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https://www.readbyqxmd.com/read/27884421/interpreting-the-incremental-cardiopulmonary-exercise-test
#1
REVIEW
Samir Nusair
The incremental cardiopulmonary exercise test (CPET) is an increasingly used diagnostic method that serves to evaluate patients with chief complaint of dyspnea during exercise. Performing maximal symptom-limited CPET can show if the tested subject has a reduced exercise capacity and give clues to the mechanism of such exercise capacity reduction, cardiac, pulmonary, or pulmonary vascular source. In this review, it is suggested that the evaluation of the complex results of CPET should be performed by first determining if myocardial/circulatory insufficiency is present and second if there is gas exchange abnormality...
November 1, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27881097/ischaemic-stroke-and-clostridium-septicum-sepsis-and-meningitis-in-a-patient-with-occult-colon-carcinoma-a-case-report-and-review-of-the-literature
#2
Kosmas Macha, Antje Giede-Jeppe, Hannes Lücking, Roland Coras, Hagen B Huttner, Jürgen Held
BACKGROUND: Clostridium septicum is a rare cause of meningitis and brain abscess in children and adults. Gas production by the pathogen can lead to pneumocephalus and the overall mortality rate of Clostridium septicum CNS infection is as high as 74%. The most common entry site of the pathogen is the gastrointestinal tract. CASE PRESENTATION: We describe a 74-year-old man who presented with a left-sided cerebral infarction in the middle cerebral artery territory...
November 24, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27875408/diagnosing-acute-respiratory-distress-syndrome-in-resource-limited-settings-the-kigali-modification-of-the-berlin-definition
#3
Elisabeth D Riviello, Egide Buregeya, Theogene Twagirumugabe
PURPOSE OF REVIEW: The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27858372/severe-respiratory-acidosis-in-status-epilepticus-as-a-possible-etiology-of-sudden-death-in-lesch-nyhan-disease-a-case-report-and-review-of-the-literature
#4
Alison Christy, William Nyhan, Jenny Wilson
INTRODUCTION: Lesch-Nyhan disease (LND) is an X-linked disorder of purine metabolism, associated with self-mutilation, dystonia, and chorea. Seizures are uncommon in LND. Patients with LND are at risk for sudden and unexpected death. The etiology of this is unknown, but appears to occur from a respiratory process. We propose that respiratory failure secondary to subclinical seizure may lead to sudden death in these patients. CASE: We report a case of an 11-year-old boy with LND who had two episodes of nocturnal gasping...
November 18, 2016: JIMD Reports
https://www.readbyqxmd.com/read/27731850/a-critical-review-of-mechanical-ventilation-virtual-simulators-is-it-time-to-use-them
#5
Juliana Arcanjo Lino, Gabriela Carvalho Gomes, Nancy Delma Silva Vega Canjura Sousa, Andrea K Carvalho, Marcelo Emanoel Bezerra Diniz, Antonio Brazil Viana Junior, Marcelo Alcantara Holanda
BACKGROUND: Teaching mechanical ventilation at the bedside with real patients is difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation. OBJECTIVE: We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies...
June 14, 2016: JMIR Medical Education
https://www.readbyqxmd.com/read/27729704/esmolol-corrects-severe-hypoxemia-in-patients-with-femoro-femoral-venoarterial-extracorporeal-life-support-for-lung-transplantation
#6
Mohamed Ghalayini, Pierre-Yves Brun, Pascal Augustin, Elise Guivarch, Marie Pierre Dilly, Sophie Provenchere, Pierre Mordant, Yves Castier, Philippe Montravers, Dan Longrois
Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-blocker (esmolol). Our purpose was to retrospectively review the efficacy of esmolol in this situation and hypothesize on the potential mechanisms of action and the associated risks...
September 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27635266/fatal-cerebral-air-embolism-a-case-series-and-literature-review
#7
Rashmi Mishra, Pavithra Reddy, Misbahuddin Khaja
Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27617753/intractable-bradycardia-associated-with-hyperkalaemia-in-a-patient-with-end-stage-renal-disease-a-case-report-and-review-of-literature
#8
W Hwang, K Lee, J Joo
A 75-year-old male was diagnosed with diabetic foot syndrome and scheduled for amputation of the right second toe under general anaesthesia. He had suffered from Type 2 diabetes mellitus (DM); he had received maintenance haemodialysis (HD) three times a week for end-stage renal disease (ESRD) due to DM. At 30 minutes after induction, the heart rate decreased below 50 beats per minute (bpm); the arterial blood gas analysis (ABGA) showed a potassium concentration of 6.7 mEq/L without any other abnormal findings...
September 18, 2015: West Indian Medical Journal
https://www.readbyqxmd.com/read/27607154/noninvasive-monitoring-of-co2-during-polysomnography-a-review-of-the-recent-literature
#9
Christopher A Gerdung, Adetayo Adeleye, Valerie G Kirk
PURPOSE OF REVIEW: Sleep-related breathing disorders are complex conditions that require the integration of clinical and sleep laboratory findings to support a diagnosis. Analysis of carbon dioxide (CO2) levels during sleep provides important additional information to the clinician that is not obtained from other polysomnographic indices, and that may have a direct impact on both diagnosis and patient mortality. Although arterial blood gas (ABG) is considered the gold standard for assessing PaCO2 levels, there are numerous drawbacks...
November 2016: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/27579200/a-case-of-the-tof-with-apv-complicated-with-polyhydramnios-and-severe-bronchomalacia
#10
Ali Seven, Emine Esin Yalinbas, Rahmi Ozdemir
Absent pulmonary valve syndrome (APVS) is a rare congenital heart disease with severe pulmonary insufficiency, characterized with aneurysmal dilation in the pulmonary artery and one or both of its branches. We presented a rare case with APVS and literature review in this letter. Prenatal USG examination of the fetus at the 26th week of gestation revealed severe polyhydramnios, dilatation at right ventricle, and abnormal appearance of the heart. At the 31st gestational week, the baby was born with cesarean section...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27569948/four-year-experience-with-extracorporeal-membrane-oxygenation-for-kidney-transplant-patients-with-severe-refractory-cardiopulmonary-insufficiency
#11
J-K Baek, J S Lee, T H Kim, Y H Kim, D J Han, S K Hong
BACKGROUND: Kidney transplant (KT) recipients are vulnerable to infections because of their immunosuppressive treatments, and they occasionally exhibit serious acute cardiopulmonary dysfunction. The purpose of this study was to report the clinical outcomes of using extracorporeal membrane oxygenation (ECMO) in KT recipients and to identify risk factors for ECMO weaning failure. METHODS: We retrospectively reviewed the electronic medical records of KT patients who experienced severe cardiopulmonary dysfunction refractory to conventional therapy and received ECMO at the Asan Medical Center Surgical Intensive Care Unit between December 2010 and December 2014...
July 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27530418/continuous-high-frequency-oscillation-therapy-in-invasively-ventilated-pediatric-subjects-in-the-critical-care-setting
#12
Stephen Morgan, Christoph P Hornik, Niyati Patel, Walter L Williford, David A Turner, Ira M Cheifetz
BACKGROUND: Continuous high-frequency oscillation (CHFO) creates a pressure gradient in the small airways that accelerates expiratory flow. The intended use of CHFO therapy is to facilitate secretion removal and treat atelectasis. Our objective was to assess the feasibility, safety, and efficacy of CHFO in the mechanically ventilated pediatric population. METHODS: After institutional review board approval, we retrospectively reviewed medical records of mechanically ventilated children treated with CHFO (the MetaNeb system) at our institution from July 1, 2007 through August 31, 2012...
August 16, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27528100/sources-of-mortality-on-dialysis-with-an-emphasis-on-microemboli
#13
Bernd G Stegmayr
Patients on chronic hemodialysis have a shortened survival compared to the general population. There are multiple sources of morbidity and mortality unique to the dialysis population that account for this. Reasons include the effects of blood membrane interactions, intradialytic hypotension, myocardial stunning, excessive interdialytic weight gain, high-flow arteriovenous fistulae, and impaired lipid break down by anticoagulation administered during HD. Another risk factor, not well appreciated, is the occurrence of microemboli of air (microbubbles) during HD...
November 2016: Seminars in Dialysis
https://www.readbyqxmd.com/read/27511813/an-evaluation-of-association-between-train-of-four-values-and-gas-exchange-indices-in-moderate-to-severe-acute-respiratory-distress-syndrome
#14
Lara M Groetzinger, Ryan M Rivosecchi, Sandra L Kane-Gill, Michael P Donahoe
BACKGROUND: Acute respiratory distress syndrome (ARDS) is associated with a mortality rate of approximately 40%. Neuromuscular blockade is associated with an improvement in oxygenation and a reduction in mortality in ARDS. OBJECTIVE: The goal of this evaluation was to determine if the depth of paralysis, determined by train-of-four (TOF) monitoring, correlates with gas exchange in moderate to severe ARDS. METHODS: This was a retrospective review of moderate to severe ARDS patients who were prescribed >12 hours of continuous infusion cisatracurium between January 1, 2013, and December 31, 2014, with a PaO2:FiO2 ratio <150 and documented TOF and arterial blood gases...
August 10, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27471142/exercise-hypoxaemia-as-a-predictor-of-pulmonary-hypertension-in-copd-patients-without-severe-resting-hypoxaemia
#15
Yoshio Nakahara, Hiroyuki Taniguchi, Tomoki Kimura, Yasuhiro Kondoh, Shinichi Arizono, Koichi Nishimura, Koji Sakamoto, Satoru Ito, Masahiko Ando, Yoshinori Hasegawa
BACKGROUND AND OBJECTIVE: Pulmonary hypertension (PH) in COPD is associated with morbidity and mortality. Previous studies showed a relationship between resting hypoxaemia and PH, but little is known about the relationship between exercise hypoxaemia and PH in COPD without resting hypoxaemia. METHODS: A retrospective observational study of COPD patients without resting hypoxaemia was conducted to evaluate the relationships between exercise hypoxaemia and pulmonary haemodynamics...
July 28, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/27251106/reduction-of-laboratory-utilization-in-the-intensive-care-unit
#16
Samih Raad, Rachel Elliott, Evan Dickerson, Babar Khan, Khalil Diab
OBJECTIVE: In our academic intensive care unit (ICU), there is excess ordering of routine laboratory tests. This is partially due to a lack of transparency of laboratory-processing costs and to the admission order plans that favor daily laboratory test orders. We hypothesized that a program that involves physician and staff education and alters the current ICU order sets will lead to a sustained decrease in routine laboratory test ordering. DESIGN: Prospective cohort study...
June 1, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27222001/the-importance-of-preoperative-oxygen-saturation-as-a-predictor-of-pulmonary-arterial-hypertension-after-surgery-of-atrial-septal-defects
#17
Han Ki Park, Hong Ju Shin, Young Hwan Park, Bo Gyoung Ma
OBJECTIVES: There is no concrete predictor of the change of pulmonary arterial pressure after surgical closure of an atrial septal defect (ASD) in patients with pulmonary arterial hypertension (PAH). The aim of this study was to investigate the role of preoperative room air arterial oxygen saturation (SaO2) (arterial blood gas data) as a predictor of postoperative PAH. METHODS: The medical records of 36 patients [>20 years, mean pulmonary arterial pressure (mPAP) ≥25 mmHg] who underwent surgical closure of an ASD between March 2004 and January 2014 were retrospectively reviewed...
September 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27216950/neonatal-metabolic-acidosis-at-birth-in-search-of-a-reliable-marker
#18
C Racinet, P Ouellet, F Charles, T Daboval
OBJECTIVE: A newborn may present acidemia on the umbilical artery blood which can result from respiratory acidosis or metabolic acidosis or be of mixed origin. Currently, in the absence of a satisfactory definition, the challenge is to determine the most accurate marker for metabolic acidosis, which can be deleterious for the neonate. METHODS: We reviewed the methodological and physiological aspects of the perinatal literature to search for the best marker of NMA...
June 2016: Gynécologie, Obstétrique & Fertilité
https://www.readbyqxmd.com/read/27127003/uremic-encephalopathy-mr-imaging-findings-and-clinical-correlation
#19
D M Kim, I H Lee, C J Song
BACKGROUND AND PURPOSE: Uremic encephalopathy is a metabolic disorder in patients with renal failure. The purpose of this study was to describe the MR imaging findings of uremic encephalopathy. MATERIALS AND METHODS: This study retrospectively reviewed MR imaging findings in 10 patients with clinically proved uremic encephalopathy between May 2005 and December 2014. Parameters evaluated were lesion location and appearance; MR signal intensity of the lesions on T1WI, T2WI, and T2 fluid-attenuated inversion recovery images; the presence or absence of restricted diffusion on diffusion-weighted images and apparent diffusion coefficient maps; and the reversibility of documented signal-intensity abnormalities on follow-up MR imaging...
September 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27124045/trimethoprim-sulfamethoxazole-induced-severe-lactic-acidosis-a-case-report-and-review-of-the-literature
#20
Marie Bulathsinghala, Kimberly Keefer, Andry Van de Louw
Propylene glycol (PG) is used as a solvent in numerous medications, including trimethoprim/sulfamethoxazole (TMP/SMX) and lorazepam, and is metabolized in the liver to lactic acid. Cases of lactic acidosis related to PG toxicity have been described and always involved large doses of benzodiazepines and PG. We present the first case of severe lactic acidosis after a 3-day course of TMP/SMX alone, involving allegedly safe amounts of PG.A 31-year-old female with neurofibromatosis and pilocytic astrocytoma, receiving temozolomide and steroids, was admitted to the intensive care unit for pneumonia and acute respiratory failure requiring intubation...
April 2016: Medicine (Baltimore)
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