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https://www.readbyqxmd.com/read/28741229/inhaled-antimicrobials-for-ventilator-associated-pneumonia-practical-aspects
#1
Garyphallia Poulakou, Dimitrios K Matthaiou, David P Nicolau, Georgios Siakallis, George Dimopoulos
Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size...
July 24, 2017: Drugs
https://www.readbyqxmd.com/read/28740394/a-case-of-iatrogenic-pneumothorax-in-which-chest-tube-placement-could-be-avoided-by-intraoperative-evaluation-with-transthoracic-ultrasonography
#2
Izumi Sato, Hirotsugu Kanda, Megumi Kanao-Kanda, Atsushi Kurosawa, Takayuki Kunisawa
We report a case of iatrogenic pneumothorax in which chest tube placement was avoided by continuous intraoperative evaluation with transthoracic ultrasonography. A 53-year-old man had undergone a subsegmentectomy. While attempting to place a central venous catheter in the right internal jugular vein after the induction of anesthesia, we identified gas absorption during the puncture and suspected a pneumothorax. Chest X-ray revealed an ~5-mm collapse of the right lung apex. Tension pneumothorax was a concern during surgery because of the long-term positive pressure ventilation, but we decided to start the operation without preventative chest tube placement...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28739281/ventilation-rate-in-adults-with-a-tracheal-tube-during-cardiopulmonary-resuscitation-a-systematic-review
#3
REVIEW
Gino Vissers, Jasmeet Soar, Koenraad G Monsieurs
The optimal ventilation rate during cardiopulmonary resuscitation (CPR) with a tracheal tube is unknown. We evaluated whether in adults with cardiac arrest and a secure airway (tracheal tube), a ventilation rate of 10min(-1), compared to any other rate during CPR, improves outcomes.
July 21, 2017: Resuscitation
https://www.readbyqxmd.com/read/28733536/do-cancer-patients-with-dementia-receive-less-aggressive-treatment-in-end-of-life-care-a-nationwide-population-based-cohort-study
#4
Huei-Kai Huang, Jyh-Gang Hsieh, Chia-Jung Hsieh, Ying-Wei Wang
Dementia is a progressive, incurable disease that can deprive patients of the ability to make decisions. This study determines whether dementia influences the medical care that a cancer patient receives at the end of life. We conducted a nationwide population-based cohort study on patients aged ≥20 with newly diagnosed cancer during 2000-2012. After matching to reduce confounders, there were 7,111 patients with and 28,444 without dementia. The adjusted odd ratios (OR) for medical interventions, including intensive care, palliative care, invasive procedures, and advanced diagnostic testing, were calculated for the final month and three months of life by a multiple logistic regression model...
June 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/28730932/effect-site-concentration-of-remifentanil-required-to-blunt-haemodynamic-responses-during-tracheal-intubation-a-randomized-comparison-between-single-and-double-lumen-tubes
#5
Tae Kyong Kim, Deok Man Hong, Seo Hee Lee, Hyesun Paik, Se Hee Min, Jeong-Hwa Seo, Chul-Woo Jung, Jae-Hyon Bahk
Objective To investigate the effect-site concentration of remifentanil required to blunt haemodynamic responses during tracheal intubation with a single-lumen tube (SLT) or a double-lumen tube (DLT). Methods Patients scheduled for thoracic surgery requiring one-lung ventilation were randomly allocated to either the SLT or DLT group. All patients received a target-controlled infusion of propofol and a predetermined concentration of remifentanil. Haemodynamic parameters during intubation were recorded. The effect-site concentration of remifentanil was determined using a delayed up-and-down sequential allocation method...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28725445/manual-ventilation-and-open-suction-procedures-contribute-to-negative-pressures-in-a-mechanical-lung-model
#6
Espen Rostrup Nakstad, Helge Opdahl, Fridtjof Heyerdahl, Fredrik Borchsenius, Ole Henning Skjønsberg
INTRODUCTION: Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/28723800/effects-of-somatostatin-octreotide-treatment-in-neonates-with-congenital-chylothorax
#7
Rong Yin, Rong Zhang, Jin Wang, Lin Yuan, Liyuan Hu, Siyuan Jiang, Chao Chen, Yun Cao
The influence of somatostatin/octreotide treatment on outcomes of neonates with congenital chylothorax remains controversial. We retrospectively reviewed our experience with somatostatin/octreotide therapy in neonates with this very rare disease.Fourteen neonates with congenital chylothorax who were treated with somatostatin (3.5-7 μg/kg/h, before 2016) or octreotide (1-6 μg/kg/h, after January 2016), along with traditional management between 2013 and 2016, were retrospectively reviewed in this observational study...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28720675/the-effect-of-nebulizer-position-on-aerosolized-epoprostenol-delivery-in-an-adult-lung-model
#8
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/28720674/tracheal-tube-design-and-ventilator-associated-pneumonia
#9
REVIEW
Anahita Rouzé, Emmanuelle Jaillette, Julien Poissy, Sébastien Préau, Saad Nseir
Microaspiration of contaminated oropharyngeal and gastric secretions is the main mechanism for ventilator-associated pneumonia (VAP) in critically ill patients. Improving the performance of tracheal tubes in reducing microaspiration is one potential means to prevent VAP. The aim of this narrative review is to discuss recent findings on the impact of tracheal tube design on VAP prevention. Several randomized controlled studies have reported that subglottic secretion drainage (SSD) is efficient in VAP prevention...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28720673/challenges-with-implementation-of-a-respiratory-therapist-driven-protocol-of-spontaneous-breathing-trials-in-the-pediatric-icu
#10
Conrad Krawiec, Dale Carl, Christy Stetter, Lan Kong, Gary D Ceneviva, Neal J Thomas
BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28719483/difficult-intubation-and-ventilation-in-an-infant-with-retropharyngeal-abscess-with-mediastinal-extension
#11
Michael A Bruno, Tomas Drabek, Mioara D Manole
A previously healthy 7-month-old male infant presented for evaluation of fever, deceased oral intake, and intermittent noisy breathing. Physical examination revealed neck tenderness. Soft tissue neck radiographs and computed tomography (CT) scan supported a diagnosis of retropharyngeal swelling with extension to the superior mediastinum. Surgical exploration was planned, and endotracheal intubation was performed in the operating room. Significant cardiorespiratory derangements developed immediately after the tracheal tube was inserted, including hypotension, hypoxia, and bradycardia with signs of cardiac ischemia...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719384/anesthetic-management-of-an-infant-with-postnatally-diagnosed-tracheal-agenesis-undergoing-tracheal-reconstruction-a-case-report
#12
Brittany L Willer, Kayla G Bryan, Daiva E Parakininkas, Michael R Uhing, Susan R Staudt, Kathleen M Dominguez, Michael E McCormick, Michael E Mitchell, John C Densmore, Keith T Oldham, Richard J Berens
A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis. He underwent staged tracheal reconstruction. He was discharged to home at 4 months of age with a tracheostomy collar, cervical spit fistula, and gastrostomy tube. He represents the sole survivor-to-discharge of tracheal agenesis in the United States...
July 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28707773/sudden-onset-of-pheochromocytoma-multisystem-crisis-at-38%C3%A2-weeks-of-gestation-resulted-in-intrauterine-fetal-death-a-case-report
#13
Jun Iwase, Michiko Yamanaka
A 24-year-old woman at 38 weeks of gestation with no past medical history was transferred to our hospital because of acute onset of severe dyspnea. Her conscious level was E4V2M5 on the Glasgow Coma Scale and she displayed stress cardiomyopathy (Takotsubo cardiomyopathy) with multiple organ failure. Intrauterine fetal death was confirmed. After immediate application of intubated ventilation, percutaneous cardiopulmonary support and hemodialysis, she was diagnosed with pheochromocytoma multisystem crisis. After multidisciplinary team discussion, surgical resection of the left pheochromocytoma was performed on the same day...
July 14, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28698267/clinical-criteria-for-tracheostomy-decannulation-in-subjects-with-acquired-brain-injury
#14
Claudia Enrichi, Irene Battel, Cristiano Zanetti, Isabella Koch, Laura Ventura, Katie Palmer, Francesca Meneghello, Francesco Piccione, Simonetta Rossi, Marta Lazzeri, Maurizio Sommariva, Andrea Turolla
BACKGROUND: Patients with acquired brain injury (ABI) often require long periods of having a tracheostomy tube for airway protection and prolonged mechanical ventilation. It has been recognized that fast and safe decannulation improves outcomes and facilitates the recovery process. Nevertheless, few studies have provided evidence for decannulation criteria, despite the high prevalence of ABI subjects with tracheostomies. The aim of our study was to assess which clinical parameters are the best predictors for decannulation in subjects with ABI...
July 11, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28690533/dysphagia-in-perry-syndrome-pharyngeal-pressure-in-two-cases
#15
George Umemoto, Yoshio Tsuboi, Hirokazu Furuya, Takayasu Mishima, Shinsuke Fujioka, Naoki Fujii, Hajime Arahata, Miwa Sugahara, Mitsuaki Sakai
BACKGROUND: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. CASE PRESENTATION: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis...
May 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28688562/decisional-regret-following-ventilation-tube-insertion
#16
Michele M Carr, Jillian Printz, Shreya Thakur
OBJECTIVE: The purpose of this study was to see if parental regret following ventilation tube (VT) insertion was related to non-resolution of ear infections and thus ongoing need for otolaryngological care and VT reinsertion. MATERIALS AND METHODS: All consecutive parents presenting with children who had VT in place were given a validated regret survey and asked the reason for their visit. Chart review was used for medical history. RESULTS: Two hundred and ten respondents were included...
August 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28685017/traumatic-diaphragmatic-rupture-with-underlying-lung-laceration-and-tension-pneumoperitoneum
#17
Zexi Allan, Calvin Peng, Raaj Chandra
Tension pneumoperitoneum is commonly caused by gastrointestinal perforation and pulmonary causes are extremely rare. We present a case of a 47-year-old male post motor vehicle accident with a suspected left-sided haemopneumothorax on initial chest x-ray. CT of the chest post chest tube insertion showed a left-sided diaphragmatic rupture and an extensive diaphragmatic hernia. While en-route to the operating theatre, the intubated patient developed tension pneumoperitoneum with positive pressure ventilation and required immediate surgical intervention and repair...
June 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28682859/multidisciplinary-interventions-and-continuous-quality-improvement-to-reduce-unplanned-extubation-in-adult-intensive-care-units-a-15-year-experience
#18
Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Chung-Han Ho, Chin-Ming Chen, Willy Chou
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28682316/neonatal-outcomes-based-on-mode-and-intensity-of-delivery-room-resuscitation
#19
A Bashir, B Bird, L Wu, S Welles, H Taylor, E Anday, V Bhandari
OBJECTIVE: To examine outcomes of neonates based on the mode and intensity of resuscitation received in the delivery room (DR). STUDY DESIGN: A retrospective study of 439 infants with birth weight ⩽1500 g receiving DR resuscitation at two hospital centers in Philadelphia, Pennsylvania. RESULTS: Of 439 infants, 22 (5%) received routine care, 188 (43%) received noninvasive positive pressure ventilation (PPV) and 229 (52%) received endotracheal tube (ETT) intubation in the DR...
July 6, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28681751/assessment-of-surgical-risk-factors-in-the-development-of-ventilator-associated-pneumonia-in-neurosurgical-intensive-care-unit-patients-alarming-observations
#20
Deepashu Sachdeva, Daljit Singh, Poonam Loomba, Amandeep Kaur, Monica Tandon, Ishu Bishnoi
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in patients receiving mechanical ventilation (MV) and contributes to a longer intensive care unit (ICU) stay, duration of MV, and a high morbidity and mortality. OBJECTIVE: The purpose of study was to determine the incidence of VAP in neurosurgery ICU patients and to assess the probable contributing neurosurgical risk factors like the site and nature of the lesion in the brain, the duration of surgery, blood loss during surgery, and infection elsewhere in the body, in the development of VAP...
July 2017: Neurology India
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