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https://www.readbyqxmd.com/read/29782356/acute-neurologic-complications-during-extracorporeal-membrane-oxygenation-a-systematic-review
#1
Raoul Sutter, Kai Tisljar, Stephan Marsch
OBJECTIVES: We determine the frequency, risk factors, and mortality of neurologic complications in adults on extracorporeal membrane oxygenation and propose an algorithm for preventive strategies. DATA SOURCES: PubMed, Embase, and Cochrane databases. STUDY SELECTION: Screening was performed using predefined search terms to identify cohort studies reporting neurologic complications in adults during extracorporeal membrane oxygenation from 1990 to 2017...
May 18, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29776707/unplanned-extubations-in-an-intensive-care-unit-findings-from-a-critical-incident-technique
#2
Matteo Danielis, Simona Chiaruttini, Alvisa Palese
BACKGROUND: Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. OBJECTIVES: To gain a greater understanding of the antecedents of unplanned extubations...
May 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#3
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29753476/technical-note-the-development-of-a-methodology-for-ruminal-and-colon-tissue-biopsying-of-young-holstein-dairy-calves
#4
J K van Niekerk, M Middeldorp, M A Steele
The objectives of this study were to develop a methodology for biopsying the rumen and colon of young dairy calves and to collect suitable quality tissue samples for microscopic and gene expression analysis. Six Holstein dairy bull calves (45.0 ± 1.5 kg birth weight) were ruminally cannulated during the second week of life and weaned at the end of wk 6. Ruminal and colon tissue samples were collected at the end of wk 5, 6, 7, 8, and 12. Calves were not sedated but were restrained in a chute for sampling. The endoscope (100 cm length, 9...
May 9, 2018: Journal of Dairy Science
https://www.readbyqxmd.com/read/29746721/melatonin-for-the-promotion-of-sleep-in-adults-in-the-intensive-care-unit
#5
REVIEW
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients...
May 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29732181/optimising-drug-dosing-in-patients-receiving-extracorporeal-membrane-oxygenation
#6
REVIEW
Vesa Cheng, Mohd-Hafiz Abdul-Aziz, Jason A Roberts, Kiran Shekar
Optimal pharmacological management during extracorporeal membrane oxygenation (ECMO) involves more than administering drugs to reverse underlying disease. ECMO is a complex therapy that should be administered in a goal-directed manner to achieve therapeutic endpoints that allow reversal of disease and ECMO wean, minimisation of complications (treatment of complications when they do occur), early interruption of sedation and rehabilitation, maximising patient comfort and minimising risks of delirium. ECMO can alter both the pharmacokinetics (PK) and pharmacodynamics (PD) of administered drugs and our understanding of these alterations is still evolving...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29628332/patients-lived-experience-of-intensive-care-when-being-on-mechanical-ventilation-during-the-weaning-process-a-hermeneutic-phenomenological-study
#7
Catarina Tingsvik, Fredrik Hammarskjöld, Jan Mårtensson, Maria Henricson
BACKGROUND: The medical and nursing care of the patient on mechanical ventilation has developed and proceeds in terms of ventilator functions, sedation strategies and patient participation. New data are needed to explore the weaning process from the patients' perspective. Therefore, the aim of this study was to explore the meaning of being a patient on mechanical ventilation during the weaning process in the intensive care unit. METHODS: This study used van Manen's hermeneutic phenomenological approach...
April 5, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29619866/enteral-guanfacine-to-treat-severe-anxiety-and-agitation-complicating-critical-care-after-cardiac-surgery
#8
Habib Srour, Komal Pandya, Alex Flannery, Kevin Hatton
This article is the first reported case describing the off-label use of enteral immediate-release guanfacine, a long-acting α-2 adrenergic agonist most commonly used in the treatment of attention-deficit hyperactivity disorder, for sedation in a patient with severe anxiety and agitation limiting mechanical ventilation weaning several days after cardiac surgery. In this case, after several days of unsuccessful attempts to control his agitation and anxiety with conventional therapies, guanfacine therapy was initiated, and the patient was rapidly weaned from all other sedatives and mechanical ventilation shortly thereafter...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29570859/oral-lorazepam-can-be-substituted-for-intravenous-midazolam-when-weaning-paediatric-intensive-care-patients-off-sedation
#9
Anna C van der Vossen, Merel van Nuland, Erwin G Ista, Saskia N de Wildt, Lidwien M Hanff
AIM: Intravenous sedatives used in the paediatric intensive care unit (PICU) need to be tapered after prolonged use to prevent iatrogenic withdrawal syndrome (IWS). We evaluated the occurrence of IWS and the levels of sedation before and after conversion from intravenous midazolam to oral lorazepam. METHODS: This was a retrospective, observational, single cohort study of children under the age of 18 admitted to the PICU of the Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands, between January 2013 and December 2014...
March 23, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29557601/sedation-and-analgesia-in-patients-on-mechanical-ventilation-in-pediatric-intensive-care-units-in-argentina
#10
Pedro Taffarel, German Bonetto, Facundo Jorro Barón, Claudia Meregalli
INTRODUCTION: Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). OBJECTIVE: To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. MATERIAL AND METHODS: Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys...
April 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29545985/the-effect-of-daily-sedation-weaning-application-on-morbidity-and-mortality-in-intensive-care-unit-patients
#11
Selcuk Kayir, Hulya Ulusoy, Guvenc Dogan
Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013...
January 13, 2018: Curēus
https://www.readbyqxmd.com/read/29522601/-levomepromazine-as-adjuvant-sedation-in-a-pediatric-intensive-care-unit
#12
Verónica Becerra, Daniel Buamscha, Corina Ponce, Carlos Cambaceres, Alejandro Noman, María E Galván, Miriam Lenz
INTRODUCTION: Sedation of patients in pediatric ICU extubated and in weaning of mechanic ventilation is diffcult under regular sedation, because of the tolerance and/or abstinence generated by its sustained use. The objective of this study is to describe the use of Levomepromazine as sedative coadjuvant in these patients. POPULATION AND METHODS: Observational and longitudinal study in intensive care from Juan P. Garrahan Pediatric Hospital. Patients older than 2 years were included, extubated and in weaning of mechanic ventilation with requirements of additional sedation...
November 2017: Vertex: Revista Argentina de Psiquiatriá
https://www.readbyqxmd.com/read/29502195/effect-of-sedation-regimen-on-weaning-from-mechanical-ventilation-in-the-intensive-care-unit
#13
Silvia L Nunes, Sune Forsberg, Hans Blomqvist, Lars Berggren, Mikael Sörberg, Toni Sarapohja, Carl-Johan Wickerts
BACKGROUND: Intensive care unit patients undergoing mechanical ventilation have traditionally been sedated to make them comfortable and to avoid pain and anxiety. However, this may lead to prolonged mechanical ventilation and a longer length of stay. OBJECTIVE: The aim of this retrospective study was to explore whether different sedation regimens influence the course and duration of the weaning process. PATIENTS AND METHODS: Intubated adult patients (n = 152) from 15 general intensive care units in Sweden were mechanically ventilated for ≥ 24 h...
June 2018: Clinical Drug Investigation
https://www.readbyqxmd.com/read/29489604/out-of-hospital-cardiac-arrest-due-to-ventricular-fibrillation-in-a-5-year-old-pediatric-patient
#14
Jozef Klučka, Tomáš Juřenčák, Petr Štourač, Pavel Vít, Vladimíra Foralová, Iva Synková
Out-of-hospital cardiac arrest in pediatric population is rare and predominantly has respiratory aetiology. Authors present the relatively unique case of out-of hospital cardiac arrest in 5-years old pediatric patient due to ventricular fibrillation (VF) as the initial rhythm during the advanced life support. The patient was resuscitated by his parents and the initial rhythm was VF. After defibrillation the patient was admitted to the pediatric intensive care were another two episodes of VF was detected and treated...
February 28, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29458319/proportional-assist-ventilation-versus-pressure-support-ventilation-in-weaning-ventilation-a-pilot-randomised-controlled-trial
#15
John Botha, Cameron Green, Ian Carney, Kavi Haji, Sachin Gupta, Ravindranath Tiruvoipati
OBJECTIVE: Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation. DESIGN: Prospective randomised controlled trial comparing PSV with PAV+. SETTING: University-affiliated, tertiary referral intensive care unit (ICU)...
March 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29429908/efficacy-of-artisanal-preparations-of-cannabidiol-for-the-treatment-of-epilepsy-practical-experiences-in-a-tertiary-medical-center
#16
Giulia S Porcari, Cary Fu, Emily D Doll, Emma G Carter, Robert P Carson
Medically refractory epilepsy continues to be a challenge worldwide, and despite an increasing number of medical therapies, approximately 1 in 3 patients continues to have seizures. Cannabidiol (CBD), one of many constituents of the Cannabis sativa or marijuana plant, has received renewed interest in the treatment of epilepsy. While highly purified CBD awaits Food and Drug Administration (FDA) approval, artisanal formulations of CBD are readily available and are seeing increased use in our patient population...
March 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29346133/dexmedetomidine-impairs-diaphragm-function-and-increases-oxidative-stress-but-does-not-aggravate-diaphragmatic-atrophy-in-mechanically-ventilated-rats
#17
Thomas Breuer, Christian Bleilevens, Rolf Rossaint, Gernot Marx, Julian Gehrenkemper, Henning Dierksen, Antoine Delpierre, Joachim Weis, Ghislaine Gayan-Ramirez, Christian S Bruells
BACKGROUND: Anesthetics in ventilated patients are critical as any cofactor hampering diaphragmatic function may have a negative impact on the weaning progress and therefore on patients' mortality. Dexmedetomidine may display antioxidant and antiproteolytic properties, but it also reduced glucose uptake by the muscle, which may impair diaphragm force production. This study tested the hypothesis that dexmedetomidine could inhibit ventilator-induced diaphragmatic dysfunction. METHODS: Twenty-four rats were separated into three groups (n = 8/group)...
April 2018: Anesthesiology
https://www.readbyqxmd.com/read/29341985/dexmedetomidine-as-single-continuous-sedative-during-noninvasive-ventilation-typical-usage-hemodynamic-effects-and-withdrawal
#18
Brittany L Shutes, Samantha W Gee, Cheryl L Sargel, Kelsey A Fink, Joseph D Tobias
OBJECTIVES: Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodynamic effects, discontinuation strategies, and risk factors for withdrawal. DESIGN: Retrospective chart review. SETTING: Large, single-center, quaternary care pediatric academic institution...
January 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29184423/propofol-or-benzodiazepines-for-short-and-long-term-sedation-in-intensive-care-units-an-economic-evaluation-based-on-meta-analytic-results
#19
Lorenzo Pradelli, Massimiliano Povero, Hartmut Bürkle, Tim-Gerald Kampmeier, Giorgio Della-Rocca, Astrid Feuersenger, Jean-Francois Baron, Martin Westphal
Purpose: This evaluation compares propofol and benzodiazepine sedation for mechanically ventilated patients in intensive care units (ICUs) in order to identify the potential economic benefits from different payers' perspectives. Methods: The patient-level simulation model incorporated efficacy estimates from a structured meta-analysis and ICU-related costs from Italy, Germany, France, UK, and the USA. Efficacy outcomes were ICU length of stay (LOS), mechanical ventilation duration, and weaning time...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#20
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs ) is a surrogate for pleural pressures (PPl ), and the difference between airway pressure (PAO ) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL ). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
February 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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