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https://www.readbyqxmd.com/read/28651419/-significance-of-evaluating-the-severity-of-patients-with-extremely-severe-burn-by-platelet-count-recovery-in-the-early-stage-post-burn
#1
Y Wu, Q Zhang, J Liu, J J Tang, J X Zheng, M Liu
Objective: To retrospectively analyze the prognostic value of platelet count recovery in the early stage post burn for patients with extremely severe burn, so as to evaluate their severity. Methods: A study involving 244 adult patients with extremely severe burn admitted to our hospital from January 2006 to December 2015, conforming to the inclusion criteria, was conducted. Data of their demography, injury, transmission, disease change in hospital, and platelet count from post injury day (PID) 1 to 10 were collected...
May 20, 2017: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
https://www.readbyqxmd.com/read/28650903/thigh-ultrasound-monitoring-identifies-decreases-in-quadriceps-femoris-thickness-as-a-frequent-observation-in-critically-ill-children
#2
Frederic V Valla, David K Young, Muriel Rabilloud, Uvaraj Periasami, Manoj John, Florent Baudin, Carole Vuillerot, Aurélie Portefaix, Deborah White, Jenna A Ridout, Rosan Meyer, Bénédicte Gaillard Le Roux, Etienne Javouhey, Nazima Pathan
OBJECTIVES: Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring...
June 23, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28650414/combined-thoracic-ultrasound-assessment-during-a-successful-weaning-trial-predicts-postextubation-distress
#3
Stein Silva, Dalinda Ait Aissa, Pierre Cocquet, Lucille Hoarau, Jean Ruiz, Fabrice Ferre, David Rousset, Michel Mora, Arnaud Mari, Olivier Fourcade, Béatrice Riu, Samir Jaber, Bénoît Bataille
BACKGROUND: Recent studies suggest that isolated sonographic assessment of the respiratory, cardiac, or neuromuscular functions in mechanically ventilated patients may assist in identifying patients at risk of postextubation distress. The aim of the present study was to prospectively investigate the value of an integrated thoracic ultrasound evaluation, encompassing bedside respiratory, cardiac, and diaphragm sonographic data in predicting postextubation distress. METHODS: Longitudinal ultrasound data from 136 patients who were extubated after passing a trial of pressure support ventilation were measured immediately after the start and at the end of this trial...
June 23, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28650070/the-human-ventilatory-response-to-stress-rate-or-depth
#4
Michael J Tipton, Abbi Harper, Julian F R Paton, Joseph T Costello
Many stressors cause an increase in ventilation in humans. This is predominantly reported as an increase in minute ventilation (V̇E ). But, the same V̇E can be achieved by a wide variety of changes in the depth (tidal volume, VT ) and number of breaths (respiratory frequency, ƒR). This review investigates the impact of stressors including: cold, heat, hypoxia, pain and panic on the contributions of ƒR and VT to V̇E to see if they differ with different stressors. Where possible we also consider the potential mechanisms that underpin the responses identified, and propose mechanisms by which differences in ƒR and VT are mediated...
June 26, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28649575/ecmo-in-major-burn-patients-feasibility-and-considerations-when-multiple-modes-of-mechanical-ventilation-fail
#5
Jason D Kennedy, Wesley Thayer, Reuben Beuno, Kelly Kohorst, Avinash B Kumar
BACKGROUND: We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant literature. CASE PRESENTATION: The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified Parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress syndrome...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28649385/the-practice-of-tracheostomy-decannulation-a-systematic-review
#6
REVIEW
Ratender Kumar Singh, Sai Saran, Arvind K Baronia
Decannulation is an essential step towards liberating tracheostomized patients from mechanical ventilation. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. Presence of an intact sensorium coordinated swallowing and protective coughing are often the minimum requirements for a successful decannulation. Objective criteria for each of these may help better the clinical judgement of decannulation. In this systematic review on decannulation, we focus attention to this important aspect of tracheostomy care...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28648859/ceftriaxone-versus-ceftriaxone-plus-a-macrolide-for-community-acquired-pneumonia-in-hospitalized-patients-with-hiv-aids-a-randomized-controlled-trial
#7
Claudia Figueiredo-Mello, Pontus Naucler, Marinella D Negra, Anna S Levin
OBJECTIVES: Evaluate if treatment with ceftriaxone and a macrolide, improved patient outcome when compared with monotherapy with ceftriaxone, in hospitalized patients with HIV/AIDS with community-acquired pneumonia (CAP). METHODS: Adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion (Brazilian Clinical Trials Registry: RBR-8wtq2b). The primary outcome was in-hospital mortality and the secondary outcomes were mortality within 14 days, need for vasoactive drugs, need for mechanical ventilation, time to clinical stability and length of hospitalization...
June 22, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28648671/late-complications-of-percutaneous-tracheostomy-using-the-balloon-dilation-technique
#8
J B Araujo, J M Añón, A García de Lorenzo, A M García-Fernandez, M Esparcia, J Adán, S Relanzon, D Quiles, V de Paz, A Molina
OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy...
June 22, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28648664/high-dose-ivig-successfully-reduces-high-rhgaa-igg-antibody-titers-in-a-crim-negative-infantile-pompe-disease-patient
#9
Mugdha Rairikar, Zoheb B Kazi, Ankit Desai, Crista Walters, Amy Rosenberg, Priya S Kishnani
Alglucosidase alfa (rhGAA) has altered the course of an otherwise fatal outcome in classic infantile Pompe disease (IPD), which presents with cardiomyopathy and severe musculoskeletal involvement. However, the response to therapy is determined by several factors including the development of high and sustained antibody titers (HSAT) to rhGAA. Cross-reactive immunologic material (CRIM) negative patients are at the highest risk for development of HSAT. Immune tolerance induction (ITI) with methotrexate, rituximab, and intravenous immunoglobulin (IVIG) has been largely successful in preventing the immune response and in achieving tolerance when done in conjunction with enzyme replacement therapy (ERT) initiation...
May 18, 2017: Molecular Genetics and Metabolism
https://www.readbyqxmd.com/read/28648309/economic-burden-of-community-acquired-pneumonia-among-pediatric-patients-aged-3-months-to-19-years-in-the-philippines
#10
Bernadette A Tumanan-Mendoza, Victor L Mendoza, Melchor Victor G Frias, Dolores D Bonzon
OBJECTIVE: 1) To determine the hospitalization, follow-up and total costs, and the economic burden of community-acquired pneumonia among pediatric patients aged 3 months to <19 years of age; 2) To compare the estimated cost of hospitalization to the pneumonia case rate payments of the Philippine Health Insurance Corporation (PhilHealth). METHODS: Using the societal perspective, both healthcare and non-healthcare costs were estimated. This was done through two tertiary private hospitals in the Philippines...
May 2017: Value in Health Regional Issues
https://www.readbyqxmd.com/read/28645982/a-multicentre-randomised-controlled-non-inferiority-trial-comparing-nasal-high-flow-with-nasal-continuous-positive-airway-pressure-as-primary-support-for-newborn-infants-with-early-respiratory-distress-born-in-australian-non-tertiary-special-care-nurseries
#11
Brett J Manley, Calum T Roberts, Gaston R B Arnolda, Ian M R Wright, Louise S Owen, Kim M Dalziel, Jann P Foster, Peter G Davis, Adam G Buckmaster
INTRODUCTION: Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. METHODS AND ANALYSIS: The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645964/the-predictive-value-of-serial-changes-in-diaphragm-function-during-the-spontaneous-breathing-trial-for-weaning-outcome-a-study-protocol
#12
Pengmin Zhou, Zhongheng Zhang, Yucai Hong, Huabo Cai, Hui Zhao, Peifeng Xu, Yiming Zhao, Shengping Lin, Xuchang Qin, JiaWei Guo, Yun Pan, Junru Dai
INTRODUCTION: There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS: This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645462/analgosedation-practices-and-the-impact-of-sedation-depth-on-clinical-outcomes-among-patients-requiring-mechanical-ventilation-in-the-emergency-department-a-cohort-study
#13
Robert J Stephens, Enyo Ablordeppey, Anne M Drewry, Christopher Palmer, Brian T Wessman, Nicholas M Mohr, Brian W Roberts, Stephen Y Liang, Marin H Kollef, Brian M Fuller
BACKGROUND: Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the intensive care unit influences outcome, this has not been investigated in the emergency department (ED). Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients, and to test the hypothesis that ED sedation depth is associated with worse outcomes METHODS: This was a cohort study on a prospectively compiled ED registry of adult, mechanically ventilated patients at a single academic medical center...
June 20, 2017: Chest
https://www.readbyqxmd.com/read/28644175/guillain-barr%C3%A3-syndrome-after-elective-spinal-surgery
#14
Eric Yensen Chen, Corinne Stratton, Brian Mercer, Anna Hohler, Tony Y Tannoury, Chadi Tannoury
Guillain-Barré syndrome is a rare autoimmune condition characterized by ascending motor weakness of the extremities that can ascend to the diaphragm, causing substantial morbidity and mortality. This case report describes a 57-year-old man who exhibited characteristics of Guillain-Barré syndrome 9 days after undergoing lumbar fusion at L3-S1. The diagnosis was based on the patient's ascending motor weakness and areflexia and was confirmed with electromyography. The patient progressed to respiratory failure, requiring mechanical ventilation...
June 21, 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28644040/hypoxic-pulmonary-vasoconstriction-does-not-explain-all-regional-perfusion-redistribution-in-asthma
#15
Vanessa J Kelly, Kathryn A Hibbert, Puja Kohli, Mamary Kone, Elliot E Greenblatt, Jose G Venegas, Tilo Winkler, R Scott Harris
RATIONALE: Regional hypoventilation in bronchoconstricted asthmatics is spatially associated with reduced perfusion, which is proposed to result from Hypoxic Pulmonary Vasoconstriction (HPV). Our study aimed to determine the role of HPV in the regional perfusion redistribution in bronchoconstricted asthmatics. METHODS: Eight asthmatics completed PET-CT lung imaging at baseline and after bronchoconstriction, breathing either Room Air or 80% Oxygen (80%O2, separate days)...
June 23, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28642106/ecmo-for-adult-respiratory-failure-2017-update
#16
REVIEW
Darryl Abrams, Daniel Brodie
The use of extracorporeal membrane oxygenation (ECMO) for respiratory failure in adults is growing rapidly, driven in large part by advances in technology, which have made ECMO devices easier to implement, safer and more efficient. Accompanying this increase in utilization is a nearly exponential increase in ECMO-related literature. However, the great majority of the literature is comprised of retrospective observational data, often in the form of single-center studies with relatively small numbers of subjects...
June 19, 2017: Chest
https://www.readbyqxmd.com/read/28641754/ventilation-modalities-in-infants-with-congenital-diaphragmatic-hernia
#17
Francesco Morini, Irma Capolupo, Willem van Weteringen, Irwin Reiss
Neonates with congenital diaphragmatic hernia are among the more complex patients to support with mechanical ventilation. They have particular features that add to the difficulties already present in the neonatal patient. A ventilation strategy tailored to the patient's underlying physiology rather than mode of ventilation is a crucial issue for clinicians treating these delicate patients.
June 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28641231/association-between-timing-of-intubation-and-outcome-in-critically-ill-patients-a-secondary-analysis-of-the-icon-audit
#18
Philippe R Bauer, Ognjen Gajic, Rahul Nanchal, Rahul Kashyap, Ignacio Martin-Loeches, Yasser Sakr, Stephan M Jakob, Bruno François, Xavier Wittebole, Richard G Wunderink, Jean-Louis Vincent
PURPOSE: The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. MATERIAL AND METHODS: In a secondary analysis of the large, prospective ICON database, we used a piecewise proportional hazards model to compare outcomes in patients who underwent intubation early (within two days after intensive care unit [ICU] admission) or later. RESULTS: After excluding 5340 patients already intubated on admission or with therapeutic limitation, 4729 patients were analyzed, of whom 4074 never underwent intubation...
June 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28640084/effect-of-dexmedetomidine-and-midazolam-for-flexible-fiberoptic-bronchoscopy-in-intensive-care-unit-patients-a-retrospective-study
#19
Yang Gao, Kai Kang, Haitao Liu, Liu Jia, Rong Tang, Xing Zhang, Hongliang Wang, Kaijiang Yu
This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n  =  72) and midazolam (n  =  76) groups according to sedative mode...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28640020/extubation-success-prediction-in-a-multicentric-cohort-of-patients-with-severe-brain-injury
#20
Karim Asehnoune, Philippe Seguin, Sigismond Lasocki, Antoine Roquilly, Adrien Delater, Antoine Gros, Florian Denou, Pierre-Joachim Mahé, Nicolas Nesseler, Dominique Demeure-Dit-Latte, Yoann Launey, Karim Lakhal, Bertrand Rozec, Yannick Mallédant, Véronique Sébille, Samir Jaber, Aurélie Le Thuaut, Fanny Feuillet, Raphaël Cinotti
BACKGROUND: Patients with brain injury are at high risk of extubation failure. METHODS: We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with brain injury. RESULTS: A total of 437 consecutive patients with brain injury were included, and 338 patients (77.3%) displayed successful extubation...
June 21, 2017: Anesthesiology
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