Effects Of Mechanical Ventilation Research Articles

Pneumo-Scrotum as Diagnosis of Ectopic Air in Other Locations

A 43-year-old woman presented spontaneous delivery at 35+4 weeks. An unreactive fetus was born in addition to abruptio placentae, joint exit of placenta and fetus and a true cord knot. We proceed to a deep resuscitation. During the ventilation it was observed that the scrotal volume was increased. A X-ray was done confirming ectopic air in chest, peritoneum and scrotum. Pneumo-scrotum is a rare disease that has been described in immature newborns. It has been reported secondary as infection, after aggressive resuscitation, as a consequence of mechanical ventilation and secondary to gastric perforations. Its treatment is etiological. The simple thoracic and abdominal radiography are sufficient for diagnosis. In the neonatal period, the presence of pneumo-scrotum during resuscitation may reveal ectopic air in the thorax or peritoneum.

Investigating the Relationship between Red Cell Width Distribution (RDW) and Outcome in Ventilator-Associated Pneumonia: A Prospective Cross-Sectional Study

Background: Ventilator-associated pneumonia (VAP) is a consequence of mechanical ventilation, which can be fatal. Several markers are available to predict outcomes related to VAP. Choosing a predictor that is inexpensive, affordable, and accurate is advantageous. This study aimed to examine red cell distribution width (RDW) as a predictor of mortality in patients with VAP.
 Methods: This prospective cohort study was conducted among 49 patients in the intensive care unit (ICU) of Valiasr Hospital in Tehran. A researcher-made checklist was used to collect RDW and other marker data, as well as mortality outcomes and length of stay (LOS) in the ICU. The Pearson correlation coefficient in the SPSS software and the regression model in the Eviews software were used to examine the relationship between markers and different outcomes.
 Results: Of a total of 49 patients (57.1% male; mean age = 54 ± 16), the length of ICU stays ranged from 7 to 14 days. According to the Pearson correlation coefficient, a significant association between RDW and mortality (P =.009) was noted. But no significant relationship between RDW and length of stay in the ICU (P =.81) was noted. Additionally, the regression model showed a positive relationship between RDW and white blood cells (WBC), lactate, and sequential organ failure assessment (SOFA).
 Conclusion: Our study showed a positive but weak correlation between RDW and ICU mortality in patients with VAP. Due to its availability and low cost of measurement, RDW is an appropriate option for predicting mortality risk in patients who are admitted to the ICU and develop VAP.

Secondary Autologous Fat Grafting for the Treatment of Chin Necrosis as a Consequence of Prone Position in COVID-19 Patients.

Due to the spread of the coronavirus disease 2019 pandemic, an increasing number of ill patients have been admitted to intensive care unit requiring mechanical ventilation. Although prone positioning is considered beneficial, long periods in this position may induce important complications, including pressure ulcers in high-risk and uncommon body areas. We report five cases of pressure ulcer necrosis of the chin in coronavirus disease 2019 patients as a consequence of mechanical ventilation in prone positioning using autologous fat grafting (AFG) as a secondary technique. A series of five patients with secondarily-healed chin necrosis treated by AFG between February and June 2020 were reviewed. All patients had been treated initially with surgical debridement followed by conservative treatment. Secondary AFG was performed to reduce patient's pain, improve chin contour-projection, and minimize cosmetic sequelae and scarring. Patient satisfaction was assessed using a five-point Likert scale (0-4). Vancouver scale was used to evaluate the chin scars clinically. The average amount of fat injected into the chin area was 8.1 ± 2.0 ml. At 6-month follow-up, all patients were mostly satisfied (average Likert-scale 3.2 ± 0.4). Based on the Vancouver scale, improvement of the chin scar from 9.5 ± 0.8 to 4.7 ± 0.8 was found. We report a positive experience with secondary AFG for correction of painful and unaesthetic scarring and contour abnormality following surgical debridement and secondary-intention healing of chin pressure ulcers.

Spontaneous Post-COVID-19 Pneumothorax in a Patient with No Prior Respiratory Tract Pathology: A Case Report

Spontaneous pneumothorax in the setting of coronavirus disease 19 (COVID-19) has been first described as an unlikely complication, mainly occurring in critically ill patients or as a consequence of mechanical ventilation. We report a case with COVID-19 pneumonia followed by a spontaneous pneumothorax in a young non-smoker without any predisposing pathology.

Cognitive impairment in COVID-19: associations, pathogenesis and treatment questions

Cognitive impairment (CI) can be neurological symptoms or complications of coronavirus disease 2019 (COVID-19). Among the pathogenetic mechanisms, the neurotropicity of the SARS- CoV-2 virus, endothelial dysfunction, coagulopathy, thrombus formation, systemic inflammatory reaction, the consequences of mechanical ventilation and drug sedation are considered. Treatment strategies for COVID-19 patients with CI have not yet been developed. The following tactics of patient management is advisable: prevention of re-infection, assessment and correction of the emotional state, treatment of cardiovascular diseases. The possibilities of vinpocetine in the treatment of CI after COVID-19 are discussed.

Assisted mechanical ventilation promotes recovery of diaphragmatic thickness in critically ill patients: a prospective observational study

BackgroundDiaphragm atrophy and dysfunction are consequences of mechanical ventilation and are determinants of clinical outcomes. We hypothesize that partial preservation of diaphragm function, such as during assisted modes of ventilation, will restore diaphragm thickness. We also aim to correlate the changes in diaphragm thickness and function to outcomes and clinical factors.MethodsThis is a prospective, multicentre, observational study. Patients mechanically ventilated for more than 48 h in controlled mode and eventually switched to assisted ventilation were enrolled. Diaphragm ultrasound and clinical data collection were performed every 48 h until discharge or death. A threshold of 10% was used to define thinning during controlled and recovery of thickness during assisted ventilation. Patients were also classified based on the level of diaphragm activity during assisted ventilation. We evaluated the association between changes in diaphragm thickness and activity and clinical outcomes and data, such as ventilation parameters.ResultsSixty-two patients ventilated in controlled mode and then switched to the assisted mode of ventilation were enrolled. Diaphragm thickness significantly decreased during controlled ventilation (1.84 ± 0.44 to 1.49 ± 0.37 mm, p < 0.001) and was partially restored during assisted ventilation (1.49 ± 0.37 to 1.75 ± 0.43 mm, p < 0.001). A diaphragm thinning of more than 10% was associated with longer duration of controlled ventilation (10 [5, 15] versus 5 [4, 8.5] days, p = 0.004) and higher PEEP levels (12.6 ± 4 versus 10.4 ± 4 cmH2O, p = 0.034). An increase in diaphragm thickness of more than 10% during assisted ventilation was not associated with any clinical outcome but with lower respiratory rate (16.7 ± 3.2 versus 19.2 ± 4 bpm, p = 0.019) and Rapid Shallow Breathing Index (37 ± 11 versus 44 ± 13, p = 0.029) and with higher Pressure Muscle Index (2 [0.5, 3] versus 0.4 [0, 1.9], p = 0.024). Change in diaphragm thickness was not related to diaphragm function expressed as diaphragm thickening fraction.ConclusionMode of ventilation affects diaphragm thickness, and preservation of diaphragmatic contraction, as during assisted modes, can partially reverse the muscle atrophy process. Avoiding a strenuous inspiratory work, as measured by Rapid Shallow Breathing Index and Pressure Muscle Index, may help diaphragm thickness restoration.

Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix

PurposeMortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix. MethodsRetrospective study in patients admitted to ICU (1987–2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome. ResultsOverall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group. ConclusionsAfter correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.

Early mobilization in the pediatric intensive care unit: a systematic review.

Children admitted to the pediatric intensive care unit (PICU) can experience significant morbidity as a consequence of mechanical ventilation and sedative medications. This morbidity could potentially be decreased with the implementation of activities to promote early mobilization during critical illness. The objective of this systematic review is to summarize the current evidence regarding rehabilitation therapies in the PICU and to highlight the knowledge gaps and avenues for future research on early mobilization in the PICU. Using a combination of controlled vocabulary and key word terms PubMed, CINAHL, and EMBASE databases were searched; no limiters were imposed on search strategies. Two reviewers abstracted data and assessed quality independently. From the 1928 articles identified in the search 168 abstracts were identified for full text review. Fifty-nine articles were chosen for data extraction and five were identified for inclusion in review. A sixth article was identified through expert clinician query. The studies were categorized into three groups based on the outcomes discussed: safety and feasibility, functional outcomes, and length of stay. A synthesis of the studies indicates that early rehabilitation in the PICU is safe and feasible with potential short and long-term benefits. Institutional, provider and patient-related barriers to initiation of early rehabilitation in the PICU are identified. Recommendations for future investigation include early rehabilitation protocols for children hospitalized in the PICU and identification of outcome measures.

Airway Humidification Reduces the Inflammatory Response During Mechanical Ventilation.

Currently, no clinical or animal studies have been performed to establish the relationship between airway humidification and mechanical ventilation-induced lung inflammatory responses. Therefore, an animal model was established to better define this relationship. Rabbits (n = 40) were randomly divided into 6 groups: control animals, sacrificed immediately after anesthesia (n = 2); dry gas group animals, subjected to mechanical ventilation for 8 h without humidification (n = 6); and experimental animals, subjected to mechanical ventilation for 8 h under humidification at 30, 35, 40, and 45°C, respectively (n = 8). Inflammatory cytokines in the bronchi alveolar lavage fluid (BALF) were measured. The integrity of the airway cilia and the tracheal epithelium was examined by scanning and transmission electron microscopy, respectively. Peripheral blood white blood cell counts and the wet to dry ratio and lung pathology were determined. Dry gas group animals showed increased tumor necrosis factor alpha levels in BALF compared with control animals (P < .05). The tumor necrosis factor alpha and interleukin-8 levels in the BALF reached baseline levels when the humidification temperature was increased to 40°C. Scanning and transmission electron microscopy analysis revealed that cilia integrity was maintained in the 40°C groups. Peripheral white blood cell counts were not different among those groups. Compared with control animals, the wet to dry ratio was significantly elevated in the dry gas group (P < .05). Moreover, humidification at 40°C resulted in reduced pathologic injury compared with the other groups based on the histologic score. Pathology and reduced inflammation observed in animals treated at 40°C was similar to that observed in the control animals, suggesting that appropriate humidification reduced inflammatory responses elicited as a consequence of mechanical ventilation, in addition to reducing damage to the cilia and reducing water loss in the airway.

Hemodynamic Effects of Volume-Controlled Ventilation Versus Pressure-Controlled Ventilation in Head Trauma Patients

Background. Controlled ventilation for head trauma patients should reduce hypoxemia, hypercapnia and prevent secondary brain injury. However, changes in cardiac output and arterial blood pressure are the common consequences of mechanical ventilation. This study was designed to compare pressure- versus volume-controlled ventilation modes in severe head trauma patients to identify the mode with least hemodynamic compromise and best oxygenation profile. Methods. This prospective crossover study was carried out on 15 severe head trauma patients admitted to surgical ICU for mechanical ventilation and critical care. All patients were initially ventilated with volume-controlled ventilation for 12 hours then the mode of ventilation was changed to pressure-controlled ventilation for the next 12 hours. Arterial and pulmonary artery catheters were inserted for continuous monitoring of arterial blood pressure, cardiac output, pulmonary artery pressure, pulmonary wedge pressure, pulmonary vascular resistance, and systemic vascular resistance every 4 hours from the start of each ventilation mode. Lung mechanics and arterial blood gases were simultaneously recorded during the times of hemodynamic monitoring. Results. Cardiac output did not show significant changes between the 2 ventilation modes and mean group differences at 4, 8, and 12 hours were −0.2, −0.2, −0.1 L/min (95% confidence interval = −1.04 to 0.64, −0.92 to 0.52, and −0.68 to 0.48 L/min), respectively. Additionally, the other hemodynamic variables were comparable at all levels of study analysis. Volume-controlled ventilation was associated with significant higher peak air way pressure in comparison with pressure-controlled ventilation after 4, 8, and 12 hours. The oxygenation values and other lung mechanics were not significantly change between the 2 ventilation modes. Conclusion. Both volume-controlled and pressure-controlled ventilations have comparable hemodynamic and oxygenation profiles in severe head trauma patients for short-term ventilation.

The Effectiveness of Inspiratory Muscle Training in Weaning Critically Ill Patients from Mechanical Ventilation

BACKGROUND: Inspiratory muscle weakness is a consequence of mechanical ventilation that contributes to weaning failure in critical ill patients. Since 1980, case reports of inspiratory muscle training (IMT) in ventilated, difficult to be weaned patients have proposed that this training strategy is associated with successful weaning. OBJECTIVE: We evaluated the efficacy of the inspiratory muscle training on the weaning process. METHODS: We conducted a literature search in the following databases: PubMed, EMBASE, Scopus and Google scholar. Selected keywords included inspiratory/ respiratory muscle training, weaning/failure, mechanical ventilation, critically ill, threshold load, intubated/ tracheostomy. RESULTS: In our analysis we included three randomized control trials involving 150 patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly increased inspiratory muscle strength in relation to sham or no training. CONCLUSION: Although IMT leads to significant increase of respiratory muscle strength, it has not yet been clearly demonstrated that this also leads to successful weaning. Further large randomized studies are needed to determine the beneficial effect of IMT in weaning patients from ventilatory support.

Tracheal Intubation Through Tracheoesophageal Fistula

Tracheal Intubation Through Tracheoesophageal Fistula

Spectrophotometric analysis of CSF after subarachnoid hemorrhage: limitations in the diagnosis of rebleeding.

We studied the course of CSF xanthochromia after subarachnoid hemorrhage by serial spectrophotometric analysis of lumbar CSF in 15 patients without clinical or CT evidence of rebleeding. The xanthochromic index rose in some patients up to the seventeenth day, and the proportion of oxyhemoglobin or the absolute concentration of hemoglobin often fluctuated. Therefore, rebleeding can be demonstrated in lumbar CSF only by increased xanthochromia, if previous samples had shown a decrease. These criteria could be applied in only 6 of 17 consecutive patients with rebleeding as demonstrated by CT, and they were met in 5.