Average Ventilation Time Research Articles

Results of minimally invasive surgery for the treatment of infundibular ventricular septal defect in children

Objective: evaluate the feasibility and results of minimally invasive surgery for the treatment of infundibular ventricular septal defect in children. Summary: infundibular ventricular septal defect is located below the pulmonary and aortic valve, accounting for about 6% of ventricular septal defect. In Asians, infundibular defects are more common, accounting for about 30% of all ventricular septal defect cases. Currently, early surgery is indicated in cases of heart failure, pulmonary hypertension that cannot be controlled with medication and to prevent aortic valve prolapse. Minimally invasive surgery has been performed routinely for perimembranous ventricular septal defect. However, for the infundibular position, numerous challenges remain. Therefore, we conducted this study. Subjects and methods: Prospective, descriptive study. From December 2022 to July 2024, 33 children with infundibular ventricular septal defect underwent minimally invasive surgery through infra-axillary incision. Results: Mean age was 11.47 months, mean weight was 7.35 kg. Echocardiography showed an average hole diameter of 6.2 mm. Pulmonary artery pressure: 32.6 mmHg. Cardiopulmonary bypass and cross-clamping aortic times were 68.5 minutes and 47.3 minutes, respectively. No patients required sternotomy. Average ventilation time was 14.4 hours. No cases of fatality or neurological, bleeding and arrhythmias complications. Postoperative echocardiography demonstrated the perfect closure of VSD, no aortic valve regurgitation. The average postoperative follow-up time was 9 months, clinical heart failure according to ROSS classification at grade 1, echocardiography showed closed ventricular septal defect without the appearance of pulmonary hypertension. Conclusion: Minimally invasive surgery through the right axillary approach to treat infundibular ventricular septal defect in children can be performed safely with promising results.

A Prospective Randomised Observational Study of Obstructed Total Anamalous Pulmonary Venous Connection (TAPVC) Repair Patients with Milrinone Versus Milrinone and Inhaled Nitric Oxide

Abstract Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-centre prospective randomised and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Results of using thoraflextm hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital

Background: The aim of this study was to introduce and evaluate the early results after the frozen elephant trunk (FET) procedure with ThoraflexTM Hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital. Methods: This is a retrospective descriptive study of all acceptable patients after the frozen elephant trunk (FET) procedure with ThoraflexTM Hybrid prothesis at Viet Duc University Hospital from January 2021 to May 2023. Results: There were 21 patients with a male rate of 85.7% and an average age 58.2±10 years old (range 40–73). History of patients with hypertension: 19 (90.5%); post-dissection aortic aneurysm: 2 (9.5%) patients. By cause, the number of patients with thoracic aortic aneurysm was 03 (14.3%), acute aortic dissection type A was 16 (76.1%), and aortic dissection type B was 02 (9.5%). In which there were 16 cases of emergency surgery (76.1%). Replacement of the aortic arch was performed under moderate hypothermic (280 °C on average) circulatory arrest and bilateral selective antegrade cerebral perfusion with permanent monitoring of cerebral tissue oxygenation by the MASIMO machine. Average cardio-pulmonary bypass time, aortic cross clamp time, distal hypothermic circulatory arrest time, and operating time were 137,5±22,9 minutes; 86,3±17,6 minutes; 25,2±8,9 minutes; and 7,7±10,3 hours. The average ventilation time, length of intensive care unit stay, and hospital stay were 7,2±9,7 days, 18,8±20,7 days, and 19,9 ± 6,5 days. There was one patient with post-operative cerebrospinal fluid drainage. No patient had bleeding complications, recurrent nerve palsy, reoperation, or in-hospital mortality. Conclusion: The initial results after the frozen elephant trunk procedure with ThoraflexTM Hybrid prothesis for the treatment of complex aortic disease at Viet Duc University Hospital were safe, good, and feasible.

Major Symptoms and Outcome of Covid-19 Positive Patients: A Study in a Tertiary Care Hospital in Bangladesh

Background: An outbreak of Covid-19 caused by the SARS-Cov-2 initially emerged in China in December 2019 and the first Covid-19 patient was detected on 8 March 2020 in Bangladesh. The preconception about the major symptoms and outcomes of Covid-19-positive patients may be helpful for healthcare professionals in the management of Covid-19 patients. This study aimed to evaluate the major symptoms and outcomes of covid-19 positive patients.
 Methods: This prospective observational study was conducted in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2021 to December 2021. In total 67 confirmed Covid-19 cases by RT-PCR tests who attended the mentioned hospital were enrolled in this study as the study population. For data collection, a pre-designed questionnaire was used. Along with demographic and clinical features data regarding in-hospital mortality, intensive care unit (ICU) admission, use of invasive mechanical ventilation, total hospital length of stay, complications, and treatment patterns were recorded. Collected data were processed, analyzed and disseminated by using the MS Excel program.
 Results: The highest number of patients were with a cough which was found among 49% of cases. Besides this, shortness of breath, hypoxemia/oxygen use, lower limb swelling and bleeding were found among 39%, 27%, 12% and the rest 7% of patients respectively. The highest number of patients were with hypertension (HTN) as comorbidity which was found in 15% of cases. Besides this, diabetes mellitus (DM), chronic kidney diseases (CKD), chronic respiratory diseases (CRD), cancer/immunodeficiency and cardiac diseases were found among 12, 10%, 7%, 4% and the rest 1% of patients, respectively. As the outcomes, the cure rate was found up to 97% and death occurred in only 3% (n=2) cases. We observed that 10% of patients did not stay at the hospital even for a single day. For only 7% of patients, ventilation facilities were in needed and the average ventilation time was 13.5 days.
 Conclusion: Cough and shortness of breath are two major symptoms for Covid-19 patients. Proper ventilation and ICU facilities can decrease the suffering, mortality as well as morbidity of Covid-19 patients.

Feasibility of an Innovative Absorbable Ventilation Tube Designed to Provide Intermediate-Term Middle Ear Ventilation.

Myringotomy with ventilation tube placement is a common surgical procedure performed in children and adults to remove fluid buildup behind the tympanic membrane. However, retention of tubes beyond achievement of therapeutic response increases risk for complications and additional intervention. This small feasibility study was conducted to demonstrate proof of concept of a novel bioabsorbable ventilation tube that provides the necessary duration of ventilation with absorption shortly thereafter. Tubes were placed in 15 ears of 14 patients meeting indications for short or intermediate duration of middle ear ventilation. Two independent examiners documented tube patency and tube absorption status at 3, 6, and 12 weeks or until absorption was complete. Results indicate that average ventilation time was 12 weeks (range, 3 weeks to 18 months). There was no observation of blockage. These findings support the feasibility of a novel bioabsorbable ventilation tube.

Variations in chest compression time, ventilation time and rescuers' heart rate during conventional cardiopulmonary resuscitation in trained male rescuers.

ObjectiveThis study was conducted to determine why rescuers could maintain adequate chest compression depth for longer periods during conventional cardiopulmonary resuscitation (CPR).MethodsVarious CPR parameters, including average compression depth (ACD), average compression rate, average ventilation time (AVT), and rescuers’ heart rates were recorded in real-time when 20 health care providers performed 10 minutes of conventional CPR during a simulation experiment.ResultsThe ACD was maintained above 50 mm and was not significantly different during 19 consecutive CPR cycles. The average compression rate increased from 114.9±10.0/min (2nd cycle) to 120.1±13.8/min (18th cycle) (P=0.007), and the AVT increased from 8.7±1.5 seconds (3rd cycle) to 10.1±2.6 seconds (18th cycle) (P=0.002). The rescuers’ heart rates also increased gradually for 10 min; however, they increased rapidly and were highest during the ventilation phase. Their heart rates then decreased and were lowest during the early chest compression phases of each CPR cycle. Decreases in heart rates were significant in all CPR cycles (average decrease: 14.5±4.5 beats/min, P<0.001).ConclusionThe ACD was maintained adequately during 10 minutes of conventional CPR. However, the AVT increased significantly during the 10-minute period. The rescuers’ heart rates increased and decreased throughout all CPR cycles. These results showed that the ventilation phase might play a role as a resting period and be a reason for the maintenance of adequate chest compression depth for prolonged periods during conventional CPR.

Electronic Health Record Tool to Promote Team Communication and Early Patient Mobility in the Intensive Care Unit.

Intensive care unit early mobility programs improve patients' outcomes while reducing costs for both patients and institutions. Inadequate interprofessional communication is a known barrier to achieving good early mobility program outcomes. Electronic health record communication tools promoting interprofessional communication have demonstrated improved patient outcomes, but have not been evaluated for mobility in the intensive care unit. To implement an early mobility collaboration program in an existing early mobility program, consisting of protocol education and an electronic health record tool designed to improve interprofessional communication and collaboration. In phase 1, staff members viewed an online educational module, the existing mobility protocol, and the "Mobility Levels" grading scale. In phase 2, an electronic health record communication tool displayed recently recorded mobility levels to all care providers. Staff knowledge of the early mobility program and perceptions of mobility-related communication were assessed by survey; patient outcomes including mobility goals, mechanical ventilation time, length of intensive care unit stay, and cost were assessed by records review. Statistically significant increases were found for staff satisfaction with mobility-related communication (P < .001) and communication frequency (P = .02), but not for staff knowledge (P = .28). Hours to achievement of mobility goal (P = .02) and length of intensive care unit stay (P = .02) decreased significantly. Average ventilation time decreased by 27 hours. Discharge recommendations at higher functional levels increased. Total intensive care unit cost decreased significantly (-39.5%; P = .04). Interprofessional communication and collaboration can lead to improved outcomes. Combining routine educational reviews and an electronic health record communication tool may improve patient and system outcomes for intensive care unit early mobility program patients.

Extracorporeal lung support in patients with spinal cord injury: Single center experience

Objective: Trauma-related spinal cord injury (SCI) leads to a loss of motor, sensory and vegetative functions and is disproportionately associated with respiratory complications. SCI has a significant impact on respiratory muscle function and can lead to respiratory dysfunction or severe lung failure.Participants: Between 2008 and 2014, 7 patients with severe lung failure following SCI received veno-venous extracorporeal membrane oxygenation (ECMO) n = 5 and interventional lung assist (iLA) n = 2.Results: The median duration of extracorporeal lung support was 8 (5.7–17.6) days. All 5 of the ECMO-supported patients were successfully weaned, and one of the two patients treated with iLA was weaned from the device. The median intensive care unit (ICU) stay was 35 (8.5–44.5) days. The mean hospital stay was 81 (8.5–120.7) days, and the average ventilation time was 817 (206–1,225) hours. Five (71.4%) of the 7 patients were discharged from the ICU and hospital.Conclusions: In patients with SCI, serious complications include microatelectasis, infection, ventilation-perfusion mismatching and aspiration (special case: salt-water aspiration after jumping into shallow water). In patients with SCI with post-traumatic lung failure, ECMO is a feasible and life-saving procedure. After surviving spinal shock, a long rehabilitation period with intensive follow-up in specialized centers is required.

Revascularização do miocárdio minimamente invasiva videoassistida

In general, surgeries currently tend to be less invasive and cardiac surgery has started to follow this trend. To evaluate the evolution of one hundred patients undergoing minimally-invasive coronary artery bypass grafting. Access to the heart was attained through a small; 6-cm thoracotomy, located in the 4th left intercostal space, starting at the nipple. Through the same intercostal space, 3 cm after the primary incision, a 6.5-mm optical device was inserted at 30º. Where the saphenous vein was used, the pericardium was opened above the aorta and the latter was partially clamped with a systolic pressure of 80 mmHg, with the proximal anastomosis being carried out in the conventional manner. The distal anastomoses were carried out in the conventional manner. The procedure was performed off-pump using single lung ventilation. The mean age was 63.9 ± 10.66 years. Sixty-eight (68%) patients were males. Fifty-three (53%) were in functional class III or IV. Left ventricular function was normal in fifty-three (53%) patients. Forty-two (42%) had undergone previous angioplasty. A total of 153 anastomoses were performed, ranging from 1 to 3. The average ventilation time was 4.06 ± 4.08 hours. Seventeen (17%) patients had atrial fibrillation and eight (8%) had pneumonia. There were two deaths in this series. Revascularization was safe with low mortality and morbidity. With the advent of new devices, this surgery may have a greater applicability.

Albumin‐Coated Tympanostomy Tubes: Prospective, Double‐Blind Clinical Study

Coating an implant with albumin prevents adhesion of proteins, bacteria, and platelets and thus may lead to its improved and prolonged function. Previously, we have demonstrated the inhibition of binding of fibronectin, one of the most adhesive glycoproteins, on human serum albumin (HSA)-coated tympanostomy tubes and the durability of this binding inhibition in a 8-month trial. We have also demonstrated that the HSA coating inhibits the binding of Staphylococcus aureus and Pseudomonas aeruginosa to titanium plates. This prospective study evaluated the effect of albumin coating on tympanostomy tube sequelae and on the outcome of tympanostomized patients. Double-blind, prospective, randomized clinical trial. Two otolaryngological centers in southern Finland enrolled 179 pediatric patients. Number of tube occlusions and otorrhea and tube ventilation time in the ears with HSA-coated titanium tympanostomy tubes were compared with the contralateral ear with its uncoated, otherwise identical titanium tube during a 9-month follow-up period. In HSA-coated tubes, average ventilation time was slightly longer and the number of early tube occlusions significantly less (P < .05). Moreover, in patients with perioperative bleeding, the coating prolonged average ventilation time of tympanostomy tubes significantly (P < .05). HSA coating reduces early tube occlusions by preventing adherence of blood and secretion.

Ventilação mecânica próximo dos grandes centros. Experiência de uma unidade de apoio perinatal.

A retrospective study of the newborns who were submitted to mechanical ventilation at the Neonatal Intermediate Care Unit was made between July 1991 and June 1994. Mechanical ventilation in such a unit should be transitory and not exceed 24 hours. Information concerning pregnancy, labour, neonates, type of ventilation and its problems was gathered. Forty seven neonates were ventilated. The average ventilation time was six hours (1-20 hours). The main cause of ventilation was hyaline membrane disease which occurred in 24% of all cases. Mortality observed was 16.6% and some sequellae were registered which were related not only to ventilation but also to the basic pathology in 26% of cases.

Tracheal Aspirate Correlates With Protected Specimen Brush in Long-term Ventilated Patients Who Have Clinical Pneumonia

This study was undertaken to determine whether tracheal aspirate cultures correlate with protected specimen brush (PSB) cultures in the diagnosis of probable ventilator-associated pneumonia (VAP). Retrospective evaluation of 52 episodes of clinical pneumonia in 38 patients who underwent bronchoscopy and PSB as well as tracheal aspirate cultures. The study took place in long-term, acute care hospital associated with a university medical school. This hospital specializes in ventilator-assisted patients. The patient population consisted of long-term ventilated patients (average ventilation time was 22 weeks; range, 4 weeks to 3 years) who presented with the clinical diagnosis of VAP (fever, increased white blood cell count, new infiltrate on chest radiograph, and bronchorrhea). No patient had received antibiotics for the preceding 5 days at the time of bronchoscopy or tracheal aspirate culture. The tracheal aspirate and PSB culture and sensitivities results. Identical organisms were recovered in both the tracheal aspirate and PSB cultures in 36 of 52 episodes of VAP (69 percent). No organism was recovered in either the tracheal aspirate or the PSB in 4 of 52 suspected episodes (8 percent). Positive bacterial cultures in the tracheal aspirate but not the PSB were found in 8 of 52 (15 percent) episodes. In 3 of 52 episodes (6 percent), 1 isolate of pathogenic bacteria was found on PSB and 2 were found on tracheal aspirate cultures. However, all three isolates had the similar antibiotic sensitivities. In the final episode, the PSB culture grew an organism that was not present in the tracheal aspirate culture (2 percent). When comparing the tracheal aspirate with the PSB, the following were calculated: sensitivity = 97.7 percent; specificity = 50 percent; positive predictive value = 91.3 percent; and negative predictive value = 80 percent. Tracheal aspirate cultures correlate with PSB cultures in patients receiving long-term ventilation who have clinical pneumonia, and they can be used to direct initial antibiotic therapy in this group of patients.