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https://www.readbyqxmd.com/read/28219811/stress-echocardiography-in-patients-who-experienced-mechanical-ventilation-weaning-failure
#1
Manuel Ruiz-Bailén, Jesús Cobo-Molinos, Ana Castillo-Rivera, María Dolores Pola-Gallego-de-Guzmán, Antonio Cárdenas-Cruz, Antonio Martínez-Amat, María Sevilla-Martínez, Clara Hernández-Caballero
INTRODUCTION: Critically ill patients may suffer varying degrees of temporary myocardial dysfunction during respiratory weaning that could play an important role in weaning failure. OBJECTIVES: In this study, we tried to assess the existence of temporary diastolic dysfunction during respiratory weaning. METHODS: Inclusion period is from 2006 to 2015. In this study, we included 181 ventilated patients with cardiogenic shock that were being weaned from mechanical ventilation...
January 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28216201/intratracheal-milrinone-bolus-administration-during-acute-right-ventricular-dysfunction-after-cardiopulmonary-bypass
#2
Caroline Eva Gebhard, Georges Desjardins, Cathérine Gebhard, Paul Gavra, André Y Denault
OBJECTIVE: To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass. DESIGN: Retrospective analysis. SETTING: Single-center study. PARTICIPANTS: The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass. INTERVENTIONS: After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube...
November 22, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28203417/clinical-factors-associated-with-weaning-failure-in-patients-requiring-prolonged-mechanical-ventilation
#3
Hong-Joon Shin, Jin-Sun Chang, Seong Ahn, Tae-Ok Kim, Cheol-Kyu Park, Jung-Hwan Lim, In-Jae Oh, Yu-Il Kim, Sung-Chul Lim, Young-Chul Kim, Yong-Soo Kwon
BACKGROUND: For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU). METHODS: We retrospectively reviewed the clinical and laboratory characteristics of 127 patients who received MV for more than 21 days in the medical ICU at Chonnam National University Hospital in South Korea between January 2005 and December 2014...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28198753/mechanical-ventilation-weaning-practices-and-decision-making-in-european-picus
#4
Lyvonne N Tume, Martin C J Kneyber, Bronagh Blackwood, Louise Rose
OBJECTIVES: This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. DESIGN: Cross-sectional electronic survey...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28193535/the-utility-of-nurse-managed-extracorporeal-life-support-in-an-adult%C3%A2-cardiac-intensive-care-unit
#5
Amy E Hackmann, Luke M Wiggins, Glenn P Grimes, Richard M Fogel, Felicia A Schenkel, Mark L Barr, Michael E Bowdish, Mark J Cunningham, Vaughn A Starnes
BACKGROUND: The use of extracorporeal life support (ECLS) worldwide has increased exponentially since 2009. The patient requiring ECLS demands an investment of hospital resources, including personnel. Educating bedside nurses to manage ECLS circuits broadens the availability of trained providers. METHODS: Experienced cardiothoracic intensive care unit (CTICU) nurses underwent training to manage ECLS circuits, including volume assessment, treatment of arterial blood gas values, the physiology of ECLS, and recognition of common emergencies...
February 10, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28178160/extracorporeal-membrane-oxygenation-support-in-post-traumatic-cardiopulmonary-failure-a-10-year-single-institutional-experience
#6
Chun-Yu Lin, Feng-Chun Tsai, Hsiu-An Lee, Yuan-His Tseng
Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support.From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28176473/durable-remission-of-c3-glomerulonephritis-with-mycophenolate-mofetil
#7
REVIEW
Nicole Lioufas, Moira Finlay, Thomas Barbour
In C3 glomerulopathy, uncontrolled complement C3 activation via the alternative pathway results in glomerular C3 deposition and, in many cases, progressive renal failure. Despite advances in understanding of C3G pathogenesis over the last few years, there are no proven treatments. We describe a patient in whom C3 glomerulopathy was associated with renal impairment and elevated serum free kappa light chains. An initial response to corticosteroids was followed by relapse once steroids were weaned, prompting use of mycophenolate mofetil to maintain remission...
February 2017: Nephrology
https://www.readbyqxmd.com/read/28168966/extracorporeal-membrane-oxygenation-for%C3%A2-acute-respiratory-distress-syndrome-after-pneumonectomy
#8
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...
March 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28166285/p38%C3%AE-regulates-actin-cytoskeleton-and-cytokinesis-in-hepatocytes-during-development-and-aging
#9
Ana M Tormos, Sergio Rius-Pérez, María Jorques, Patricia Rada, Lorena Ramirez, Ángela M Valverde, Ángel R Nebreda, Juan Sastre, Raquel Taléns-Visconti
BACKGROUND: Hepatocyte poliploidization is an age-dependent process, being cytokinesis failure the main mechanism of polyploid hepatocyte formation. Our aim was to study the role of p38α MAPK in the regulation of actin cytoskeleton and cytokinesis in hepatocytes during development and aging. METHODS: Wild type and p38α liver-specific knock out mice at different ages (after weaning, adults and old) were used. RESULTS: We show that p38α MAPK deficiency induces actin disassembly upon aging and also cytokinesis failure leading to enhanced binucleation...
2017: PloS One
https://www.readbyqxmd.com/read/28161016/high-flow-warm-humidified-oxygen-versus-standard-low-flow-nasal-cannula-oxygen-for-moderate-bronchiolitis-hfwho-rct-an-open-phase-4-randomised-controlled-trial
#10
Elizabeth Kepreotes, Bruce Whitehead, John Attia, Christopher Oldmeadow, Adam Collison, Andrew Searles, Bernadette Goddard, Jodi Hilton, Mark Lee, Joerg Mattes
BACKGROUND: Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. METHODS: In this open, phase 4, randomised controlled trial, we recruited children aged less than 24 months with moderate bronchiolitis attending the emergency department of the John Hunter Hospital or the medical unit of the John Hunter Children's Hospital in New South Wales, Australia...
February 1, 2017: Lancet
https://www.readbyqxmd.com/read/28159528/therapeutic-hypothermia-may-improve-neurological-outcomes-in-extracorporeal-life-support-for-adult-cardiac-arrest
#11
Philip Y K Pang, Gillian H L Wee, Ming Jie Huang, Anne E E Hoo, Ismail Mohamed Tahir Sheriff, See Lim Lim, Teing Ee Tan, Yee Jim Loh, Victor T T Chao, Jia Lin Soon, Ka Lee Kerk, Zakir Hussain Abdul Salam, Yoong Kong Sin, Chong Hee Lim
BACKGROUND: Limited data exists on patients receiving therapeutic hypothermia during extracorporeal life support (ECLS). We investigated outcomes and prognostic factors in these patients. METHODS: A retrospective review was conducted for 225 consecutive adult patients treated with ECLS between July 2003 and January 2016. Extracorporeal life support was initiated for refractory cardiac arrest (>10 mins) in 79 patients (35.1%). Patient demographics, ECLS-related complications, in-hospital mortality and neurological outcomes were analysed...
January 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28154913/right-ventricle-to-pulmonary-artery-shunt-in-pulmonary-atresia-with-a-ventricular-septal-defect-a-word-of-caution
#12
Kwang Ho Choi, Si Chan Sung, Hyungtae Kim, Hyoung Doo Lee, Gil Ho Ban, Geena Kim, Hoon Ko
The management of pulmonary atresia with a ventricular septal defect (PA/VSD) depends on the anatomy of the pulmonary artery or on the surgical strategy used at individual institutions. In our institution, we adopted a right ventricle-to-pulmonary artery (RV-PA) shunt in 2011 as a palliative procedure for PA/VSD to overcome the disadvantages of a Blalock-Taussig shunt. We evaluated the results of the RV-PA shunt as initial palliative surgery for PA/VSD. Thirteen patients with ductus-dependent PA/VSD from August 2011 to August 2015 were enrolled...
February 3, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28154601/cardiac-resynchronization-therapy-device-implantation-in-a-patient-with-cardiogenic-shock-under-percutaneous-mechanical-circulatory-support
#13
Kyunghee Lim, Jin-Oh Choi, Jeong Hoon Yang, Seung-Jung Park, Sun Hwa Kim, Jiseok Kang, Hyun Sung Joh, Sun Hye Shin
65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible...
January 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28151886/impact-of-fiber-optic-laryngoscopy-on-the-weaning-process-from-mechanical-ventilation-in-high-risk-patients-for-postextubation-stridor
#14
Malcolm Lemyze, Emmanuelle Durville, Mehdi Meddour, Marie Jonard, Johanna Temime, Stéphanie Barailler, Didier Thevenin, Jihad Mallat
The objective of this study was to assess the impact of fiber-optic laryngoscopy (FOL) on the weaning process from mechanical ventilation in critically ill patients with a positive cuff leak test (CLT) as compared with the current recommended strategy based on corticosteroids.In this prospective observational pilot study conducted over a 1-year period in a 15-bed ICU, CLT was systematically performed before extubation in all intubated patients having passed a spontaneous breathing trial (SBT). After the endotracheal tube cuff was deflated, cuff leak volume (CLVol) was assessed during assisted controlled ventilation...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28149511/the-development-and-role-of-microbial-host-interactions-in-gut-mucosal-immune-development
#15
REVIEW
C R Stokes
At birth the piglet's immune system is immature and it is dependent upon passive maternal protection until weaning. The piglet's mucosal immune system develops over the first few weeks but has not reached maturity at weaning ages which are common on commercial farms. At weaning piglets are presented with a vast and diverse range of microbial and dietary/environmental antigens. Their ability to distinguish between antigens and mount a protective response to potential pathogens and to develop tolerance to dietary antigens is critical to their survival and failure to do so is reflected in the high incidence of morbidity and mortality in the post-weaning period...
2017: Journal of Animal Science and Biotechnology
https://www.readbyqxmd.com/read/28149025/comparison-of-patient-ventilator-asynchrony-during-pressure-support-ventilation-and-proportional-assist-ventilation-modes-in-surgical-intensive-care-unit-a-randomized-crossover-study
#16
Parshotam Lal Gautam, Gaganjot Kaur, Sunil Katyal, Ruchi Gupta, Preetveen Sandhu, Nikhil Gautam
BACKGROUND: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28137906/idiosyncratic-drug-reactions-and-membranous-glomerulopathy
#17
Amrit Kirpalani, Michael J Rieder, Kevin C Bax, Guido Filler
An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19 000  iU/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea...
January 30, 2017: BMJ Case Reports
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
#18
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/28129317/a-novel-treatment-using-an-intraventricular-stent-graft-for-postinfarction-ventricular-septal-rupture-in-a-porcine-model
#19
Yuji Nishida, Shigeyuki Tomita, Ryuta Kiuchi, Hiroshi Ohtake, Go Watanabe
OBJECTIVE: Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction, and the conventional technique for repair is associated with high operative mortality. A novel intraventricular stent graft (IVSG) device was tested as a less invasive treatment for VSR; it does not require cardiopulmonary bypass, cardiac arrest, or left ventricular incision. Its effectiveness was assessed using animal experiments. METHODS: Six pigs were placed on cardiopulmonary bypass...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28127473/hemadsorption-with-adult-cytosorb%C3%A2-in-a-low-weight-pediatric-case
#20
Catalin Gabriel Cirstoveanu, Ileana Barascu, Samantha Mc Kenzie Stancu
Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb...
2017: Case Reports in Critical Care
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