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https://www.readbyqxmd.com/read/28338483/prevalence-and-impact-on-weaning-of-pleural-effusion-at-the-time-of-liberation-from-mechanical-ventilation-a-multicenter-prospective-observational-study
#1
Martin Dres, Damien Roux, Tài Pham, Alexandra Beurton, Jean-Damien Ricard, Muriel Fartoukh, Alexandre Demoule
BACKGROUND: Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown. METHODS: In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h...
March 24, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28270888/how-mechanical-ventilation-measurement-cutoff-and-duration-affect-rapid-shallow-breathing-index-accuracy-a-randomized-trial
#2
Elaine Cristina Goncalves, Alessandra Fabiane Lago, Elaine Caetano Silva, Marcelo Barros de Almeida, Anibal Basile-Filho, Ada Clarice Gastaldi
BACKGROUND: Decreased accuracy of the rapid shallow breathing index (RSBI) can stem from 1) the method used to obtain this index, 2) duration of mechanical ventilation (MV), and 3) the established cutoff point. The objective was to evaluate the values of RSBI determined by three different methods, using distinct MV times and cutoff points. METHODS: This prospective study included 40 subjects. Before extubation, three different methods were employed to measure RSBI: pressure support ventilator (PSV) (PSV = 5 - 8 cm H2O; positive end-expiratory pressure (PEEP) = 5 cm H2O) (RSBI_MIN), automatic tube compensation (ATC) (PSV = 0, PEEP = 5 cm H2O, and 100% tube compensation) (RSBI_ATC), and disconnected MV (RSBI_SP)...
April 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28259455/variation-in-extubation-failure-rates-after-neonatal-congenital-heart-surgery-across-pediatric-cardiac-critical-care-consortium-hospitals
#3
Brian D Benneyworth, Christopher W Mastropietro, Eric M Graham, Darren Klugman, John M Costello, Wenying Zhang, Michael Gaies
OBJECTIVE: In a multicenter cohort of neonates recovering from cardiac surgery, we sought to describe the epidemiology of extubation failure and its variability across centers, identify risk factors, and determine its impact on outcomes. METHODS: We analyzed prospectively collected clinical registry data on all neonates undergoing cardiac surgery in the Pediatric Cardiac Critical Care Consortium database from October 2013 to July 2015. Extubation failure was defined as reintubation less than 72 hours after the first planned extubation...
February 4, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28183550/airway-management-for-glossopexy-in-infants-with-micrognathia-and-obstructive-breathing
#4
Yoshinari Morimoto, Aiko Ohyamaguchi, Mika Inoue, Chizuko Yokoe, Hiroshi Hanamoto, Uno Imaizumi, Mitsutaka Sugimura, Hitoshi Niwa
STUDY OBJECTIVES: To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. DESIGN: Retrospective, observational study. SETTINGS: Operating room of a university hospital between January 2003 and March 2015. All operations were performed by oral and maxillofacial surgeons. PATIENTS: Thirteen patients who received general anesthesia for glossopexy and reversal after 7 months...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28167019/treatment-of-bronchial-foreign-body-aspiration-with-extracorporeal-life-support-in-a-child-a-case-report-and-literature-review
#5
REVIEW
Li Deng, Baichun Wang, Yan Wang, Lifeng Xiao, Hongyu Liu
We present a case in which extracorporeal life support treatment of a 6-year-old girl asphyxiated by aspiration of an elliptic plastic ball is described. The attempts for extraction of the foreign body by conventional bronchoscopy under critically ill conditions had failed. Thus, a skin incision was made in the midline, and an emergency open-chest cardiopulmonary bypass (CPB) with aortic, superior vena cava and inferior vena cava cannulation was performed for circulatory support. Following tracheal extubation, a video-assisted rigid bronchoscope was inserted to clear the airway and remove the foreign body...
March 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28146296/nasal-intermittent-positive-pressure-ventilation-nippv-versus-nasal-continuous-positive-airway-pressure-ncpap-for-preterm-neonates-after-extubation
#6
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/28139937/risk-factors-for-tracheostomy-requirement-in-extremely-low-birth-weight-infants
#7
Orly L Levit, Veronika Shabanova, Alia Bazzy-Asaad, Matthew J Bizzarro, Vineet Bhandari
AIM: To identify variables that affect the risk of tracheostomy in a population of extremely low birth weight (ELBW) infants. METHODS: A retrospective matched case-control study was conducted. ELBW infants with a tracheostomy were compared with controls without tracheostomy. Data collection included demographics, detailed information about each intubation and extubation attempt, the use of steroids and the presence of comorbidities. Statistical analyses include conditional logistic regression and Poisson regression for clustered observations...
February 21, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28118771/risk-factors-associated-with-failure-of-extubation-in-very-low-birth-weight-newborns
#8
Slobodan Spasojevic, Aleksandra Doronjski
AIM: To identify risk factors associated with the failure of extubation of mechanically ventilated very-low-birth-weight newborns. STUDY DESIGN: Prospective observational study. Assessment of the occurrence of extubation failure in relation to demographic and ventilation parameters, the SpO2/FiO2 ratio, the spontaneous breathing test (SBT) and values of the Silverman-Andersen score (SAS). Extubation failure was defined as the need for reintubation for any reason within 72 h after extubation...
February 21, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28097852/laryngotracheal-edema-due-to-thermal-injury-a-complication-after-thyroidectomy-in-children
#9
Pinar Kendigelen, Ayse C Tutuncu, Gulruh Ashyralyyeva, Senol Emreb, Seval Urkmez, Tughan Utkua, Guner Kaya
Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions...
February 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28074818/cannulation-strategies-in-adult-veno-arterial-and-veno-venous-extracorporeal-membrane-oxygenation-techniques-limitations-and-special-considerations
#10
REVIEW
Arun L Jayaraman, Daniel Cormican, Pranav Shah, Harish Ramakrishna
Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28063686/extubation-failure-after-neonatal-cardiac-surgery-a-multicenter-analysis
#11
Christopher W Mastropietro, Katherine Cashen, Lisa M Grimaldi, Keshava Murty Narayana Gowda, Kurt D Piggott, Michael Wilhelm, Eleanor Gradidge, Elizabeth A S Moser, Brian D Benneyworth, John M Costello
OBJECTIVES: To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease. STUDY DESIGN: We conducted a prospective observational study of neonates ≤30 days of age who underwent cardiac surgery at 7 centers within the US in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified with the use of multivariable logistic regression analysis and reported as OR with 95% CIs...
March 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28063121/monitoring-of-electrical-activity-of-the-diaphragm-shows-failure-of-t-piece-trial-earlier-than-protocol-based-parameters-in-prolonged-weaning-in-non-communicative-neurological-patients
#12
Oliver Trapp, Mascha Fiedler, Michael Hartwich, Martin Schorl, Armin Kalenka
BACKGROUND: The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion...
January 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054235/heated-humidified-high-flow-nasal-cannula-for-prevention-of-extubation-failure-in-preterm-infants
#13
Sasivimon Soonsawad, Buranee Swatesutipun, Anchalee Limrungsikul, Pracha Nuntnarumit
OBJECTIVES: To compare extubation failure rate between the heated humidified high-flow nasal cannula (HHHFNC) and continuous positive airway pressure (CPAP) groups. METHODS: Intubated infants with gestational age (GA) <32 wk, who were ready to extubate, were randomized to receive respiratory support with either CPAP or HHHFNC after extubation. In CPAP group, nasal mask CPAP with preset pressure and fraction of inspired oxygen (FiO2) equal to positive end-expiratory pressure (PEEP) and FiO2 of ventilator before extubation was applied...
January 5, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/27955899/nasa-model-of-threat-and-error-in-pediatric-cardiac-surgery-patterns-of-error%C3%A2-chains
#14
Edward Hickey, Eric Pham-Hung, Yaroslavna Nosikova, Fredrik Halvorsen, Michael Gritti, Steven Schwartz, Christopher A Caldarone, Glen Van Arsdell
BACKGROUND: We introduced the National Aeronautics and Space Association threat-and-error model to our surgical unit. All admissions are considered flights, which should pass through stepwise deescalations in risk during surgical recovery. We hypothesized that errors significantly influence risk deescalation and contribute to poor outcomes. METHODS: Patient flights (524) were tracked in real time for threats, errors, and unintended states by full-time performance personnel...
December 9, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27927604/factors-predicting-failure-of-noninvasive-ventilation-assist-for-preventing-reintubation-among-medical-critically-ill-patients
#15
Preecha Thomrongpairoj, Surat Tongyoo, Withaya Tragulmongkol, Chairat Permpikul
PURPOSE: Reintubation after failed extubation is associated with high mortality. Noninvasive ventilation (NIV) has been used to prevent reintubation, but the results have been inconclusive. We investigated the factors predicting failure of NIV-assisted extubation among medical critically ill patients. MATERIALS AND METHODS: This retrospective cohort study enrolled patients who were admitted to medical intensive care units at Siriraj Hospital between March 2012 and August 2015 who required more than 48 hours of mechanical ventilation and who received NIV after endotracheal extubation...
April 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27899469/emergency-surgical-airways-following-activation-of-a-difficult-airway-management-team-in-hospitalized-critically-ill-patients-a-case-series
#16
REVIEW
Joseph M Darby, Gregory Halenda, Courtney Chou, Joseph J Quinlan, Louis H Alarcon, Richard L Simmons
INTRODUCTION: An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. METHODS: We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT)...
November 28, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27836002/cardiac-dysfunction-induced-by-weaning-from-mechanical-ventilation-incidence-risk-factors-and-effects-of-fluid-removal
#17
Jinglun Liu, Feng Shen, Jean-Louis Teboul, Nadia Anguel, Alexandra Beurton, Nadia Bezaz, Christian Richard, Xavier Monnet
BACKGROUND: Weaning-induced pulmonary oedema (WiPO) is a well-recognised cause of failure of weaning from mechanical ventilation, but its incidence and risk factors have not been reliably described. We wanted to determine the incidence and risk factors in a population of critically ill patients. In addition, we wanted to describe the effects of diuretics when they are administered in this context. METHODS: We monitored 283 consecutive spontaneous breathing trials (SBT; T-piece trial) performed in 81 patients...
November 12, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27762595/an-official-american-thoracic-society-american-college-of-chest-physicians-clinical-practice-guideline-liberation-from-mechanical-ventilation-in-critically-ill-adults-rehabilitation-protocols-ventilator-liberation-protocols-and-cuff-leak-tests
#18
Timothy D Girard, Waleed Alhazzani, John P Kress, Daniel R Ouellette, Gregory A Schmidt, Jonathon D Truwit, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy Fan, Miguel Ferrer, Gilles L Fraser, Michelle Ng Gong, Catherine L Hough, Sangeeta Mehta, Rahul Nanchal, Sheena Patel, Amy J Pawlik, William D Schweickert, Curtis N Sessler, Thomas Strøm, Kevin C Wilson, Peter E Morris
BACKGROUND: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults. METHODS: Two methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation...
January 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27758969/extracorporeal-membrane-oxygenation-support-for-life-threatening-acute-severe-status-asthmaticus
#19
Gabriella Di Lascio, Edvin Prifti, Elmi Messai, Adriano Peris, Guy Harmelin, Roland Xhaxho, Albana Fico, Guido Sani, Massimo Bonacchi
INTRODUCTION: Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure due to asthma that is unresponsive to standard therapeutic measures. We used extracorporeal membrane oxygenation (ECMO) to treat patients with near-fatal status asthamticus who did not respond to aggressive medical therapies and mechanical ventilation under controlled permissive hypercapnia. MATERIALS AND METHODS: Between January 2011 and October 2015, we treated 16 adult patients with status asthmaticus (8 women, 8 men, mean age: 50...
October 6, 2016: Perfusion
https://www.readbyqxmd.com/read/27741103/establishing-predictors-for-successfully-planned-endotracheal-extubation
#20
Chih-Cheng Lai, Chin-Ming Chen, Shyh-Ren Chiang, Wei-Lun Liu, Shih-Feng Weng, Mei-I Sung, Shu-Chen Hsing, Kuo-Chen Cheng
The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded...
October 2016: Medicine (Baltimore)
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