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https://www.readbyqxmd.com/read/28096571/acute-respiratory-failure-and-mechanical-ventilation-in-pregnant-patient-a-narrative-review-of-literature
#1
REVIEW
Pradeep Kumar Bhatia, Ghansham Biyani, Sadik Mohammed, Priyanka Sethi, Pooja Bihani
Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28087104/improved-outcomes-from-extracorporeal-membrane-oxygenation-versus-ventricular-assist-device-temporary-support-of-primary-graft-dysfunction-in-heart-transplant
#2
Koji Takeda, Boyangzi Li, Arthur R Garan, Veli K Topkara, Jiho Han, Paolo C Colombo, Maryjane A Farr, Yoshifumi Naka, Hiroo Takayama
BACKGROUND: Primary graft dysfunction (PGD) is one of the most common causes of early death after orthotopic heart transplantation. Mechanical circulatory support devices are required for severe forms of PGD. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and temporary ventricular assist device (VAD) support have both been reported to be useful for severe PGD. METHODS: Between January 2007 and December 2015, 597 patients received a heart transplant at our center...
December 23, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28075489/cough-augmentation-techniques-for-extubation-or-weaning-critically-ill-patients-from-mechanical-ventilation
#3
REVIEW
Louise Rose, Neill Kj Adhikari, David Leasa, Dean A Fergusson, Douglas McKim
BACKGROUND: There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28074820/airway-management-of-the-cardiac-surgical-patients-current-perspective
#4
REVIEW
Arindam Choudhury, Nishkarsh Gupta, Rohan Magoon, Poonam Malhotra Kapoor
The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28063121/monitoring-of-electrical-activity-of-the-diaphragm-shows-failure-of-t-piece-trial-earlier-than-protocol-based-parameters-in-prolonged-weaning-in-non-communicative-neurological-patients
#5
Oliver Trapp, Mascha Fiedler, Michael Hartwich, Martin Schorl, Armin Kalenka
BACKGROUND: The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion...
January 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28057868/glucocorticoid-receptor-alters-isovolumetric-contraction-and-restrains-cardiac-fibrosis
#6
Rachel Richardson, Emma Batchen, Adrian Thomson, Rowan Darroch, Xinlu Pan, Eva Rog-Zielinska, Wiktoria Wyrzykowska, Kathleen Scullion, Emad A S Al-Dujaili, Mary Diaz, Carmel Moran, Chris J Kenyon, Gillian A Gray, Karen Chapman
Corticosteroids directly affect the heart and vasculature and are implicated in the pathogenesis of heart failure. Attention has focussed upon the role of the mineralocorticoid receptor (MR) in mediating pro-fibrotic and other adverse effects of corticosteroids upon the heart. In contrast, the role of the glucocorticoid receptor (GR) in the heart and vasculature is less well understood. We addressed this in mice with cardiomyocyte and vascular smooth muscle deletion of GR (SMGRKO mice). Survival of SMGRKO mice to weaning was reduced compared with littermate controls...
January 5, 2017: Journal of Endocrinology
https://www.readbyqxmd.com/read/28052886/intestinal-rehabilitation-for-children-with-intestinal-failure-is-cost-effective-a-simulation-study
#7
Henk Groen, Esther G Neelis, Marten J Poley, Joanne F Olieman, René Scheenstra, Paul Fm Krabbe, Gerard Dijkstra, Edmond Hhm Rings
BACKGROUND: Children with intestinal failure (IF) depend on parenteral nutrition (PN). The goal in the treatment of IF is to wean children off PN through intestinal rehabilitation (IR). Although the healthcare burden of IF is enormous, to our knowledge there has been no previous cost-effectiveness analysis in pediatric IF including IR. OBJECTIVE: We sought to determine the cost-effectiveness of IR in terms of costs and life-years. DESIGN: We simulated the treatment of IF in children in a discrete-event model...
January 4, 2017: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28042370/review-of-critical-illness-myopathy-and-neuropathy
#8
Starane Shepherd, Ayush Batra, David P Lerner
Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination-critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens...
January 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28040370/benefit-of-extracorporeal-membrane-oxygenation-in-major-burns-after-stun-grenade-explosion-experience-from-a-single-military-medical-center
#9
Po-Shun Hsu, Yi-Ting Tsai, Chih-Yuan Lin, Shyi-Gen Chen, Niann-Tzyy Dai, Cheng-Jung Chen, Jia-Lin Chen, Chien-Sung Tsai
INTRODUCTION: Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. METHODS: This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan...
December 28, 2016: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28031086/respiratory-and-cardiac-characteristics-of-icu-patients-aged-90-years-and-older-a-report-of-12-cases
#10
Hong-Min Zhang, Da-Wei Liu, Xiao-Ting Wang, Yun Long, Quan-Hui Yang
Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit (ICU) patients.Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients' clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound Results...
March 20, 2016: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
https://www.readbyqxmd.com/read/27980751/a-case-of-veno-venous-extracorporeal-membrane-oxygenation-for-severe-respiratory-failure-in-a-superobese-patient
#11
Mirko Belliato, Luca Cremascoli, Anna Aliberti, Michele Pagani, Carlo Pellegrini, Giorgio Antonio Iotti
After risk assessment, veno-venous extracorporeal membrane oxygenation (ECMO) has been achieved in a superobese adult patient as a bridge to recovery of respiratory failure, despite the weight-related difficulties. Early v-v ECMO implantation could be considered to support and to conduct weaning both from sedation and from invasive mechanical ventilation, with the goal to perform physiokinesitherapy during awake ECMO.
December 2016: Clinical Case Reports
https://www.readbyqxmd.com/read/27979608/early-mobilization-reduces-duration-of-mechanical-ventilation-and-intensive-care-unit-stay-in-patients-in-acute-respiratory-failure
#12
Chih-Cheng Lai, Willy Chou, Khee-Siang Chan, Kuo-Chen Cheng, Kuo-Shu Yuan, Chien-Ming Chao, Chin-Ming Chen
OBJECTIVES: To evaluate the effects of a quality improvement program to introduce early mobilization on the outcome of mechanical ventilation (MV) patients in the Intensive Care Unit (ICU). DESIGN: A retrospective observational study SETTING: 19-beds ICU at a medical center PARTICIPANTS: All adults MV patients admitted a medical ICU INTERVENTION: A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, and patients' family) initiated the protocol within 72 hours of MV, when patients become hemodynamically stable...
December 12, 2016: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/27977533/successful-management-of-fulminant-guillain-barr%C3%A3-syndrome-and-its-complications
#13
Atsushi Kamei, Manami Akasaka, Nami Araya, Ken Ishikawa, Akira Takada, Hiromi Furukawa, Sachiko Tanifuji, Maya Asami, Yurie Nasu, Kotaro Oyama, Shoichi Chida
A 3-year-old girl presented with muscle weakness of her limbs and trunk 6 days after developing symptoms of common cold. Two days later, she experienced respiratory arrest with a Glasgow Coma Scale score of 3, necessitating endotracheal intubation. Therefore, she was transferred to our hospital with suspected acute encephalopathy. Although no abnormalities were observed on brain and spinal magnetic resonance imaging and electroencephalography, peripheral nerve conduction velocity tests failed to evoke motor and sensory nerve action potentials...
December 12, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27956916/h1n1-influenza-patient-saved-by-extracorporeal-membrane-oxygenation-first-report-from-iran
#14
Alireza Jahangirifard, Zargham Hossein Ahmadi, Majid Golestani Eraghi, Payam Tabarsi, Majid Marjani, Afshin Moniri, Seyed Ali Reza Nadji, Seyed Mohammad Reza Hashemian, Ali Akbar Velayati
Respiratory failure is a serious complication of H1N1 influenza that, if not properly managed, can cause death. When mechanical ventilation is not effective, the only way to save the patient's life is extracorporeal membrane oxygenation (ECMO). A prolonged type of cardiopulmonary bypass, ECMO is a high-cost management modality compared to other conventional types and its maintenance requires skilled personnel. Such staff usually comprises the members of open-heart surgical teams. Herein, we describe a patient with H1N1 influenza and severe respiratory failure not improved by mechanical ventilation who was admitted to Masih Daneshvari Medical Center in March 2015...
July 6, 2016: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/27955912/are-biventricular-assist-devices-underused-as-a-bridge-to-heart-transplantation-in-patients-with-a-high-risk-of-postimplant-right-ventricular-failure
#15
Sven-Erik Bartfay, Göran Dellgren, Hans Lidén, Mikael Holmberg, Jakob Gäbel, Bengt Redfors, Odd Bech-Hanssen, Kristjan Karason
OBJECTIVE: Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure. METHODS: Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure...
November 15, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27951475/activation-of-respiratory-muscles-during-weaning-from-mechanical-ventilation
#16
Stephan Walterspacher, Julia Gückler, Fabian Pietsch, David Johannes Walker, Hans-Joachim Kabitz, Michael Dreher
PURPOSE: Respiratory muscle dysfunction is a key component of weaning failure. Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies. However, the effects of body positioning on the respiratory muscles during weaning remains unclear. MATERIALS AND METHODS: This study aimed at assessing respiratory drive by surface electromyography (EMG) of the diaphragm (EMGdia) and parasternal muscles (EMGpara) in tracheotomized patients during prolonged weaning in 3 randomized body positions-supine, 30° semirecumbent, and 80° sitting-during mechanical ventilation and spontaneous breathing...
December 2, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27941112/antisynthetase-syndrome-ass-presenting-as-acute-respiratory-distress-syndrome-ards-in-a-patient-without-myositis-features
#17
Venkat Kiran Kanchustambham, Swetha Saladi, Sarah Mahmoudassaf, Setu Patolia
A woman aged 61 years presented to the emergency room with a 1-week history of dyspnoea on exertion and dry cough. X-ray of the chest showed diffuse interstitial opacities and was started on antibiotics and furosemide, and despite these measures, patient's respiratory status worsened, prompting endotracheal intubation. CT of the chest showed diffuse bilateral ground glass opacities and underwent bronchoscope with trans-bronchial biopsy that showed chronic bronchitis. Pt was empirically started on intravenous steroids due to concerns for interstitial lung disease (ILD)...
December 9, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27940189/hydrocortisone-vitamin-c-and-thiamine-for-the-treatment-of-severe-sepsis-and-septic-shock-a-retrospective-before-after-study
#18
Paul E Marik, Vikramjit Khangoora, Racquel Rivera, Michael H Hooper, John Catravas
BACKGROUND: The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries. METHODS: In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a 7-month period (treatment group) compared to a control group treated in our ICU during the preceding 7 months...
December 6, 2016: Chest
https://www.readbyqxmd.com/read/27924176/our-clinical-experience-of-self-expanding-metal-stent-for-malignant-central-airway-obstruction
#19
Akash Verma, Chee Kiang Phua, Qiu Mei Wu, Wen Yuan Sim, Audrey Wee Chuan Rui, Soon Keng Goh, Benjamin Ho, Ai Ching Kor, Andrew S Y Wong, Albert Y H Lim, Dessmon Y H Tai, John Abisheganaden
BACKGROUND: We studied the safety, effectiveness, and limitations of airway stenting using self-expanding metal stent (SEMS) in patients with malignant central airway obstruction (CAO). METHODS: A retrospective review of records of patients undergoing SEMS placement for malignant CAO during year 2013 - 2014 was done. RESULTS: Sixteen patients (11 males and five females) underwent SEMS placement for malignant CAO. Median (range) age was 66 (54 - 78) years...
January 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/27903208/early-experience-of-a-new-extracorporeal-carbon-dioxide-removal-device-for-acute-hypercapnic-respiratory-failure
#20
Ravindranath Tiruvoipati, Hergen Buscher, James Winearls, Jeff Breeding, Debasish Ghosh, Shimonti Chaterjee, Gary Braun, Eldho Paul, John F Fraser, John Botha
BACKGROUND: Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation. OBJECTIVE: We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
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