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Refractory respiratory failure

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https://www.readbyqxmd.com/read/28190548/venovenous-versus-venoarterial-extracorporeal-membrane-oxygenation-for-adult-patients-with-acute-respiratory-distress-syndrome-requiring-precannulation-hemodynamic-support-a-review-of-the-elso-registry
#1
Zachary N Kon, Gregory J Bittle, Chetan Pasrija, Si M Pham, Michael A Mazzeffi, Daniel L Herr, Pablo G Sanchez, Bartley P Griffith
BACKGROUND: In addition to severe hypoxia and hypercapnia, acute respiratory distress syndrome (ARDS) can present with substantial hemodynamic compromise, requiring inotropic or vasopressor support or both. Either venovenous (VV) or venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be offered in this situation. However, a contemporary comparison of these two cannulation strategies has yet to be well described. METHODS: The Extracorporeal Life Support Organization Registry was reviewed for all cases of adult ARDS in patients that required inotropic agents or vasopressors or both before ECMO initiation (2009 to 2013)...
February 9, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28169009/role-of-adenoidectomy-in-chronic-nasal-obstruction-after-nasal-steroid-therapy-failure
#2
Peter J Ciolek, Allen Xu, Samantha Anne, Katie Geelan-Hansen
OBJECTIVE: To identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients. DESIGN: Retrospective chart review. SETTING: Tertiary care academic center. SUBJECTS: Analysis was performed on children that underwent adenoidectomy between 2011 and 2015 for chronic nasal obstruction refractory to nasal steroids...
February 2, 2017: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/28168966/extracorporeal-membrane-oxygenation-for%C3%A2-acute-respiratory-distress-syndrome-after-pneumonectomy
#3
Jeremie Reeb, Anne Olland, Julien Pottecher, Xavier Delabranche, Mickael Schaeffer, Stephane Renaud, Nicola Santelmo, Romain Kessler, Gilbert Massard, Pierre-Emmanuel Falcoz
BACKGROUND: Postpneumonectomy acute respiratory distress syndrome (ppARDS) is a life-threatening condition with a disastrous prognosis. This study assessed the efficacy of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with unresponsive severe ppARDS. METHODS: We retrospectively reviewed data of all patients treated with VV-ECMO for ppARDS from January 2009 to December 2015. We calculated the Sequential Organ Failure Assessment score before ECMO insertion and monitored the subsequent mechanical ventilation settings...
February 3, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28166435/adverse-events-during-inter-hospital-transports-on-extracorporeal-membrane-oxygenation
#4
Anders Ericsson, Björn Frenckner, L Mikael Broman
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published...
February 6, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28156665/efficacy-and-safety-of-methadone-in-the-treatment-of-pain-in-palliative-care-patients-with-cancer-the-equimeth2-national-randomized-open-phase-iii-study
#5
Marie Pierre Berleur, Shimsi Lefki, Daniele Lefebvre Kunt, Eric Serra, Gisele Chvetzoff, Alain Derniaux, Flora Tremellat, Marilène Filbet, Anna Simon, Bich Dang Vu, Cyril Guillaume
: 212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. METHODS: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28137226/management-of-status-asthmaticus-in-children
#6
Kam-Lun E Hon, Alexander K C Leung
BACKGROUND: Status asthmaticus is an acute exacerbation of asthma that is persistent and intractable and remains unresponsive to initial treatment with bronchodilators and systemic corticosteroids and that can result in hypoxemia, hypercarbia, and secondary respiratory failure. METHOD: We reviewed treatment and recent patents on management of status asthmaticus. CONCLUSIONS: Supplemental oxygen should be given to maintain an oxygen saturation of ≥92% in room air...
30, 2017: Recent Patents on Inflammation & Allergy Drug Discovery
https://www.readbyqxmd.com/read/28132594/extracorporeal-membrane-oxygenation-in-the-management-of-post-pneumonectomy-air-leak-and-adult-respiratory-distress-syndrome-of-the-non-operated-lung
#7
Szkorupa Marek, Simek Martin, Zuscich Ondrej, Chudacek Josef, Neoral Cestmir, Lonsky Vladimir
Post-pneumonectomy air leak and severe respiratory failure of the non-operated lung is considered to be a life-threatening complication of lung surgery. We present the case report of a 68-year-old man who underwent a right pneumonectomy for spinocellular carcinoma. Refractory respiratory failure occurred following bronchial stump air leakage and adult respiratory distress syndrome (ARDS) of the non-operated lung. Established veno-venous extracorporeal membrane oxygenation (VV ECMO) was utilized to maintain tissue oxygenation while re-do surgery was performed...
January 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28126982/novel-one-lung-ventilation-strategy-olv-for-a-patient-with-complete-unilateral-endobronchial-obstruction-causing-hypoxic-respiratory-failure
#8
Amaraja Kanitkar, Sarah J Lee
BACKGROUND Mechanical ventilation strategies for one lung ventilation (OLV) differ from conventional modalities in that it can adapt to greater degrees of ventilation/perfusion (V/Q) mismatch. We present a case of cancer causing complete unilateral endobronchial obstruction with refractory hypoxia that improved with OLV strategy. CASE REPORT Our patient was an elderly male, admitted to our intensive care unit (ICU) on mechanical ventilation with worsening hypoxic respiratory failure secondary to lung mass and post-obstructive atelectasis...
January 27, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28099641/sepsis-related-acute-respiratory-distress-syndrome-in-children-with-cancer-the-respiratory-dynamics-of-a-devastating-condition
#9
Rodrigo Genaro Arduini, Orlei Ribeiro de Araujo, Dafne Cardoso Bourguignon da Silva, Andreza Almeida Senerchia, Antonio Sergio Petrilli
Objective: To evaluate the clinical course and respiratory parameters of mechanically ventilated children with cancer suffering from sepsis-related acute respiratory distress syndrome. Methods: This 2-year prospective, longitudinal, observational cohort study enrolled 29 children and adolescents. Clinical data, measurements of blood gases and ventilation parameters were collected at four different time points. Fluctuations between measurements as well as differences in estimated means were analyzed by linear mixed models in which death within 28 days from the onset of acute respiratory distress syndrome was the primary endpoint...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28096226/disseminated-adenovirus-infection-causing-severe-ards
#10
Steven J Campbell, Jessica A Kynyk, John A Davis
A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure...
January 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28074818/cannulation-strategies-in-adult-veno-arterial-and-veno-venous-extracorporeal-membrane-oxygenation-techniques-limitations-and-special-considerations
#11
Arun L Jayaraman, Daniel Cormican, Pranav Shah, Harish Ramakrishna
Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28072930/left-ventricular-outflow-tract-obstruction-be-prepared
#12
J S Evans, S J Huang, A S McLean, M Nalos
The current trend to treat hypotension in critically ill patients is to place a greater emphasis on inotropic support and less on fluid resuscitation in order to limit the potential harm from fluid overload. This combination may trigger left ventricular outflow tract obstruction (LVOTO) in susceptible patients. Although LVOTO is classically described in patients with hypertrophic cardiomyopathy it has been reported in other conditions including septic shock, apical ballooning syndrome, myocardial infarction, respiratory failure, and post valvular surgery...
January 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28067630/novel-swine-model-of-ricin-induced-acute-respiratory-distress-syndrome
#13
Shahaf Katalan, Reut Falach, Amir Rosner, Michael Goldvaser, Tal Brosh-Nissimov, Ayana Dvir, Avi Mizrachi, Orr Goren, Barak Cohen, Yoav Gal, Anita Sapoznikov, Sharon Ehrlich, Tamar Sabo, Chanoch Kronman
Pulmonary exposure to the plant toxin ricin, leads to respiratory insufficiency and death. To date, in-depth study of the functional disorders ensuing pulmonary intoxication, a prerequisite for establishing a clinically-relevant therapeutic protocol, is hampered by the lack of an appropriate animal model. To this end, we set up the pig, as a large animal model for the comprehensive study of the multifarious clinical manifestations of pulmonary ricinosis.Here we report for the first time, the monitoring of barometric whole body plethysmography for pulmonary function tests in non-anesthetized ricin-intoxicated pigs...
January 6, 2017: Disease Models & Mechanisms
https://www.readbyqxmd.com/read/28054897/thrombosis-of-the-right-internal-jugular-vein-is-not-a-contraindication-to-ambulatory-veno-venous-extracorporeal-membrane-oxygenation-with-a-bicaval-dual-lumen-single-cannula-system
#14
Anthony Kronfli, Chetan Pasrija, Aakash Shah, Mehrdad Ghoreishi, Jose P Garcia, Si M Pham, Pablo G Sanchez, Zachary N Kon
BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an ever-emerging method of managing respiratory failure in patients who are refractory to conventional mechanical ventilatory support. An increasingly common method of cannulation involves placement of a bicaval dual-lumen, single cannula via the right internal jugular (IJ) vein. Thrombus in this vein has been considered a contraindication for cannula placement. CASE REPORT: A 45-year-old Hispanic male presented with bleomycin-induced respiratory failure resulting in acute respiratory distress syndrome (ARDS)...
14, 2016: Heart Surgery Forum
https://www.readbyqxmd.com/read/28017465/refractory-hypoxemic-respiratory-failure-from-metal-fume-inhalation-emergency-department-procedure
#15
Hong Joon Ahn, Jun Wan Lee, Seung Ryu, Yong Chul Cho, Won Joon Jeong
No abstract text is available yet for this article.
December 12, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27998223/phase-i-phase-ii-study-of-blinatumomab-in-pediatric-patients-with-relapsed-refractory-acute-lymphoblastic-leukemia
#16
Arend von Stackelberg, Franco Locatelli, Gerhard Zugmaier, Rupert Handgretinger, Tanya M Trippett, Carmelo Rizzari, Peter Bader, Maureen M O'Brien, Benoît Brethon, Deepa Bhojwani, Paul Gerhardt Schlegel, Arndt Borkhardt, Susan R Rheingold, Todd Michael Cooper, Christian M Zwaan, Phillip Barnette, Chiara Messina, Gérard Michel, Steven G DuBois, Kuolung Hu, Min Zhu, James A Whitlock, Lia Gore
Purpose Blinatumomab is a bispecific T-cell engager antibody construct targeting CD19 on B-cell lymphoblasts. We evaluated the safety, pharmacokinetics, recommended dosage, and potential for efficacy of blinatumomab in children with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Methods This open-label study enrolled children < 18 years old with relapsed/refractory BCP-ALL in a phase I dosage-escalation part and a phase II part, using 6-week treatment cycles. Primary end points were maximum-tolerated dosage (phase I) and complete remission rate within the first two cycles (phase II)...
December 20, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27931091/evaluation-of-altered-drug-pharmacokinetics-in-critically-ill-adults-receiving-extracorporeal-membrane-oxygenation
#17
REVIEW
Michael A Ha, Adam C Sieg
Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. A significant resurgence in the use ECMO has been seen in recent years as a result of substantial improvements in technology and survival benefit. With expanding ECMO use, a better understanding of how ECMO affects drug pharmacokinetics (PK) is necessary. The vast majority of PK studies in patients receiving ECMO have been conducted within neonatal or pediatric populations or within a controlled environment (e...
December 8, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27898438/rescue-therapies-for-acute-respiratory-distress-syndrome-what-to-try-first
#18
Onnen Moerer, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure adequate oxygenation and survival. This review provides a summary and assessment of treatment options that can be beneficial when the standard approach fails. RECENT FINDINGS: 'Life-threatening' conditions or refractory hypoxemia during mechanical ventilation are more a matter of personal rating than an objective diagnosis based on defined and/or unanimously agreed thresholds that would mandate the use of rescue therapies...
February 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27875409/extracorporeal-membrane-oxygenation-beyond-rescue-therapy-for-acute-respiratory-distress-syndrome
#19
Alain Combes, Nicolas Bréchot, Charles-Edouard Luyt, Matthieu Schmidt
PURPOSE OF REVIEW: This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. RECENT FINDINGS: Successful VV-ECMO treatment in patients with extremely severe influenza A(H1N1)-associated acute respiratory distress syndrome (ARDS) and positive results of the CESAR trial have led to an exponential use of the technology in recent years...
February 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27854085/co-cccurrence-of-guillain-barre-syndrome-and-primary-sj%C3%A3-gren-syndrome-in-an-elderly-woman
#20
Yu-Kai Lin, Fu-Chi Yang, Feng-Cheng Liu, Jiunn-Tay Lee, Yueh-Feng Sung
PURPOSE: Co-occurrence of Guillain-Barré syndrome (GBS) and other autoimmune diseases is rare. We present the case of a patient with co-occurrence of GBS and primary Sjögren syndrome (pSS). CASE REPORT: An 82-year-old woman presented with acute ascending flaccid paralysis and acute respiratory failure. Nerve conduction studies and cerebrospinal fluid analysis confirmed the diagnosis of GBS of acute inflammatory demyelinating polyradiculoneuropathy subtype. The initial unresponsiveness to plasma exchange therapy raised the suspicion of other potential diseases...
September 15, 2016: Acta Neurologica Taiwanica
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