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https://www.readbyqxmd.com/read/29138242/role-of-ecmo-in-congenital-diaphragmatic-hernia
#1
REVIEW
Merrill McHoney, Philip Hammond
Congenital diaphragmatic hernia (CDH) is typified morphologically by failure of diaphragmatic development with accompanying lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Patients who have labile physiology and low preductal saturations despite optimal ventilatory and inotropic support may be considered for extracorporeal membrane oxygenation (ECMO). Systematic reviews into the benefits of ECMO in CDH concluded that any benefit is unclear. Few randomised trials exist to demonstrate clear benefit and guide management...
November 14, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29135617/lessons-to-learn-from-epidemiologic-studies-in-ards
#2
Bairbre A McNicholas, Grainne M Rooney, John G Laffey
PURPOSE OF REVIEW: Recent advances in our understanding of the epidemiology of ARDS has generated key insights into the incidence, risk factors, demographics, management and outcomes from this devastating clinical syndrome. RECENT FINDINGS: ARDS occurs in 10% of all ICU patients, in 23% of all mechanically ventilated patients, with 5.5 cases per ICU bed each year. Although some regional variation exists regarding ARDS incidence, this may be less than previously thought...
November 11, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29109879/legionnaires-disease-complicated-with-rhabdomyolysis-and-acute-kidney-injury-in-an-aids-patient
#3
Karan Seegobin, Satish Maharaj, Cherisse Baldeo, Julio Perez Downes, Pramod Reddy
Objective: To present a case of an uncommon triad of Legionella pneumonia, rhabdomyolysis, and renal failure, with review of the relevant literature. Case: A 51-year-old with a history of human immunodeficiency virus (HIV), chronic obstructive pulmonary disease (COPD), and hypertension presented with fever, cough, and shortness of breath over four days. Chest X-ray showed consolidation in left lower lung field; urine was positive for Legionella antigen and myoglobin; creatine kinase was 51092U/L; creatine was 6...
2017: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/29033733/anesthesia-management-for-a-case-of-laryngeal-keel-placement
#4
Kundan Gosavi, Paulomi Dey, Sachin Swami, Akshay Salunke
Congenital laryngeal web is a rare anomaly with incidence of 1 in 10,000 births. Its clinical presentation may range from an asymptomatic patient or mild hoarseness of voice to severe respiratory stridor. The primary goals of surgical intervention for congenital laryngeal web are to establish a patent airway and to achieve a good voice quality. As recurrence rate after plain excision of laryngeal web is very high, its removal may be coupled by placement of a silastic keel in between vocal cords. Endolaryngeal placement of a keel is definitely less invasive than laryngofissure, but little is known about its anesthesia management...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28971036/noninvasive-respiratory-management-of-patients-with-neuromuscular-disease
#5
REVIEW
John R Bach
This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes...
August 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28964643/pathophysiology-evaluation-and-management-of-sleep-disorders-in-the-mucopolysaccharidoses
#6
REVIEW
David M Rapoport, John J Mitchell
The mucopolysaccharidoses (MPS) represent a heterogeneous group of lysosomal storage disorders, each one associated with a deficiency in one of the enzymes involved in glycosaminoglycan degradation. Sleep disorders are a frequent manifestation of all types of MPS. Underlying causes are diverse and comprised of both respiratory and central nervous system (CNS) abnormalities. Sleep disordered breathing such as obstructive sleep apnea and nocturnal hypoventilation can arise in patients with upper airway obstruction and/or with alterations in respiratory mechanics, causing restrictive pulmonary disease...
August 25, 2017: Molecular Genetics and Metabolism
https://www.readbyqxmd.com/read/28940032/the-impact-of-22q11-2-microdeletion-on-cardiac-surgery-postoperative-outcome
#7
Goran Cuturilo, Danijela Drakulic, Ida Jovanovic, Slobodan Ilic, Jasna Kalanj, Irena Vulicevic, Misela Raus, Dejan Skoric, Marija Mijovic, Biljana Medjo, Snezana Rsovac, Milena Stevanovic
22q11.2 microdeletion is the most common microdeletion in humans. The purpose of this study was to evaluate postoperative outcome in children with 22q11.2 microdeletion who had undergone complete surgical correction of a congenital heart defect. The study included 34 patients who underwent complete correction of conotruncal heart defects. Of these, 17 patients diagnosed with 22q11.2 microdeletion represent the investigated group. Another 17 patients without 22q11.2 microdeletion represent the control group...
September 22, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28931394/the-efficacy-of-initial-ventilation-strategy-for-adult-immunocompromised-patients-with-severe-acute-hypoxemic-respiratory-failure-study-protocol-for-a-multicentre-randomized-controlled-trial-venim
#8
Tao Wang, Gang Liu, Kun He, Xin Lu, Xianquan Liang, Meng Wang, Rong Zhu, Zongru Li, Feng Chen, Jun Ke, Qingming Lin, Chuanyun Qian, Bo Li, Jie Wei, Jingjun Lv, Li Li, Yanxia Gao, Guofeng Wu, Xiaohong Yu, Weiqin Wei, Ying Deng, Fengping Wang, Hong Zhang, Yun Zheng, Hong Zhan, Jinli Liao, Yingping Tian, Dongqi Yao, Jingsong Zhang, Xufeng Chen, Lishan Yang, Jiali Wu, Yanfen Chai, Songtao Shou, Muming Yu, Xudong Xiang, Dongshan Zhang, Fengying Chen, Xiufeng Xie, Yong Li, Bo Wang, Wenzhong Zhang, Yongli Miao, Michael Eddleston, Jianqiang He, Yong Ma, Shengyong Xu, Yi Li, Huadong Zhu, Xuezhong Yu
BACKGROUND: Acute respiratory failure (ARF) is still one of the most severe complications in immunocompromised patients. Our previous systematic review showed noninvasive mechanical ventilation (NIV) reduced mortality, length of hospitalization and ICU stay in AIDS/hematological malignancy patients with relatively less severe ARF, compared to invasive mechanical ventilation (IMV). However, this systematic review was based on 13 observational studies and the quality of evidence was low to moderate...
September 20, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28918753/neonatal-intestinal-obstruction-associated-with-situs-inversus-totalis-two-case-reports-and-a-review-of-the-literature
#9
Rahul Gupta, Varsha Soni, Prakash Devidas Valse, Ram Babu Goyal, Arun Kumar Gupta, Praveen Mathur
BACKGROUND: The association of neonatal intestinal obstruction with situs inversus totalis is extremely rare with only few cases reported in the literature to date. This association poses dilemmas in management. We present two such cases (of Indian origin), and briefly discuss the pertinent literature and measures to prevent unfavorable outcome. CASE PRESENTATION: Case 1: a 1-month-old preterm (1300 g) male neonate belonging to Hindu (Indian) ethnicity presented with recurrent bile-stained vomiting, non-passage of stools and epigastric fullness...
September 18, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28918201/clinical-management-of-pressure-control-ventilation-an-algorithmic-method-of-patient-ventilatory-management-to-address-forgotten-but-important-variables
#10
Lonny Ashworth, Yasuhiro Norisue, Megan Koster, Jeff Anderson, Junko Takada, Hatsuyo Ebisu
Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#11
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28895380/how-to-optimize-the-lung-donor
#12
Gabriele Sales, Andrea Costamagna, Vito Fanelli, Massimo Boffini, Francesco Pugliese, Luciana Mascia, Luca Brazzi
In the last two decades, lung transplantation emerged as the standard of care for patients with advanced and terminal lung disease. Despite the increment in lung transplantation rates, in 2016 the overall mortality while on waiting list in Italy reached the 10%, whereas only the 39% of the wait-list patients were successfully transplanted. A number of approaches, including protective ventilatory strategy, accurate management of fluid balance, administration of a hormonal resuscitation therapy have been reported to improve lung donor performance before organ retrieval...
September 11, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28862962/inspiratory-muscle-training-is-associated-with-improved-inspiratory-muscle-strength-resting-cardiac-output-and-the-ventilatory-efficiency-of-exercise-in-patients-with-a-fontan-circulation
#13
Karina Laohachai, David Winlaw, Hiran Selvadurai, Ganesh Kumar Gnanappa, Yves d'Udekem, David Celermajer, Julian Ayer
BACKGROUND: Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS: Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily...
August 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28862210/pulmonary-toxicity-following-bleomycin-use-a-single-center-experience
#14
Irappa Madabhavi, Gaurang Modi, Apurva Patel, Asha Anand, Harsha Panchal, Sonia Parikh
BACKGROUND: Bleomycin-induced pulmonary (BIP) toxicity is a notorious entity and cropped up in roughly 10% of cases. The aim of the study is to evaluate BIP at our tertiary care cancer center. PATIENTS AND METHODS: This is a retrospective, analytical study conducted at a tertiary care center from January 1998 to December 2012. Records of all the patients who were offered bleomycin chemotherapy as an integral part of adriamycin, bleomycin, vinblastine, and dacarbazine or bleomycin, etoposide, and cisplatin regimen in Hodgkin disease (HD) or germ cell tumor (GCT) were studied for the study inclusion criteria...
July 2017: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28855978/a-case-of-shunting-postoperative-patent-foramen-ovale-under-mechanical-ventilation-controlled-by-different-ventilator-settings
#15
Claudio Pragliola, Sara Di Michele, Domenico Galzerano
A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28845544/ventilatory-choices-for-intubated-patients-during-helicopter-stretcher-winching
#16
John Hollott
INTRODUCTION: The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety...
August 28, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28805258/impact-of-beta-blockers-on-cardiopulmonary-exercise-testing-in-patients-with-advanced-liver-disease
#17
M P Wallen, A Hall, K A Dias, J S Ramos, S E Keating, A J Woodward, T L Skinner, G A Macdonald, R Arena, J S Coombes
BACKGROUND: Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta-blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing. AIM: To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease...
August 14, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28801794/management-of-congenital-tracheal-stenosis-in-the-neonatal-period
#18
Keiichi Morita, Kosaku Maeda, Kiyoaki Yabe, Yoshihiro Oshima
PURPOSE: Few reports have focused on the management of congenital tracheal stenosis (CTS) in the neonatal period. The aim of this study was to determine appropriate management strategies for CTS in the neonatal period. METHODS: The medical records of eight neonatal patients with CTS at a single institution between January 2007 and December 2016 were retrospectively reviewed. RESULTS: Three patients with frequent ventilatory insufficiency despite assisted ventilation underwent surgical intervention (balloon tracheoplasty: n = 1, slide tracheoplasty: n = 2)...
October 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28766156/a-primer-on-nerve-agents-what-the-emergency-responder-anesthesiologist-and-intensivist-needs-to-know
#19
Keith Candiotti
PURPOSE: The purpose of this review article is to familiarize first responders, anesthesiologists, and intensivists with the medical management of patients exposed to nerve agents. SOURCE: This review is based on the current medical literature available to the general medical community. PRINCIPAL FINDINGS: Nerve agents are some of the deadliest substances known to humanity. Though they kill primarily via muscle paralysis, which leads to respiratory arrest, these agents affect virtually every organ system in the body...
August 1, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28750686/carbon-dioxide-narcosis-due-to-inappropriate-oxygen-delivery-a-case-report
#20
Thomas Herren, Eva Achermann, Thomas Hegi, Adrian Reber, Max Stäubli
BACKGROUND: Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. CASE PRESENTATION: A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry...
July 28, 2017: Journal of Medical Case Reports
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