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https://www.readbyqxmd.com/read/28930049/experience-with-the-syncardia-total-artificial-heart-in-a-canadian-centre
#1
Anthony Nguyen, Michel Pellerin, Louis P Perrault, Michel White, Anique Ducharme, Normand Racine, Michel Carrier
BACKGROUND: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. METHODS: We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. RESULTS: From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%)...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28906275/vv-ecmo-assisted-high-risk-endobronchial-stenting-as-rescue-for-asphyxiating-mediastinal-mass
#2
Brandon T Nokes, Laszlo Vaszar, Jama Jahanyar, Karen L Swanson
The use of venovenous extracorporeal membrane oxygenation (VV-ECMO) has traditionally been limited to a narrow set of clinical circumstances, such as acute hypoxic respiratory failure, submassive pulmonary embolism, and cardiopulmonary collapse. Within the pediatric population, there have been cases of VV-ECMO in the context of extrinsic airway compression by a mediastinal mass, typically in the setting of either a lymphoma or germ cell tumors. However, the use of VV-ECMO for adults with extrinsic airway compression is comparatively limited...
September 12, 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/28901791/determinants-of-1-year-survival-in-critically-ill-acute-leukemia-patients-a-grrr-oh-study
#3
Márcio Tavares, Virginie Lemiale, Djamel Mokart, Frédéric Pène, Etienne Lengliné, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Michael Darmon, Elie Azoulay
Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs...
September 13, 2017: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/28880699/mobile-ecmo-a-divine-technology-or-bridge-to-nowhere
#4
Julia Merkle, Ilija Djorjevic, Anton Sabashnikov, Elmar W Kuhn, Antje-Christin Deppe, Kaveh Eghbalzadeh, Javid Fattulayev, Christopher Hohmann, Mohamed Zeriouh, Ferdinand Kuhn-Régnier, Yeong-Hoon Choi, Navid Mader, Thorsten Wahlers
Extracorporeal life support emerged as a salvage option in patients with therapy-refractory severe hemodynamic or respiratory failure. However, this promising therapy option has been limited by the use of experienced teams in highly specialized tertiary-care centers. Thus, in order to provide this standard of care in local hospitals and due to increasing evidence on improved outcomes using ECMO devices and setting for patients with heart and lung failure, an increasing number of experienced ECMO centers have launched mobile ECMO retrieval services in recent years...
September 12, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28879093/refractory-acute-respiratory-failure-due-to-pneumocystis-jiroveci-pcp-and-cytomegalovirus-cmv-pneumonitis-a-case-report-and-review-of-literature
#5
Kairav Shah, Kartikeya Cherabuddi, Stacy G Beal, Gautam Kalyatanda
BACKGROUND: Opportunistic infections with Pneumocystis jiroveci pneumonia (PCP) are common in patients with HIV (human immunodeficiency virus) and are encountered once the CD4 count decreases below 200 cells/mm3. Cytomegalovirus (CMV) tends to cause disease once the CD4 count drops below 50 cells/mm3. CMV pneumonitis is not common in this population. However, detecting its presence in broncho-alveolar lavage (BAL) fluid has been associated with increased morbidity and mortality. The role of antiviral therapy against CMV remains unclear...
2017: IDCases
https://www.readbyqxmd.com/read/28875324/-extreme-obesity-particular-aspect-of-invasive-and-noninvasive-ventilation
#6
REVIEW
M Deppe, P Lebiedz
The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Therefore, current strategies are based on the individual experiences of ICU physicians and single-center studies. Noninvasive ventilation (NIV) in critically ill patients with acute respiratory failure and obesity hypoventilation syndrome (OHS) is an efficient treatment option and should be provided as early as possible is an effort to avoid intubation...
September 5, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28814329/severe-persistent-pulmonary-hypertension-of-the-newborn-and-dysmorphic-features-in-neonate-with-a-deletion-involving-twist1-and-phf14-a-case-report
#7
Carina Schinagl, Guro Reinholt Melum, Olaug Kristin Rødningen, Kathrine Bjørgo, Jannicke Hanne Andresen
BACKGROUND: Persistent pulmonary hypertension is a well-known disease of the newborn that in most cases responds well to treatment with nitric oxide and treatment of any underlying causes. Genetic causes of persistent pulmonary hypertension of the newborn are rare. The TWIST1 gene is involved in morphogenetics, and deletions are known to cause Saethre-Chotzen syndrome. Deletions of PHF14 have never been reported in neonates, but animal studies have shown a link between severe defects in lung development and deletions of this gene...
August 17, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28803505/extracorporeal-membrane-oxygenation-in-an-hiv-positive-man-with-severe-acute-respiratory-distress-syndrome-secondary-to-pneumocystis-and-cytomegalovirus-pneumonia
#8
Deirdre Morley, Almida Lynam, Edmund Carton, Ignacio Martin-Loeches, Gerard Sheehan, Niamh Lynn, Serena O'Brien, Fiona Mulcahy
The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO...
January 1, 2017: International Journal of STD & AIDS
https://www.readbyqxmd.com/read/28772036/implantation-of-a-left-ventricular-assist-device-to-provide-long-term-support-for-end-stage-duchenne-muscular-dystrophy-associated-cardiomyopathy
#9
Douglas Stoller, Faris Araj, Alpesh Amin, Catherine Fitzsimmons, Robert Morlend, Jennifer T Thibodeau, Claudio Ramaciotti, Mark H Drazner, Dan M Meyer, Pradeep P A Mammen
A young man with Duchenne muscular dystrophy presented to the UT Southwestern Neuromuscular Cardiomyopathy Clinic with advanced heart failure. Despite maximal medical therapy, his cardiac function continued to decline requiring initiation of inotrope therapy. Given the patient's clinical deterioration, a left ventricular assist device (LVAD) was implanted as destination therapy after undergoing a multidisciplinary assessment. The patient tolerated the surgical implantation of the LVAD without any significant complications, and he has had a relatively unremarkable course 38 months post-LVAD implantation...
August 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28756973/extracorporeal-membrane-oxygenation-support-may-be-a-lifesaving-modality-in-patients-with-burn-and-severe-acute-respiratory-distress-syndrome-experience-of-formosa-water-park-dust-explosion-disaster-in-taiwan
#10
Yu-Jen Chiu, Hsu Ma, Wen-Chieh Liao, Yu-Chung Shih, Mei-Chun Chen, Chun-Che Shih, Tai-Wei Chen, Cherng-Kang Perng
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been reported to improve outcomes in patients with refractory respiratory failure. These successful experiences have stimulated interest in using ECMO as a potential therapy for patients with acute pulmonary failure resulting from burn and inhalation lung injury. Current literature has supported the use of ECMO in critically-ill, pediatric burn patients. On the other hand, it is controversial to apply ECMO in adult burn patients, and the evidence is limited by the shortcomings of small sample size...
July 27, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28754757/adjunctive-extracorporeal-carbon-dioxide-removal-in-refractory-status-asthmaticus
#11
Chuan Jiang, Jodi Galaydick, Harold Fernandez, Jonathan Caronia
Status asthmaticus (SA) is a life-threatening disorder. Severe respiratory failure may require extracorporeal membrane oxygenation (ECMO). Previous reports have demonstrated utility of ECMO in SA in various patients with varying success. A 25-year-old man was admitted with status asthmatics and severe hypercapnic respiratory failure. Despite tailored ventilator therapies, such as pressure control ventilation and maximal pharmacological therapy, including general anaesthesia, the patient’s condition deteriorated rapidly...
July 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28724464/refractory-longitudinally-extensive-transverse-myelitis-responsive-to-cyclophosphamide
#12
Laura J Baxter, Shuo Chen, Philippe Couillard, James N Scott, Christopher J Doig, Fiona Costello, Louis P Girard, John Klassen, Jodie M Burton
Severe longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. Disease cessation and significant recovery was achieved after cyclophosphamide induction. In patients with severe acute immune-mediated LETM who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered...
July 20, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
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 (ie, severe-moderate and severe ARDS). For these patients, we support setting the ventilator to a tidal volume of 4 to 8 mL/kg predicted body weight (PBW), with plateau pressure (Pplat) ≤ 30 cm H2O, and initial positive end-expiratory pressure (PEEP) of 10 to 12 cm H2O. To promote alveolar recruitment, we propose increasing PEEP in increments of 2 to 3 cm provided that Pplat remains ≤ 30 cm H2O and driving pressure does not increase...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28704817/outcome-of-preterm-neonates-with-a-birth-weight-1-500-g-with-severe-hypoxemic-respiratory-failure-rescued-by-inhaled-nitric-oxide-therapy-and-high-frequency-oscillatory-ventilation
#14
Atoosa Golfar, Jagmeet Bhogal, Barbara Kamstra, Ann Hudson-Mason, Mosarrat Qureshi, Georg M Schmölzer, Po-Yin Cheung
BACKGROUND: Despite being an experimental therapy in preterm neonates, inhaled nitric oxide (iNO) is used as a rescue therapy when high-frequency oscillatory ventilation (HFOV) and other conventional therapies fail. OBJECTIVE: We aimed to determine the outcomes of very-low-birth-weight (VLBW) neonates with hypoxemic respiratory failure (HRF) who had received iNO after maximal conventional therapies. METHODS: We retrospectively reviewed preterm neonates (<33 weeks of gestation with a birth weight <1,500 g) who had all received HFOV and then iNO from March 1, 2009 to April 1, 2014 at the Royal Alexandra Hospital...
July 14, 2017: Neonatology
https://www.readbyqxmd.com/read/28702868/safety-and-tolerability-of-the-ketogenic-diet-used-for-the-treatment-of-refractory-childhood-epilepsy-a-systematic-review-of-published-prospective-studies
#15
REVIEW
Qian-Yun Cai, Zhong-Jie Zhou, Rong Luo, Jing Gan, Shi-Ping Li, De-Zhi Mu, Chao-Min Wan
BACKGROUND: To review the available evidence from prospective studies on the safety and tolerability of the ketogenic diet (KD) for the treatment of refractory childhood epilepsy. METHODS: A comprehensive bibliographic search was performed with the aim of retrieving prospective studies that monitored adverse effects (AEs) in children after receiving the classic or medium-chain triglyceride KD therapy for refractory epilepsy. RESULTS: A total of 45 studies were retrieved, including 7 randomized controlled trials...
July 12, 2017: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/28649486/constrictive-pericarditis-induced-shunting-through-a-pfo-persistence-despite-pericardiectomy
#16
Emily Schuiteman, Thomas Verrill, Nader Mina, Bhavinkumar Dalal
A patent foramen ovale (PFO) is found in around 25-30% of patients. The discovery is often made only on autopsy, as most PFOs are clinically silent and any inter-atrial blood exchange typically shunts from the left to right heart [1]. Thus, when a patient presents with hypoxic respiratory failure, concern for presence of a PFO is rarely at the top of the differential. However, in the setting of elevated right heart pressures, PFOs can become of great hemodynamic importance and can lead to deadly complications, including right to left shunting and refractory hypoxic respiratory failure...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28645776/selective-inhibition-of-flt3-by-gilteritinib-in-relapsed-or-refractory-acute-myeloid-leukaemia-a-multicentre-first-in-human-open-label-phase-1-2-study
#17
MULTICENTER STUDY
Alexander E Perl, Jessica K Altman, Jorge Cortes, Catherine Smith, Mark Litzow, Maria R Baer, David Claxton, Harry P Erba, Stan Gill, Stuart Goldberg, Joseph G Jurcic, Richard A Larson, Chaofeng Liu, Ellen Ritchie, Gary Schiller, Alexander I Spira, Stephen A Strickland, Raoul Tibes, Celalettin Ustun, Eunice S Wang, Robert Stuart, Christoph Röllig, Andreas Neubauer, Giovanni Martinelli, Erkut Bahceci, Mark Levis
BACKGROUND: Internal tandem duplication mutations in FLT3 are common in acute myeloid leukaemia and are associated with rapid relapse and short overall survival. The clinical benefit of FLT3 inhibitors in patients with acute myeloid leukaemia has been limited by rapid generation of resistance mutations, particularly in codon Asp835 (D835). We aimed to assess the highly selective oral FLT3 inhibitor gilteritinib in patients with relapsed or refractory acute myeloid leukaemia. METHODS: In this phase 1-2 trial, we enrolled patients aged 18 years or older with acute myeloid leukaemia who either were refractory to induction therapy or had relapsed after achieving remission with previous treatment...
August 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28623282/a-nationwide-study-of-severe-and-protracted-diarrhoea-in-patients-with-primary-immunodeficiency-diseases
#18
Wen-I Lee, Chien-Chang Chen, Tang-Her Jaing, Liang-Shiou Ou, Chuen Hsueh, Jing-Long Huang
Diarrhoea lasting longer than 14 days and failing to respond to conventional management is defined as severe and protracted diarrhoea (SD). In this study, we investigated the prevalence, pathogens and prognosis of SD in primary immunodeficiency diseases (PIDs). Among 246 patients with predominantly paediatric-onset PIDs from 2003-2015, 21 [Btk (six), IL2RG (four), WASP, CD40L, gp91 (three each), gp47, RAG2 (one each)] and five [CVID (four), SCID (one)] without identified mutations had SD before prophylactic treatment...
June 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28583555/veno-arterial-venous-hybrid-mode-of-extracorporeal-membrane-oxygenation-for-acute-respiratory-distress-syndrome-combined-with-septic-shock-in-a-liver-transplant-patient-a-case-report
#19
J-I Park, B-H Jung, S-G Lee
BACKGROUND: Post-operative respiratory failure is common in liver transplant patients, with a direct effect on graft and recipient outcomes. We present a case of successful treatment for a patient who had acute respiratory distress syndrome combined with septic shock after living-donor liver transplantation with veno-arterial-venous hybrid mode of extracorporeal membrane oxygenation (ECMO) support. METHODS: A 49-year-old male patient underwent successful emergency living-donor liver transplantation for acute-on-chronic liver failure associated with alcoholic liver cirrhosis...
June 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28549024/the-epidemiology-of-hospital-death-following-pediatric-severe-sepsis-when-why-and-how-children-with-sepsis-die
#20
Scott L Weiss, Fran Balamuth, Josey Hensley, Julie C Fitzgerald, Jenny Bush, Vinay M Nadkarni, Neal J Thomas, Mark Hall, Jennifer Muszynski
OBJECTIVE: The epidemiology of in-hospital death after pediatric sepsis has not been well characterized. We investigated the timing, cause, mode, and attribution of death in children with severe sepsis, hypothesizing that refractory shock leading to early death is rare in the current era. DESIGN: Retrospective observational study. SETTING: Emergency departments and ICUs at two academic children's hospitals. PATIENTS: Seventy-nine patients less than 18 years old treated for severe sepsis/septic shock in 2012-2013 who died prior to hospital discharge...
September 2017: Pediatric Critical Care Medicine
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