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Prolonged mechanical ventilation

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https://www.readbyqxmd.com/read/29921058/-management-strategies-of-granulation-in-tracheal-post-tracheostomy-caused-by-prolonged-mechanical-ventilation
#1
Y Yang, L Y Wang, L Zhang, X Y Wang, H T Song, W N Huang
Objective: To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation. Method: We treated the patients with airway stenosis caused by granulation tissue. The patients with grade Ⅰ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube, and the holmium laser under a fibro-laryngoscope were applied for the patients with grade Ⅲ airway stenosis.Two hundred and sixteen patients were enrolled in this study. Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia, accounting for 20...
June 5, 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
https://www.readbyqxmd.com/read/29907270/avoiding-respiratory-and-peripheral-muscle-injury-during-mechanical-ventilation-diaphragm-protective-ventilation-and-early-mobilization
#2
REVIEW
Annia Schreiber, Michele Bertoni, Ewan C Goligher
Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907209/using-artificial-intelligence-to-predict-prolonged-mechanical-ventilation-and-tracheostomy-placement
#3
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29903030/diastolic-dysfunction-is-common-and-predicts-outcome-after-cardiac-surgery
#4
Thomas S Metkus, Alejandro Suarez-Pierre, Todd C Crawford, Jennifer S Lawton, Lee Goeddel, Jeffrey Dodd-O, Monica Mukherjee, Theodore P Abraham, Glenn J Whitman
BACKGROUND: Diastolic dysfunction (DD) identified on echocardiography predicts mortality after cardiac surgery, however the most useful diastolic parameters for assessment and the association of DD with prolonged mechanical ventilation, ICU re-admission, and hospital length of stay are not established. METHODS: We included patients that underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure (CAB-AVR) from 2010 to 2016, and who had preoperative transthoracic echocardiography (TTE) at our institution within 6 months of the operation...
June 15, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29898662/decannulation-of-tracheotomized-patients-after-long-term-mechanical-ventilation-results-of-a-prospective-multicentric-study-in-german-neurological-early-rehabilitation-hospitals
#5
Maria-Dorothea Heidler, Annett Salzwedel, Michael Jöbges, Olaf Lück, Christian Dohle, Michael Seifert, Andrea von Helden, Wibke Hollweg, Heinz Völler
BACKGROUND: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. METHODS: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 ± 12.9 years, 68% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e...
June 13, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29898149/on-pump-beating-non-beating-cabg-in-stable-angina-have-similar-outcomes
#6
Victor Dayan, Juan Jose Paganini, Alvaro Marichal, Daniel Brusich
OBJECTIVE: On pump beating/non-beating coronary artery bypass grafts (CABG) has been compared in patients with unstable angina and/or severe left ventricular dysfunction. There is scarce evidence regarding the beneficial use of on-pump beating CABG in patients with stable angina and normal left ventricular function. Our aim was to study the postoperative results using both techniques in this group of patients. METHODS: One thousand one hundred and forty-five patients with stable angina underwent on-pump isolated CABG in Uruguay from 2011 to 2015...
March 2018: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29891258/epidemiology-of-lower-extremity-deep-venous-thrombosis-in-critically-ill-adolescents
#7
Edward Vincent S Faustino, Veronika Shabanova, Matthew G Pinto, Simon Li, Erin Trakas, Michael Miksa, Shira Gertz, Lee A Polikoff, Massimo Napolitano, Adele R Brudnicki, Joana A Tala, Cicero T Silva
OBJECTIVE: To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. STUDY DESIGN: We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation...
June 8, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29884495/association-of-dead-space-ventilation-and-prolonged-ventilation-after-repair-of-tetralogy-of-fallot-with-pulmonary-atresia
#8
Andrew M Koth, David M Kwiatkowski, Tiffany R Lim, Holly Bauser-Heaton, Ritu Asija, Doff B McElhinney, Frank L Hanley, Catherine D Krawczeski
BACKGROUND: We set out to determine whether patients with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCA) are at risk for elevated dead space ventilation fraction (VD/VT), and whether this is associated with prolonged mechanical ventilation. We hypothesized that elevated VD/VT (>20%) in the first 24 hours after unifocalization surgery is associated with increased risk for prolonged mechanical ventilation (>7 days). METHODS: All patients with TOF/PA/MAPCA undergoing unifocalization surgery between January 2003 and December 2015 were included in this study...
April 30, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29879852/predictors-of-extubation-failure-after-open-chest-cardiac-surgery-based-on-routinely-collected-data-the-importance-of-a-shared-interprofessional-clinical-assessment
#9
Gianfranco Sanson, Massimiliano Sartori, Lorella Dreas, Roberta Ciraolo, Adam Fabiani
BACKGROUND: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2 /FiO2 ), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. AIM: To identify variables that are predictive of ExtF and related outcomes...
June 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29879056/diaphragm-electromyography-guidance-for-a-lung-transplant-recipient-with-difficult-weaning-from-mechanical-ventilation-a-case-report
#10
Yuanda Xu, Qi Qing, Minyong Liang, Weibo Liang, Zhimin Lin, Weiliang Wu, Weiqun He, Xiaoqing Liu, Yuanming Luo, Yimin Li, Jianxing He
RATIONALE: Many factors contribute to a complicated postoperative course following difficult weaning off a ventilator after lung transplantation. PATIENT CONCERNS: A female patient underwent a successful surgery but received a size-mismatched lung graft. The graft had been pruned before transplantation. She experienced delayed ventilator weaning 3 days after lung transplantation. DIAGNOSES: A postoperative X-ray revealed a normal mediastinal structure and diaphragm position...
June 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29878554/controversies-in-the-use-of-lipid-injectable-emulsion-in-hospitalized-patients
#11
Jane Maria Gervasio
Soybean oil-based lipid injectable emulsion (SO-based ILE) is an 18-carbon, ω-6 macronutrient providing a concentrated source of calories, which can be administered in or with parenteral nutrition to patients unable to tolerate or consume adequate enteral nutrition. Beyond the provision of energy, SO-based ILE provides linoleic and linolenic acid, 2 essential fatty acids necessary for the prevention of essential fatty acid deficiency. However, SO-based ILE with its high levels of ω-6 fatty acids, long-chain triglycerides, phospholipid emulsifiers, and glycerin has been associated with worsening clinical outcomes, including increase of infections, lengthier intensive care and hospital stay, and prolonged mechanical ventilation...
June 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29871684/junctional-ectopic-tachycardia-following-tetralogy-of-fallot-repair-in-children-under-2-years
#12
Mohamed Fouad Ismail, Amr A Arafat, Tamer E Hamouda, Amira Esmat El Tantawy, Azzahra Edrees, Abdulbadee Bogis, Nashwa Badawy, Alaa B Mahmoud, Ahmed Farid Elmahrouk, Ahmed A Jamjoom
BACKGROUND: Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age...
June 5, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29866205/effects-of-dexmedetomidine-on-delirium-duration-of-non-intubated-icu-patients-4d-trial-study-protocol-for-a-randomized-trial
#13
Clémence Louis, Thomas Godet, Gérald Chanques, Nathalie Bourguignon, Dominique Morand, Bruno Pereira, Jean-Michel Constantin
BACKGROUND: Delirium during intensive care unit (ICU) stay is frequent and associated with significant morbidity, mortality and healthcare-related costs. International guidelines suggest its prevention. However, curative treatment remains unclearly established. Despite contradictory and ambiguous academic literature, international guidelines suggest the use of second-generation (atypical) antipsychotics over haloperidol. However, haloperidol remains the most widely used neuroleptic worldwide as a first-line treatment of agitation and/or delirium...
June 4, 2018: Trials
https://www.readbyqxmd.com/read/29864552/health-related-quality-of-life-and-predictive-factors-six-months-after-intensive-care-unit-discharge
#14
Nathan Ferrand, Cédrick Zaouter, Brigitte Chastel, Karim Faye, Catherine Fleureau, Hadrien Roze, Antoine Dewitte, Alexandre Ouattara
BACKGROUND: Advances in critical care medicine have improved patients' survival rate. However, physical and cognitive sequels after Intensive Care Unit (ICU) discharge remain substantial. Our objectives were to evaluate the Health-related Quality of Life (HRQL) at 6-month after ICU discharge and identify the risk factors of this outcomes. METHODS: We performed a single-centre prospective observational study. The components of Short Form 36 (SF-36) were analysed for assessing HRQL on preadmission and at 3- and 6-month after ICU discharge...
June 1, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29807378/-mechanical-ventilation-essentials-of-4-german-guidelines
#15
Bernd Schönhofer
In recent decades, respiratory medicine has become established as an integral part of intensive care medicine. In addition to continuous improvement of the technical possibilities, the availability of differentiated ventilation methods, sound pathophysiological and clinical knowledge are indispensable for realizing respiratory medicine at a high level of quality.Based on relevant experience, knowledge and research on the major topics of mechanical ventilation recently in Germany the following 4 guidelines have been published:S3 - guideline: Non-invasive mechanical ventilation in acute respiratory failureS2k - guideline: Non-Invasive and invasive home mechanical ventilation for treatment of chronic respiratory failureS2k - guideline: Prolonged WeaningS3 - guideline: Mechanical ventilation and use of extracorporal procedures in acute respiratory failureIn this article the main recommendations and take home messages of these guidelines are presented...
June 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29793889/effects-of-home-mechanical-ventilation-on-left-ventricular-function-in-sarcoglycanopathies-limb-girdle-muscular-dystrophies
#16
Abdallah Fayssoil, Lee S Nguyen, Adam Ogna, Paris Meng, Olivier Nardi, Pascal Laforet, Bernard Clair, Helene Prigent, Frederic Lofaso, France Leturcq, Rabah Ben Yaou, Djillali Annane, David Orlikowski
Cardiac and respiratory function may be impaired in sarcoglycanopathies, a subgroup of muscular dystrophies due to sarcoglycan proteins (α, β, γ, and δ) genes mutations. Management of patients with restrictive respiratory failure mainly relies on home mechanical ventilation (HMV). Little is known about the cardiac effects of prolonged mechanical ventilation in patients with muscular dystrophy and restrictive respiratory insufficiency. We aimed to assess the effects of HMV on cardiac function in sarcoglycanopathies...
April 16, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29775603/genetic-and-extracardiac-anomalies-are-associated-with-inferior-single-ventricle-palliation-outcomes
#17
Bahaaldin Alsoufi, Courtney McCracken, Matthew Oster, Subhadra Shashidharan, Kirk Kanter
BACKGROUND: We aim to examine the effect of genetic syndromes and extracardiac anomalies (GS/EC) on single ventricle (SV) palliation with focus on hospital death, interstage mortality, and progression towards subsequent palliation stages. METHODS: 530 neonates with SV underwent first-stage palliation: Norwood (n=284,53%), shunt (n=173,33%), band (n=73,14%). Outcomes were compared between those with GS/EC (n=121,23%) and without GS/EC (n=409,77%). Regression analyses were adjusted for other risk factors (age, gender, prematurity, weight, SV anomaly, first-stage palliation surgery)...
May 15, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29770192/safety-and-efficacy-of-n-acetyl-cysteine-for-prophylaxis-of-ventilator-associated-pneumonia-a-randomized-double-blind-placebo-controlled-clinical-trial
#18
Mojtaba Sharafkhah, Ali Abdolrazaghnejad, Nader Zarinfar, Abolfazl Mohammadbeigi, Ali Massoudifar, Sahand Abaszadeh
Ventilator-associated-pneumonia (VAP) is characterized by morbidity, mortality, and prolonged length of stay in intensive care unit (ICU). The present study aimed to examine the effect of N-acetyl-cysteine (NAC) in preventing VAP in patients hospitalized in ICU. We performed a prospective, randomized, double-blind, placebo-controlled trial of 60 mechanically ventilated patients at high risk of developing VAP. NAC (600 mg/twice daily) and placebo (twice daily) were administered to NAC group ( n = 30) and control group ( n = 30), respectively, through the nasogastric tube in addition to routine care...
January 2018: Medical Gas Research
https://www.readbyqxmd.com/read/29769438/cytometry-tof-identifies-alveolar-macrophage-subtypes-in-acute-respiratory-distress-syndrome
#19
Eric D Morrell, Alice Wiedeman, S Alice Long, Sina A Gharib, T Eoin West, Shawn J Skerrett, Mark M Wurfel, Carmen Mikacenic
Studies in human peripheral blood monocyte-derived macrophages in vitro have shown clear evidence that multiple macrophage polarization states exist. The extent to which different alveolar macrophage (AM) polarization states exist in homeostasis or in the setting of severe injury such as acute respiratory distress syndrome (ARDS) is largely unknown. We applied single-cell cytometry TOF (CyTOF) to simultaneously measure 36 cell-surface markers on CD45+ cells present in bronchoalveolar lavage from healthy volunteers, as well as mechanically ventilated subjects with and without ARDS...
May 17, 2018: JCI Insight
https://www.readbyqxmd.com/read/29768017/the-signaling-network-resulting-in-ventilator-induced-diaphragm-dysfunction
#20
Huibin Tang, Joseph B Shrager
Mechanical ventilation (MV) is a life-saving measure for those incapable of adequately ventilating or oxygenating without assistance. Unfortunately, even brief periods of MV result in diaphragm weakness (i.e., "ventilator-induced diaphragm dysfunction" - VIDD) that may render it difficult to wean the ventilator. Prolonged MV is associated with cascading complications and is a strong risk factor for death. Thus, prevention of VIDD may have a dramatic impact on mortality rates. Here, we summarized the current understanding of the pathogenic events underlying VIDD...
May 16, 2018: American Journal of Respiratory Cell and Molecular Biology
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