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Prone ventilation

Christian Svendsen Juhl, Martin Ballegaard, Morten H Bestle, Peer Tfelt-Hansen
Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by external compression of the nerve during its course close to the anterior superior iliac spine. We present a case of a patient with acute respiratory distress induced by Legionella pneumonia who was admitted to the intensive care unit (ICU) for mechanical ventilation. In the ICU, the patient received one session of prone position ventilation for 8.5 consecutive hours. At evaluation six months later, the patient reported persistent bilateral numbness of the anterolateral thigh, which he complained had begun right after he woke up at the ICU...
2016: Case Reports in Critical Care
Sheetal Gupta, Ghanshyam Singh Sengar, Praveen K Meti, Anil Lahoti, Mukesh Beniwal, Murlidhar Kumawat
OBJECTIVE: To determine incidence, risk factors, and outcome of acute kidney injury (AKI) in Pediatric Intensive Care Unit (PICU). MATERIALS AND METHODS: This is a prospective, observational study conducted in PICU of Department of Paediatrics, S.P. Medical College, Bikaner, from October 2013 to May 2014. In this study, 536 patients of aged 29 days to 16 years were screened for AKI according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria...
September 2016: Indian Journal of Critical Care Medicine
Andrea Schlegel, Michael Linecker, Philipp Kron, Georg Györi, Michelle L De Oliveira, Beat Müllhaupt, Pierre-Alain Clavien, Philipp Dutkowski
Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high MELD cohort (lab MELD≥30, n=100, median lab MELD of 35 (IQR: 31-37) of liver transplant recipients at our center over the last ten years, and compared results with a low MELD group, matched by propensity scoring for donor age, recipient age and cold ischemia. Endpoints of our study were cumulative post-transplant morbidity, cost, and survival. Six different prediction models, including D-MELD, Delta MELD, DRI, SOFT, BAR, and UCLA-FRS, were applied in both cohorts to identify risk for poor outcome and high cost...
September 27, 2016: American Journal of Transplantation
Anna Brzęk, Anna Famuła, Anna Kowalczyk, Ryszard Plinta
BACKGROUND: Wind instruments musicians are particularly prone to excessive respiratory efforts. Prolonged wind instruments performing may lead to changes in respiratory tracts and thus to respiratory muscles overload. It may result in decreasing lung tissue pliability and, as a consequence, in emphysema. Aim of the research has been to describe basic spirometric parameters for wind players and causes of potential changes. MATERIAL AND METHODS: Slow and forced spirometry with the use of Micro Lab Viasys (Micro Medical, Great Britain) was conducted on 31 wind musicians (group A)...
2016: Medycyna Pracy
Mats J Johansson, John-Peder Escobar Kvitting, Torun Flatebø, Anne Nicolaysen, Gunnar Nicolaysen, Sten M Walther
BACKGROUND: Local formation of nitric oxide in the lung induces vasodilation in proportion to ventilation and is a putative mechanism behind ventilation-perfusion matching. We hypothesized that regional ventilation-perfusion matching occurs in part due to local constitutive nitric oxide formation. METHODS: Ventilation and perfusion were analyzed in lung regions (≈1.5 cm) before and after inhibition of constitutive nitric oxide synthase with N-nitro-L-arginine methyl ester (L-NAME) (25 mg/kg) in 7 prone sheep ventilated with 10 cm H2O positive end-expiratory pressure...
September 12, 2016: Anesthesia and Analgesia
A A Sayampanathan
OBJECTIVES: We aimed to understand the effect diabetes plays on the extent of complications and patient outcomes in burn trauma. METHODOLOGY: We searched MEDLINE, Science Direct and the Cochrane Review Database for 571 articles. Through our selection criteria, 12 articles were selected for systematic review and meta-analysis. Data was analysed via Review Manager 5.3, using Mantel-Haenszel statistics and random effect models. RESULTS: The odds of a diabetic patient sustaining a wound or local infection was 2...
August 29, 2016: Burns: Journal of the International Society for Burn Injuries
Roberto Roncon-Albuquerque, João Ferreira-Coimbra, Rodrigo Vilares-Morgado, Paulo Figueiredo, José Artur Paiva
BACKGROUND: During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2; PF ratio reflects native and artificial lung blood oxygenation). In this study we analyzed PF ratio during ECMO support and its association with clinical outcome. METHODS: This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome...
September 1, 2016: Annals of Thoracic Surgery
Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
Manila Singh, Rajeev Uppal, Kapil Chaudhary, Amit Javed, Anil Aggarwal
Minimally invasive and hybrid minimally invasive esophagectomy (MIE) is a technically challenging procedure. Anesthesia for the same is equally challenging due to special requirements of the video-assisted thoracoscopic technique used and shared operative and respiratory fields. Standard ventilatory strategy for this kind of surgery has been 1-lung ventilation with the help of a double-lumen tube. Prone positioning for thoracoscopic dissection facilitates gravity-dependant collapse of the operative side lung induced by a unilateral capnothorax, thus making the use of single-lumen endotracheal tube a feasible option for this surgery...
September 2016: Journal of Clinical Anesthesia
C Hermes, P Nydahl, D Henzler, T Bein
The 2007 guidelines "Positioning for prophylaxis and therapy of pulmonary disorders" were completely revised in 2015 on behalf of the German Society of Anaesthesiology and Intensive Care Medicine. With regard to practical and scientific relevance, early mobilization of patients in critical care has been included in the guidelines for the first time. Furthermore, the recommendations for prone positioning have been updated, based on current evidence in medicine and nursing. In addition, recommendations regarding unsuitable positions that may actually harm patients were made...
September 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
A Biermann, A Geissler
BACKGROUND: Diagnosis-related groups (DRGs) have been used to reimburse hospitals services in Germany since 2003/04. Like any other reimbursement system, DRGs offer specific incentives for hospitals that may lead to unintended consequences for patients. In the German context, specific procedures and their documentation are suspected to be primarily performed to increase hospital revenues. Mechanical ventilation of patients and particularly the duration of ventilation, which is an important variable for the DRG-classification, are often discussed to be among these procedures...
September 2016: Der Anaesthesist
Fernanda F Cruz, Daniel J Weiss, Patricia R M Rocco
INTRODUCTION: Despite progress in understanding the pathophysiology of the acute respiratory distress syndrome (ARDS), it remains a devastating clinical disorder associated with high mortality rates, and those who survive can experience significant long-term morbidity. Recent advances in the management of ARDS have mostly been achieved in supportive care, including the use of protective mechanical ventilation, neuromuscular blocking agents, prone positioning, and conservative fluid strategies...
August 4, 2016: Expert Opinion on Biological Therapy
Alexis Paternot, Xavier Repessé, Antoine Vieillard-Baron
Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy...
October 2016: Respiratory Care
G F Curley, J G Laffey, H Zhang, A S Slutsky
The pathophysiological mechanisms by which mechanical ventilation can contribute to lung injury - termed ventilator induced lung injury (VILI) - is increasingly well understood. "Biotrauma" describes release of mediators by injurious ventilatory strategies, which can lead to lung and distal organ injury. Insights from preclinical models demonstrating that traditional high tidal volumes drove the inflammatory response helped lead to clinical trials demonstrating lower mortality in patients ventilated with a lower tidal volume strategy...
July 28, 2016: Chest
Claude Guerin, Luciano Gattinoni
No abstract text is available yet for this article.
October 2016: Intensive Care Medicine
Gloria-Beatrice Wintermann, Kerstin Weidner, Bernhard Strauß, Jenny Rosendahl, Katja Petrowski
BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients...
December 2016: Annals of Intensive Care
Eric L Scholten, Jeremy R Beitler, G Kim Prisk, Atul Malhotra
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in the acute respiratory distress syndrome (ARDS). Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiology mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proven challenging; several contemporary trials showed no major clinical benefits with proning...
July 8, 2016: Chest
Guillermo Dominguez-Cherit, Alethse De la Torre, Asgar Rishu, Ruxandra Pinto, Silvio A Ñamendys-Silva, Adrián Camacho-Ortiz, Marco Antonio Silva-Medina, Carmen Hernández-Cárdenas, Michel Martínez-Franco, Alejandro Quesada-Sánchez, Guadalupe Celia López-Gallegos, Juan L Mosqueda-Gómez, Norma E Rivera-Martinez, Fernando Campos-Calderón, Eduardo Rivero-Sigarroa, Thierry Hernández-Gilsoul, Lourdes Espinosa-Pérez, Alejandro E Macías, Dolores M Lue-Martínez, Christian Buelna-Cano, Ana-Sofía Ramírez-García Luna, Nestor G Cruz-Ruiz, Manuel Poblano-Morales, Fernando Molinar-Ramos, Martin Hernandez-Torre, Marco Antonio León-Gutiérrez, Oscar Rosaldo-Abundis, José Ángel Baltazar-Torres, Henry T Stelfox, Bruce Light, Philippe Jouvet, Steve Reynolds, Richard Hall, Nikki Shindo, Nick Daneman, Robert A Fowler
OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria...
October 2016: Critical Care Medicine
Winward Choy, Zachary A Smith, Stephanus V Viljoen, Timothy E Lindley, Nader S Dahdaleh
We report a unique instance of a 66-year-old male patient with an unstable three-column thoracic extension injury at the level of T4/5 who was treated with recumbency and bracing without surgery. A posterior long segment fixation was attempted three times on two separate occasions over the course of a week with failure due to difficulty in ventilating the patient during prone positioning, cardiopulmonary arrest, and hemodynamic instability during prone positioning for surgery. The decision then was to treat this fracture with recumbency...
2016: Curēus
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