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https://www.readbyqxmd.com/read/28413621/recent-advances-in-pediatric-ventilatory-assistance
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28217065/unsuspected-subglottic-web-in-a-child-managed-for-severe-respiratory-obstruction
#12
Reena, Arun Kumar, Shrawin Kumar Singh, Vineet Agrawal
Subglottic stenosis is a known complication of a traumatic and prolonged intubation. In a child, subglottic area is narrower and more prone to damage by an oversized or overinflated endotracheal tube. The stenosis can present with complaints of change in voice, croup, or respiratory obstruction. Those presenting with respiratory obstruction require immediate diagnosis under direct laryngoscopy and timely corrective intervention under general anesthesia. A 4-year-old child came to the emergency department with severe respiratory obstruction...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28150165/elective-delivery-versus-expectant-management-for-pre-eclampsia-a-meta-analysis-of-rcts
#13
Yonghong Wang, Min Hao, Stephanie Sampson, Jun Xia
PURPOSE: To evaluate the effectiveness and safety of elective delivery versus expectant management for women with pre-eclampsia (PE) and to assess neonatal outcomes before and after 34 weeks gestation. METHODS: We searched Biomed Central, CINAHL, Cochrane Library, Embase, HMIC, Medline, and WHO trial registry, British Nursing Index, ClinicalTrials.gov, Current Controlled Trials, and Web of Science on 16 March, 2016. 1704 citations were identified. Randomised controlled trials comparing elective delivery with expectant management for women with PE were included...
March 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28149572/effect-of-changing-from-the-national-health-and-nutritional-examination-survey-iii-spirometry-reference-range-to-that-of-the-global-lung-initiative-2012-at-gold-coast-hospital-and-health-service
#14
Laura A K Embling, Debbie Zagami, Krishna Bajee Sriram, Robert J Gordon, Pathmanathan Sivakumaran
The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National Health and Nutritional Examination Survey III (NHANES III) dataset, resulted in a change in diagnosis between OVD, TRVD and normal ventilatory pattern (NVP)...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28149568/recommendations-for-the-management-of-idiopathic-pulmonary-fibrosis-in-south-africa-a-position-statement-of-the-south-african-thoracic-society
#15
REVIEW
Coenraad F N Koegelenberg, Gillian M Ainslie, Keertan Dheda, Brian W Allwood, Michelle L Wong, Umesh G Lalloo, Mohamed S Abdool-Gaffar, Hoosain Khalfey, Elvis M Irusen
Idiopathic pulmonary fibrosis (IPF) is a very specific form of a chronic, progressive fibroproliferative interstitial pneumonia of unknown aetiology. The disease is generally associated with a poor prognosis. Several international evidence-based guidelines on the diagnosis and management of IPF and other interstitial lung diseases (ILDs) have been published and updated in the last decade, and while the body of evidence for the use of some treatment modalities has grown, others have been shown to be futile and even harmful to patients...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28146296/nasal-intermittent-positive-pressure-ventilation-nippv-versus-nasal-continuous-positive-airway-pressure-ncpap-for-preterm-neonates-after-extubation
#16
REVIEW
Brigitte Lemyre, Peter G Davis, Antonio G De Paoli, Haresh Kirpalani
BACKGROUND: Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. However, this treatment sometimes 'fails' in infants, and they may require endotracheal re-intubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. Older children and adults with chronic respiratory failure benefit from NIPPV, and the technique has been applied to neonates...
February 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28117330/successful-tracheostomy-decannulation-after-complete-or-sensory-incomplete-cervical-spinal-cord-injury
#17
D H Kim, S W Kang, W A Choi, H J Oh
STUDY DESIGN: Retrospective study. OBJECTIVES: To report the successful tracheostomy decannulation/extubation in cervical spinal cord injury (C-SCI) patients. SETTING: Tertiary university hospital, pulmonary rehabilitation center. METHODS: Complete or sensory incomplete C-SCI patients who had received invasive acute phase respiratory management, and succeeded in decannulation/extubation became candidates of this study...
January 24, 2017: Spinal Cord
https://www.readbyqxmd.com/read/28114193/the-homburg-lung-efficacy-and-safety-of-a-minimal-invasive-pump-driven-device-for-veno-venous-extracorporeal-carbon-dioxide-removal
#18
Frederik Seiler, Franziska Trudzinski, Kai Hennemann, Tom Niermeyer, Christian Schmoll, Annegret Kamp, Robert Bals, Ralf Muellenbach, Hendrik Haake, Philipp M Lepper
Extracorporeal carbon dioxide removal (ECCO2R) is increasingly considered a viable therapeutic approach in the management of hypercapnic lung failure in order to avoid intubation or to allow lung-protective ventilator settings. This study aimed to analyze efficacy and safety of a minimal-invasive ECCO2R device, the Homburg lung. The Homburg lung is a pump-driven system for veno-venous ECCO2R with ¼" tubing and a 0.8 m surface oxygenator. Vascular access is usually established via a 19F/21cm bilumen cannula in the right internal jugular vein...
January 19, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28107308/acute-right-heart-failure-after-hemorrhagic-shock-and-trauma-pneumonectomy-a-management-approach-a-blinded-randomized-controlled-animal-trial-using-inhaled-nitric-oxide
#19
Andrea L Lubitz, Lars O Sjoholm, Amy Goldberg, Abhijit Pathak, Thomas Santora, Thomas E Sharp, Markus Wallner, Remus M Berretta, Lauren A Poole, Jichuan Wu, Marla R Wolfson
BACKGROUND: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. Inhaled nitric oxide (iNO) lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure...
February 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28100527/transnasal-humidified-rapid-insufflation-ventilatory-exchange-thrive-in-children-a-randomized-controlled-trial
#20
S Humphreys, P Lee-Archer, G Reyne, D Long, T Williams, A Schibler
BACKGROUND: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was introduced to adult anaesthesia to improve the safety of airway management during apnoea before intubation. The objective of our study was to determine whether THRIVE safely prolongs apnoeic oxygenation in children. METHODS: This was a randomized controlled trial in 48 healthy children, with normal airways and cardiorespiratory function, in age groups 0-6 and 7-24 months, 2-5 and 6-10 yr old, presenting for elective surgery or imaging under general anaesthesia...
February 2017: British Journal of Anaesthesia
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