6,576 results match your criteria Ventilator Management


Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of the CHECKLIST-ICU trial database.

J Crit Care 2020 Jun 18;59:118-123. Epub 2020 Jun 18.

D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Brazilian Research in Intensive Care Network (BRICNet), Brazil; Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil. Electronic address:

Purpose: Characteristics of structure and process impact ICU performance and the outcomes of critically ill patients. We sought to identify organizational characteristics associated with efficient ICUs in low-resource settings.

Materials And Methods: This is a secondary analysis of a multicenter cluster-randomized clinical trial in Brazil (CHECKLIST-ICU). Read More

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http://dx.doi.org/10.1016/j.jcrc.2020.06.008DOI Listing

A Comprehensive Bench Assessment of Automatic Tube Compensation in ICU Ventilators for Better Clinical Management.

Respir Care 2020 Jun 30. Epub 2020 Jun 30.

Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, INSERM 955, Créteil, France.

Background: Automatic tube compensation (ATC) unloads endotracheal tube (ETT) resistance. We conducted a bench assessment of ATC functionality in ICU ventilators to improve clinical management.

Methods: This study had 2 phases. Read More

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http://dx.doi.org/10.4187/respcare.07608DOI Listing

Education Experiences of Adult Subjects and Caregivers for Mechanical Insufflation-Exsufflation at Home.

Respir Care 2020 Jun 30. Epub 2020 Jun 30.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.

Background: In 2014, the Ministry of Health of Ontario, Canada, approved a program of public funding for specialist-prescribed mechanical insufflation-exsufflation (MI-E) devices for home use by individuals with neuromuscular respiratory insufficiency. Since 2014, 1,926 MI-E devices have been provided, exceeding device-use projections. Few studies describe the initial and ongoing education and support needs of home MI-E users and their family caregivers. Read More

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http://dx.doi.org/10.4187/respcare.07534DOI Listing

[Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines].

Rev Bras Anestesiol 2020 Jun 9. Epub 2020 Jun 9.

University of Mississippi Medical Center, Department of Anesthesiology, Jackson, Mississippi.

The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Read More

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http://dx.doi.org/10.1016/j.bjan.2020.06.001DOI Listing

Update of the treatment of nosocomial pneumonia in the ICU.

Crit Care 2020 Jun 29;24(1):383. Epub 2020 Jun 29.

ICU, Trinity Centre for Health Science HRB-Wellcome Trust, St James's Hospital, Dublin, Ireland.

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients' risk factors. Read More

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http://dx.doi.org/10.1186/s13054-020-03091-2DOI Listing

Computing the Effects of SARS-CoV-2 on Respiration Regulatory Mechanisms in COVID-19.

ACS Chem Neurosci 2020 Jun 29. Epub 2020 Jun 29.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been established as a cause of severe alveolar damage and pneumonia in patients with advanced Coronavirus disease (COVID-19). The consolidation of lung parenchyma precipitates alteration in blood gases in COVID-19 patients that are known to complicate and cause hypoxemic respiratory failure. With SARS-CoV-2 damaging multiple organs in COIVD-19, including the central nervous system that regulates the breathing process, it is a daunting task to compute the extent to which the failure of the central regulation of the breathing process contributes in the mortality of the COIVD-19 affected patients. Read More

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http://dx.doi.org/10.1021/acschemneuro.0c00349DOI Listing

[Practice of nosocomial infection management in burn department based on the American hospital evaluation standard of the Joint Commission International].

Zhonghua Shao Shang Za Zhi 2020 Jun;36(6):488-492

Department of Burns, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.

To explore the role of continuous quality improvement measures based on the American hospital evaluation standard of the Joint Commission International (JCI) in prevention and control of nosocomial infection in Burn Department of the Second Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as the author' s department). From 2013 to 2018, based on 11 JCI standards related to infection prevention and control and the current situation of the author' s department, more than 50 doctors, nurses, and nursing assistants from the author' s department participated in continuous improvement of the three-level management system of nosocomial infection in the author' s department, focusing on implementing of management of patient with multidrug resistant bacteria infection, optimizing the infection control management of instrument and cloth, and implementing target management on 5 indicators such as hand hygiene implementation rate, and carrying out inspection, quality management, and improvement on 11 items of prevention and control of nosocomial infection. The implementation rate of hand hygiene from 2013 to 2018 and the accuracy rate of hand hygiene from 2016 to 2018 of medical staff in the author' s department, and incidences of catheter-related bloodstream infection (CRBSI) of central venous, catheter-associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP) of burn intensive care unit in the author's department from 2013 to 2018 were monitored. Read More

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http://dx.doi.org/10.3760/cma.j.cn501120-20190206-00020DOI Listing

Intraoperative Anesthetic Management of the Thoracic Patient.

Thorac Surg Clin 2020 Aug 28;30(3):279-291. Epub 2020 Apr 28.

Surgical Intensive Care Unit, Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, 750 Albany Street, Power Plant, 2nd Floor, Boston, MA 02118, USA. Electronic address:

The intraoperative anesthetic management for thoracic surgery can impact a patient's postoperative course, especially in patients with significant lung disease. One-lung ventilation poses an inherent risk to patients, including hypoxemia, acute lung injury, and right ventricular dysfunction. Patient-specific ventilator management strategies during one-lung ventilation can reduce postoperative morbidity. Read More

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http://dx.doi.org/10.1016/j.thorsurg.2020.04.011DOI Listing

Apnoeic oxygenation in paediatric anaesthesia: a narrative review.

Authors:
C Lyons M Callaghan

Anaesthesia 2020 Jun 27. Epub 2020 Jun 27.

Department of Anaesthesia, Galway University Hospitals, Galway, Ireland.

Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. Read More

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http://dx.doi.org/10.1111/anae.15107DOI Listing

Cancellation of elective surgery and intensive care unit capacity in New York state: a retrospective cohort analysis.

Anesth Analg 2020 Jun 23. Epub 2020 Jun 23.

Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY.

Background: In response to the COVID-19 pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear.

Methods: We retrospectively reviewed 5 years of New York State data on ICU usage. Read More

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http://dx.doi.org/10.1213/ANE.0000000000005083DOI Listing

Inhalational volatile-based sedation for COVID-19 pneumonia and ARDS.

Intensive Care Med 2020 Jun 25. Epub 2020 Jun 25.

Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, Canada.

Hospitals worldwide are experiencing a shortage in essential intravenous sedative medications. This is attributable to high number and high sedative needs of COVID-19 critical care patients with disruption of drug supply chains. Inhaled volatile anesthetic agents are an abundant resource and readily implementable solution for providing ICU sedation. Read More

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http://dx.doi.org/10.1007/s00134-020-06154-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315695PMC

A prospective, randomized, controlled study assessing vagus nerve stimulation using the gammaCore®-Sapphire device for patients with moderate to severe CoViD-19 Respiratory Symptoms (SAVIOR): A structured summary of a study protocol for a randomised controlled trial".

Trials 2020 Jun 26;21(1):576. Epub 2020 Jun 26.

Hospital Clínico Universitario de Valencia, Anaesthesia, Critical Care and Pain Management Unit, Valencia, Spain.

Objectives: Primary Objective: The primary objective is to reduce initiation of mechanical ventilator dependency in patients with moderate to severe CoViD- 19. This will be measured as the difference between the control group and active group for subjects admitted to the hospital for CoViD-19. Secondary Objectives: • To evaluate cytokine trends / Prevent cytokine storms • To evaluate supplemental oxygen requirements • To decrease mortality of CoViD-19 patients • Delay onset of ventilation TRIAL DESIGN: The study is a single centre, 2-arm, prospective, randomized (ratio 1:1), controlled trial with parallel groups design to compare the reduction of respiratory distress in a CoViD-19 population, using the intervention of the gammaCore®-Sapphire device plus standard of care (active) vs. Read More

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http://dx.doi.org/10.1186/s13063-020-04486-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316576PMC

Healthcare Utilization and Costs of Pediatric Home Mechanical Ventilation in Canada.

Pediatr Pulmonol 2020 Jun 24. Epub 2020 Jun 24.

Department of Medicine, University of Toronto.

Background/objectives: Children using home mechanical ventilation (HMV) live at home for better quality of life, despite financial burden for their family. Previous studies of healthcare utilization and costs have not considered public and private expenditures, including family caregiver time. Our objective was to examine public and private healthcare utilization and costs for children using HMV, and variables associated with highest costs. Read More

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http://dx.doi.org/10.1002/ppul.24923DOI Listing

Management of primary blast lung injury: a comparison of airway pressure release versus low tidal volume ventilation.

Intensive Care Med Exp 2020 Jun 23;8(1):26. Epub 2020 Jun 23.

Anaesthesia & Critical Care, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.

Background: Primary blast lung injury (PBLI) presents as a syndrome of respiratory distress and haemoptysis resulting from explosive shock wave exposure and is a frequent cause of mortality and morbidity in both military conflicts and terrorist attacks. The optimal mode of mechanical ventilation for managing PBLI is not currently known, and clinical trials in humans are impossible due to the sporadic and violent nature of the disease.

Methods: A high-fidelity multi-organ computational simulator of PBLI pathophysiology was configured to replicate data from 14 PBLI casualties from the conflict in Afghanistan. Read More

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http://dx.doi.org/10.1186/s40635-020-00314-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309205PMC

Using critical care physicians to deliver anesthesia and boost surgical caseload in austere environments: the Critical Care General Anesthesia Syllabus (CC GAS).

Heliyon 2020 Jun 18;6(6):e04142. Epub 2020 Jun 18.

Memorial Hospital Trauma Center, South Bend, IN, USA.

Background: Despite an often severe lack of surgeons and surgical equipment, the rate-limiting step in surgical care for the nearly five billion people living in resource-limited areas is frequently the absence of safe anesthesia. During disaster relief and surgical missions, critical care physicians (CCPs), who are already competent in complex airway and ventilator management, can help address the need for skilled anesthetists in these settings.

Methods: We provided a descriptive analysis that CCPs were trained to provide safe general anesthesia, monitored anesthesia care (MAC), and spinal anesthesia using a specifically designed and simple syllabus. Read More

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http://dx.doi.org/10.1016/j.heliyon.2020.e04142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305384PMC

Venous thromboembolism after penetrating femoral and popliteal artery injuries: an opportunity for increased prevention.

Trauma Surg Acute Care Open 2020 11;5(1):e000468. Epub 2020 Jun 11.

Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.

Methods: A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013-2017). Read More

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http://dx.doi.org/10.1136/tsaco-2020-000468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295438PMC

Objective Characterization of Opiate-Induced Chest Wall Rigidity.

Cureus 2020 Jun 5;12(6):e8459. Epub 2020 Jun 5.

Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.

Introduction Opiate-induced chest wall rigidity is a syndrome that largely goes unrecognized. To date, no study has presented significant objective data to better understand this syndrome. Objective The aim of this study was to explore the correlation between the dosage of opiates and the incidence of chest wall rigidity, ventilatory changes, and effects of naloxone administration. Read More

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http://dx.doi.org/10.7759/cureus.8459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301427PMC

Persistent pain in intensive care survivors: a systematic review.

Br J Anaesth 2020 Jun 18. Epub 2020 Jun 18.

Department of Anaesthesiology, Tampere University Hospital, Tampere, Finland. Electronic address:

Background: According to earlier studies where the main aim has been quality of life, there is growing evidence of increased levels of persistent pain in survivors of critical illness. The cause of admission and several factors during intensive care may have associated risk factors for pain persistence. This systematic review aims to determine the incidence or prevalence of persistent pain after critical illness and to identify risk factors for it. Read More

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http://dx.doi.org/10.1016/j.bja.2020.04.084DOI Listing

COVID-19 Diagnostics, Tools, and Prevention.

Diagnostics (Basel) 2020 Jun 16;10(6). Epub 2020 Jun 16.

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA.

The Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), outbreak from Wuhan City, Hubei province, China in 2019 has become an ongoing global health emergency. The emerging virus, SARS-CoV-2, causes coughing, fever, muscle ache, and shortness of breath or dyspnea in symptomatic patients. The pathogenic particles that are generated by coughing and sneezing remain suspended in the air or attach to a surface to facilitate transmission in an aerosol form. Read More

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http://dx.doi.org/10.3390/diagnostics10060409DOI Listing

Ventilator management of adult patients in the emergency department.

Authors:
Ryan Pedigo

Emerg Med Pract 2020 07 1;22(7):1-20. Epub 2020 Jul 1.

Director, Medical Student Education, Harbor-UCLA Medical Center; Assistant Professor of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. Read More

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[Legal Issues of Resource Allocation in the COVID-19 Pandemic - Between Utilitarianism and Life Value Indifference].

Pneumologie 2020 06 17;74(6):366-370. Epub 2020 Jun 17.

Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck.

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http://dx.doi.org/10.1055/a-1155-1840DOI Listing

Regulating drugs, medical devices, and diagnostic tests in the European Union: early lessons from the COVID-19 pandemic?

Eur Heart J 2020 06;41(23):2140-2144

Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.

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http://dx.doi.org/10.1093/eurheartj/ehaa506DOI Listing

Aerosol-Generating Procedures and Simulated Cough in Dental Anesthesia.

Anesth Prog 2020 Jun 18. Epub 2020 Jun 18.

Clinical Associate Professor, Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.

Dental professionals are at an increased risk for exposure to the severe acute respiratory syndrome coronavirus 2 with aerosol-generating procedures (AGPs), and dental anesthesia practices have additional risks due to airway management procedures. The purpose of this pilot study was to examine the extent of splatter on dental personnel that may occur with AGPs and coughing in a dental anesthesia practice. A Dentoform model was fitted into a dental mannequin and coated with Glo Germ to detect splatter during simulated dental AGPs produced with use of a high-speed handpiece, an ultrasonic scaler, and an air-water syringe, all in conjunction with high-volume suction. Read More

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http://dx.doi.org/10.2344/anpr-67-03-04DOI Listing

Impact of a respiratory ICU rotation on resident knowledge and confidence in managing mechanical ventilation.

J Bras Pneumol 2020 15;46(5):e20190108. Epub 2020 Jun 15.

. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas -HCFMUSP - Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.

Objective: To develop and apply a competency-based test to assess learning among internal medicine residents during a respiratory ICU rotation at a university hospital.

Methods: We developed a test comprising 19 multiple-choice questions regarding knowledge of mechanical ventilation (MV) and 4 self-assessment questions regarding the degree of confidence in the management of MV. The test was applied on the first and last day of a 30-day respiratory ICU rotation (pre-rotation and post-rotation, respectively). Read More

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http://dx.doi.org/10.36416/1806-3756/e20190108DOI Listing

An interesting case summary of tubercular pneumonia masquerading as viral pneumonia kept on extra-corporeal membrane oxygenation.

Indian J Tuberc 2020 Apr 12;67(2):268-273. Epub 2019 Sep 12.

Department of Pulmonary Medicine, SAMC and PGI, Indore, India. Electronic address:

Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We herein, report a case of 40 year old female, with ARDS due to severe pulmonary tuberculosis. She was admitted in the intensive care unit of a tertiary care centre. Read More

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http://dx.doi.org/10.1016/j.ijtb.2019.09.001DOI Listing

Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1500g: a 9-year single center experience.

J Cardiothorac Surg 2020 Jun 17;15(1):144. Epub 2020 Jun 17.

Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University School of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.

Background: The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management.

Methods: Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 preterm neonates weighing less than 1500g with HSPDA were enrolled in our study. Read More

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http://dx.doi.org/10.1186/s13019-020-01191-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298442PMC

Rapid and Point-of-Care Testing in Respiratory Tract Infections: An Antibiotic Guardian?

ACS Pharmacol Transl Sci 2020 Jun 12;3(3):401-417. Epub 2020 May 12.

University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.

This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Read More

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http://dx.doi.org/10.1021/acsptsci.0c00027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233852PMC

Pathological Findings and Management of COVID-19 Patients: A Brief Overview of Modern-day Pandemic.

Cureus 2020 May 15;12(5):e8136. Epub 2020 May 15.

Obstetrics and Gynecology, Tehsil Headquarter Hospital, Gujranwala, PAK.

Today the world is facing one of the deadliest pandemics caused by COVID-19. This highly transmissible virus has an incubation period of 2 to 14 days. It acts by attaching to the angiotensin-converting enzyme (ACE2) with the help of glycoprotein spikes, which it uses as a receptor. Read More

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http://dx.doi.org/10.7759/cureus.8136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294857PMC

A Review on Non-invasive Respiratory Support for Management of Respiratory Distress in Extremely Preterm Infants.

Front Pediatr 2020 28;8:270. Epub 2020 May 28.

Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.

Majority of extremely preterm infants require positive pressure ventilatory support at the time of delivery or during the transitional period. Most of these infants present with respiratory distress (RD) and continue to require significant respiratory support in the neonatal intensive care unit (NICU). Bronchopulmonary dysplasia (BPD) remains as one of the major morbidities among survivors of the extremely preterm infants. Read More

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http://dx.doi.org/10.3389/fped.2020.00270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270199PMC

The American Heart Association COVID-19 CVD Registry powered by Get With The Guidelines®.

Circ Cardiovasc Qual Outcomes 2020 Jun 17. Epub 2020 Jun 17.

UT Southwestern Medical Center, Dallas, TX.

: In response to the public health emergency created by the COVID-19 pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality improvement, and research. In less than 4 weeks after it was first announced on April 3, 2020, AHA's COVID-19 CVD Registry powered by Get With The Guidelines® (GWTG) received its first clinical records. : Participating hospitals are enrolling consecutive hospitalized patients with active COVID-19 disease, regardless of CVD status. Read More

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http://dx.doi.org/10.1161/CIRCOUTCOMES.120.006967DOI Listing

Anesthesiology, the Tragedy of the Commons, and COVID-19.

Authors:
Alan P Marco

Anesth Analg 2020 07;131(1):120-123

From the Department of Anesthesiology, The Ohio State University, Columbus, Ohio.

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http://dx.doi.org/10.1213/ANE.0000000000004927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202107PMC

Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.

PLoS One 2020 15;15(6):e0234879. Epub 2020 Jun 15.

Department of Anesthesiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.

Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234879PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295221PMC

Endoscopic Endonasal Transclival Approach to Spontaneous Hypertensive Brainstem Hemorrhage.

J Craniofac Surg 2020 Jun 11. Epub 2020 Jun 11.

Department of Neurosurgery, Xi'an Fengcheng Hospital.

Surgical management of spontaneous hypertensive brainstem hemorrhage remains a challenge for neurosurgeons, especially when the hemorrhage is located the ventral brainstem. Recently endoscopic endonasal approach has been applied for resection of ventral brainstem lesions, though no published literature has explored its utility in treating brainstem hemorrhage. Here we reported a successful evacuation of severe hypertensive brainstem hemorrhage through endoscopic endonasal transclival approach. Read More

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http://dx.doi.org/10.1097/SCS.0000000000006599DOI Listing

Use of Anesthesia Machines in a Critical Care Setting During the Coronavirus Disease 2019 Pandemic.

Authors:
Kent M K Haina

A A Pract 2020 May;14(7):e01243

From the Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University Langone Medical Center, New York, NY.

The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented need for mechanical ventilation in critically ill patients. To meet this increased demand, some facilities were forced to use anesthesia gas machines (AGMs) as intensive care unit (ICU) ventilators. While an off-label use, AGM manufacturers, the Anesthesia Patient Safety Foundation, and the American Society of Anesthesiologists have guidelines for AGM use in the ICU, however, there is scant literature describing their use. Read More

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http://dx.doi.org/10.1213/XAA.0000000000001243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258842PMC

Reducing Aerosol Generation During Ventilator Weaning in a Coronavirus Disease 2019 Patient Using a Supraglottic Airway: A Case Report.

A A Pract 2020 May;14(7):e01247

From the Department of Emergency and Critical Care Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan.

We report weaning from mechanical ventilation with no coughing in a patient with coronavirus disease 2019 (COVID-19). Substituting the endotracheal tube for a supraglottic airway (SGA), which is less stimulating to the trachea, can reduce coughing with weaning from mechanical ventilation and extubation. Personal protective equipment is in short supply worldwide. Read More

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http://dx.doi.org/10.1213/XAA.0000000000001247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258843PMC

[Recommendations for treatment of severe coronavirus disease 2019 based on critical care ultrasound].

Zhonghua Nei Ke Za Zhi 2020 Jun 15;59(0):E015. Epub 2020 Jun 15.

Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.

Severe patients with COVID-19 are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. Based on the recommendations of critical care experts from all over the country who fight against the epidemic in Wuhan, this article summarizes the guidelines for the treatment of COVID-19 based on critical ultrasonography, hoping to provide help for the treatment of severe patients. Read More

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http://dx.doi.org/10.3760/cma.j.cn112138-20200219-00098DOI Listing

Acute Respiratory Distress Syndrome: Diagnosis and Management.

Am Fam Physician 2020 Jun;101(12):730-738

8th Theater Sustainment Command, Fort Shafter, HI, USA.

Acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema that manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. Diagnostic criteria include onset within one week of a known insult or new or worsening respiratory symptoms, profound hypoxemia, bilateral pulmonary opacities on radiography, and inability to explain respiratory failure by cardiac failure or fluid overload. ARDS is thought to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting inflammatory cell accumulation in the alveoli and microcirculation of the lung. Read More

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The assessment of esophageal pressure using different devices: a validation study.

Minerva Anestesiol 2020 Jun 12. Epub 2020 Jun 12.

Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.

Background: Although esophageal pressure measurement could help clinicians to improve the ventilatory management of ARDS patients, it has been mainly used in clinical research. Aim of this study was to compare the measurements of end-expiratory esophageal pressure, end-expiratory transpulmonary pressure and lung stress by three systems: a dedicated manual device, taken as gold standard, a new automatic system (Optivent) and a bedside equipment, consisting of a mechanical ventilator and a hemodynamic monitor.

Methods: In sedated and paralyzed mechanically ventilated ARDS patients the esophageal pressure was measured at three PEEP levels in random fashion (baseline level, 50% higher and 50% lower). Read More

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http://dx.doi.org/10.23736/S0375-9393.20.14458-4DOI Listing

COVID-19 model-based practice changes in managing a large prostate cancer practice: following the trends during a month-long ordeal.

J Robot Surg 2020 Jun 14. Epub 2020 Jun 14.

Adventhealth Global Robotics Institute, Advent Health Celebration Health, Suite 200, 410 celebration place, Celebration, FL, 34747, USA.

Coronavirus (COVID-19) has been a life-changing experience for both individuals and institutions. We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Read More

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http://dx.doi.org/10.1007/s11701-020-01100-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293882PMC

A junior doctor's experience of critical illness: from treating patients to becoming a patient with COVID-19.

Authors:
S Ramachandran

Anaesth Rep 2020 Jan-Jun;8(1):59-62. Epub 2020 Jun 10.

Department of Acute Medicine Leighton Hospital, Mid-Cheshire Hospitals NHS Foundation Trust Manchester UK.

When the coronavirus disease 2019 (COVID-19) pandemic was declared, it was clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) would have far-reaching impacts on medicine, society and everyday life. As a junior doctor working closely with patients with SARS-CoV-2 infection, I was aware of my personal risk of exposure to the virus. I assumed that as a fit and well 26-year-old with no comorbidities, if I were to become infected, it was unlikely that COVID-19 would be severe. Read More

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http://dx.doi.org/10.1002/anr3.12052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286718PMC

Enhanced Recovery After Surgery-Based Perioperative Protocol for Head and Neck Free Flap Reconstruction.

OTO Open 2020 Apr-Jun;4(2):2473974X20931037. Epub 2020 Jun 2.

Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Objectives: Evaluate an enhanced recovery after surgery (ERAS)-based free flap management protocol implemented at our center.

Study Design: Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group.

Setting: Tertiary care academic medical center. Read More

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http://dx.doi.org/10.1177/2473974X20931037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268136PMC

Hospital Pharmacy: Comprehensive management of medical devices during SARS-CoV-2.

Farm Hosp 2020 06 12;44(7):21-23. Epub 2020 Jun 12.

Servicio de Farmacia, Hospital General Universitario de Alicante. Alicante. España.

Medical devices have become essential to the prevention and control of the  COVID-19 pandemic, being crucial for health professionals and patients in  particular, and the population in general. It is important to be aware of the laws  that regulate the management, distribution, and control of medical devices.  Article 82 of the Spanish Law 29/2006 on Guarantees and Rational Use of  Medicines and Medical Devices establishes that it is the responsibility of Hospital  Pharmacy Services "to participate in and coordinate the purchase of medicines and medical devices in the hospital to ensure an efficient acquisition  and rational use of medical devices". Read More

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http://dx.doi.org/10.7399/fh.11486DOI Listing

Incidental COVID-19 in a heart-kidney transplant recipient with malnutrition and recurrent infections: Implications for the SARS-CoV-2 immune response.

Transpl Infect Dis 2020 Jun 13:e13367. Epub 2020 Jun 13.

Hartford Hospital Transplant & Comprehensive Liver Center, Hartford, Connecticut, USA.

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. Read More

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http://dx.doi.org/10.1111/tid.13367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323106PMC

Dexmedetomidine for dyspnoea.

BMJ Support Palliat Care 2020 Jun 11. Epub 2020 Jun 11.

Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.

Dexmedetomidine is a selective α-adrenoreceptor agonist with a broad range of effects, including easily controllable sedation, analgesia and anxiolysis. Because of these favorable features, it has replaced traditional sedatives, such as benzodiazepines, and is becoming the first-line sedative for the patients in intensive care units. Terminally ill patients often need sedatives for symptom management, especially for dyspnoea. Read More

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http://dx.doi.org/10.1136/bmjspcare-2020-002334DOI Listing

Bundle of Coated Devices to Reduce Nosocomial Infections in the Intensive Care Unit: CRITIC Pilot Randomized Controlled Trial.

Ann Am Thorac Soc 2020 Jun 11. Epub 2020 Jun 11.

Instituto Latino-Americano de Sepsis, Sao Paulo, Brazil.

Rationale: Coated devices may reduce biofilm formation and reduce occurrence of device-related infections in critically ill patients. A bundle of coated devices (endotracheal tube - ETT, central venous catheter - CVC, urinary catheter - UC) simultaneously inserted may optimize benefits of coated devices in most severe patients.

Objectives: To assess feasibility of a randomized controlled trial on simultaneous insertion of gold-silver-palladium coated devices versus uncoated devices in severely ill patients required sequential insertion of all three devices (ETT, CVC and UC) for support in intensive care unit (ICU). Read More

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http://dx.doi.org/10.1513/AnnalsATS.202003-206OCDOI Listing

Biotinidase Deficiency With Suspected Sotos Syndrome: A Rare Entity.

Cureus 2020 May 7;12(5):e8000. Epub 2020 May 7.

Pediatrics, Abbasi Shaheed Hospital, Karachi, PAK.

Biotinidase deficiency (BTD) is a rare yet treatable metabolic autosomal recessive (AR) disorder in which the body is unable to recycle the vitamin biotin. Early diagnosis and treatment can be life-saving, but some symptoms of the disease are irreversible, and the condition can even prove to be fatal if not correctly diagnosed and managed. Here we present a case of a six-month-old child who presented with cough, fever, and difficulty in breathing. Read More

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http://dx.doi.org/10.7759/cureus.8000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274502PMC

[A comparative study of four cross-sectional investigations on the status of pediatric intensive care unit in China over the past 30 years].

Zhonghua Er Ke Za Zhi 2020 Jun;58(6):488-492

Hunan Provincial Institute of Emergency Medicine, Changsha 410005, China.

To understand the history, current situation and trends of intensive care unit (ICU) of pediatrics in China over the past 30 years. The results of the cross-sectional investigation on the status of ICU of pediatrics in 2014 were compared with those in 1993, 2001 and 2009. The main measurements were the number of participated provinces and hospitals, the availability of equipment, staffing, and medical technologies, the major diseases and the source of the patients. Read More

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http://dx.doi.org/10.3760/cma.j.cn112140-20191118-00735DOI Listing

Respiratory and ventilator management of COVID-19.

J Pak Med Assoc 2020 May;70(Suppl 3)(5):S60-S63

Fellow, Sleep Medicine, Sleep Wake Disorder Centre, Montefiore Medical Centre, Bronx, New York, USA.

The current pandemic of COVID-19 has infected around 2.5 million people with more than 125,000 deaths across the globe till date, and numbers are still rising. The causative organism is a virus of corona family. Read More

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http://dx.doi.org/10.5455/JPMA.23DOI Listing

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran.

Epidemiol Health 2020 1;42:e2020037. Epub 2020 Jun 1.

Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Objectives: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.

Methods: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. Read More

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http://dx.doi.org/10.4178/epih.e2020037DOI Listing