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    Effect of antibiotics administered via the respiratory tract in the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis.
    J Crit Care 2017 Sep 18;43:240-245. Epub 2017 Sep 18.
    Pulmonary and Critical Care Division, University Hospital of Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil. Electronic address:
    Purpose: We evaluated the effect of antibiotics administered via the respiratory tract to prevent the ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients.

    Methods: We searched relevant articles for trials that evaluated the impact of prophylactic antibiotics administered through the respiratory tract on the occurrence of VAP. The end-point was the occurrence of VAP in MV patients. Read More

    Delirium in Pediatric Critical Care.
    Pediatr Clin North Am 2017 Oct;64(5):1117-1132
    Pediatrics, Weill Cornell Medical College, 525 East 68th Street, M-508, New York, NY 10065, USA. Electronic address:
    Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Read More

    Mechanical Ventilation and Decision Support in Pediatric Intensive Care.
    Pediatr Clin North Am 2017 Oct 18;64(5):1057-1070. Epub 2017 Aug 18.
    University of Utah College of Nursing, 10 S 2000 East, Salt Lake City, UT 84112.
    Respiratory support is required in most children in the pediatric intensive care unit. Decision-support tools (paper or electronic) have been shown to improve the quality of medical care, reduce errors, and improve outcomes. Computers can assist clinicians by standardizing descriptors and procedures, consistently performing calculations, incorporating complex rules with patient data, and capturing relevant data. Read More

    Ventilator-Associated Pneumonia in Critically Ill Children: A New Paradigm.
    Pediatr Clin North Am 2017 Oct 18;64(5):1039-1056. Epub 2017 Aug 18.
    Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, 13001 East 17th, B119, Aurora, CO 80045, USA.
    Ventilator-associated pneumonia (VAP) is a serious complication of critical illness. Surveillance definitions have undergone revisions for more objective and consistent reporting. The 1 organism-1 disease paradigm for microbial involvement may not adequately apply to many cases of VAP, in which pathogens are introduced to a pre-existing and often complex microbial community that facilitates or hinders the potential pathogen, consequently determining whether progression to VAP occurs. Read More

    Noninvasive airway approaches for acute neuromuscular respiratory failure in emergency departments.
    Pediatr Pulmonol 2017 Oct;52(10):E55-E57
    Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
    Emerging evidence advocates for noninvasive ventilation (NIV) combined with mechanical in-exsufflation (MIE) as a first-line approach for acute respiratory failure (ARF) in patients with neuromuscular disorders (NMD). To date, most NIV studies of ARF in NMD patients have been performed in intensive care units or in hospital settings. However, the utility of using combined NIV/MIE in the emergency department (ED) settings is unclear. Read More

    Hearts transplanted after circulatory death in children: Analysis of the International Society for Heart and Lung Transplantation registry.
    Pediatr Transplant 2017 Sep 21. Epub 2017 Sep 21.
    Division of Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
    We aimed to describe worldwide DCD HT experience in children using the International Society for Heart and Lung Transplantation Registry. The Registry was queried for primary HT performed in children (2005-2014). Kaplan-Meier analysis was used to assess survival for recipients grouped by DCD or DBD hearts. Read More

    Using the Sophia Observational Withdrawal Scale improved the assessment of paediatric iatrogenic withdrawal symptoms.
    Acta Paediatr 2017 Sep 22. Epub 2017 Sep 22.
    Department of Paediatrics and Adolescent medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
    Analgesia and sedation are standard practice when paediatric intensive care patients receive mechanical ventilation. Prolonged exposure to opioid and benzodiazepine leads to an increased risk of withdrawal symptoms when medication ceases or patients are weaned off them (1). When we were updating our local clinical guidelines for managing withdrawal symptoms, we identified the need to improve the assessment of withdrawal symptoms. Read More

    Determination of respiratory system compliance during pressure support ventilation by small variations of pressure support.
    J Clin Monit Comput 2017 Sep 22. Epub 2017 Sep 22.
    Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 12, 24105, Kiel, Germany.
    In mechanically ventilated patients, measurement of respiratory system compliance (Crs) is of high clinical interest. Spontaneous breathing activity during pressure support ventilation (PSV) can impede the correct assessment of Crs and also alter the true Crs by inducing lung recruitment. We describe a method for determination of Crs during PSV and assess its accuracy in a study on 20 mechanically ventilated patients. Read More

    Novel Therapies for Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Systematic Review of Current Evidence.
    J Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Pharmacy, Erlanger Health System, Chattanooga, Tennessee.
    Background: Angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema can occur at any point during therapy and, when severe, can require mechanical ventilation. Standard agents for anaphylactic reactions have limited efficacy for bradykinin-mediated angioedema and, therefore, agents approved for hereditary angioedema are increasingly prescribed for these patients.

    Objective Of The Review: This systematic review critically evaluates evidence describing the off-label use of fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), complement 1 esterase inhibitor (C1-INH), icatibant, and ecallantide for treatment of ACEI-induced angioedema. Read More

    [Progress of pain assessment and analgesia strategy for mechanical ventilation patients].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):861-864
    Department of Critical Care Medicine, the First Affiliated Hospital of Dalian Medical University, Critical Care Medical Research Institute of Dalian Medical University, Dalian 116011, Liaoning, China. Corresponding author: Li Qingdong, Email:
    Objective: Standardized pain assessment is a precondition of appropriate analgesia for mechanical ventilation patients. However, routine pain assessment rates remain very low in intensive care unit (ICU). Behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) can be used to assess pain in mechanical ventilation patients who are unable to report pain by themselves. Read More

    [Effect of sedation on respiratory function of patients undergoing mechanical ventilation].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):857-860
    Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China. Corresponding author: Kang Yan, Email:
    Objective: Sedation and analgesia for ventilated patients is an important treatment in intensive care unit (ICU). Patients receiving mechanical ventilation therapy comfortably and safely can improve patient-ventilator synchrony, reduce ventilation-related lung injury (VILI), improve compliance, decrease oxygen consumption and stress, prevent accidents, and reduce the incidence of complications and mortality in critical patients. Although sedation may protect lung function, it also has a greater impact on respiratory function. Read More

    [Progress of mechanical ventilation during cardiopulmonary resuscitation].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):853-856
    Department of Emergency, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, Guangdong, China (Wen C, Yu T); Department of Emergency, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China (Wang LX). Corresponding author: Yu Tao, Email:
    Objective: Mechanical ventilation is regarded as an effective means of replacing artificial ventilation during cardiopulmonary resuscitation (CPR), and has been widely used in the treatment of cardiac arrest (CA) patients. However, there are still some controversial issues remaining to be settled, such as the assessment of the effectiveness of mechanical ventilation, the selection of the optimal oxygen concentration (FiO2), tidal volume (VT), respiratory frequency, and mode of ventilation during the CPR process. The pros and cons of positive pressure ventilation are also inconclusive. Read More

    [Evaluation of the effect of a new fixation tape for tracheal catheter in intensive care patients].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):836-839
    Department of Nursing, the Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China (Chen LM, Liu RH, Shen BY); Department of Spinal Surgery, the Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China (Wang LL, Cui ZM, Xu GH). Corresponding author: Xu Guanhua, Email:
    Objective: To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients.

    Methods: A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. Read More

    [Correlation between APACHE II scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):821-824
    Department of Critical Care Medicine, Hunan Provincial People's Hospital, Changsha 410005, Hunan, China. Corresponding author: Zhou Xu, Email:
    Objective: To investigate the correlation between acute physiology and chronic health evaluation II (APACHE II) scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation (MV).

    Methods: A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit (ICU) of Hunan Provincial People's Hospital from January 2015 to March 2017 were enrolled. Read More

    [Application of injection test in confirming the ideal position of esophageal balloon catheter].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):783-788
    Department of Critical Care Medicine, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China (Chen H, Xu M, He X, Zhou JX); Third Department of Critical Care Medicine, Fujian Provincial Clinical College, Fujian Medical University, Fuzhou 350001, Fujian, China (Chen H is working in Fujian); Department of Critical Care Medicine, Beijing Electric Power Hospital, Beijing 100073, China (Yang YL). Corresponding author: Zhou Jianxin, Email:
    Objective: To evaluate the safety and feasibility of injection test which is used to locate esophageal balloon catheter.

    Methods: A prospective study was conducted. The patients undergoing invasive mechanical ventilation (MV) admitted to general intensive care unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from May 2015 and March 2017 were enrolled. Read More

    Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    Service of Neonatology and Pediatric Intensive Care, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Purpose: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. Read More

    Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome.
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China.
    Purpose: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV).

    Methods: A total of 138 patients with ARDS who received mechanical ventilation for <48 h between May 2015 to October 2016 while in the critical care medicine unit (ICU) of the West China Hospital of Sichuan University were enrolled in the study. Read More

    Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France.
    Purpose: The aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment.

    Methods: Prospective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment. Read More

    Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial.
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    Department of Intensive Care, Hospital Sant Joan de Dèu -Fundació Althaia, CIBERES, Universitat Internacional de Catalunya, Manresa, Spain.
    Background: Spontaneous breathing trials (SBT) can be exhausting, but the preventive role of rest has never been studied. This study aimed to evaluate whether reconnection to mechanical ventilation (MV) for 1 h after the effort of a successful SBT could reduce the need for reintubation in critically ill patients.

    Methods: Randomized multicenter trial conducted in 17 Spanish medical-surgical intensive care units (Oct 2013-Jan 2015). Read More

    Chronic inflammatory demyelinating polyradiculoneuropathy and anesthesia: a case series.
    Acta Neurol Belg 2017 Sep 21. Epub 2017 Sep 21.
    Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune demyelinating polyneuropathy characterized by symmetrical diffuse weakness that also can rarely affect bulbar and respiratory muscles. The study objective was to describe perioperative outcomes of patients with CIDP who received general anesthesia. This retrospective observational study evaluated patients with active (diagnosed or treated within the previous year) CIDP who underwent general anesthesia at our institution between January 1, 2010, and December 31, 2015. Read More

    Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    Université de Nantes, Nantes, France.
    Purpose: The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives.

    Methods: This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. Read More

    Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial.
    Lancet Respir Med 2017 Sep 18. Epub 2017 Sep 18.
    Department of Anaesthesia and Intensive Care, Montpellier University Saint Eloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
    Background: Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes.

    Methods: We did a randomised, parallel-group, clinical trial at three ICUs in France. Read More

    Predictive factors for the outcome of high flow nasal cannula therapy in a pediatric intensive care unit: Is the SpO2/FiO2 ratio useful?
    J Crit Care 2017 Sep 6. Epub 2017 Sep 6.
    Tepecik Teaching and Research Hospital, Pediatric Emergency Department, Izmir, Turkey.
    Objectives: To determine the predictive factors for the outcome of high-flow nasal cannula (HFNC) therapy in a pediatric intensive care unit (PICU).

    Materials And Methods: We prospectively included all patients with acute respiratory distress/failure aged 1month to 18years who were admitted to the PICU between January 2015 and May 2016 and treated with HFNC as a primary support and for postextubation according to our pre-established protocol. HFNC failure was defined as the need for escalation to non-invasive ventilation (NIV) or invasive mechanical ventilation (MV). Read More

    Factors Associated With Unplanned Extubation in Children: A Case-Control Study.
    J Intensive Care Med 2017 Jan 1:885066617731274. Epub 2017 Jan 1.
    2 Health Technologies Assessment Center, Federal University of São Paulo, São Paulo, Brazil.
    Purpose: Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit.

    Methods: Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. Read More

    Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis.
    J Thorac Dis 2017 Aug;9(8):2599-2607
    Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
    Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions.

    Methods: We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology. Read More

    Chylothorax after pediatric cardiac surgery complicates short-term but not long-term outcomes-a propensity matched analysis.
    J Thorac Dis 2017 Aug;9(8):2466-2475
    Department of Anesthesiology and Pediatric Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
    Background: The occurrence of postoperative chylothorax in children with congenital heart disease is a rare and serious complication in cardiac intensive care units (ICUs). The aim of our study was to identify the perioperative characteristics, treatment options, resource utilization and long term complications of patients having chylothorax after a pediatric cardiac surgery.

    Methods: Patients were retrospectively assessed for the presence of chylothorax between January 2002 and December 2012 in a tertiary national cardiac center. Read More

    Peritoneal Dialysis for the Treatment of Cardiorenal Syndrome Type 1: A Prospective Brazilian Study.
    Perit Dial Int 2017 Sep-Oct;37(5):578-583
    Botucatu School of Medicine - UNESP, Internal Medicine, Botucatu, Brazil.
    This study aimed to explore the role of high-volume peritoneal dialysis (HVPD) in cardiorenal syndrome (CRS) type 1 patients in relation to metabolic and fluid control and outcome. Sixty-four patients were treated by HVPD (prescribed Kt/V = 0.50/session), flexible catheter and cycler. Read More

    Neutrophil transfer of miR-223 to lung epithelial cells dampens acute lung injury in mice.
    Sci Transl Med 2017 Sep;9(408)
    Organ Protection Program, Department of Anesthesiology, University of Colorado Denver, Aurora, CO 80045, USA.
    Intercellular transfer of microRNAs can mediate communication between critical effector cells. We hypothesized that transfer of neutrophil-derived microRNAs to pulmonary epithelial cells could alter mucosal gene expression during acute lung injury. Pulmonary-epithelial microRNA profiling during coculture of alveolar epithelial cells with polymorphonuclear neutrophils (PMNs) revealed a selective increase in lung epithelial cell expression of microRNA-223 (miR-223). Read More

    Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature.
    J Med Case Rep 2017 Sep 21;11(1):268. Epub 2017 Sep 21.
    Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
    Background: Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. Read More

    The efficacy of initial ventilation strategy for adult immunocompromised patients with severe acute hypoxemic respiratory failure: study protocol for a multicentre randomized controlled trial (VENIM).
    BMC Pulm Med 2017 Sep 20;17(1):127. Epub 2017 Sep 20.
    Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
    Background: Acute respiratory failure (ARF) is still one of the most severe complications in immunocompromised patients. Our previous systematic review showed noninvasive mechanical ventilation (NIV) reduced mortality, length of hospitalization and ICU stay in AIDS/hematological malignancy patients with relatively less severe ARF, compared to invasive mechanical ventilation (IMV). However, this systematic review was based on 13 observational studies and the quality of evidence was low to moderate. Read More

    Clinical Factors Associated With Adherence to the Premedication Protocol for Withdrawal of Mechanical Ventilation in Terminally Ill Patients: A 4-Year Experience at a Single Medical Center in Asia.
    Am J Hosp Palliat Care 2017 Jan 1:1049909117732282. Epub 2017 Jan 1.
    2 Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan.
    Purpose: Data on end-of-life care practices in Asia are scarce. This study aimed to analyze the clinical factors associated with the recommended premedication protocol for mechanical ventilation withdrawal, in Taiwan.

    Methods: A total of 135 terminally ill patients who had mechanical ventilation withdrawn between 2013 and 2016 from a single medical center in Taiwan were enrolled. Read More

    Neutrophil-to-Lymphocyte Ratio Predicts Death in Acute-on-Chronic Liver Failure Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study.
    Shock 2017 Sep 19. Epub 2017 Sep 19.
    *Department of critical care medicine, Cliniques universitaires Saint Luc, Université catholique de Louvain (UCL), Brussels, Belgium †Department of Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium.
    The neutrophil-to-lymphocyte ratio (NLR) is an inflammation score recognized as associated with outcome. While inflammation has been shown to correlate with the development of acute-on-chronic liver failure (ACLF), we sought to investigate the role of NLR in predicting 90-day mortality in cirrhotic patients experiencing ACLF.We performed a retrospective cohort study involving a total of 108 consecutive cirrhotic patients admitted in the intensive care unit (ICU). Read More

    Variability in Usual Care Mechanical Ventilation for Pediatric Acute Respiratory Distress Syndrome: Time for a Decision Support Protocol?
    Pediatr Crit Care Med 2017 Sep 19. Epub 2017 Sep 19.
    1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 2Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 3University of Utah College of Nursing, Salt Lake City, UT. 4Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 5Department of Pediatrics, Division of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, University of Michigan, Ann Arbor, MI. 9Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 12Department of Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles, CA. 13Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 14Pediatric Trauma and Critical Illness Branch, National Institutes of Child Health and Human Development (NICHD), Bethesda, MD. 15Formerly Pediatric Trauma and Critical Illness Branch, National Institutes of Child Health and Human Development (NICHD), Bethesda, MD.
    Objectives: Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol. Read More

    Neurologic and Functional Morbidity in Critically Ill Children With Bronchiolitis.
    Pediatr Crit Care Med 2017 Sep 19. Epub 2017 Sep 19.
    1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH. 2Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
    Objectives: Neurologic and functional morbidity occurs in ~30% of PICU survivors, and young children may be at particular risk. Bronchiolitis is a common indication for PICU admission among children less than 2 years old. Two single-center studies suggest that greater than 10-25% of critical bronchiolitis survivors have neurologic and functional morbidity but those estimates are 20 years old. Read More

    Temporal Changes in Prescription of Neuropharmacologic Drugs and Utilization of Resources Related to Neurologic Morbidity in Mechanically Ventilated Children With Bronchiolitis.
    Pediatr Crit Care Med 2017 Sep 19. Epub 2017 Sep 19.
    1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH. 2Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
    Objectives: Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis.

    Design: Analysis of the multicenter Pediatric Health Information System database. Read More

    50 Years of Research in ARDS. Tidal Volume Selection in the Acute Respiratory Distress Syndrome.
    Am J Respir Crit Care Med 2017 Sep 20. Epub 2017 Sep 20.
    School of Medicine, Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States ;
    Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Read More

    Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes.
    Am J Respir Crit Care Med 2017 Sep 20. Epub 2017 Sep 20.
    University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
    Rationale Diaphragm dysfunction worsens outcomes in mechanically ventilated patients but the clinical impact of potentially preventable changes in diaphragm structure and function due to mechanical ventilation is unknown. Objectives To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation. Methods Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction. Read More

    Experience with the SynCardia total artificial heart in a Canadian centre.
    Can J Surg 2017 Oct 1;60(6):3617. Epub 2017 Oct 1.
    From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Nguyen, Pellerin, Perrault, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Ducharme, Racine).
    Background: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. Read More

    Impact of weekend admission on mortality and other outcomes among patients with burn injury: A nationwide analysis.
    Burns 2017 Sep 16. Epub 2017 Sep 16.
    Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, 4940 Eastern Ave, Baltimore, MD 21224, United States. Electronic address:
    Objective: To study the relationship between day of admission and important outcomes among patients with burn injuries.

    Methods: The 2014 National Inpatient Sample database was used. Inclusion criterion was a principal diagnosis of burn injury. Read More

    Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study.
    Neonatology 2017 Sep 20;112(4):402-408. Epub 2017 Sep 20.
    Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
    Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN.

    Objectives: To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. Read More

    Use of corticosteroids in acute respiratory distress syndrome: Perspective from an Indian intensive care unit.
    Med J Armed Forces India 2017 Apr 16;73(2):118-122. Epub 2016 Dec 16.
    Professor (Medicine), Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
    Background: Acute respiratory distress syndrome (ARDS) causes overwhelming inflammation, which serves as a potential target for corticosteroids. Despite extensive Western literature, there are no Indian studies evaluating steroids in ARDS.

    Methods: This was a retrospective study at an Indian intensive care unit (ICU) on ARDS patients. Read More

    Attenuated PDGF signaling drives alveolar and microvascular defects in neonatal chronic lung disease.
    EMBO Mol Med 2017 Sep 18. Epub 2017 Sep 18.
    Comprehensive Pneumology Center, University Hospital of the University of Munich and Helmholtz Zentrum Muenchen, Munich, Germany
    Neonatal chronic lung disease (nCLD) affects a significant number of neonates receiving mechanical ventilation with oxygen-rich gas (MV-O2). Regardless, the primary molecular driver of the disease remains elusive. We discover significant enrichment for SNPs in the PDGF-Rα gene in preterms with nCLD and directly test the effect of PDGF-Rα haploinsufficiency on the development of nCLD using a preclinical mouse model of MV-O2 In the context of MV-O2, attenuated PDGF signaling independently contributes to defective septation and endothelial cell apoptosis stemming from a PDGF-Rα-dependent reduction in lung VEGF-A. Read More

    Feasibility of Lung Transplantation From Donation After Circulatory Death Donors Following Portable Ex Vivo Lung Perfusion: A Pilot Study.
    Transplant Proc 2017 Oct;49(8):1885-1892
    Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada; Alberta Transplant Institute, Edmonton, Canada; Canadian National Transplant Research Program, Edmonton, Canada. Electronic address:
    Background: Donation after circulatory death (DCD) has the potential to significantly alleviate the shortage of transplantable lungs. We report our initial experience with the use of portable ex vivo lung perfusion (EVLP) with the Organ Care System Lung device for evaluation of DCD lungs.

    Methods: We performed a retrospective review of the DCD lung transplantation (LTx) experience at a single institution through the use of a prospective database. Read More

    An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency.
    J Infect Chemother 2017 Sep 8. Epub 2017 Sep 8.
    Division of Pharmacy, University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chiba, Japan.
    Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Read More

    Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction Operation.
    Pediatr Crit Care Med 2017 Sep 15. Epub 2017 Sep 15.
    1Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia. 2Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 3Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia. 4Murdoch Children's Research Institute, Melbourne, VIC, Australia.
    Objectives: To identify the prevalence, causes, risk factors, and outcomes associated with extubation failure following first stage single ventricle reconstruction surgery.

    Design: Retrospective cohort analysis of neonates who underwent a first stage single ventricle reconstruction operation. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt. Read More

    Perioperative Inflammation and Its Modulation by Anesthetics.
    Anesth Analg 2017 Sep 14. Epub 2017 Sep 14.
    From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
    Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. Read More

    Interstitial pneumonia with autoimmune features: an additional risk factor for ARDS?
    Ann Intensive Care 2017 Sep 18;7(1):98. Epub 2017 Sep 18.
    Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
    Background: Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period. Read More

    No Impact of Preadmission Anti-Inflammatory Drug Use on Risk of Depression and Anxiety After Critical Illness.
    Crit Care Med 2017 Oct;45(10):1635-1641
    1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.2Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark.3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.4National Center for PTSD, VA Boston Healthcare System, Boston, MA.5Department of Psychiatry, Boston University, Boston, MA.6Department of Epidemiology, Boston University, Boston, MA.7Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA.8Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.
    Objectives: Risk of depression and anxiety is elevated after intensive care. Drugs with anti-inflammatory properties may have antidepressant and anxiolytic effects. The aim of this study was to investigate the association between preadmission use of drugs with anti-inflammatory effects and risk of new-onset depression and anxiety among adult patients admitted to an ICU. Read More

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