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protective mechanical ventilation

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https://www.readbyqxmd.com/read/28102521/clinical-assessment-and-train-of-four-measurements-in-critically-ill-patients-treated-with-recommended-doses-of-cisatracurium-or-atracurium-for-neuromuscular-blockade-a-prospective-descriptive-study
#1
Pierre Bouju, Jean-Marc Tadié, Nicolas Barbarot, Julien Letheulle, Fabrice Uhel, Pierre Fillatre, Guillaume Grillet, Angélique Goepp, Yves Le Tulzo, Arnaud Gacouin
BACKGROUND: Despite few studies, a monitoring of a neuromuscular blockade with a train of four (TOF) is recommended in intensive care unit (ICU). Our objective was to compare the results of ulnar and facial TOF measurements with an overall clinical assessment for neuromuscular blockade in ICU patients treated with recommended doses of atracurium or cisatracurium, including patients with acute respiratory disease syndrome (ARDS). METHODS: We prospectively included in two ICUs 119 patients, 94 with ARDS, who required a neuromuscular blockade for more than 24 h...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28100323/-high-risk-factors-and-clinical-characteristics-of-massive-pulmonary-hemorrhage-in-infants-with-extremely-low-birth-weight
#2
Dan Chen, Meng Wang, Xin Wang, Xue-Wei Ding, Rui-Hua Ba, Jian Mao
OBJECTIVE: To explore the high-risk factors and analyze the clinical characteristics of massive pulmonary hemorrhage (MPH) in infants with extremely low birth weight (ELBW). METHODS: Two hundred and eleven ELBW infants were included in this study. Thirty-five ELBW infants who were diagnosed with MPH were labelled as the MPH group, and 176 ELBW infants without pulmonary hemorrhage were labelled as the control group. The differences in clinical characteristics, mortality rate, and incidence of complications between the two groups were analysed...
January 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/28099693/factors-associated-with-maternal-mortality-among-patients-meeting-criteria-of-severe-maternal-morbidity-and-near-miss
#3
Hesly M P Lima, Francisco Herlânio C Carvalho, Francisco Edson L Feitosa, George C Nunes
OBJECTIVE: To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. METHODS: A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceará and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death...
December 7, 2016: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28079607/mapping-regional-differences-of-local-pressure-volume-curves-with-electrical-impedance-tomography
#4
Alessandro Beda, Alysson R Carvalho, Nadja C Carvalho, Sören Hammermüller, Marcelo B P Amato, Thomas Muders, Claudia Gittel, Katharina Noreikat, Hermann Wrigge, Andreas W Reske
OBJECTIVES: Lung-protective mechanical ventilation aims to prevent alveolar collapse and overdistension, but reliable bedside methods to quantify them are lacking. We propose a quantitative descriptor of the shape of local pressure-volume curves derived from electrical impedance tomography, for computing maps that highlight the presence and location of regions of presumed tidal recruitment (i.e., elastance decrease during inflation, pressure-volume curve with upward curvature) or overdistension (i...
January 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28067830/bronchopulmonary-dysplasia-chronic-lung-disease-of-infancy-and-long-term-pulmonary-outcomes
#5
REVIEW
Lauren M Davidson, Sara K Berkelhamer
Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required...
January 6, 2017: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/28063223/neurally-adjusted-ventilatory-assist-for-infants-under-prolonged-ventilation
#6
Juyoung Lee, Han-Suk Kim, Young Hwa Jung, Chang Won Choi, Yong Hoon Jun
BACKGROUND: Severe bronchopulmonary dysplasia (BPD) often leads to prolonged mechanical ventilation lasting several months. Cyanotic episodes frequently occur in these patients, which necessitate long-term sedation and/or intermittent muscle paralysis. Neurally adjusted ventilatory assist (NAVA) might provide precisely the amount of support that these patients need without sedation. METHODS: We reviewed the medical records of preterm infants who underwent a tracheostomy and required mechanical ventilation for more than 6 months during a period of 6 years...
January 7, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28029185/case-control-study-demonstrates-that-surfactant-without-intubation-delayed-mechanical-ventilation-in-preterm-infants
#7
Sigrid Dannheim Vik, Torstein Vik, Stian Lydersen, Ragnhild Støen
AIM: This Norwegian study explored whether administering surfactant without intubation (SWI) delayed the need for early mechanical ventilation and reduced respiratory and non-respiratory complications in infants born before 32 weeks of gestational age. METHODS: We compared 262 infants admitted to a level three neonatal intensive care unit: 134 born before the introduction of SWI on 1 December 2011 were in the control group and 128 infants born after this date were in the study group...
December 28, 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/28027592/outcomes-of-liver-retransplantation-in-patients-with-primary-sclerosing-cholangitis
#8
Jacqueline B Henson, Yuval A Patel, Lindsay Y King, Jiayin Zheng, Shein-Chung Chow, Andrew J Muir
: Liver retransplantation in patients with primary sclerosing cholangitis (PSC) has not been well studied. The aims of this study were to characterize patients with PSC listed for and undergoing retransplantation and to describe the outcomes in these patients. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was used to identify all primary liver transplantations and subsequent relistings and first retransplantations in adults with PSC between 1987 and 2015...
December 27, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/28026113/prognostic-evaluation-by-oxygenation-with-positive-end-expiratory-pressure-in-acute-exacerbation-of-idiopathic-pulmonary-fibrosis-a-retrospective-cohort-study
#9
Atsushi Suzuki, Hiroyuki Taniguchi, Masahiko Ando, Yasuhiro Kondoh, Tomoki Kimura, Kensuke Kataoka, Toshiaki Matsuda, Toshiki Yokoyama, Koji Sakamoto, Yoshinori Hasegawa
INTRODUCTION: Acute exacerbation (AE) is a severe complication of idiopathic pulmonary fibrosis (IPF), which shares some common pathological features with acute respiratory distress syndrome (ARDS). The new definition of ARDS requires positive end-expiratory pressure (PEEP) to assess gas exchange and has better predictive validity for short-term mortality compared with the previous definition. OBJECTIVES: The aim of this study was to evaluate the prognostic utility of oxygenation with PEEP in AE-IPF...
December 27, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/28013057/neural-control-of-ventilation-prevents-both-over-distension-and-de-recruitment-of-experimentally-injured-lungs
#10
Lukas Brander, Onnen Moerer, Göran Hedenstierna, Jennifer Beck, Jukka Takala, Arthur S Slutsky, Christer Sinderby
BACKGROUND: Endogenous pulmonary reflexes may protect the lungs during mechanical ventilation. We aimed to assess integration of continuous neurally adjusted ventilatory assist (cNAVA), delivering assist in proportion to diaphragm's electrical activity during inspiration and expiration, and Hering-Breuer inflation and deflation reflexes on lung recruitment, distension, and aeration before and after acute lung injury (ALI). METHODS: In 7 anesthetised rabbits with bilateral pneumothoraces, we identified adequate cNAVA level (cNAVAAL) at the plateau in peak ventilator pressure during titration procedures before (healthy lungs with endotracheal tube, [HLETT]) and after ALI (endotracheal tube [ALIETT] and during non-invasive ventilation [ALINIV])...
December 22, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28012314/do-air-quality-targets-really-represent-safe-limits-for-lung-cancer-risk
#11
G Buonanno, L Stabile, L Morawska, G Giovinco, X Querol
In order to estimate the lung cancer risk associated to airborne particles, exposure and risk-assessment studies ordinarily use particle mass concentration as dosimetry parameter. Consequently, the corresponding air quality targets are based on this metrics, neglecting the potential impact of ultrafine particles (UFPs) due to their negligible mass. The main purpose of this study was to evaluate the reliability of air quality targets in protecting Italian non-smoking people from lung cancer risk due to exposure to polycyclic aromatic hydrocarbons and some heavy metals associated with particle inhalation...
December 21, 2016: Science of the Total Environment
https://www.readbyqxmd.com/read/28004856/effect-of-early-allograft-dysfunction-on-outcomes-following-liver-transplantation
#12
Jana Hudcova, Catlin Scopa, Jawad Rashid, Ahsan Waqas, Robin Ruthazer, Roman Schumann
Early allograft dysfunction (EAD) following liver transplantation (LT) remains a challenge for patients and clinicians. We retrospectively analyzed the effect of predefined EAD on outcomes in a 10-year cohort of deceased-donor LT recipients with clearly defined exclusion criteria. EAD was defined by at least one of the following: AST or ALT > 2000 IU/L within first week post LT, total bilirubin ≥ 10mg/dL, and/or INR ≥ 1.6 on postoperative day 7. Ten patients developed primary graft failure and were analyzed separately...
December 22, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27999152/optimizing-peep-by-electrical-impedance-tomography-in-a-porcine-animal-model-of-ards
#13
Nadine Hochhausen, Ingeborg Biener, Rolf Rossaint, Andreas Follmann, Christian Bleilevens, Till Braunschweig, Steffen Leonhardt, Michael Czaplik
BACKGROUND: Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting...
December 20, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27986329/preemptive-hemodynamic-intervention-restricting-the-administration-of-fluids-attenuates-lung-edema-progression-in-oleic-acid-induced-lung-injury
#14
A Gil Cano, M Gracia Romero, M I Monge García, P Guijo González, J Ruiz Campos
OBJECTIVE: A study is made of the influence of preemptive hemodynamic intervention restricting fluid administration upon the development of oleic acid-induced lung injury. DESIGN: A randomized in vivo study in rabbits was carried out. SETTING: University research laboratory. SUBJECTS: Sixteen anesthetized, mechanically ventilated rabbits. VARIABLES: Hemodynamic measurements obtained by transesophageal Doppler signal...
December 14, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27956843/lung-protective-mechanical-ventilation-strategies-in-cardiothoracic-critical-care-a-retrospective-study
#15
Vasileios Zochios, Matthew Hague, Kimberly Giraud, Nicola Jones
A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow progress to acute respiratory distress syndrome (ARDS) due to ventilator associated lung injury. We undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical) critical care patients receiving invasive mechanical ventilation. Independent predictors of mortality in our study included: type of surgery, albumin, H(+), bilirubin, and fluid balance...
2016: International Journal of General Medicine
https://www.readbyqxmd.com/read/27941354/the-endothelial-glycocalyx-and-perioperative-lung-injury
#16
Florian Brettner, Vera von Dossow, Daniel Chappell
PURPOSE OF REVIEW: Ventilator-induced lung injury is a major contributor to perioperative lung injury. The end-expiratory lung volume, regional lung overdistension, and tidal recruitment are known to be the main factors causing subsequent alveolar damage and inflammation. The alveolar-capillary membrane including the endothelial glycocalyx as an integral part of the vascular endothelium seems to play a major role in different kinds of lung injury. RECENT FINDINGS: Recent studies underline the pivotal importance of the endothelial glycocalyx in lung injury...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27939901/readmission-of-icu-patients-a-quality-indicator
#17
Annemarie L Woldhek, Saskia Rijkenberg, Rob J Bosman, Peter H J van der Voort
PURPOSE: Readmission rate is frequently proposed as a quality indicator because it is related to both patient outcome and organizational efficiency. Currently available studies are not clear about modifiable factors as tools to reduce readmission rate. MATERIAL AND METHODS: In a 14year retrospective cohort study of 19,750 ICU admissions we identified 1378 readmissions (7%). A multivariate logistic regression analysis for determinants of readmission within 24h, 48h, 72h and any time during hospital admission was performed with adjustment for patients' characteristics and initial admission severity scores...
December 6, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27935773/lung-protective-ventilation
#18
Rex A Marley, Kaycee Simon
Historically, mechanical ventilation of the lungs utilizing relatively large tidal volumes was common practice in the operating room and intensive care unit (ICU). The rationale behind this treatment strategy was to yield better patient outcomes, that is, fewer pulmonary complications, and a reduction in morbidity and mortality. As evidence-based practice has evolved, potential harmful effects of traditional, nonphysiological mechanical ventilation (ventilation with larger tidal volumes and the tolerance of high airway pressures) even in shortterm treatment have been shown to correlate with systemic inflammation and the development of ventilator-associated lung injury...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27932671/coupling-of-eit-with-computational-lung-modeling-for-predicting-patient-specific-ventilatory-responses
#19
Christian J Roth, Tobias Becher, Inez Frerichs, Norbert Weiler, Wolfgang A Wall
Providing personalised optimal mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalising protective ventilatory treatment. The underlying computational lung model is able to predict global quantities e.g., tracheal flow and tidal volume, as well as local tissue aeration and strains for any ventilation manoeuvre...
December 8, 2016: Journal of Applied Physiology
https://www.readbyqxmd.com/read/27925855/costs-associated-with-influenza-related-hospitalization-in-the-elderly
#20
Núria Torner, Encarna Navas, Núria Soldevila, Diana Toledo, Gemma Navarro, Aurea Morillo, Maria José Pérez, Angela Domínguez
Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 y admitted to 20 hospitals from 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101)...
December 7, 2016: Human Vaccines & Immunotherapeutics
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