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https://www.readbyqxmd.com/read/28738508/modelling-of-airborne-particulate-matter-concentration-in-underground-stations-using-a-two-size-class-conservation-model
#1
E Walther, M Bogdan, R Cohen
This study presents an attempt of predictive modelling of airborne particulate matter in underground railway stations. The aerosol is represented by a set of simple, ordinary differential equations that describe apparent emission of two particles size-classes in relation with train traffic, ventilation and deposition. The parameters of the equations are identified numerically by a genetic algorithm and comply with their respective expected order of magnitude. A quantitative comparison of numerical results with experimental data from Paris underground station exhibits a good accordance...
July 18, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28736089/long-term-cognitive-impairment-and-delirium-in-intensive-care-a-prospective-cohort-study
#2
Marion L Mitchell, David H K Shum, Gabor Mihala, Jenny E Murfield, Leanne M Aitken
BACKGROUND: Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported. OBJECTIVES: To assess the association between the incidence of delirium, duration of mechanical ventilation and long term cognitive impairment in general ICU patients. METHODS: Prospective cohort study conducted in a tertiary level ICU in Queensland, Australia...
July 20, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28734732/perinatal-and-neonatal-use-of-sedation-and-analgesia
#3
REVIEW
Christopher McPherson, Terrie Inder
Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus...
July 19, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28733094/isolated-non-cardiogenic-pulmonary-edema-a-rare-complication-of-mdma-toxicity
#4
Astrid Haaland, Elliot Warman, Illya Pushkar, Antonios Likourezos, Matt S Friedman
This is a case of a 19-year-old male who presented to the medical tent at an outdoor electronic dance music festival (EDMF) due to an altered mental state in the setting of acute 3,4-methylenedioxymethamphetamine (MDMA) intoxication. He was noted to be in severe respiratory distress, required endotracheal intubation in the field and subsequently developed Acute Respiratory Distress Syndrome (ARDS) without other acute organ dysfunction. He was hospitalized for 5days requiring endotracheal intubation and mechanical ventilation...
June 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28730574/mechanical-ventilation-guided-by-electrical-impedance-tomography-in-pediatric-acute-respiratory-distress-syndrome
#5
Jeffrey Dmytrowich, Tanya Holt, Karen Schmid, Gregory Hansen
Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS...
July 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28730554/bedside-selection-of-positive-end-expiratory-pressure-by-electrical-impedance-tomography-in-hypoxemic-patients-a-feasibility-study
#6
Nilde Eronia, Tommaso Mauri, Elisabetta Maffezzini, Stefano Gatti, Alfio Bronco, Laura Alban, Filippo Binda, Tommaso Sasso, Cristina Marenghi, Giacomo Grasselli, Giuseppe Foti, Antonio Pesenti, Giacomo Bellani
BACKGROUND: Positive end-expiratory pressure (PEEP) is a key element of mechanical ventilation. It should optimize recruitment, without causing excessive overdistension, but controversy exists on the best method to set it. The purpose of the study was to test the feasibility of setting PEEP with electrical impedance tomography in order to prevent lung de-recruitment following a recruitment maneuver. We enrolled 16 patients undergoing mechanical ventilation with PaO2/FiO2 <300 mmHg...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28729471/hypoxic-vascular-response-and-ventilation-perfusion-matching-in-end-stage-copd-may-depend-on-p22phox
#7
Chandran Nagaraj, Christoph Tabeling, Bence M Nagy, Pritesh P Jain, Leigh M Marsh, Rita Papp, Michael Pienn, Martin Witzenrath, Bahil Ghanim, Walter Klepetko, E Kenneth Weir, Stefan Heschl, Grazyna Kwapiszewska, Andrea Olschewski, Horst Olschewski
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease in which the amount of emphysema and airway disease may be very different between individuals, even in end-stage disease. Emphysema formation may be linked to the involvement of the small pulmonary vessels. The NAPDH oxidase (Nox) family is emerging as a key disease-related factor in vascular diseases, but currently its role in hypoxia-induced pulmonary remodelling in COPD remains unclear.Here we investigate the role of p22phox, a regulatory subunit of Nox, in COPD lungs, hypoxic pulmonary vasoconstriction (HPV), hypoxia-induced pulmonary vascular remodelling and pulmonary hypertension...
July 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28725223/gas-exchange-disturbances-regulate-alveolar-fluid-clearance-during-acute-lung-injury
#8
REVIEW
István Vadász, Jacob I Sznajder
Disruption of the alveolar-capillary barrier and accumulation of pulmonary edema, if not resolved, result in poor alveolar gas exchange leading to hypoxia and hypercapnia, which are hallmarks of acute lung injury and the acute respiratory distress syndrome (ARDS). Alveolar fluid clearance (AFC) is a major function of the alveolar epithelium and is mediated by the concerted action of apically-located Na(+) channels [epithelial Na(+) channel (ENaC)] and the basolateral Na,K-ATPase driving vectorial Na(+) transport...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28721033/interfaces-and-ventilator-settings-for-long-term-noninvasive-ventilation-in-copd-patients
#9
Jens Callegari, Friederike Sophie Magnet, Steven Taubner, Melanie Berger, Sarah Bettina Schwarz, Wolfram Windisch, Jan Hendrik Storre
INTRODUCTION: The establishment of high-intensity (HI) noninvasive ventilation (NIV) that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed. METHODS: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28720675/the-effect-of-nebulizer-position-on-aerosolized-epoprostenol-delivery-in-an-adult-lung-model
#10
Allison C Anderson, Meagan N Dubosky, Kelly A Fiorino, Vanessa Quintana, Carl A Kaplan, David L Vines
BACKGROUND: Aerosolized epoprostenol is an alternative for inhaled nitric oxide in the management of pulmonary arterial hypertension and possibly acute hypoxemia. Our objective was to determine differences in drug deposition based on different nebulizer positions in the ventilator circuit, using a vibrating mesh nebulizer. METHODS: An 8.0-mm inner diameter endotracheal tube (ETT) was connected to a training test lung, compliance of 30 mL/cm H2O, with a collecting filter placed at the ETT-test lung junction...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28720600/is-the-mechanism-of-re-expansion-pulmonary-oedema-in-a-heart-lung-interaction
#11
Candy Masego Mokotedi, Martin Balik
The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension...
July 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28719228/successful-use-of-noninvasive-ventilation-in-chronic-obstructive-pulmonary-disease-how-do-high-performing-hospitals-do-it
#12
Kimberly A Fisher, Kathleen M Mazor, Sarah Goff, Mihaela S Stefan, Penelope S Pekow, Lauren A Williams, Vida Rastegar, Michael B Rothberg, Nicholas S Hill, Peter K Lindenauer
RATIONALE: Noninvasive ventilation (NIV) is a cornerstone of treatment for patients with severe exacerbations of chronic obstructive pulmonary disease (COPD) where it has been shown to reduce the need for intubation, hospital length of stay, and mortality. Despite high quality evidence and strong recommendations in clinical guidelines, use of NIV varies widely across hospitals. OBJECTIVE: To identify approaches used by hospitals which have been successful in implementing NIV to treat patients with severe exacerbations of COPD...
July 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28716645/update-in-management-of-severe-hypoxemic-respiratory-failure
#13
REVIEW
Dharani Kumari Narendra, Dean R Hess, Curtis N Sessler, Habtamu M Belete, Kalpalatha K Guntupalli, Felix Khusid, Charles Mark Carpati, Mark Elton Astiz, Suhail Raoof
Mortality related to severe-moderate and severe ARDS remains high. We searched the literature to update this topic. We defined severe hypoxemic respiratory failure as PaO2/FIO2 < 150 mm Hg (i.e., severe-moderate and severe ARDS). For these patients, we support setting the ventilator to a tidal volume of 4-8 mL/kg predicted body weight (PBW) with plateau pressure ≤30 cm H2O, and initial PEEP of 10 - 12 cm H2O. To promote alveolar recruitment, we propose increasing PEEP in increments of 2 - 3 cm, provided plateau pressure remains ≤30 cm H2O and driving pressure does not increase...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28715077/age-and-gender-related-peculiarities-of-patients-with-delirium-in-the-cardiac-intensive-care-unit
#14
Pranas Serpytis, Petras Navickas, Alvydas Navickas, Rokas Serpytis, Giedrius Navickas, Sigita Glaveckaite
BACKGROUND: The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender...
July 17, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28710215/a-study-protocol-for-an-observational-cohort-investigating-cognitive-outcomes-and-wellness-in-survivors-of-critical-illness-the-cogwell-study
#15
M Elizabeth Wilcox, Andrew S Lim, Mary P McAndrews, Richard A Wennberg, Ruxandra L Pinto, Sandra E Black, Karolina D Walczak, Jan O Friedrich, Michael S Taglione, Gordon D Rubenfeld
INTRODUCTION: Up to 9 out of 10 intensive care unit (ICU) survivors will suffer some degree of cognitive impairment at hospital discharge and approximately half will have decrements that persist for years. The mechanisms for this newly acquired brain injury are poorly understood. The purpose of this study is to describe the prevalence of sleep abnormalities and their association with cognitive impairment, examine a well-known genetic risk factor for dementia (Apolipoprotein E ε4) that may allow for genetic risk stratification of ICU survivors at greatest risk of cognitive impairment and determine if electroencephalography (EEG) is an independent predictor of long-term cognitive impairment and possibly a candidate intermediate end point for future clinical trials...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28708896/characteristics-and-outcomes-of-a-cohort-hospitalized-for-pandemic-and-seasonal-influenza-in-germany-based-on-nationwide-inpatient-data
#16
Daniel von der Beck, Werner Seeger, Susanne Herold, Andreas Günther, Benjamin Löh
RATIONALE: From June of 2009 to August of 2010 the influenza subtype H1N1pdm09 caused a worldwide pandemic. The impact on populations and health care systems around the globe evolved differently. Substantial data come from the German national surveillance network in an outpatient and private practice setting, while information on hospitalized patients in Germany is rather limited. METHODS: Data from the Federal Statistics Office comprising health insurance claims of the entire nationwide inpatient sample from 2005 to 2012 were used to identify patients who were hospitalized for laboratory-confirmed influenza and to analyse demographical aspects, comorbidities, hospitalization duration, outcomes and ventilator use during the pandemic and seasonal waves of influenza...
2017: PloS One
https://www.readbyqxmd.com/read/28707030/-update-acute-hypercapnic-respiratory-failure
#17
REVIEW
F Seiler, F C Trudzinski, M Kredel, C Lotz, P M Lepper, R M Muellenbach
BACKGROUND: Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. OBJECTIVE: Summarizing the state of the art in the management of hypercapnic respiratory failure with special regard to the role of ECCO2R. METHODS: Review based on a selective literature search and the clinical and scientific experience of the authors...
July 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28704639/a-sense-of-agency-an-ethnographic-exploration-of-being-awake-during-mechanical-ventilation-in-the-intensive-care-unit
#18
Eva Laerkner, Ingrid Egerod, Finn Olesen, Helle Ploug Hansen
BACKGROUND: There is a current trend towards lighter or no sedation of mechanically ventilated patients in the intensive care unit. The advantages of less sedation have been demonstrated as shorter duration of mechanical ventilation and reduced length of stay in the intensive care unit and hospital. Non-sedated patients are more awake during mechanical ventilation, but little is known about how this affects the intensive care patient. AIM: To explore patients' experiences of being awake during critical illness and mechanical ventilation in the intensive care unit...
June 30, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28704248/low-end-tidal-carbon-dioxide-at-the-onset-of-emergent-trauma-surgery-is-associated-with-nonsurvival-a-case-series
#19
Roman Dudaryk, Danielle K Bodzin, Juliet J Ray, Craig S Jabaley, Richard R McNeer, Richard H Epstein
BACKGROUND: End-tidal carbon dioxide (EtCO2) is a valuable marker of the return of adequate circulation following cardiac arrest due to medical causes. Previously, the prognostic value of capnography in trauma has been studied among limited populations in prehospital and emergency department settings. We aimed to investigate the relationship between early intraoperative EtCO2 and nonsurvival of patients undergoing emergency surgery at a level 1 academic trauma center as a case series...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28702957/non-invasive-ventilation-for-the-management-of-acute-hypercapnic-respiratory-failure-due-to-exacerbation-of-chronic-obstructive-pulmonary-disease
#20
REVIEW
Christian R Osadnik, Vanessa S Tee, Kristin V Carson-Chahhoud, Joanna Picot, Jadwiga A Wedzicha, Brian J Smith
BACKGROUND: Non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) is commonly used to treat patients admitted to hospital with acute hypercapnic respiratory failure (AHRF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). OBJECTIVES: To compare the efficacy of NIV applied in conjunction with usual care versus usual care involving no mechanical ventilation alone in adults with AHRF due to AECOPD. The aim of this review is to update the evidence base with the goals of supporting clinical practice and providing recommendations for future evaluation and research...
July 13, 2017: Cochrane Database of Systematic Reviews
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