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https://www.readbyqxmd.com/read/28329231/cardiac-protective-effects-of-remote-ischaemic-preconditioning-in-children-undergoing-tetralogy-of-fallot-repair-surgery-a-randomized-controlled-trial
#1
Qingping Wu, Tingting Wang, Shiqiang Chen, Quanjun Zhou, Haobo Li, Na Hu, Yinglu Feng, Nianguo Dong, Shanglong Yao, Zhengyuan Xia
Aims: Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia in distant tissues protects the heart against myocardial ischaemia-reperfusion injury (IRI) in children undergoing open-heart surgery, although its effectiveness in adults with comorbidities is controversial. The effectiveness and mechanism of RIPC with respect to myocardial IRI in children with tetralogy of Fallot (ToF), a severe cyanotic congenital cardiac disease, undergoing open heart surgery are unclear. We hypothesized that RIPC can confer cardioprotection in children undergoing ToF repair surgery...
February 18, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28327076/myocardial-protection-during-minimally-invasive-cardiac-surgery-through-right-mini-thoracotomy
#2
Micaela De Palo, Pietro Guida, Florinda Mastro, Daniela Nanna, Teresa A P Quagliara, Ruggiero Rociola, Giosuè Lionetti, Domenico Paparella
BACKGROUND: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. AIM: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS...
April 2017: Perfusion
https://www.readbyqxmd.com/read/28315940/a-multi-faceted-strategy-to-reduce-ventilation-associated-mortality-in-brain-injured-patients-the-bi-vili-project-a-nationwide-quality-improvement-project
#3
Karim Asehnoune, Ségolène Mrozek, Pierre François Perrigault, Philippe Seguin, Claire Dahyot-Fizelier, Sigismond Lasocki, Anne Pujol, Mathieu Martin, Russel Chabanne, Laurent Muller, Jean Luc Hanouz, Emmanuelle Hammad, Bertrand Rozec, Thomas Kerforne, Carole Ichai, Raphael Cinotti, Thomas Geeraerts, Djillali Elaroussi, Paolo Pelosi, Samir Jaber, Marie Dalichampt, Fanny Feuillet, Véronique Sebille, Antoine Roquilly
PURPOSE: We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS: Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French intensive care units (ICUs) were included. The management of invasive ventilation in brain-injured patients admitted between 1 July 2013 and 31 October 2013 (4 months) was monitored and analysed...
March 18, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28306327/fifty-years-of-research-in-ards-respiratory-mechanics-in-acute-respiratory-distress-syndrome
#4
William R Henderson, Lu Chen, Marcelo B P Amato, Laurent J Brochard
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, while lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small tidal volumes, low plateau and driving pressures, and high levels of positive end expiratory pressure. Collectively, these interventions are termed "lung protective ventilation". Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation...
March 17, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28303021/age-and-surgical-complexity-impact-on-renoprotection-by-remote-ischemic-preconditioning-during-adult-cardiac-surgery-a-meta-analysis
#5
Chenghui Zhou, Heerajnarain Bulluck, Nengxin Fang, Lihuan Li, Derek J Hausenloy
We aimed to conduct an up-to-date meta-analysis to comprehensively assess the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing adult cardiac surgery. 21 randomized controlled trials (RCTs) with a total of 6302 patients were selected and identified. Compared with controls, RIPC significantly reduced the incidence of acute kidney injury (AKI) [odds ratio (OR) = 0.79; P = 0.02; I(2) = 38%], and in particular, AKI stage I (OR = 0.65; P = 0.01; I(2) = 55%)...
March 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28301956/the-effect-of-tracheostomy-performed-within-72%C3%A2-h-after-traumatic-brain-injury
#6
Keita Shibahashi, Kazuhiro Sugiyama, Hidenori Houda, Yuichi Takasu, Yuichi Hamabe, Akio Morita
The optimal timing of tracheostomy in patients with traumatic brain injury (TBI) remains unclear. The purpose of this study was to examine the effects of tracheostomy performed within 72 h after admission. In this retrospective cohort study, the authors reviewed the data for a series of 120 consecutive patients who underwent tracheostomy after suffering TBI with an Abbreviated Injury Scale (AIS) score of ≥4. The exclusion criteria were as follows: age <18 years, severe chest injury with an AIS score of ≥4, and a requirement for intubation because of upper airway obstruction...
March 16, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28295658/successful-closure-of-post-tracheostomy-large-chronic-trachea-esophageal-fistula-with-new-over-the-scope-clip
#7
P Rai, R Bhargava
Acquired tracheo-esophageal fistula mostly occurs secondary to malignancy, infection, ruptured diverticula, and injuries.(1) Among the benign conditions, prolonged mechanical ventilation is the most common (47%), followed by injury (17%), prior laryngectomy (17%), and prior esophagostomy (17%).(2) A 19 y male had a road traffic accident and was managed in an intensive care unit with ventilator support and had tracheostomy for 20 days. This article is protected by copyright. All rights reserved.
March 10, 2017: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
https://www.readbyqxmd.com/read/28292533/assessment-of-hydration-status-using-bioelectrical-impedance-vector-analysis-in-critical-patients-with-acute-kidney-injury
#8
Ana Cláudia da Rosa Hise, Maria Cristina Gonzalez
BACKGROUND & AIMS: The state of hyperhydration in critically ill patients with acute kidney injury (AKI) is associated with increased mortality. Bioelectrical impedance vector analysis (BIVA) appears to be a viable method to access the fluid status of critical patients but has never been evaluated in critical patients with AKI. The objective of this study is to evaluate the hydration status measured using BIVA in critical patients under intensive care at the time of AKI diagnosis and to correlate this measurement with mortality...
February 21, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28290154/the-role-of-calpains-in-ventilator-induced-diaphragm-atrophy
#9
Xiaoping Zhu, Hieronymus W H van Hees, Leo Heunks, Feifei Wang, Lei Shao, Jiaru Huang, Lei Shi, Shaolin Ma
BACKGROUND: Controlled mechanical ventilation (CMV) is associated with diaphragm dysfunction. Dysfunction results from muscle atrophy and injury of diaphragm muscle fibers. Enhanced proteolysis and reduced protein synthesis play an important role in the development of atrophy. The current study is to evaluate the effects of the calpains inhibitor calpeptin on the development of diaphragm atrophy and activation of key enzymes of the ubiquitin-proteasome pathway in rats under CMV. METHODS: Three groups of rats were studied: control animals (CON, n = 8), rats subjected to 24 h of MV (CMV, n = 8), and rats subjected to 24 h of MV after administration of the calpain inhibitor calpeptin (CMVC, n = 8)...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28288543/renal-function-weaning-and-survival-in-patients-with-ventilator-dependent-respiratory-failure
#10
Debapriya Datta, Raymond J Foley, Rong Wu, James Grady, Paul Scalise
BACKGROUND: Acute kidney injury in acute critical illness has been associated with poor weaning and survival outcomes. The relation between renal dysfunction as defined by creatinine clearance (CrCl) and weaning from prolonged mechanical ventilation (PMV) is not known. The objective of this study was to determine the relation of measured CrCl to weaning and survival in patients on PMV. METHODS: We retrospectively studied 167 patients on PMV admitted to a long-term acute care facility for weaning over a 3-year period...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28286784/the-influence-of-metabolic-imbalances-and-oxidative-stress-on-the-outcome-of-critically-ill-polytrauma-patients-a-review
#11
REVIEW
Alexandru Florin Rogobete, Dorel Sandesc, Marius Papurica, Emil Robert Stoicescu, Sonia Elena Popovici, Lavinia Melania Bratu, Corina Vernic, Adriana Mariana Sas, Adrian Tudor Stan, Ovidiu Horea Bedreag
The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28284096/prevalence-of-graduated-compression-stocking-associated-pressure-injuries-in-surgical-intensive-care-units
#12
Deborah B Hobson, Tracy Y Chang, Jonathan K Aboagye, Brandyn D Lau, Hasan M Shihab, Betsy Fisher, Samantha Young, Nancy Sujeta, Dauryne L Shaffer, Victor O Popoola, Peggy S Kraus, Gina Knorr, Norma E Farrow, Michael B Streiff, Elliott R Haut
PURPOSE: This study aimed to determine the prevalence of static graduated compression stocking (sGCS)-associated pressure injury among patients in surgical intensive care units (ICUs). METHODS: We retrospectively reviewed data from wound care rounds between April 2011 and June 2012 at 3 surgical ICUs at an urban, tertiary care hospital. Patients with sGCS-associated pressure injury were identified and descriptive analysis was performed on their demographic, perioperative, and postoperative characteristics...
February 27, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28283699/opening-pressures-and-atelectrauma-in-acute-respiratory-distress-syndrome
#13
Massimo Cressoni, Davide Chiumello, Ilaria Algieri, Matteo Brioni, Chiara Chiurazzi, Andrea Colombo, Angelo Colombo, Francesco Crimella, Mariateresa Guanziroli, Ivan Tomic, Tommaso Tonetti, Giordano Luca Vergani, Eleonora Carlesso, Vladimir Gasparovic, Luciano Gattinoni
PURPOSE: Open lung strategy during ARDS aims to decrease the ventilator-induced lung injury by minimizing the atelectrauma and stress/strain maldistribution. We aim to assess how much of the lung is opened and kept open within the limits of mechanical ventilation considered safe (i.e., plateau pressure 30 cmH2O, PEEP 15 cmH2O). METHODS: Prospective study from two university hospitals. Thirty-three ARDS patients (5 mild, 10 moderate, 9 severe without extracorporeal support, ECMO, and 9 severe with it) underwent two low-dose end-expiratory CT scans at PEEP 5 and 15 cmH2O and four end-inspiratory CT scans (from 19 to 40 cmH2O)...
March 10, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28277372/one-hit-models-of-ventilator-induced-lung-injury-benign-inflammation-versus-inflammation-as-a-by-product
#14
Dennis Lex, Stefan Uhlig
BACKGROUND: One important explanation for the detrimental effects of conventional mechanical ventilation is the biotrauma hypothesis that ventilation may trigger proinflammatory responses that subsequently cause lung injury. This hypothesis has frequently been studied in so-called one-hit models (overventilation of healthy lungs) that so far have failed to establish an unequivocal link between inflammation and hypoxemic lung failure. This study was designed to develop a one-hit biotrauma model...
March 9, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28275224/aggressive-versus-conservative-antibiotic-use-to-prevent-and-treat-ventilator-associated-pneumonia-in-patients-with-severe-traumatic-brain-injury-comparison-of-two-case-series
#15
Arturo Chieregato, Paolo Malacarne, Francesco Cocciolo, Maurizio Ravaldini, Emanuele Russo, Bruno Viaggi, Michele Giardino, Carlotta Rossi, Bruno Simini, Guido Bertolini
BACKGROUND: In patients with traumatic brain injury (TBI), ventilator-associated pneumonia (VAP) is considered a dangerous complication, prompting early aggressive antibiotic treatment and prophylaxis. While this approach increases the selection of multidrug-resistant bacteria (MDR), its clinical benefit has not been demonstrated. METHODS: One-year incidence of VAP in severe TBI patients (ICU stay >48 hours, with either Glasgow Coma Scale 8 or receiving intracranial pressure monitoring, or having undergone emergency surgery) and the prevalence of MDR among those who eventually developed it, were compared in two Italian intensive care units (ICUs) adopting different antibiotic approaches...
March 8, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28274684/high-frequency-ultrasound-sacral-images-in-the-critically-ill-tissue-characteristics-versus-visual-evaluation
#16
Mary Jo Grap, Christine M Schubert, Ruth S Burk, Valentina Lucas, Paul A Wetzel, Anathea Pepperl, Cindy L Munro
PURPOSE: High frequency ultrasound (HFUS) systems may identify tissue injury. We compared HFUS tissue characteristics (dermal thickness and dermal density) with visual image examination. METHODS: Longitudinal study in critically ill mechanically ventilated adults, from three ICUs (Surgical Trauma, Medical Respiratory, Neuroscience) enrolled within 24hours of airway intubation. Sacral HFUS images were obtained daily for up to seven days. Expert evaluation of the best image per day was completed and compared to HFUS generated tissue characteristics (dermal thickness and dermal density)...
March 5, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28270863/respiratory-problems-and-management-in-people-with-spinal-cord-injury
#17
David J Berlowitz, Brooke Wadsworth, Jack Ross
Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations...
December 2016: Breathe
https://www.readbyqxmd.com/read/28270643/charlson-comorbidity-index-for-prediction-of-outcome-of-acute-kidney-injury-in-critically-ill-patients
#18
Sumaira Talib, Fatima Sharif, Sidra Manzoor, Sonia Yaqub, Waqar Kashif
INTRODUCTION: This study aimed to determine predictors of outcomes in critically ill patients with acute kidney injury (AKI), and to study the impact of the Charlson Comorbidity Index (CCI) as a prognostic indicator. MATERIALS AND METHODS: This retrospective study included critically ill patients who were admitted with AKI or developed AKI during their hospital stay. The impact of comorbidity was evaluated by the CCI, while severity of AKI was assessed by the RIFLE criteria...
March 2017: Iranian Journal of Kidney Diseases
https://www.readbyqxmd.com/read/28268882/noninvasive-estimation-of-alveolar-pressure
#19
Francesco Vicario, Roberto Buizza, William A Truschel, Nicolas W Chbat
This paper presents an algorithm for noninvasive estimation of alveolar pressure in mechanically ventilated patients who are spontaneously breathing. Continual monitoring of alveolar pressure is desirable to prevent ventilator-induced lung injury and to assess the intrinsic positive end-expiratory pressure (PEEPi), which is a parameter of clinical relevance in respiratory care and difficult to measure noninvasively. The algorithm is based on a physiological model of the respiratory system and, as such, it also provides insight into the respiratory mechanics of the patient under mechanical ventilation...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28267376/favorable-neurocognitive-outcome-with-low-tidal-volume-ventilation-after-cardiac-arrest
#20
Jeremy R Beitler, Tiffany Bita Ghafouri, Sayuri P Jinadasa, Ariel Mueller, Leeyen Hsu, Ryan J Anderson, Jisha Joshua, Sanjeev Tyagi, Atul Malhotra, Rebecca E Sell, Daniel Talmor
RATIONALE: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) often is poor even when initial resuscitation succeeds. Lower tidal volumes (VT) attenuate extrapulmonary organ injury in other disease states and are neuro-protective in preclinical models of critical illness. OBJECTIVE: To evaluate the association between VT and neurocognitive outcome following OHCA. METHODS: Propensity-adjusted analysis of two-center retrospective cohort of OHCA patients who received mechanical ventilation for at least the first 48 hours of hospitalization...
March 7, 2017: American Journal of Respiratory and Critical Care Medicine
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