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Davinder Ramsingh, Ethan Frank, Robert Haughton, John Schilling, Kimberly M Gimenez, Esther Banh, Joseph Rinehart, Maxime Cannesson
BACKGROUND: Unrecognized malposition of the endotracheal tube (ETT) can lead to severe complications in patients under general anesthesia. The focus of this double-blinded randomized study was to assess the accuracy of point-of-care ultrasound in verifying the correct position of the ETT and to compare it with the accuracy of auscultation. METHODS: Forty-two adult patients requiring general anesthesia with ETT were consented. Patients were randomized to right main bronchus, left main bronchus, or tracheal intubation...
May 2016: Anesthesiology
J Pinto, L Cordeiro, C Pereira, R Gama, H L Fernandes, J Assunção
BACKGROUND: Unpredicted difficult intubation can have severe consequences, and it is a significant source of morbidity and mortality. Although recent studies indicate that specific ultrasonography (US) measurements may be predictors of difficult laryngoscopy, their use is still limited, and its quantification is missing. The purpose of this prospective observational study is to evaluate the use of US-measured distance from skin to epiglottis (DSE) for difficult laryngoscopy prediction...
June 2016: Journal of Critical Care
Laurent Papazian, Amanda Corley, Dean Hess, John F Fraser, Jean-Pierre Frat, Christophe Guitton, Samir Jaber, Salvatore M Maggiore, Stefano Nava, Jordi Rello, Jean-Damien Ricard, François Stephan, Rocco Trisolini, Elie Azoulay
Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality...
September 2016: Intensive Care Medicine
Jose E Irazuzta, Fatima Paredes, Viviana Pavlicich, Sara L Domínguez
OBJECTIVE: To assess the efficacy of a high-dose prolonged magnesium sulfate infusion in patients with severe, noninfectious-mediated asthma. DESIGN: Prospective, randomized, open-label study. SETTING: Twenty-nine-bed pediatric emergency department located in a children's hospital in Asuncion, Paraguay. PATIENTS: All patients of 6-16 years old who failed to improve after 2 hours of standard therapy for asthma. INTERVENTIONS: Subjects were randomized to receive magnesium sulfate, 50 mg/kg over 1 hour (bolus) or high-dose prolonged magnesium sulfate infusion of 50 mg/kg/hr for 4 hours (max, 8...
February 2016: Pediatric Critical Care Medicine
Reinoud Gosens, Chris Grainge
Recent work has demonstrated that mechanical forces occurring in the airway as a consequence of bronchoconstriction are sufficient to not only induce symptoms but also influence airway biology. Animal and human in vitro and in vivo work demonstrates that the airways are structurally and functionally altered by mechanical stress induced by bronchoconstriction. Compression of the airway epithelium and mechanosensing by the airway smooth muscle trigger the activation and release of growth factors, causing cell proliferation, extracellular matrix protein accumulation, and goblet cell differentiation...
March 2015: Chest
Shahrokh Javaheri, Lee K Brown, Winfried J Randerath
The beginning of the 21st century witnessed the advent of new positive airway pressure (PAP) technologies for the treatment of central and complex (mixtures of obstructive and central) sleep apnea syndromes. Adaptive servoventilation (ASV) devices applied noninvasively via mask that act to maintain a stable level of ventilation regardless of mechanism are now widely available. These PAP devices function by continually measuring either minute ventilation or airflow to calculate a target ventilation to be applied as needed...
August 2014: Chest
Allison B Hall, Maria C Ziadi, Judith A Leech, Shin-Yee Chen, Ian G Burwash, Jennifer Renaud, Robert A deKemp, Haissam Haddad, Lisa M Mielniczuk, Keiichiro Yoshinaga, Ann Guo, Li Chen, Olga Walter, Linda Garrard, Jean N DaSilva, John S Floras, Rob S B Beanlands
BACKGROUND: Heart failure with reduced ejection fraction and obstructive sleep apnea (OSA), 2 states of increased metabolic demand and sympathetic nervous system activation, often coexist. Continuous positive airway pressure (CPAP), which alleviates OSA, can improve ventricular function. It is unknown whether this is due to altered oxidative metabolism or presynaptic sympathetic nerve function. We hypothesized that short-term (6-8 weeks) CPAP in patients with OSA and heart failure with reduced ejection fraction would improve myocardial sympathetic nerve function and energetics...
September 9, 2014: Circulation
Sumit Gupta, Ruth Hartley, Umair T Khan, Amisha Singapuri, Beverly Hargadon, William Monteiro, Ian D Pavord, Ana R Sousa, Richard P Marshall, Deepak Subramanian, David Parr, James J Entwisle, Salman Siddiqui, Vimal Raj, Christopher E Brightling
BACKGROUND: Asthma heterogeneity is multidimensional and requires additional tools to unravel its complexity. Computed tomography (CT)-assessed proximal airway remodeling and air trapping in asthmatic patients might provide new insights into underlying disease mechanisms. OBJECTIVES: The aim of this study was to explore novel, quantitative, CT-determined asthma phenotypes. METHODS: Sixty-five asthmatic patients and 30 healthy subjects underwent detailed clinical, physiologic characterization and quantitative CT analysis...
March 2014: Journal of Allergy and Clinical Immunology
Pierre-Olivier Girodet, Gaël Dournes, Matthieu Thumerel, Hugues Begueret, Pierre Dos Santos, Annaig Ozier, Isabelle Dupin, Thomas Trian, Michel Montaudon, François Laurent, Roger Marthan, Patrick Berger
RATIONALE: Severe asthma is a major public health issue throughout the world. Increased bronchial smooth muscle (BSM) mass, a characteristic feature of airway remodeling in severe asthma, is associated with resistance to high-intensity treatment and poor prognosis. In vitro, the Ca(2+)-channel blocker gallopamil decreased the proliferation of BSM cells from patients with severe asthma. OBJECTIVES: We conducted a double-blind, randomized, placebo-controlled study to evaluate the effect of gallopamil on airway remodeling in patients with severe asthma...
April 15, 2015: American Journal of Respiratory and Critical Care Medicine
Cassie C Kennedy, Eric K Cannon, David O Warner, David A Cook
OBJECTIVE: To perform a systematic review and meta-analysis of the literature on teaching airway management using technology-enhanced simulation. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. STUDY SELECTION: Observational or controlled trials instructing medical professionals in direct or fiberoptic intubation, surgical airway, and/or supraglottic airway using technology-enhanced simulation were included...
January 2014: Critical Care Medicine
Damien Adam, Jacqueline Roux-Delrieu, Emilie Luczka, Arnaud Bonnomet, Julien Lesage, Jean-Claude Mérol, Myriam Polette, Michel Abély, Christelle Coraux
Chronic inflammation is a hallmark of cystic fibrosis (CF) lung disease and airway epithelium damage and remodelling are important components of lung pathology progression in CF. Whether this remodelling is secondary to deleterious infectious and inflammatory mediators, or to alterations of CF human airway epithelial (HAE) cells, such as their hyper inflammatory phenotype or their basic cystic fibrosis transmembrane conductance regulator (CFTR) default, remains debated. In this study, we evaluated the involvement of alterations of CF HAE cells in airway epithelium remodelling...
February 2015: Journal of Pathology
Marco Idzko, Simon Pitchford, Clive Page
Increasing evidence suggests an important role for platelets and their products (e.g., platelet factor 4, β-thromboglobulin, RANTES, thromboxane, or serotonin) in the pathogenesis of allergic diseases. A variety of changes in platelet function have been observed in patients with asthma, such as alterations in platelet secretion, expression of surface molecules, aggregation, and adhesion. Moreover, platelets have been found to actively contribute to most of the characteristic features of asthma, including bronchial hyperresponsiveness, bronchoconstriction, airway inflammation, and airway remodeling...
June 2015: Journal of Allergy and Clinical Immunology
Maria Vargas, Paolo Pelosi, Gaetano Tessitore, Fulvio Aloj, Iole Brunetti, Enrico Arditi, Dorino Salami, Robert M Kacmarek, Giuseppe Servillo
OBJECTIVE: Gas exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double-lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study prospectively evaluated the in vivo feasibility, gas exchange, and airway pressures during PDT with DLET compared with a conventional endotracheal tube (ETT). METHODS: According to eligibility criteria, patients were divided into a case group (those receiving PDT with DLET) and a control group (those receiving PDT with a conventional ETT)...
May 2015: Chest
Gaël Dournes, François Laurent, Florence Coste, Claire Dromer, Elodie Blanchard, François Picard, Fabien Baldacci, Michel Montaudon, Pierre-Olivier Girodet, Roger Marthan, Patrick Berger
RATIONALE: Pulmonary hypertension (PH) is an established complication of advanced chronic obstructive pulmonary disease (COPD) associated with increased mortality. The mechanisms coupling PH and bronchial obstruction are unknown; in particular, PH appears to be unrelated to emphysema. We hypothesized that computed tomographic (CT) measurement of airway remodeling instead of emphysema may correlate with PH in COPD. OBJECTIVES: We aimed to describe the clinical and CT characteristics of patients with COPD with or without PH and to correlate CT measurements of airway remodeling and emphysema with PH...
January 1, 2015: American Journal of Respiratory and Critical Care Medicine
A Higgs, C Swampillai, R Dravid, V Mitchell, A Patel, M Popat
No abstract text is available yet for this article.
August 2010: Anaesthesia
Mark J Sagarin, Vincent Chiang, John C Sakles, Erik D Barton, Richard E Wolfe, Robert J Vissers, Ron M Walls
OBJECTIVES: To characterize current practice with respect to pediatric emergency airway management using a multicenter data set. METHODS: A multicenter collaboration was undertaken to gather data prospectively regarding emergency intubation. Analysis of data on adult emergency department (ED) intubations clearly demonstrated that rapid sequence intubation (RSI) was the method used most often. We then conducted an observational study of the prospectively collected database of pediatric ED intubations (EDIs) using the National Emergency Airway Registry Phase One data, gathered in 11 participating EDs over a 16-month time period...
December 2002: Pediatric Emergency Care
Emmanuel Martinod, Agathe Seguin, Dana M Radu, Guillaume Boddaert, Kader Chouahnia, Anne Fialaire-Legendre, Hervé Dutau, Nicolas Vénissac, Charles-Hugo Marquette, Christophe Baillard, Dominique Valeyre, Alain Carpentier
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization...
July 29, 2013: European Journal of Medical Research
Jeffrey L Apfelbaum, Carin A Hagberg, Robert A Caplan, Casey D Blitt, Richard T Connis, David G Nickinovich, Carin A Hagberg, Robert A Caplan, Jonathan L Benumof, Frederic A Berry, Casey D Blitt, Robert H Bode, Frederick W Cheney, Richard T Connis, Orin F Guidry, David G Nickinovich, Andranik Ovassapian
No abstract text is available yet for this article.
February 2013: Anesthesiology
J Adam Law, Natasha Broemling, Richard M Cooper, Pierre Drolet, Laura V Duggan, Donald E Griesdale, Orlando R Hung, Philip M Jones, George Kovacs, Simon Massey, Ian R Morris, Timothy Mullen, Michael F Murphy, Roanne Preston, Viren N Naik, Jeanette Scott, Shean Stacey, Timothy P Turkstra, David T Wong
BACKGROUND: Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group's mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered...
November 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
M Popat, V Mitchell, R Dravid, A Patel, C Swampillai, A Higgs
Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri-operative practice...
March 2012: Anaesthesia
2015-12-27 10:34:54
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