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management of ards

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https://www.readbyqxmd.com/read/29149363/indications-for-extracorporeal-support-why-do-we-need-the-results-of-the-eolia-trial
#1
REVIEW
A Combes, N Bréchot, C-E Luyt, M Schmidt
Acute respiratory distress syndrome (ARDS) is a severe lung disease, with an associated mortality rate exceeding 60% for the most severe forms of the disease. In these situations, establishing an extracorporeal circuit, combining a centrifugal pump and a membrane oxygenator (extra-corporeal membrane oxygenation, ECMO), can ensure total pulmonary assistance and allow the lungs to rest under ultraprotective mechanical ventilation. Unfortunately, former trials of ECMO in ARDS were negative or highly criticized due to many technical and methodological shortcomings...
November 17, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29146420/extracorporeal-membrane-oxygenation-used-successfully-in-a-near-fatal-case-of-opioid-induced-acute-respiratory-distress-syndrome
#2
Karen Greenberg, Benjamin Kohl
Acute Respiratory Distress Syndrome (ARDS) was first recognized during the 1960s. It is a distinct type of hypoxemic respiratory failure characterized by acute abnormality of both lungs. Extracorporeal membrane oxygenation (ECMO) is being increasingly used for patients with severe ARDS refractory to otherwise conventional management. A 29year old male arrived with Emergency Medical Services (EMS) status post presumed heroin overdose. He was administered Naloxone 2mg intravenously prior to arrival in the emergency department...
November 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29138069/traumatic-fractures-of-the-cervical-spine-analysis-of-changes-in-incidence-etiology-concurrent-injuries-and-complications-among-488-262-patients-from-2005-2013
#3
Peter G Passias, Gregory W Poorman, Frank A Segreto, Cyrus M Jalai, Samantha R Horn, Cole A Bortz, Dennis Vasquez-Montes, Bassel G Diebo, Shaleen Vira, Olivia J Bono, Rafael De La Garza-Ramos, John Y Moon, Charles Wang, Brandon P Hirsch, Peter L Zhou, Michael Gerling, Heiko Koller, Virginie Lafage
OBJECTIVE: The etiologies and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, etiology, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. METHODS: Retrospective review of the Nationwide Inpatient Sample. ICD-9 E-Codes identified trauma cases from 2005-2013. Patients with cervical fracture were isolated...
November 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29135617/lessons-to-learn-from-epidemiologic-studies-in-ards
#4
Bairbre A McNicholas, Grainne M Rooney, John G Laffey
PURPOSE OF REVIEW: Recent advances in our understanding of the epidemiology of ARDS has generated key insights into the incidence, risk factors, demographics, management and outcomes from this devastating clinical syndrome. RECENT FINDINGS: ARDS occurs in 10% of all ICU patients, in 23% of all mechanically ventilated patients, with 5.5 cases per ICU bed each year. Although some regional variation exists regarding ARDS incidence, this may be less than previously thought...
November 11, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29135527/venovenous-extracorporeal-membrane-oxygenation-to-prolong-pregnancy-a-case-report
#5
Omar Alyamani, Michael A Mazzeffi, Shobana Bharadwaj, Jessica H Galey, Ruofan Yao, Nirav G Shah, Andrew M Malinow
We report a gravida in fulminant acute respiratory distress syndrome, mechanically ventilated at 27 weeks estimated gestational age, who further deteriorated into severe combined hypercarbic, hypoxemic respiratory failure. At 30 weeks estimated gestational age, she was placed on venovenous extracorporeal membrane oxygenation (ECMO) because of refractory respiratory failure. Her physical status improved without fetal deterioration. She was managed expectantly in an effort to allow continued fetal maturation...
November 9, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#6
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29132978/intensive-care-in-severe-malaria-report-from-the-task-force-on-tropical-diseases-by-the-world-federation-of-societies-of-intensive-and-critical-care-medicine
#7
REVIEW
Dilip R Karnad, Mohd Basri Mat Nor, Guy A Richards, Tim Baker, Pravin Amin
Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare...
November 8, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29132514/ventilator-strategies-for-chronic-obstructive-pulmonary-disease-and-acute-respiratory-distress-syndrome
#8
REVIEW
Nathan T Mowery
The management of the ventilator in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS) has a dramatic effect on the overall outcome. The incidence of COPD is increasing as the US population grows older. The most effective means to deal with pulmonary complications is to avoid them, but both COPD and ARDS have evidence-based interventions that have been shown to improve outcomes. Pulmonary complications affect up to 40% of patients, and their occurrence is associated with an increased duration of hospital stay, and an increased mortality...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29122557/-maternal-deaths-due-to-anesthesia-complications-results-from-the-french-confidential-enquiry-into-maternal-deaths-2010-2012
#9
D Chassard
Over the period 2010-2012, maternal mortality linked to anesthesia accounted for 2% of maternal deaths, with no significant change since 2007-2009. Of the 7 maternal deaths analyzed by the expert committee, anesthetic complications were in 5 cases the main cause of death: 4 attributed to direct causes related to anesthetic procedures during childbirth and 1 to indirect cause in connection with an ENT complication during pregnancy. The anesthetic causes of maternal mortality were for the 2010-2012 period: cardiac arrest under spinal anesthesia during caesarean section, local anesthetic intoxication with unsuccessful resuscitation after cardiac arrest without intralipid administration, acute respiratory distress syndrome in the postpartum period after pulmonary aspiration during caesarean section, cardiac arrest during caesarean section under general anesthesia in a context of non-Hodgkin lymphoma with mediastinal syndrome, unsuccessful endotracheal intubation in a context of cellulitis of the oral cavity floor...
November 6, 2017: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/29114830/comparisons-of-interventions-for-preventing-falls-in-older-adults-a-systematic-review-and-meta-analysis
#10
Andrea C Tricco, Sonia M Thomas, Areti Angeliki Veroniki, Jemila S Hamid, Elise Cogo, Lisa Strifler, Paul A Khan, Reid Robson, Kathryn M Sibley, Heather MacDonald, John J Riva, Kednapa Thavorn, Charlotte Wilson, Jayna Holroyd-Leduc, Gillian D Kerr, Fabio Feldman, Sumit R Majumdar, Susan B Jaglal, Wing Hui, Sharon E Straus
Importance: Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise. Objective: To assess the potential effectiveness of interventions for preventing falls. Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned...
November 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29111984/asbestos-exposures-mesothelioma-incidence-and-mortality-and-awareness-by-general-practitioners-in-the-molise-region-central-italy
#11
Giancarlo Ripabelli, Manuela Tamburro, Domiziana Di Tella, Francesco Carrozza, Michela Lucia Sammarco
OBJECTIVE: To evaluate environmental asbestos sources, mesothelioma incidence and mortality, awareness on asbestos-related diseases (ARD) by general practitioners (GPs) in Molise Region. METHODS: The contaminated sites in three towns were identified by census; mesothelioma incidence (2000-2012) and mortality (2003-2013) was achieved from local registries; GPs were interviewed on practiced population's exposures and ARD diagnosis. RESULTS: 54...
November 3, 2017: Journal of Occupational and Environmental Medicine
https://www.readbyqxmd.com/read/29109640/obstetric-critical-care-requirements-felt-by-the-obstetricians-an-experience-based-study
#12
Mohan Deep Kaur, Jyoti Sharma, Prasoon Gupta, Tarun Deep Singh, Saurav Mitra Mustafi
Background and Aims: Pregnancy is a state of physiological stress to a woman's health. Concomitant complications and infections during pregnancy may necessitate intensive monitoring and management of such patients in critical care settings. This study aims to determine the perceptions about the requirement of obstetric critical care based on the experience of obstetricians. Material and Methods: An observational, questionnaire-based study was conducted in 200 obstetricians working in various settings, who were approached during obstetric conferences...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29079016/the-8-year-experience-of-the-florence-referral-ecmo-center-and-retrieval-team-for-acute-respiratory-failure
#13
Giovanni Cianchi, Chiara Lazzeri, Manuela Bonizzoli, Stefano Batacchi, Morena Cozzolino, Marco Ciapetti, Pasquale Bernardo, Andrea Franci, Marco Chiostri, Adriano Peris
OBJECTIVE: Many extracorporeal membrane oxygenation (ECMO) centers for respiratory failure and ECMO mobile teams were instituted during the H1N1 pandemic. Data on transportation are scarce and heterogeneous. The authors therefore described the experience of their referral ECMO center for severe respiratory failure from 2009 to 2016 and gave a comprehensive report of transfers performed by their mobile ECMO team. DESIGN: Observational retrospective study. SETTING: An intensive care unit (ECMO referral center) in a teaching hospital...
June 8, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29073534/3-month-prognostic-impact-of-severe-acute-renal-failure-under-veno-venous-ecmo-support-importance-of-time-of-onset
#14
C Delmas, T Zapetskaia, J M Conil, B Georges, F Vardon-Bounes, T Seguin, L Crognier, O Fourcade, L Brouchet, V Minville, S Silva
PURPOSE: Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome. METHODS: Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included...
October 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29066591/the-role-of-rescue-therapies-in-the-treatment-of-severe-ards
#15
REVIEW
Francesco Alessandri, Francesco Pugliese, V Marco Ranieri
ARDS is characterized by a non-cardiogenic pulmonary edema with bilateral chest radiograph opacities and hypoxemia refractory to oxygen therapy. It is a common cause of admission to the ICU due to hypoxemic respiratory failure requiring mechanical ventilation. Corticosteroids are not recommended in ARDS patients. Rescue therapies alleviate hypoxemia in patients unable to maintain reasonable oxygenation: recruitment maneuvers, prone positioning, inhaled nitric oxide, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation improve oxygenation, but their impact on mortality remains unproven...
October 24, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29064179/a-case-of-hypothermia-on-crrt
#16
Gurwant Kaur, Prameela Banoth, Preethi Yerram, Madhukar Misra
A 64-year-old Asian man, with past medical history of hypertension, hypothyroidism, and hyperlipidemia, presented with 3 days history of fever associated with cough and worsening shortness of breath. Subsequent clinical course was complicated by acute lung injury leading to acute respiratory distress syndrome requiring positive pressure ventilation, septic shock requiring inotropic support, and acute kidney injury requiring continuous renal replacement therapy (CRRT). On day 3 of CRRT, the patient developed significant hypothermia (temporal temperature 27...
October 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29045280/sedation-practice-in-extracorporeal-membrane-oxygenation-treated-patients-with-acute-respiratory-distress-syndrome-a-retrospective-study
#17
Julian deBacker, Erik Tamberg, Laveena Munshi, Lisa Burry, Eddy Fan, Sangeeta Mehta
Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29021726/investigating-the-relationship-between-microalbuminuria-and-prognosis-of-patients-with-severe-burns-in-the-motahari-burn-hospital
#18
M Roham, K Anbari, M J Fatemi, M Momeni
Microalbuminuria seems to be a reflection of increased vascular permeability caused by systemic inflammatory response, and is likely to be a predictor of mortality, sepsis and other outcomes of severe burn patients. We investigated the impact of microalbuminuria on the prognosis of patients with severe burns. This is a prospective study on severe burn patients (above 20%) admitted in the first 24 hours after burns to the Motahari Burn Hospital. Patients' microalbuminuria was measured at admission and 48 hours later, and its relationship with patient prognosis (sepsis, renal failure, death, inhalation injury and systemic inflammatory response syndrome) was analyzed...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/29018041/spontaneous-breathing-trials-and-conservative-sedation-practices-reduce-mechanical-ventilation-duration-in-subjects-with-ards
#19
Richard H Kallet, Hanjing Zhuo, Vivian Yip, Antonio Gomez, Michael S Lipnick
BACKGROUND: Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. METHODS: All ARDS survivors from 2002 to 2016 (N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016)...
October 10, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29016366/acute-life-threatening-hypoxemia-during-mechanical-ventilation
#20
Thomas Piraino, Eddy Fan
PURPOSE OF REVIEW: To describe current evidence-based practice in the management of acute life-threatening hypoxemia in mechanically ventilated patients and some of the methods used to individualize the care of the patient. RECENT FINDINGS: Patients with acute life-threatening hypoxemia will often meet criteria for severe ARDS, for which there are only a few treatment strategies that have been shown to improve survival outcomes. Recent findings have increased our knowledge of the physiological effects of spontaneous breathing and the application of PEEP...
December 2017: Current Opinion in Critical Care
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