation. ECCO2R makes use of low to moderate extracorporeal blood flow rates, whereas extracorporeal membrane oxygenation (ECMO) requires high blood flows. STATE OF THE ART: For each ECCO2R device it is important to consider not only performance in terms of CO2 removal, but also cost and safety, including the incidence of hemolysis and of hemorrhagic and thrombotic complications...
May 12, 2017: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/28466119/critical-care-management-of-acute-ischemic-stroke
#3
REVIEW
Matthew B Bevers, W Taylor Kimberly
Ischemic stroke accounts for approximately 85% of all strokes. Although severe strokes constitute a minority of cases, they are associated with a majority of the subsequent disability and death. Reperfusion therapy with intravenous tissue plasminogen activator (tPA) and/or endovascular thrombectomy is a mainstay of acute stroke management. Intensive care management of stroke is focused on reducing complications of reperfusion, such as hemorrhagic transformation, and minimizing secondary brain injury, including brain edema and progressive stroke...
June 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#4
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28459325/ajrccm-100-year-anniversary-homeward-bound-a-centenary-of-home-mechanical-ventilation
#5
Matthew Hind, Michael I Polkey, Anita K Simonds
The evolution of home mechanical ventilation is an intertwined chronicle of negative and positive pressure modes and their role in managing ventilatory failure in neuromuscular diseases and other chronic disorders. The uptake of noninvasive positive pressure ventilation has resulted in widespread growth in home ventilation internationally and fewer patients being ventilated invasively. As with many applications of domiciliary medical technology, home ventilatory support has either led or run in parallel with acute hospital applications and has been influenced by medical and societal shifts in the approach to chronic care, the creation of community support teams, a preference of recipients to be treated at home, and economic imperatives...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28458554/patient-characteristics-associated-with-false-arrhythmia-alarms-in-intensive-care
#6
Patricia R Harris, Jessica K Zègre-Hemsey, Daniel Schindler, Yong Bai, Michele M Pelter, Xiao Hu
INTRODUCTION: A high rate of false arrhythmia alarms in the intensive care unit (ICU) leads to alarm fatigue, the condition of desensitization and potentially inappropriate silencing of alarms due to frequent invalid and nonactionable alarms, often referred to as false alarms. OBJECTIVE: The aim of this study was to identify patient characteristics, such as gender, age, body mass index, and diagnosis associated with frequent false arrhythmia alarms in the ICU. METHODS: This descriptive, observational study prospectively enrolled patients who were consecutively admitted to one of five adult ICUs (77 beds) at an urban medical center over a period of 31 days in 2013...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28452241/respiratory-monitoring-in-adult-intensive-care-unit
#7
Pongdhep Theerawit, Yuda Sutherasan, Lorenzo Ball, Paolo Pelosi
The mortality of patients with respiratory failure has steadily decreased with the advancements in protective ventilation and treatment options. Although respiratory monitoring per se has not been proven to affect the mortality of critically ill patients, it plays a crucial role in patients' care, as it helps to titrate the ventilatory support. Several new monitoring techniques have recently been made available at the bedside. The goals of monitoring comprise alerting physicians to detect the change in the patients' conditions, to improve the understanding of pathophysiology to guide the diagnosis and provide cost-effective clinical management...
May 10, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28442965/unusual-airways-management-during-one-lung-ventilation-in-thoracic-surgery
#8
Paolo Primieri, Paolo Ancona, Elisabetta Gualtieri
Airways management in thoracic surgery is usually more difficult than in other surgery. We reported a case of a patient who underwent surgery of evacuation of empyema where after a correct insertion of a left double-lumen tube 37 Fr (DLT), one-lung ventilation was not permitted by the high airways pressure. In fact, the hole of bronchial tip was just against the left bronchial wall retracted probably from inflammatory process. We introduced blindly an Arndt blocker 9 Fr inside the tracheal lumen of DLT until the orifice of the right upper lobe bronchus, the distance was checked before...
April 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28441913/the-masquerading-presentation-of-a-systemic-anaplastic-large-cell-lymphoma-alk-positive-a-case-report-and-review-of-the-literature
#9
Selma Al-Ahmad, Vincent Maertens, Christophe Libeer, Vera Schelfhout, Filip Vanhoenacker, Nancy Boeckx, Marleen Vandevenne
We report an unusual case of systemic anaplastic large cell lymphoma (ALCL), ALK positive with leukemic involvement in a 57-year-old woman. The patient presented with a fulminant respiratory infection unresponsive to treatment requiring intensive care and ventilatory support. The CT scan demonstrated mediastinal and bilateral lymphadenopathy. On peripheral smear a few atypical lymphocytes were visualized. Based on the increasing number of atypical lymphocytes in the daily peripheral bloodsmears, the diagnosis ALCL was suggested...
April 25, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/28413621/recent-advances-in-pediatric-ventilatory-assistance
#10
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/28398073/the-link-between-reduced-inspiratory-capacity-and-exercise-intolerance-in-chronic-obstructive-pulmonary-disease
#11
Denis E O'Donnell, Amany F Elbehairy, Katherine A Webb, J Alberto Neder
Low inspiratory capacity (IC), chronic dyspnea and reduced exercise capacity are inextricably linked and are independent predictors of increased mortality in chronic obstructive pulmonary disease (COPD). It is no surprise, therefore, that a major goal of management is to improve IC by reducing lung hyperinflation in order to improve respiratory symptoms and health-related quality of life. The negative effects of lung hyperinflation on respiratory muscle and cardio-circulatory function during exercise are now well established...
April 11, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28393008/an-unusual-cause-of-ventilatory-failure-in-motor-neurone-disease
#12
Epaminondas Markos Valsamis, Ian Smith, Adri De Sousa
A patient previously diagnosed with motor neurone disease (MND) and gastrostomy-fed was under surveillance for ventilatory decline via our respiratory centre. At a planned review she was found to be hypercapnic, which would usually prompt an offer of non-invasive ventilation for home use. However, she was alkalotic and not acidotic as we might expect. Her serum potassium was checked urgently and confirmed as low. It was established that the community team had prescribed a feeding regime with insufficient potassium...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28375677/cardiopulmonary-exercise-testing-in-adult-congenital-heart-disease
#13
Valentina Mantegazza, Anna Apostolo, Alfred Hager
Recently, the number of patients with congenital heart diseases reaching adulthood has been progressively increasing in developed countries and new issues are emerging regarding them: the evaluation of their capacity to cope with physical activity, and whether this knowledge can be used to optimize medical management. A symptom-limited cardiopulmonary exercise test has proven to be an essential tool because it can objectively evaluate the functional cardiovascular capacity of these patients, identify the pathological mechanisms of the defect (circulatory failure, shunts, pulmonary hypertension) and help prescribe an individualized rehabilitation program when needed...
April 4, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28362512/prognostic-role-of-cardiopulmonary-exercise-testing-in-clinical-practice
#14
Stefania Paolillo, Piergiuseppe Agostoni
Risk stratification is a mainstay in the care of cardiac and pulmonary disorders, as the identification of adverse outcomes helps provide measures to improve survival and quality of life. Cardiopulmonary exercise test is a useful prognostic tool in the clinical evaluation of several pathological conditions, such as heart diseases, respiratory disorders, and pulmonary hypertension. If not contraindicated, a cardiopulmonary exercise test should always be performed and integrated with clinical, laboratory, and hemodynamic parameters to better stratify patient risk...
March 31, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28356171/a-case-of-abnormally-abnormal-hypoxic-ventilatory-responses-a-novel-nparm-phox2b-gene-mutation
#15
Stefan A Unger, Maude Guillot, Donald S Urquhart
Congenital central hypoventilation syndrome (CCHS) is a rare disorder associated with dysregulation of the autonomic ventilatory response to hypoxia and hypercarbia usually caused by polyalanine repeat expansion mutations in the PHOX2B gene. Non-polyalanine repeat mutations (NPARM) represent approximately 10% of cases, and usually require continuous ventilation during sleep, although our knowledge of disease progression is limited. Here we present a case with a novel NPARMCCHS mutation associated with a premature stop codon for the PHOX2B protein...
March 28, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/28347628/factors-affecting-pain-assessment-scores-in-patients-on-mechanical-ventilation
#16
Yumi Ito, Koji Teruya, Hiroshi Kubota, Tomoko Yorozu, Emiko Nakajima
OBJECTIVE: To determine how respiratory status and other aspects of the patients' condition affect pain assessments. METHODS:  Pain was assessed in 20 patients aged ≥20 years who underwent cardiovascular surgery, and required postoperative mechanical ventilation in an intensive care unit using the Behavioral Pain Scale (BPS). A BPS score of ≥6 (pain) versus <6 (no pain) was the dependent variable for determining the effect on pain. RESULTS:  Multiple logistic regression analysis showed that in 99 observations made at rest, pre- and post-turning and pre- and post-tracheal suctioning, the BPS score was significantly affected by gender, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, Richmond Agitation-Sedation Scale score, PaCO2, and HCO3(-)...
March 24, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28338349/clinical-features-of-children-and-adults-with-a-muscular-dystrophy-using-powered-indoor-outdoor-wheelchairs-disease-features-comorbidities-and-complications-of-disability
#17
Andrew Oliver Frank, Lorraine H De Souza
PURPOSE: To describe the clinical features of electric powered indoor/outdoor wheelchair users with a muscular dystrophy, likely to influence optimal prescription; reflecting features of muscular dystrophies, conditions secondary to disability, and comorbidities impacting on equipment provision. METHODS: Cross-sectional retrospective case note review of recipients of electric powered indoor/outdoor wheelchairs provided by a specialist regional wheelchair service...
February 25, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28267910/-surgical-management-of-spinal-deformity-in-a-patient-with-escobar-syndrome-review-of-the-literature
#18
M C Hernández-Hernández, J A Canales-Nájera, J S De La Cruz-Álvarez, M E Tena-Zanabria, J Matus-Jiménez
BACKGROUND: The non-lethal variant of the Escobar or multiple pterygium syndrome is an entity of autosomal recessive inheritance linked to the X chromosome; it is characterized by multiple pterygia (hence its name) located mainly in the neck (95%) and armpits (55%), as well as other orthopedic malformations such as a vertical talus, congenital hip dislocation, and congenital scoliosis. OBJECTIVE: To present an optional surgical technique for the management of severe spinal deformities...
July 2016: Acta Ortopédica Mexicana
https://www.readbyqxmd.com/read/28264672/reference-equations-for-spirometric-indices-from-a-sample-of-the-general-adult-population-in-nigeria
#19
Ademola Emmanuel Fawibe, Louis O Odeigah, Mohammed J Saka
BACKGROUND: The increasing importance of pulmonary function testing in diagnosing and managing lung diseases and assessing improvement has necessitated the need for locally derived reference equations from a sample of the general Nigerian population. METHODS: It was a cross sectional study in which we used linear regression models to obtain equations for reference values and lower limits of normal for spirometric indices in adult Nigerians from a sample of the general population aged 18-65 years (males) and 18-63 years (females)...
March 6, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28238441/mechanical-ventilation-in-acute-respiratory-distress-syndrome-the-open-lung-revisited
#20
L Amado-Rodríguez, C Del Busto, E García-Prieto, G M Albaiceta
Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. In this regard, ventilator-associated lung injury (VALI) is the main concern when this technique is used. The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them...
February 23, 2017: Medicina Intensiva
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