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https://www.readbyqxmd.com/read/29330683/cardiac-function-during-weaning-failure-the-role-of-diastolic-dysfunction
#1
Ferran Roche-Campo, Alexandre Bedet, Emmanuel Vivier, Laurent Brochard, Armand Mekontso Dessap
BACKGROUND: Cardiac dysfunction is a common cause of weaning failure. Weaning shares some similarities with a cardiac stress test and may challenge active phases of the cardiac cycle-like ventricular contractility and relaxation. This study aimed at assessing systolic and diastolic function during the weaning process and scrutinizing their dynamics during weaning trials. METHODS: Echocardiography was performed during baseline ventilator settings to assess cardiac function at the initiation of the weaning process and at the start and the end of consecutive weaning trials (performed at day-1, day-2, and before extubation if applicable) to explore the evolution of left ventricle contractility and relaxation in a subset of patients...
January 9, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29329913/predicting-extubation-outcomes-a-model-incorporating-heart-rate-characteristics-index
#2
Nitin Goel, Mallinath Chakraborty, William John Watkins, Sujoy Banerjee
OBJECTIVE: To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. STUDY DESIGN: HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline)...
January 10, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29284879/a-comparison-of-dexmedetomidine-and-clonidine-in-attenuating-the-hemodynamic-responses-at-various-surgical-stages-in-patients-undergoing-elective-transnasal-transsphenoidal-resection-of-pituitary-tumors
#3
Summaira Jan, Zulfiqar Ali, Yasir Nisar, Imtiaz Ahmad Naqash, Syed Amer Zahoor, Shabir Ahmad Langoo, Khan Azhar
Background: Transsphenoidal approach to pituitary tumors is a commonly performed procedure with the advantage of a rapid midline access to the sella with minimal complications. It may be associated with wide fluctuations in hemodynamic parameters due to intense noxious stimulus at various stages of the surgery. As duration of the surgery is short and the patients have nasal packs, it is prudent to use an anesthestic technique with an early predictable recovery. Materials and Methods: A total of 60 patients of either sex between 18 and 65 years of age, belonging to the American Society of Anesthesiologists I and II who were undergoing elective transnasal transsphenoidal pituitary surgery were chosen for this study...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#4
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29232299/the-axillary-intra-aortic-balloon-pump-as-a-bridge-to-recovery-allows-early-ambulation-in-long-term-use-case-series-and-literature-review
#5
Nnamdi Nwaejike, Andre Y Son, Chetan B Patel, Jacob N Schroder, Carmelo A Milano, Mani A Daneshmand
We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with postcardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identified. Intra-aortic balloon pump was tunneled through a 6-mm Dacron graft anastomosed to the right axillary artery. The intra-aortic balloon pump catheter is advanced under fluoroscopic guidance into the descending thoracic aorta...
November 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29208754/proactive-use-of-high-flow-nasal-cannula-with-critically-ill-subjects
#6
Keith D Lamb, Sarah K Spilman, Trevor W Oetting, Julie A Jackson, Matthew W Trump, Sheryl M Sahr
INTRODUCTION: It has been suggested that use of a high-flow nasal cannula (HFNC) could be a first-line therapy for patients with acute hypoxic respiratory failure. The purpose of this study was to determine if protocolized use of HFNC decreases unplanned intubation and adverse outcomes in an ICU population. METHODS: The study was a prospective evaluation of 2 cohorts who received HFNC per protocol. Control groups were retrospective selections of subjects who received HFNC in the pre-protocol period...
December 5, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29184049/does-diaphragmatic-electrical-activity-in-preterm-infants-predict-extubation-success
#7
Neetu Singh, Matthew J McNally, Robert A Darnall
BACKGROUND: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EAdi), a measure of neural respiratory drive and inspiratory load, may be a useful predictor of extubation success in preterm neonates. The objective of this work was to investigate whether peak EAdi could distinguish successful versus failed extubation in mechanically ventilated preterm infants...
November 28, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29145331/severe-hemodynamic-instability-after-indocyanine-green-injection-during-off-pump-coronary-artery-bypass-grafting-a-case-report
#8
Qing Zhai, Yun Wang, Ayong Tian
RATIONALE: The increasingly intraoperative use of indocyanine green (ICG) means that it is necessary to be aware of both its advantages and potential adverse effects. PATIENT CONCERNS: A 76-year-old woman developed symptoms of sudden severe hemodynamic instability while undergoing coronary artery bypass grafting with ICG injection to detect the patency of the graft. The main clinical manifestations were a sudden drop in blood pressure and increased heart rate. DIAGNOSES: Severe side effects or allergic reaction of ICG...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29137579/assessment-of-the-reliability-of-intubation-and-ease-of-use-of-the-cook-staged-extubation-set-an-observational-study
#9
C Furyk, M L Walsh, I Kaliaperumal, S Bentley, C Hattingh
The Staged Extubation Set has recently been introduced by Cook Medical for the management of difficult airway patients who potentially require reintubation; however, its reliability for intubation and ease of use is not reported in the literature. The set contains a wire and reintubation catheter with a central lumen for the wire and oxygenation if required. Reintubation is by a two-stage Seldinger-like technique. After induction of general anaesthesia, 23 low-risk elective surgical patients had the Staged Extubation Wire from the Cook set inserted into their trachea under direct laryngoscopy...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#10
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29098448/incidence-of-airway-complications-in-patients-using-endotracheal-tubes-with-continuous-aspiration-of-subglottic-secretions
#11
Jordi Vallés, Susana Millán, Emili Díaz, Eva Castanyer, Xavier Gallardo, Ignacio Martín-Loeches, Marta Andreu, Mario Prenafeta, Paula Saludes, Jorge Lema, Montse Batlle, Néstor Bacelar, Antoni Artigas
BACKGROUND: Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS: In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation...
November 2, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29066587/heart-rate-variability-in-extremely-preterm-infants-receiving-nasal-cpap-and-non-synchronized-noninvasive-ventilation-immediately-after-extubation
#12
Samantha Latremouille, Ali Al-Jabri, Philippe Lamer, Lara Kanbar, Wissam Shalish, Robert E Kearney, Guilherme M Sant'Anna
INTRODUCTION: There is a paucity of studies comparing the physiological effects of nasal CPAP or non-synchronized noninvasive ventilation (ns-NIV) during the postextubation phase in preterm infants. Heart rate variability (HRV) can identify system instability before clinical or laboratory signs of deterioration. Thus, we sought to investigate any differences in HRV between those modes. METHODS: 15 preterm infants with birthweight ≤1,250 g and undergoing their first extubation attempt were studied immediately after disconnection from mechanical ventilation...
January 2018: Respiratory Care
https://www.readbyqxmd.com/read/29060650/nonlinear-dynamic-analysis-of-the-cardiorespiratory-system-in-patients-undergoing-the-weaning-process
#13
J I Trapero, C J Arizmendi, H Gonzalez, C Forero, B F Giraldo
In this work, the cardiorespiratory pattern of patients undergoing extubation process is studied. First, the respiratory and cardiac signals were resampled, next the Symbolic Dynamics (SD) technique was implemented, followed of a dimensionality reduction applying Forward Selection (FS) and Moving Window with Variance Analysis (MWVA) methods. Finally, the Linear Discriminant Analysis (LDA) and Support Vector Machines (SVM) classifiers were used. The study analyzed 153 patients undergoing weaning process, classified into 3 groups: Successful Group (SG: 94 patients), Failed Group (FG: 39 patients), and patients who had been successful during the extubation and had to be reintubated before 48 hours, Reintubated Group (RG: 21 patients)...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29026677/bedside-ultrasound-in-the-diagnosis-and-treatment-of-children-with-respiratory-difficulty-following-cardiac-surgery
#14
REVIEW
Hussam Kanaan Hamadah, Mohamed Salim Kabbani
Many children frequently fail extubation or require a prolonged period of positive pressure ventilation support after cardiac surgery. Pediatric cardiac Intensive Care Unit (PCICU) ultrasound (US) stands as a simple, basic bedside tool that can be performed by trained intensivists for the diagnosis with immediate implication on therapeutic decisions in multiple scenarios that physicians may face in PCICU. Bedside US is widely available, convenient, and inexpensive. This educational article based mainly on our own experience is highlighting the role of US in detecting the most common causes of respiratory weaning difficulties and extubation failure in postoperative cardiac children through proposed illustration and algorithm...
2017: Journal of Clinical Imaging Science
https://www.readbyqxmd.com/read/29019905/bezold-jarisch-reflex-occurred-in-a-pediatric-patient-with-giant-intra-abdominal-teratoma-during-induction-of-anesthesia-a-case-report
#15
Kai-Ming Yuan, Shu-Ying Fu, Jun Li, Wang-Ning Shangguan, Qing-Quan Lian
RATIONALE: Bezold-Jarisch reflex (BJR) occurs when the cardioinhibitory receptors in the walls of ventricles are activated by various stimuli, with typical features of bradycardia, vasorelaxation, and hypotension. This reflex usually happens in parturient intrathecal anesthesia, as a result of decreased venous return by compression of inferior vena cava, but it is only rarely reported during general anesthesia. PATIENT CONCERNS: Severe bradycardia and hypotension, indicating BJR, occurred during the induction of general anesthesia in a 3-month-old female child with giant intra-abdominal teratoma...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28974998/successful-use-of-ketamine-for-central-neurogenic-hyperventilation-a-case-report
#16
G Morgan Jones, Adam L Wiss, Nitin Goyal, Jason J Chang
This report describes the use of ketamine in a patient with central neurogenic hyperventilation following intracerebral hemorrhage. A 41-year-old man was admitted with right thalamic intracerebral hemorrhage with intraventricular extension requiring emergent external ventricular drain placement. After aggressive management of his neurologic status and other associated complications, the patient subacutely developed an altered respiratory pattern characterized by shallow, rapid breaths. After the use of multiple sedative agents to control respiratory drive had failed, a single 2 mg/kg bolus dose of intravenous ketamine was administered...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28948503/extubating-the-neurocritical-care-patient-a-spontaneous-breathing-trial-algorithmic-approach
#17
Naresh Mullaguri, Zalan Khan, Premkumar Nattanmai, Christopher R Newey
BACKGROUND: Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28937423/deep-serratus-plane-catheter-for-management-of-acute-postthoracotomy-pain-after-descending-aortic-aneurysm-repair-in-a-morbidly-obese-patient-a-case-report
#18
Renuka M George, Maria Yared, Sylvia H Wilson
Regional procedures for postthoracotomy pain control have classically focused on paravertebral blocks and thoracic epidurals; however, these techniques may be challenging in an increasingly obese population and contraindicated with numerous anticoagulant and antiplatelet agents. While less studied, truncal blocks allow analgesic intervention for this growing patient cohort. This case report describes placement of a deep serratus anterior plane catheter in an intubated, morbidly obese patient with a lumbar drain who failed extubation secondary to acute postthoracotomy pain...
September 20, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28922269/extubation-failure-is-associated-with-increased-mortality-following-first-stage-single-ventricle-reconstruction-operation
#19
Thomas Scodellaro, Jane M McKenzie, Yves d'Udekem, Warwick Butt, Siva P Namachivayam
OBJECTIVES: To identify the prevalence, causes, risk factors, and outcomes associated with extubation failure following first stage single ventricle reconstruction surgery. DESIGN: Retrospective cohort analysis of neonates who underwent a first stage single ventricle reconstruction operation. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt. SETTING: The Royal Children's Hospital, Melbourne...
December 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28919813/a-prospective-double-blinded-randomized-comparison-of-ultrasound-guided-femoral-nerve-block-with-lateral-femoral-cutaneous-nerve-block-versus-standard-anesthetic-management-for-pain-control-during-and-after-traumatic-femur-fracture-repair-in-the-pediatric-population
#20
Nicole M Elsey, Joseph D Tobias, Kevin E Klingele, Ralph J Beltran, Tarun Bhalla, David Martin, Giorgio Veneziano, Julie Rice, Dmitry Tumin
BACKGROUND: Traumatic injury of the femur resulting in femoral fracture may result in significant postoperative pain. As with other causes of acute pain, regional anesthesia may offer a benefit over conventional therapy with intravenous opioids. This study prospectively assesses the effects of femoral nerve blockade with a lateral femoral cutaneous nerve block (FN-LFCN) on intraoperative anesthetic requirements, postoperative pain scores, and opioid requirements. MATERIALS AND METHODS: Seventeen pediatric patients (age 2-18 years) undergoing surgical repair of a traumatic femur fracture fulfilled the study criteria and were randomly assigned to general anesthesia with either an FN-LFCN block (n = 10) or intravenous opioids (n = 7)...
2017: Journal of Pain Research
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