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Ventilation support

Dirkje S Postma, Chris Brightling, Simonetta Baldi, Maarten Van den Berge, Leonardo M Fabbri, Alessandra Gagnatelli, Alberto Papi, Thys Van der Molen, Klaus F Rabe, Salman Siddiqui, Dave Singh, Gabriele Nicolini, Monica Kraft
BACKGROUND: Small airways dysfunction (SAD) is well recognised in asthma, yet its role in the severity and control of asthma is unclear. This study aimed to assess which combination of biomarkers, physiological tests, and imaging markers best measure the presence and extent of SAD in patients with asthma. METHODS: In this baseline assessment of a multinational prospective cohort study (the Assessment of Small Airways Involvement in Asthma [ATLANTIS] study), we recruited participants with and without asthma (defined as Global Initiative for Asthma severity stages 1-5) from general practices, the databases of chest physicians, and advertisements at 29 centres across nine countries (Brazil, China, Germany, Italy, Spain, the Netherlands, the UK, the USA, and Canada)...
March 12, 2019: Lancet Respiratory Medicine
Anita Duyndam, Robert Jan Houmes, Joost van Rosmalen, Dick Tibboel, Monique van Dijk, Erwin Ista
BACKGROUND: Critically ill children treated with invasive mechanical ventilation in a paediatric intensive care unit (PICU) may suffer from complications leading to prolonged duration of ventilation and PICU stay. OBJECTIVE: The objective of this study is to find out if the use of a nurse-driven ventilation weaning protocol in a PICU can shorten the duration of mechanical ventilation. METHODS: In a prospective, pretest-posttest implementation study, we implemented a nurse-driven ventilation weaning protocol and compared its outcomes with those of the usual physician-driven weaning...
March 12, 2019: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Jing Li, Xiaoxia Li, Xianmei Huang, Zhiqun Zhang
BACKGROUND: Noninvasive high-frequency oscillatory ventilation (nHFOV), a relatively new modality, is gaining popularity despite scarce evidence. This meta-analysis was designed to evaluate the efficacy and safety of nHFOV as respiratory support in premature infants. METHODS: We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from inception of the database to January 2019. All published randomized controlled trials (RCTs) evaluating the effect of nHFOV therapy with nasal continuous positive airway pressure (nCPAP) or biphasic nCPAP (BP-CPAP) in newborns for respiratory support were included...
March 15, 2019: Respiratory Research
Fumitoshi Tsurumi, Shiro Baba, Daisuke Yoshinaga, Katsutsugu Umeda, Takuya Hirata, Junko Takita, Toshio Heike
Duchenne muscular dystrophy (DMD) is the most common and severe form of muscular dystrophy. The major symptoms of this condition are walking difficulties, dyspnea caused by progressive skeletal muscle weakness, and cardiomyopathy. Recent advances in ventilator support devices have dramatically decreased mortality caused by respiratory distress. Consequently, cardiomyopathy resulting in heart failure is currently the major cause of death among DMD patients. One mechanism by which skeletal muscle is damaged in DMD patients involves elevation of the intracellular Ca2+ concentration...
2019: PloS One
Saraschandra Vallabhajosyula, Shannon M Dunlay, Kianoush Kashani, Shashaank Vallabhajosyula, Saarwaani Vallabhajosyula, Pranathi R Sundaragiri, Allan S Jaffe, Gregory W Barsness
BACKGROUND: There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients. METHODS: Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality, and resource utilization...
March 6, 2019: International Journal of Cardiology
Domenico L Grieco, Luca S Menga, Davide Eleuteri, Massimo Antonelli
The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i...
March 12, 2019: Minerva Anestesiologica
Manuela Bonizzoli, Chiara Lazzeri, Andrea Drago, Laura Tadini Boninsegni, Martina Donati, Simona Di Valvasone, Antonio Pesenti, Adriano Peris
BACKGROUND: To date, there is no agreement on the timing to perform a physical session in patients on Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO). We aimed to assess whether early physiotherapy (within the first week from ECMO start) could affect in-ICU mortality. METHODS: Our retrospective observational study included 101 adults supported on VV ECMO from 2009 to 2016, consecutively admitted at our ECMO referral Center in Florence (Italy). Clinical data right before ECMO start were collected for all patients...
March 12, 2019: Minerva Anestesiologica
Thomas Leclerc, Arnaud Baus, Patrick Duhamel, Clément Hoffmann
Acute inpatient treatment of severe burns. Acute in-hospital care of severely burned patients intricately combines surgery and intensive care. Systemic and supportive care is centered on hemodynamic management of the initial plasmorrhagic shock, airway control, enteral nutrition in order to compensate for hypercatabolism, analgesia and adjuncts. Infection is a major risk, to be prevented and managed topically. Sytemic administration of antibiotics is limited to documented sepsis. Smoke inhalation injury is diagnosed by fiberoptic bronchoscopy and managed with protective ventilation, iterative bronchoscopic cleansing, and nebulized heparin, mucolytics and bronchodilators...
December 2018: La Revue du Praticien
Scott R Coleman, Ming Chen, Srikant Patel, Hong Yan, Alan D Kaye, Marcus Zebrower, Julie A Gayle, Henry Liu, Richard D Urman
PURPOSE OF REVIEW: Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care. RECENT FINDINGS: Preoperatively, patient and family education, optimization of nutritional status, and antibiotic prophylaxis all improve outcomes...
March 14, 2019: Current Pain and Headache Reports
Mohammadhossein Dabaghi, Gerhard Fusch, Neda Saraei, Niels Rochow, John L Brash, Christoph Fusch, P Ravi Selvaganapathy
Preterm neonates suffering from respiratory distress syndrome require assistive support in the form of mechanical ventilation or extracorporeal membrane oxygenation, which may lead to long-term complications or even death. Here, we describe a high performance artificial placenta type microfluidic oxygenator, termed as a double-sided single oxygenator unit (dsSOU), which combines microwire stainless-steel mesh reinforced gas permeable membranes on both sides of a microchannel network, thereby significantly reducing the diffusional resistance to oxygen uptake as compared to the previous single-sided oxygenator designs...
July 2018: Biomicrofluidics
Jian Sun, Gang Zhao
In the present study, the clinical efficacy of the immune modulator lentinan combined with inhalation of the corticosteroid budesonide in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) under mechanical ventilation was assessed. A total of 72 cases of AECOPD treated at Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Shanghai, China) between June 2016 and September 2017 were enrolled. The AECOPD patients were randomly divided into an experimental group (n=36) and a control group (n=36)...
March 2019: Experimental and Therapeutic Medicine
Ning Gao, Xiaohui Zhang-Brotzge, Bushra Wali, Iqbal Sayeed, Joshua J Chern, Laura S Blackwell, Chia-Yi Kuan, Andrew Reisner
Traumatic brain injury (TBI) is the leading cause of death in children and adolescents in developed countries, but there are no blood-based biomarkers to support the diagnosis or prognosis of pediatric TBI to-date. Here we report that the plasma levels of osteopontin (OPN), a phosphoprotein chiefly secreted by macrophages and/or activated microglia, may contribute to this goal. In animal models of TBI, while OPN, fibrillary acidic protein (GFAP), and matrix metalloproteinase 9 (MMP-9) were all readily induced by controlled cortical impact in the brains of one-month-old mice, only OPN and GFAP ascended in the blood in correlation with high neurological severity scores (NSS)...
March 13, 2019: Journal of Cerebral Blood Flow and Metabolism
Hayoung Choi, Jong Ho Cho, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Jae Ill Zo, Young Mog Shim, Kyeongman Jeon
Background: Although acute lung injury (ALI) that develops after esophagectomy is associated with significant morbidity and mortality, there is limited information on its overall clinical course. The objective of this study was to investigate the prevalence and clinical course of ALI after esophagectomy. Methods: Data were collected from all consecutive patients diagnosed with ALI after esophagectomy for esophageal cancer from January 2012 through March 2017 and retrospectively analyzed...
January 2019: Journal of Thoracic Disease
Jiro Ito, Kazuma Nagata, Takeshi Morimoto, Mariko Kogo, Daichi Fujimoto, Atsushi Nakagawa, Kojiro Otsuka, Keisuke Tomii
Background: The role of high-flow nasal cannula oxygen therapy (HFNC) in respiratory management of acute exacerbation of interstitial pneumonia (AE-IP) is unknown. Methods: We retrospectively reviewed patients with AE-IP who were admitted to our hospital from June 2009 - May 2015 and compared mortality, complications, sedatives and analgesia use, and oral intake between cohorts before (pre-HFNC: June 2009 - May 2012) and after (post-HFNC: June 2012 - May 2015) the introduction of HFNC...
January 2019: Journal of Thoracic Disease
R Galeiras, M Mourelo, S Pértega, M E López, I Esmorís
Procedural sedation and analgesia (PSA) is a widely used strategy in various fields to carry out numerous diagnostic and therapeutic procedures. However, there is limited information on its efficacy and safety during enzymatic debridement of burn patients with Nexobrid®. The aim of our study was to describe the U-type PSA procedure in a series of patients requiring enzymatic debridement. We carried out a retrospective, descriptive study involving 28 patients requiring enzymatic debridement of a limb, trunk or multiple locations, who had been admitted to the Burn Unit of the University Hospital Complex of A Coruña (Spain)...
September 30, 2018: Annals of Burns and Fire Disasters
Tim Rahmel, Alexandra Koniusch, Martin Schwertner, Günther Oprea, Michael Adamzik, Hartmuth Nowak
INTRODUCTION: The inhalative administration of drugs is a non-invasive application form that is regularly used in the treatment of ventilated patients in critical care setting. However, assessment of effectiveness or distribution of nebulised drugs is one of the lacking cornerstones of modern intensive care monitoring. Electrical impedance tomography (EIT) may provide a promising new monitoring and guiding tool for an adequate optimisation of mechanical ventilation in critically ill patients...
March 12, 2019: BMJ Open
Kristian Soltesz, Audrius Paskevicius, Henry Pigot, Qiuming Liao, Trygve Sjöberg, Stig Steen
PURPOSE: It has previously been shown that continuous intratracheal insufflation of oxygen (CIO) is superior to intermittent positive pressure ventilation (IPPV) regarding gas exchange and haemodynamics. The purpose of this study was to investigate gas exchanged and haemodynamics with a new technique of phase-controlled intermittent insufflation of oxygen (PIIO) compared to CIO. METHOD: Twenty (20) pigs were used, stratified into two groups (CIO, PIIO), with 10 animals each...
March 9, 2019: Resuscitation
Maria Papathanasiou, Raluca-Ileana Mincu, Julia Lortz, Michael Horacek, Achim Koch, Nikolaus Pizanis, Markus Kamler, Tienush Rassaf, Peter Luedike
AIMS: Unsuccessful weaning from ventilator after major cardiovascular procedures has been shown to be associated with increased post-operative morbidity and mortality. Our study aimed to identify predictors and clinical implications of prolonged mechanical ventilation (PMV) after left ventricular assist device (LVAD) implantation. METHODS AND RESULTS: We analysed the data of patients receiving a continuous-flow LVAD in our centre from December 2010 to September 2017...
March 12, 2019: ESC Heart Failure
Gull Zareen Khan Sial, Saadiya Javed Khan
PURPOSE: Although cancer is uncommon, it is a significant cause of pediatric morbidity and mortality in the developing world. The need for intensive care in pediatric oncology has increased with more intense chemotherapeutic interventions. It is important to identify patients who will benefit from management in the intensive care unit (ICU), given the resource limitation in developing countries. In this review, we examine our institutional experience with pediatric patients with cancer needing ICU care...
March 2019: Journal of Global Oncology
Türkay Akbaş
OBJECTIVE: This study aimed to evaluate epidemiology and outcome among critically ill patients under a restrictive transfusion practice. METHODS: One hundred sixty-nine patients who were admitted to the intensive care unit (ICU) between March 2016 to December 2017 and remained in the ICU > 24 hours were retrospectively included. RESULTS: Hemoglobin levels on admission were <12 g/dL in 85% and <9 g/dL in 37.9% of patients. The median admission hemoglobin level was decreased on the last day of the ICU stay...
March 12, 2019: Journal of International Medical Research
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