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https://www.readbyqxmd.com/read/29222827/responding-to-parental-requests-for-life-sustaining-treatment%C3%A2-relational-potential-revisited
#1
Aaron Wightman, Jennifer Cobelli Kett, Benjamin Wilfond
One of the most challenging situations for pediatric clinicians is responding to parental requests for life-sustaining medical therapies for a child with profound neurodevelopmental disabilities. These therapies (e.g. intravenous medications and fluids, gastrostomy tube feeds, dialysis, tracheostomy, and/or mechanical ventilation) offer the possibility for the child to live, at home or in a facility, for months or years as opposed to experiencing their imminent death. While relatively rare, the tension surrounding these requests can be exceptionally high, as illustrated by the cases of Baby K, Baby Joseph, Jahi McMath, Charlie Gard, and many others from our own experience...
December 8, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29221302/the-society-for-translational-medicine-clinical-practice-guidelines-for-mechanical-ventilation-management-for-patients-undergoing-lobectomy
#2
REVIEW
Shugeng Gao, Zhongheng Zhang, Alessandro Brunelli, Chang Chen, Chun Chen, Gang Chen, Haiquan Chen, Jin-Shing Chen, Stephen Cassivi, Ying Chai, John B Downs, Wentao Fang, Xiangning Fu, Martínez I Garutti, Jianxing He, Jie He, Jian Hu, Yunchao Huang, Gening Jiang, Hongjing Jiang, Zhongmin Jiang, Danqing Li, Gaofeng Li, Hui Li, Qiang Li, Xiaofei Li, Yin Li, Zhijun Li, Chia-Chuan Liu, Deruo Liu, Lunxu Liu, Yongyi Liu, Haitao Ma, Weimin Mao, Yousheng Mao, Juwei Mou, Calvin Sze Hang Ng, René H Petersen, Guibin Qiao, Gaetano Rocco, Erico Ruffini, Lijie Tan, Qunyou Tan, Tang Tong, Haidong Wang, Qun Wang, Ruwen Wang, Shumin Wang, Deyao Xie, Qi Xue, Tao Xue, Lin Xu, Shidong Xu, Songtao Xu, Tiansheng Yan, Fenglei Yu, Zhentao Yu, Chunfang Zhang, Lanjun Zhang, Tao Zhang, Xun Zhang, Xiaojing Zhao, Xuewei Zhao, Xiuyi Zhi, Qinghua Zhou
Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29216437/epha2-modulation-associates-with-protective-effect-of-prone-position-in-ventilator-induced-lung-injury
#3
Byung Hoon Park, Mi Hwa Shin, Ivor S Douglas, Kyung Soo Chung, Joo Han Song, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Joon Chang, Young Sam Kim, Moo Suk Park
The erythropoietin-producing hepatoma receptor tyrosine kinase A2 (EphA2) and its ligand ephrinA1 play a pivotal role in inflammation and tissue injury by modulating the epithelial and endothelial barrier integrity. Therefore, EphA2 receptor may be a potential therapeutic target for modulating ventilator-induced lung injury (VILI). To support this hypothesis, here we analyzed EphA2/ephrinA1 signaling in the process of VILI and determined the role of EphA2/ephrinA1 signaling in the protective mechanism of prone positioning in a VILI model...
December 7, 2017: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/29215801/the-barriers-to-the-prevention-of-ventilator-associated-pneumonia-from-the-perspective-of-critical-care-nurses-a-qualitative-descriptive-study
#4
Vajihe Atashi, Hojatollah Yousefi, Hosein Mahjobipoor, Ahmadreza Yazdannik
INTRODUCTION: Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. METHODS: This qualitative descriptive study was done on a purposive sample of 23 critical care nurses...
December 7, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29215365/physiologic-evaluation-of-ventilation-perfusion-mismatch-and-respiratory-mechanics-at-different-positive-end-expiratory-pressure-in-patients-undergoing-protective-one-lung-ventilation
#5
Savino Spadaro, Salvatore Grasso, Dan Stieper Karbing, Alberto Fogagnolo, Marco Contoli, Giacomo Bollini, Riccardo Ragazzi, Gilda Cinnella, Marco Verri, Narciso Giorgio Cavallesco, Stephen Edward Rees, Carlo Alberto Volta
BACKGROUND: Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. METHODS: Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed...
December 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29211751/diffusion-tensor-imaging-detects-ventilation-induced-brain-injury-in-preterm-lambs
#6
Dhafer M Alahmari, Kyra Y Y Chan, Vanesa Stojanovska, Domenic LaRosa, Samantha K Barton, Ilias Nitsos, Valerie Zahra, Jade Barbuto, Michael Farrell, Shigeo Yamaoka, James T Pearson, Graeme R Polglase
PURPOSE: Injurious mechanical ventilation causes white matter (WM) injury in preterm infants through inflammatory and haemodynamic pathways. The relative contribution of each of these pathways is not known. We hypothesised that in vivo magnetic resonance imaging (MRI) can detect WM brain injury resulting from mechanical ventilation 24 h after preterm delivery. Further we hypothesised that the combination of inflammatory and haemodynamic pathways, induced by umbilical cord occlusion (UCO) increases brain injury at 24 h...
2017: PloS One
https://www.readbyqxmd.com/read/29211189/intraoperative-protective-mechanical-ventilation-what-is-new
#7
Luiz Marcelo Sá Malbouisson, Raphael Augusto Gomes de Oliveira
No abstract text is available yet for this article.
November 30, 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29207907/implementation-of-a-goal-directed-mechanical-ventilation-order-set-driven-by-respiratory-therapists-improves-compliance-with-best-practices-for-mechanical-ventilation
#8
Misty A Radosevich, Brendan T Wanta, Todd J Meyer, Verlin W Weber, Daniel R Brown, Nathan J Smischney, Daniel A Diedrich
PURPOSE: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29206492/intravenous-controlled-release-hydrogen-sulfide-protects-against-ventilator-induced-lung-injury
#9
Lifeng Wang, Hao Yu, Yana Zhang, Caiyu Dong, Bo Liu
BACKGROUND: Despite its critical utility in providing life support to patients with impaired respiratory functions, prolonged mechanical ventilation has been found to cause a series of pathological changes in the lung that are collectively referred to as ventilator-induced lung injury (VILI). This study aims to investigate the therapeutic effects of mesoporous silica nanoparticles (DATS-MSN), which is capable of releasing H2S in a slow and controlled manner, on VILI. METHODS: A murine VILI model was generated...
December 5, 2017: Experimental Lung Research
https://www.readbyqxmd.com/read/29202543/-experts-consensus-on-the-management-of-the-right-heart-function-in-critically-ill-patients
#10
X T Wang, D W Liu, H M Zhang, Y Long, X D Guan, H B Qiu, K J Yu, J Yan, H Zhao, Y Q Tang, X Ding, X C Ma, W Du, Y Kang, B Tang, Y H Ai, H W He, D C Chen, H Chen, W Z Chai, X Zhou, N Cui, H Wang, X Rui, Z J Hu, J G Li, Y Xu, Y Yang, B Ouyan, H Y Lin, Y M Li, X Y Wan, R L Yang, Y Z Qin, Y G Chao, Z Y Xie, R H Sun, Z Y He, D F Wang, Q Q Huang, D P Jiang, X Y Cao, R G Yu, X Wang, X K Chen, J F Wu, L N Zhang, M G Yin, L X Liu, S W Li, Z J Chen, Z Luo
To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle...
December 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29194916/the-impact-of-obesity-in-cirrhotic-patients-with-septic-shock-a-retrospective-cohort-study
#11
Beverley Kok, Constantine J Karvellas, Juan G Abraldes, Rajiv Jalan, Vinay Sundaram, David Gurka, Sean Keenan, Aseem Kumar, Greg Martinka, Brian Bookatz, Gordon Wood, Anand Kumar
BACKGROUND & AIMS: The prevalence of obesity in cirrhosis is rising. The impact of obesity in the critically-ill cirrhotic patient with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock. METHODS: A retrospective cohort study of all cirrhotic patients with septic shock (n=362) and a recorded body mass index (BMI) from an international, multicenter (CATTS) database (1996-2015) was performed...
December 1, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29194689/new-device-for-non-volitional-evaluation-of-quadriceps-force-in-ventilated-patients
#12
Franco Laghi, Najeeb Khan, Thimothy Schnell, Dinas Aleksonis, Kendra Hammond, Hameeda Shaikh, Eileen Collins, Amal Jubran, Martin Tobin
INTRODUCTION: In mechanically ventilated patients, non-volitional assessment of quadriceps weakness using femoral-nerve stimulation (twitch force) while the leg rests on a right-angle trapezoid or dangles from the bed edge is impractical. Accordingly, we developed a knee-support apparatus for use in ventilated patients. METHODS: 90 subjects (12 ventilated patients, 28 ambulatory patients and 50 healthy subjects) were enrolled. Twitches with leg-dangling, trapezoid, and knee-support setups were compared...
November 28, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/29193185/ketamine-infusion-for-adjunct-sedation-in-mechanically-ventilated-adults
#13
Lara M Groetzinger, Ryan M Rivosecchi, William Bain, Marshall Bahr, Katherine Chin, Ian Barbash, Bryan J McVerry
BACKGROUND: Many critically ill patients receive ketamine for adjunct sedation despite a paucity of evidence on its usage, dosing, and monitoring in this setting. OBJECTIVE: To describe the dosing and safety considerations of ketamine for adjunct sedation in a population of mechanically ventilated critically ill patients targeting light sedation. METHODS: We conducted a retrospective review of mechanically ventilated patients receiving continuous ketamine infusion between January 2012 and April 2016...
November 29, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29193022/experimental-study-of-delivery-of-humidified-warm-carbon-dioxide-during-open-abdominal-surgery
#14
S Carpinteri, S Sampurno, J Malaterre, R Millen, M Dean, J Kong, T Chittleborough, A Heriot, A C Lynch, R G Ramsay
BACKGROUND: The aim of this study was to monitor the effect of humidified-warm carbon dioxide (HWCO2 ) delivered into the open abdomen of mice, simulating laparotomy. METHODS: Mice were anaesthetized, ventilated and subjected to an abdominal incision followed by wound retraction. In the experimental group, a diffuser device was used to deliver HWCO2 ; the control group was exposed to passive air flow. In each group of mice, surgical damage was produced on one side of the peritoneal wall...
November 28, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29186145/respective-impact-of-implementation-of-prevention-strategies-colonization-with-multiresistant-bacteria-and-antimicrobial-use-on-the-risk-of-early-and-late-onset-vap-an-analysis-of-the-outcomerea-network
#15
Wafa Ibn Saied, Bertrand Souweine, Maité Garrouste-Orgeas, Stéphane Ruckly, Michael Darmon, Sébastien Bailly, Yves Cohen, Elie Azoulay, Carole Schwebel, Aguila Radjou, Hatem Kallel, Christophe Adrie, Anne-Sylvie Dumenil, Laurent Argaud, Guillaume Marcotte, Samir Jamali, Laurent Papazian, Dany Goldgran-Toledano, Lila Bouadma, Jean-Francois Timsit
RATIONALE: The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator-associated pneumonia (VAP) are still debated. OBJECTIVES: To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. METHODS: 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016)...
2017: PloS One
https://www.readbyqxmd.com/read/29182892/diaphragm-protective-mechanical-ventilation-to-improve-outcome-in-icu-patients
#16
Leo Heunks, Coen Ottenheijm
No abstract text is available yet for this article.
November 28, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29179681/low-flow-extracorporeal-co2-removal-in-ards-patients-a-prospective-short-term-crossover-pilot-study
#17
Harlinde Peperstraete, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, Eric Hoste
BACKGROUND: Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis. This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R). METHODS: This was a prospective pilot study, using the Abylcap® (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h...
November 28, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29173777/surgical-excision-is-the-treatment-of-choice-for-cervical-lymphatic-malformations-with-mediastinal-expansion
#18
Nader Ghaffarpour, Carmen Mesas Burgos, Tomas Wester
BACKGROUND: Lymphatic malformations (LMs) in the mediastinum are uncommon. However, cervical LMs may expand into the mediastinum. The aim of this study was to review our experience with the management of patients with LMs involving the mediastinum and to propose a treatment algorithm to guide the management of these rare malformations. MATERIAL AND METHODS: This was a descriptive retrospective chart review of all patients with LMs involving the mediastinum treated at our Institution between 2009 and 2015...
October 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29172232/review-demonstrates-that-less-invasive-surfactant-administration-in-preterm-neonates-leads-to-fewer-complications
#19
REVIEW
Ludwig Gortner, Simone S Schüller, Egbert Herting
Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced into Europe during the 1990s. Meta-analyses have indicated that using less invasive surfactant administration (LISA) techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia. Surfactant should be administered early and ventilator settings adapted to changing oxygen requirements and lung mechanics. Side effects including initial bradycardia, oxygen desaturation, tube obstruction and isolated cases of pulmonary haemorrhage have been reported CONCLUSION: Less invasive surfactant therapy improves pulmonary outcomes in preterm neonates with RDS and should ideally be administered in combination with CPAP...
November 24, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29168220/number-needed-to-suffer-replying-to-comments-on-my-paper
#20
Per-Arne Lönnqvist
I would like to reply to the issues raised by the letter from Dr Barrington (1) on my Different View article on disability-free survival and number needed to suffer (2). However, first of all I would like to provide some important background on my interest in this area.First, I worked in NICU care for more than 10 years before focusing on paediatric anaesthesia and I am the proud father of premature triplets born at 31+4 weeks. As such, I have also been a parent who has witnessed NICU care three times for three months, including surfactant replacement, mechanical ventilation, surgical ductus ligation, sepsis and necrotising entercolitis treated by nil-by-mouth, total parenteral nutrition and antibiotics...
November 23, 2017: Acta Paediatrica
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