Ventilation

BACKGROUND: Causative pathogens are currently identified in only a minority of pneumonia cases, which affects antimicrobial stewardship. Metagenomic next-generation sequencing (mNGS) has potential to enhance pathogen detection due to its sensitivity and broad applicability. However, while studies have shown improved sensitivity compared with conventional microbiological methods for pneumonia diagnosis, it remains unclear whether this can translate into clinical benefit. Most existing studies focus on patients who are ventilated, readily allowing for analysis of bronchoalveolar lavage fluid (BALF)...

BACKGROUND: During a pandemic like COVID-19, hospital resources are constrained and accurate severity triage of the patients is required. OBJECTIVE: The objective of this study is to estimate the predictive performances of candidate biomarkers for short-term worsening (STW) of COVID-19. DESIGN: Prospective, multicenter (20 hospitals in Paris) cohort study of consecutive COVID-19 patients with systematic biobanking at admission, during the first waves of COVID-19 in France in 2020 (COVIDeF cohort)...

OBJECTIVES: Increasing numbers of patients experience a prolonged stay in intensive care. Yet existing quality improvement (QI) tools used to improve safety and standardize care are not designed for their specific needs. This may result in missed opportunities for care and contribute to worse outcomes. Following an experience-based codesign process, our objective was to build consensus on the most important actionable processes of care for inclusion in a QI tool for adults with prolonged critical illness...

OBJECTIVES: There is little data within the literature regarding tracheobronchoplasty (TBP) in the setting of the acute and chronically ill, morbidly obese, or ventilator dependent patients with Tracheobronchomalacia (TBM). Short- and long-term outcomes are studied. METHODS: The series represents 12 TBM patients with American Society of Anesthesiologists (ASA) physical status scores of 3 to 5. Candidacy was based on bronchoscopic findings during spontaneous respirations with >90% collapse of the trachea and both mainstem bronchi...

BACKGROUND: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. OBJECTIVE: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP...

IMPORTANCE: Intravenous fluids are an essential part of treatment in sepsis, but there remains clinical equipoise on which type of crystalloid fluids to use in sepsis. A previously reported sepsis subphenotype (ie, group D) has demonstrated a substantial mortality benefit from balanced crystalloids compared with normal saline. OBJECTIVE: To test the hypothesis that targeting balanced crystalloids to patients with group D sepsis through an electronic health record (EHR) alert will reduce 30-day inpatient mortality...

BACKGROUND: Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2 /FiO2 ) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session...

Cardiopulmonary bypass (CPB) is a crucial technique used to repair congenital heart defects (CHD); however, it may induce inflammatory response, leading to airway inflammation and need for prolonged mechanical ventilation. In this study, we aimed to evaluate the effect of budesonide nebulization in children with high serum total immunoglobulin E (tIgE) levels undergoing surgical repair of CHD via CPB. We conducted a randomized, single-center, controlled trial at a tertiary teaching hospital. One-hundred and one children with high tIgE were enrolled and randomized into the budesonide nebulization group (BUD group, n = 50) or the normal saline nebulization group (NS group, n = 51) between January 2020 and December 2020...

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is an underdiagnosed condition that causes recurrent episodes of partial or total collapse of the upper airways during sleep. It is associated with perioperative pulmonary complications. The STOP-BANG is a screening tool for assessing patients at risk of OSAS. The aim of this study was to assess the prevalence of patients with OSAS during pre-anesthetic evaluation at a hospital and its correlation with predictors of ventilation and difficult airway...

Primary healthcare is the main gateway and priority for healthcare management in Brazil. However, there are significant challenges in the quality of care, particularly for those most vulnerable, especially maternal and infant healthcare. This fact is exacerbated by regional inequalities, which have historically left the North and Northeast regions at a relative disadvantage. The study involves an analysis of the resources available for maternal and infant healthcare in the state of Roraima, the North region, and Brazil as a whole in 2012, 2014, and 2017, using data from Module I of the National Program for the Improvement of Access and Quality of Primary Care (PMAQ-AB)...

INTRODUCTION: Traumatic brain injuries (TBIs) pose significant challenges to public health, medicine, and society due to their substantial impact on victims, caregivers, and the community. While indicators like life expectancy or death rates provide insights into mortality and long-term outcomes, they fail to address how TBIs affect aging, neurological sequelae, cognitive impairment, and psychological or psychiatric disorders. Moreover, most studies are limited to North America, limiting the generalizability of findings across different social welfare systems...

In Region Sörmland, the burden of critical illness during the first wave of Covid-19 in april 2020 lead to a 25-fold increase in the number of patients requiring invasive mechanical ventilation. The decision was made that quantity should be prioritised before individual quality. This led to a highly standardised care during the intensive care period. All patients admitted to any of the county's three hospitals were assessed as regarded their ability to survive invasive mechanical ventilation. The assessment was based on the Charlson Age-adjusted Comorbidity Index and the Clinical Frailty Scale...

INTRODUCTION: There are many criteria for diagnosing Guillain-Barré syndrome (GBS), and the yield of these diagnostic criteria varies. Each criterion requires some laboratory data and nerve conduction studies (NCS). Although supportive laboratory data are reassuring when present in suspected cases of GBS, when absent, they can potentially cause further delay in diagnosis and treatment. There is no gold standard test for the diagnosis of GBS, and there are multiple diagnostic criteria for GBS to date...

BACKGROUND: There are no studies examining the use of monoclonal antibodies in hospitalized coronavirus disease 2019 (COVID-19) patients within the Indian population. OBJECTIVES: To determine the efficacy of monoclonal antibodies in hospitalized COVID-19 patients. MATERIALS AND METHODS: This retrospective cohort observational study was conducted from June 2021 to March 2022 in the Department of Critical Care Medicine at a tertiary care hospital in Pune, Maharashtra, India...

BACKGROUND: The appropriate response to mass causality biological events requires well-established preparedness and providing a surge capacity. In such a situation, a practical solution is to convert large public venues into shelter hospitals. Due to the lack of a guideline for the transformation of a large public center into a hospital, the present study collected the design criteria for the transformation of public buildings into shelter hospitals in response to biological events such as epidemics or mass causality biological accidents...

OBJECTIVE: A surge of pediatric respiratory illnesses beset the United States in late 2022 and early 2023. This study evaluated within-surge hospital acute and critical care resource availability and utilization. The study aimed to determine pediatric hospital acute and critical care resource use during a respiratory illness surge. METHODS: Between January and February 2023, an online survey was sent to the sections of hospital medicine and critical care of the American Academy of Pediatrics, community discussion forums of the Children's Hospital Association, and PedSCCM-a pediatric critical care website...

INTRODUCTION: Although several studies have been published about COVID-19, ischemic stroke is known yet as a complicated problem for COVID-19 patients. Scientific reports have indicated that in many cases, the incidence of stroke in patients with COVID-19 leads to death. OBJECTIVES: The obtained mathematical equation in this study can help physicians' decision-making about treatment and identification of influential clinical factors for early diagnosis. METHODS: In this retrospective study, data from 128 patients between March and September 2020, including their demographic information, clinical characteristics, and laboratory parameters were collected and analyzed statistically...

INTRODUCTION: Cerebrovascular autoregulation (CA) capacity can be impaired in the aftermath of acute brain injuries. Altered physiological states, such as hypo- and hypercapnia, affect CA. Although these effects have been demonstrated in several animal experiments, the exact effect of PaCO₂ on the plateau of cerebral blood flow (CBF) across the spectrum of arterial blood pressures has not been fully disclosed. RESEARCH QUESTION: The aim was to explore pial vasodynamics in response to changing PaCO₂ in a porcine cranial window model, as preparation for an experimental setup in which the CBF plateau position is investigated under different PaCO₂ conditions...

Bioelectrical impedance techniques have been useful in various applications, including body composition analysis, impedance plethysmography, impedance cardiography, lung ventilation, perfusion, and tissue characterization. Electrical impedance methods have also been useful in characterizing different foods like meat, fruits, and beverages. However, the temperature of tissue samples can change their dielectric properties, affecting their impedance. This research investigated the effects of temperature on the impedance of various biological tissues over the frequency range of 10 Hz to 5 MHz...

INTRODUCTION: Preparing patients for extubation from mechanical ventilation (MV) necessitates focused respiratory muscle strengthening. This study aimed to evaluate the effect of threshold inspiratory muscle training (IMT) and positive expiratory pressure (PEP) exercises on outcomes of patients who underwent MV in intensive care unit (ICU). METHODS: This randomized controlled trial was conducted in 2023 at the ICUs of Imam Reza Hospital, Mashhad, Iran. Participants were allocated to either intervention or control group (each comprising 35 patients) through block randomization...