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https://www.readbyqxmd.com/read/29792537/recognizing-quantifying-and-managing-patient-ventilator-asynchrony-in-invasive-and-noninvasive-ventilation
#1
Eugenio Garofalo, Andrea Bruni, Corrado Pelaia, Luisa Liparota, Nicola Lombardo, Federico Longhini, Paolo Navalesi
Patient-ventilator asynchrony may occur with modes of partial ventilatory support. Because this problem is associated with worsened outcomes, identifying and managing asynchronies has been recognized as a relevant clinical problem during both invasive and non-invasive (NIV) mechanical ventilation. Areas covered: In this review article, we first describe the different forms of patient-ventilator asynchrony and how they are classified and quantified. Then, we show how these asynchronies can be recognized, considering the techniques used to properly detect asynchronies, by either ventilator waveform observation, or through systems based on more complexes mathematical algorithms, by means of adjunctive signals, such as the electrical activity of the diaphragm or esophageal pressure...
May 24, 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/29792513/cardiogenic-shock-complicating-peripartum-cardiomyopathy-importance-of-early-left-ventricular-unloading-and-bromocriptine-therapy
#2
Jan-Thorben Sieweke, Tobias Jonathan Pfeffer, Dominik Berliner, Tobias König, Maximiliane Hallbaum, L Christian Napp, Jörn Tongers, Christian Kühn, Jan D Schmitto, Denise Hilfiker-Kleiner, Andreas Schäfer, Johann Bauersachs
INTRODUCTION: Acute peripartum cardiomyopathy complicated by cardiogenic shock is a rare but life-threatening disease. A prolactin fragment is considered causal for the pathogenesis of peripartum cardiomyopathy. This analysis sought to investigate the role of early percutaneous mechanical circulatory support with micro-axial flow-pumps and/or veno-arterial extracorporeal membrane oxygenation in combination with the prolactin inhibitor bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy...
May 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#3
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat
BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2 ) to the fraction of inspired oxygen (Fio2 ) of less than 50 mm Hg for more than 3 hours; a Pao2 :Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29791584/risk-factors-for-early-onset-ventilator-associated-pneumonia-in-aneurysmal-subarachnoid-hemorrhage-patients
#4
J B Cui, Q Q Chen, T T Liu, S J Li
This study aimed to investigate the risk factors related to ventilator-acquired pneumonia (VAP) in aneurysmal subarachnoid hemorrhage (SAH) patients. From January 2011 to December 2015, a single-center retrospective study including 200 SAH patients requiring mechanical ventilation (MV) ≥48 h was performed. The clinical data of these patients were collected and analyzed. The age range of the patients were 41-63 and 72 (36%) were male. The Glasgow coma scale score range was 5-15 and the Simplified Acute Physiology Score II range was 31-52...
2018: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/29791547/predictors-of-mortality-among-intensive-care-unit-patients-coinfected-with-tuberculosis-and-hiv
#5
Marcia Danielle Ferreira, Cynthia Pessoa das Neves, Alexandra Brito de Souza, Francisco Beraldi-Magalhães, Giovanni Battista Migliori, Afrânio Lineu Kritski, Marcelo Cordeiro-Santos
OBJECTIVE: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. METHODS: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model...
April 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29790677/predicting-healthcare-outcomes-in-prematurely-born-infants-using-cluster-analysis
#6
Victoria MacBean, Alan Lunt, Simon B Drysdale, Muska N Yarzi, Gerrard F Rafferty, Anne Greenough
AIMS: Prematurely born infants are at high risk of respiratory morbidity following neonatal unit discharge, though prediction of outcomes is challenging. We have tested the hypothesis that cluster analysis would identify discrete groups of prematurely born infants with differing respiratory outcomes during infancy. METHODS: A total of 168 infants (median (IQR) gestational age 33 (31-34) weeks) were recruited in the neonatal period from consecutive births in a tertiary neonatal unit...
May 23, 2018: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29790144/-prone-position-and-nursing-care
#7
Shu-Ju Lu, Shiao-Pei Wang
Acute respiratory distress syndrome (ARDS) is a life-threatening disease, as acute inflammation in the lungs typically leads to hypoxia and symptoms of dyspnea. The treatment modalities of ARDS include mechanical ventilation, corticosteroid, extracorporeal membranous oxygenation, inhaled nitrogen oxide, and the prone position. Among these, the prone position is supported by evidence showing significantly reduced mortality in patients that adopt this modality. Lying in the prone position reduces atelectatic lung volumes by recruitment of dependent parts and facilitates normal regulation of alveolar ventilation, giving better-matched ventilation perfusion and, thus, improved oxygenation...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29790141/-using-trm-to-enhance-the-accuracy-of-ventilator-associated-pneumonia-preventive-measures-implemented-by-neonatal-intensive-care-unit-medical-staffs
#8
Yu-Ting Huang, Chao-Ya Huang, Hsiu-Ya Su, Chen-Te Ma
BACKGROUND & PROBLEMS: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the neonatal intensive care unit (NICU). The average VAP infection density was 4.7‰ in our unit between June and August 2015. The results of a status survey indicated that in-service education lacked specialization, leading to inadequate awareness among staffs regarding the proper care of newborns with VAP and a lack of related care guides. This, in turn, resulted in inconsistencies in care measures for newborns with VAP...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29789134/fluoroscopy-guided-removal-of-individualised-airway-covered-stents-for-airway-fistulas
#9
Y Bi, H Chen, J Li, P Fu, J Ren, X Han, G Wu
AIM: To report the techniques and complications associated with fluoroscopy-guided removal of individual covered stents for airway fistula disease over a 6-year period. MATERIALS AND METHODS: A retrospective analysis was conducted of 85 patients, 72 male and 13 female, who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Patients ranged in age from 15 to 81 years (mean, 54.9±12.3 years). Before removal, 90 stents had been placed for airway fistula disease...
May 19, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29788919/prediction-of-fluid-responsiveness-in-mechanically-ventilated-cardiac-surgical-patients-the-performance-of-seven-different-functional-hemodynamic-parameters
#10
Michael T Ganter, Martin Geisen, Sonja Hartnack, Omer Dzemali, Christoph K Hofer
BACKGROUND: Functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients. Today, different minimally- and non-invasive hemodynamic monitoring systems measure functional hemodynamic parameters. Although some of these parameters are described by the same name, they differ in their measurement technique and thus may provide different results. We aimed to test the performance of seven functional hemodynamic parameters simultaneously in the same clinical setting...
May 22, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29788897/biofilm-destruction-on-endotracheal-tube-associated-pneumonia-by-photodynamic-inactivation
#11
Kate Cristina Blanco, Amanda C Zangirolami, Natalia M Inada, Vanderlei S Bagnato
Hospital infections is a public health problem that can occur with the use of catheters and endotracheal tubes (ETT). Pathogenic microorganisms may adhere to surfaces of these materials forming biofilm. Microbial biofilms presents an extracellular polymer matrix that promotes resistance of microorganisms to factors such as pH, temperature and drugs. The ETT is used to assist a patient with compromised breathing function. ETT biofilm may cause ventilator-associated pneumonia. Pseudomonas aeruginosa and Staphylococcus aureus pneumonia is associated with a 21-fold increase in risk for mechanical ventilation...
May 22, 2018: Infectious Disorders Drug Targets
https://www.readbyqxmd.com/read/29788796/off-hours-admissions-and-mortality-in-picu-without-24-hour-onsite-intensivist-coverage
#12
Farah Chedly Thabet, Faisal Ahmed alHaffaf, Iheb Mohamed Bougmiza, Hend Ali Bafaqih, May Said Chehab, Sulaiman Abdulkareem alMohaimeed
OBJECTIVE: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. DESIGN: Prospective cohort study. SETTING: A 34-bed tertiary PICU. PATIENTS: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. MEASUREMENTS AND MAIN RESULTS: A total of 1254 patients were nonelectively admitted to the PICU...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29788047/haemodynamics-dyspnoea-and-pulmonary-reserve-in-heart-failure-with-preserved-ejection-fraction
#13
Masaru Obokata, Thomas P Olson, Yogesh N V Reddy, Vojtech Melenovsky, Garvan C Kane, Barry A Borlaug
Aims: Increases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF. Methods and results: Subjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis...
May 19, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29787415/cooccurrence-of-post-intensive-care-syndrome-problems-among-406-survivors-of-critical-illness
#14
Annachiara Marra, Pratik P Pandharipande, Timothy D Girard, Mayur B Patel, Christopher G Hughes, James C Jackson, Jennifer L Thompson, Rameela Chandrasekhar, Eugene Wesley Ely, Nathan E Brummel
OBJECTIVES: To describe the frequency of cooccurring newly acquired cognitive impairment, disability in activities of daily livings, and depression among survivors of a critical illness and to evaluate predictors of being free of post-intensive care syndrome problems. DESIGN: Prospective cohort study. SETTING: Medical and surgical ICUs from five U.S. centers. PATIENTS: Patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily livings...
May 21, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29787412/does-respiratory-variation-in-inferior-vena-cava-diameter-predict-fluid-responsiveness-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#15
Xiang Si, Hailin Xu, Zimeng Liu, Jianfeng Wu, Daiyin Cao, Juan Chen, Minying Chen, Yongjun Liu, Xiangdong Guan
BACKGROUND: We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation. METHODS: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29787304/deterioration-of-regional-lung-strain-and-inflammation-during-early-lung-injury
#16
Gabriel C Motta-Ribeiro, Soshi Hashimoto, Tilo Winkler, Rebecca M Baron, Kira Grogg, Luís F S C Paula, Arnoldo Santos, Congli Zeng, Kathryn Hibbert, Robert S Harris, Ednan Bajwa, Marcos F Vidal Melo
RATIONALE: The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVE: Test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24h of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold...
May 22, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29786953/iatrogenic-botulism-outbreak-in-egypt-due-to-a-counterfeit-botulinum-toxin-a-preparation-a-descriptive-series-of-patient-features-and-outcome
#17
Eman Abdel Monaem Abdel Rashid, Nashwa Mohamed El-Mahdy, Huda Shehata Kharoub, Ahmed Salah Gouda, Naglaa Ahmed ElNabarawy, Bruno Mégarbane
Iatrogenic botulism resulting from the substantial increase in use of botulinum neurotoxin type-A (BoNT-A) treatment is rarely reported. We aimed to describe a large iatrogenic botulism outbreak in Egypt in June-July 2017. Nine patients developed botulism after receiving intramuscular injections of BoNT-A (dose: 200-300 IU) to treat cerebral palsy (N=7), spastic dystonia (N=1), and hyperhidrosis (N=1). Detailed findings were available in 5/9 cases. Patients were admitted to the hospital 5-10 days after the BoNT-A injection...
May 22, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29786114/endothelium-dependent-vasodilation-in-the-cerebral-arterioles-of-rats-deteriorates-during-acute-hyperglycemia-and-then-is-restored-by-reducing-the-glucose-level
#18
Kazuhiro Kito, Kumiko Tanabe, Koji Sakata, Naokazu Fukuoka, Kiyoshi Nagase, Mami Iida, Hiroki Iida
PURPOSE: Acute hyperglycemia in patients with traumatic brain injury correlates with a poor neurological outcome. We investigated the endothelium function of rat cerebral arterioles during acute hyperglycemia and after reducing the glucose levels using insulin. We also examined whether or not oxidative stress was involved in the cerebral arteriole response to acute hyperglycemia. METHODS: In isoflurane-anesthetized, mechanically ventilated rats, we used closed cranial window preparation to measure the changes in the pial arteriolar diameter following the topical application of acetylcholine (ACh) or adenosine...
May 21, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29785655/early-results-after-operatively-versus-non-operatively-treated-flail-chest-a-retrospective-study-focusing-on-outcome-and-complications
#19
Mathieu M E Wijffels, Tjebbe Hagenaars, Diba Latifi, Esther M M Van Lieshout, Michael H J Verhofstad
PURPOSE: Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with non-operative treatment, with special focus on the impact of surgical complications...
May 21, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29785061/targeted-neonatal-echocardiography-tne-consult-service-in-a-large-tertiary-perinatal-center-in-canada
#20
Ismina Papadhima, Deepak Louis, Jyotsna Purna, Poorva Deshpande, Yenge Diambomba, Shoo Lee, Prakesh Shah, Dany Weisz, Afif El-Khuffash, Patrick J McNamara, Luc Mertens, Amish Jain
OBJECTIVE: To describe the utilization and study the factors associated with the impact on clinical management of a new TNE consultation service in a perinatal center. METHODS: This retrospective cohort study included all neonates who underwent TNE consultation at the neonatal unit of Mount Sinai Hospital in Toronto, Canada (November 2011 and July 2015). The consults that had "impact" were defined as those that led to a TNE suggested change in the clinical management within 6 h of its recommendation...
May 22, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
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