History Of Mechanical Ventilation Research Articles

Carbapenem-resistant Enterobacterales in Children at 18 US Health Care System Study Sites: Clinical and Molecular Epidemiology From a Prospective Multicenter Cohort Study.

Carbapenem-resistant Enterobacterales (CRE) are an urgent public health threat in the United States. Describe the clinical and molecular epidemiology of CRE in a multicenter pediatric cohort. CRACKLE-1 and CRACKLE-2 are prospective cohort studies with consecutive enrollment of hospitalized patients with CRE infection or colonization between 24 December 2011 and 31 August 2017. Patients younger than age 18 years and enrolled in the CRACKLE studies were included in this analysis. Clinical data were obtained from the electronic health record. Carbapenemase genes were detected using polymerase chain reaction and whole-genome sequencing. Fifty-one children were identified at 18 healthcare system study sites representing all U.S. census regions. The median age was 8 months, with 67% younger than age 2 years. Median number of days from admission to culture collection was 11. Seventy-three percent of patients had required intensive care and 41% had a history of mechanical ventilation. More than half of children had no documented comorbidities (Q1, Q3 0, 2). Sixty-seven percent previously received antibiotics during their hospitalization. The most common species isolated were Enterobacter species (41%), Klebsiella pneumoniae (27%), and Escherichia coli (20%). Carbapenemase genes were detected in 29% of isolates tested, which was lower than previously described in adults from this cohort (61%). Thirty-four patients were empirically treated on the date of culture collection, but only 6 received an antibiotic to which the CRE isolate was confirmed susceptible in vitro. Thirty-day mortality was 13.7%. CRE infection or colonization in U.S. children was geographically widespread, predominantly affected children younger than age 2 years, associated with significant mortality, and less commonly caused by carbapenemase-producing strains than in adults.

Factors associated with infections by multidrug-resistant bacteria in Hospital "Vicente Corral Moscoso", Cuenca, 2018-2019

Factors associated with infections by multidrug-resistant bacteria in Hospital "Vicente Corral Moscoso", Cuenca, 2018-2019

Impact of premature birth on cardiopulmonary function in later life

Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters (dot{V}O_2peak 43.9pm6.6frac{frac{ml}{kg}}{min}min vs.41.9pm8.8frac{ml}{kg}/min). The only differences were in a slightly higher oxygen uptake efficiency slope (OUES;of;1.6;pm0.4;vs;1.4;pm;0.4) and higher peak minute ventilation dot VEpeak;of;55.2pm 11.3 ml/min;vs.;49.1;ml;pm;8.8/min) in the group of children born preterm. With respect to heart rate recovery (-35.3;pm;13.8;bpm;vs.;-37.2;bpm;pm;14.0;after;1;min) and breathing efficiency dot{(V}E/dot VCO_2;of;35.9;pm;4.1;vs;34.0;pm4.6), there were no significant differences.Conclusion: Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls.What is Known:• Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms.• As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount.What is New:• Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables.• A significantly higher OUES, a surrogate parameter for VO2peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.

Type I posterior glottic stenosis: an endoscopic approach

<p class="abstract">Type I posterior glottic stenosis (PGS) is a rare and challenging entity that is defined by the presence of a posterior glottic scar band separate from interarytenoid mucosa. This case reports a child who developed PGS-I secondary to prolonged intubation submitted to an endoscopic approach. 11-year-old boy presented with a 4 years complaint of stridor triggered by physical efforts and sleep. He had an history of mechanical ventilation with entubation for a thirty day period. On indirect laryngoscopy it was observed a complete adduction and incomplete abduction of vocal folds. He underwent a diagnostic laryngotracheoscopy, where it was possible to observe and confirm the diagonis of a PGS type I. A suspension microlaryngoscopy was performed and the interarytenoid band tissue was sectioned and dilatation of this area with a balloon was done. Endotracheal intubation is the primary cause of PGS in children. Different surgical interventions have been described, from open to endoscopic techniques. A careful preoperative assessment helps achieve better outcomes.</p><p> </p>

Mortality-Related Risk Factors for Coronavirus Disease (COVID-19)-Associated Mucormycosis: a systematic review and meta-analysis.

Purpose of ReviewSevere Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a serious public health concern, particularly in developing countries. This meta-analysis aims to identify the risk factors that affect the mortality rate of patients with CAM.Recent FindingsWe systematically searched PubMed, Google Scholar, Scopus, Cochrane library, and preprint databases using pertinent keywords and the reference lists of the included relevant articles from inception till October 27, 2021. In order to reduce the effects of small-scale studies, we only selected cross-sectional, case–control, and cohort studies and case series with at least four patients. We identified 26 articles that included 821 patients with CAM. The effect size (ES) of mortality rate was 28% (95% confidence interval (CI) 20%–38%; I2 =82.28%; p for Cochran Q<0.001). The CAM patients with a history of comorbidities other than diabetes (malignancies, transplant, or renal failure), mechanical ventilation due to COVID-19, pulmonary and cerebral mucormycosis, and those who only received medical treatment for mucormycosis had the highest mortality rate.SummaryCoronavirus disease (COVID-19)-associated mucormycosis (CAM) is a major public health problem, particularly in developing countries. Severe COVID-19 infection, history of mechanical ventilation, early CAM, comorbidities other than diabetes (malignancies, transplant, or renal failure), pulmonary and rhino-orbito-cerebral mucormycosis, and delivering only medical treatment for mucormycosis were the worst prognostic factors in CAM patients. Identifying the mortality-related risk factors in CAM patients may help reduce the mortality rate by implementing optimized treatment approaches.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12281-022-00440-2.

Clinical Characteristics and Risk Factors for Pulmonary Infection in Emergency ICU Patients.

Background Pulmonary infection in the emergency ICUs increases patient morbidity, hospital stay, treatment costs, and the risk of related adverse events. Methods This study included 695 patients admitted to our emergency ICU between December 2019 and March 2021. Medical records of emergency ICU patients were reviewed to collect their clinical data, including antibiotic use, history of tracheostomy, history of mechanical ventilation, presence or absence of underlying disease, history of smoking, alcohol consumption, age, gender, and history of shock. Bacterial cultures were performed. The incidence, main clinical features, main pathogens, and risk factors of pulmonary infection in emergency ICU were analyzed. Results In this study, 69 of the 695 emergency ICU patients (9.93%) developed pulmonary infection. The main clinical features of patients with pulmonary infection included cough and expectoration (97.10%), shortness of breath and chest tightness (95.65%), leukocyte elevation (69.57%), confusion (31.88%), drowsiness (28.99%), persistent fever (27.54%), and nausea and vomiting (10.14%). The main pathogenic bacteria in those with pulmonary infection included Klebsiella pneumoniae (62.32%), Pseudomonas aeruginosa (49.28%), Streptococcus pneumoniae (21.74%), Staphylococcus aureus (39.13%), Candida albicans (7.25%), Pneumococcus pneumoniae (15.95%), Pseudomonas aeruginosa (24.64%), and lung diplococcus inflammatory (13.04%). Univariate analysis showed that there were no significant differences in the occurrence of pulmonary infection with regard to sex, smoking, and alcohol consumption, but there were significant differences with regard to age, basic disease, invasive surgery, and shock. Logistic regression analysis confirmed that age ≥ 80 years, invasive surgery, shock, and basic diseases ≥ 2 were important risk factors for pulmonary infection in emergency ICU patients. Conclusion Considering the clinical features and risk factors for pulmonary infection in the emergency ICU, preventive and control measures are required to minimize its occurrence and ensure good outcomes.

Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes

Approximately 23 700 US children undergo invasive mechanical ventilation for acute respiratory failure annually, with unknown long-term effects on neurocognitive function. To evaluate neurocognitive outcomes of children who survive pediatric intensive care unit (PICU) hospitalization for acute respiratory failure compared with their biological siblings. Prospective sibling-matched cohort study conducted at 31 US PICUs and associated neuropsychology testing centers. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and underwent mechanical ventilation. Biological siblings were aged 4 to 16 years at testing, with Pediatric Cerebral Performance Category score of 1 and no history of mechanical ventilation or general anesthesia. A total of 121 sibling pairs were enrolled from September 2, 2014, to December 13, 2017, and underwent neurocognitive testing starting March 14, 2015. The date of the final follow-up was November 6, 2018. Critical illness and PICU treatment for acute respiratory failure. The primary outcome was IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes included measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, and executive function. Evaluations occurred 3 to 8 years after hospital discharge. Patients (n = 121; 55 [45%] female patients) underwent PICU care at a median (IQR) age of 1.0 (0.2-3.2) years, received a median (IQR) of 5.5 (3.1-7.7) days of invasive mechanical ventilation, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years. Matched siblings (n = 121; 72 [60%] female siblings) were tested at a median (IQR) age of 8.4 (7.0-10.2) years. Patients had a lower mean estimated IQ than matched siblings (101.5 vs 104.3; mean difference, -2.8 [95% CI, -5.4 to -0.2]). Among secondary outcomes, patients had significantly lower scores than matched siblings on nonverbal memory (mean difference, -0.9 [95% CI, -1.6 to -0.3]), visuospatial skills (mean difference, -0.9 [95% CI, -1.8 to -0.1]), and fine motor control (mean difference, -3.1 [95% CI, -4.9 to -1.4]) and significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). There were no significant differences in the remaining secondary outcomes, including attention, verbal memory, expressive language, and executive function. Among children, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive dysfunction was associated with significantly lower subsequent IQ scores compared with matched siblings. However, the magnitude of the difference was small and of uncertain clinical importance.

History of Intermittent Mandatory Ventilation prior to 1972. Part one. Special Article

Medical history is often overlooked as advances keep moving forward. Seldom is it that advances in medicine are truly new, unique ideas, but rather built on ideas that have been considered before. Even our latest developments will become history or forgotten as science and medicine advance. This history of intermittent mandatory ventilation (IMV) is a two-part article in which the first part attempts to show that the concepts and apparatus that involve the now common mode of ventilation have been considered and described for nearly 200 years, if not earlier. This older history is not brought forward to diminish what has been done in the last 50 years, but to enhance awareness of how ideas and even mechanical ventilators change over time. The second part will describe how those ideas and mechanics changed into what we now call IMV in its many forms. Keywords: Intermittent Mandatory Ventilation, IMV, History of mechanical ventilation

Clinical Epidemiological Characteristics and Risk Factors for Severe Bronchiolitis Caused by Respiratory Syncytial Virus in Vietnamese Children.

Introduction Bronchiolitis is the most prevalent cause of hospitalization in infants under the age of 12 months. The disease is caused by respiratory syncytial virus (RSV) infection, which can cause breathing difficulties and respiratory failure. Therefore, it is necessary to discover the risk factors of severe bronchiolitis to diagnose and treat promptly. This study is aimed at describing the epidemiological characteristics and clinical features of acute bronchiolitis caused by RSV and assessing the related factors to severe acute bronchiolitis in studied patients. Methods A descriptive cross-sectional study was carried out in Haiphong Children's Hospital, Haiphong, Vietnam, for one year, from October 1, 2016, to September 30, 2017. All bronchiolitis admissions < 2 years were included. Results 377 children were evaluated, including 261 boys and 116 girls; children under 6 months accounted for the highest proportion (57%), and 47 (12.5%) of all patients had severe disease. Wheezing was the main reason to be taken to the hospital 261 (69.2%). Clinical symptoms of acute bronchiolitis such as cough, tachypnea, and runny nose were found in all patients. Bronchiolitis cases increased in the winter-spring season, and the highest registered number of patients was 42 in March. Image of bronchiolitis on chest X-ray was found in all patients, and air trapping lung was found in 124 (32.9%) patients. The risk factors included age (≤6 months), low birth weight, preterm birth, nonbreastfeeding for the first six months, early weaning, and exposition to cigarette smoke increased the severe disease (p < 0.05). Conclusion The number of hospitalized infants with bronchiolitis caused by RSV has an upward trend during the winter-spring season (from October to March). This study confirms that age, preterm birth, breastfeeding under 6 months, history of exposure to cigarette smoking, low birth weight, having sibling(s) under five years old going to kindergarten, history of undergoing cesarean section, history of mechanical ventilation, poor living condition, and maternal education are 10 risk factors of severe bronchiolitis caused by RSV.

Post-infectious bronchiolitis obliterans in children: Clinical and radiological evaluation and long-term results

Background and objectiveThis study aims to evaluate clinical and radiological findings and treatment outcomes of the patients with PIBO. MethodsOne hundred fourteen children were enrolled. Initial demographic and clinical findings were evaluated. Pre- and post-treatment clinical and radiological findings were compared. ResultsThe median age of the patients at initial pulmonary injury was 7,2 months, the median age at diagnosis was 17.5 months. Persistent wheezing was the most common complaint. Thirty-five patients had mechanical ventilation history. 82,5% of patients had clinical improvement. Bronchiectasis, atelectasis, hyperinflation and air trapping in HRCT improved significantly with treatment. Post-treatment Bhalla scores decreased from 8.3 to 6.5 (p= 0,001). Improvement was observed in radiological and clinical findings after treatment. ConclusionsThis study is one of the largest studies in the literature and one of the few studies that evaluate clinical and radiological outcomes of patients with PIBO.

P0046 / #639: THE IMPACT OF BENZODIAZEPINES AND OPIOIDS ON NEUROCOGNITIVE DEVELOPMENT IN CHILDREN

Aims & Objectives: General anesthetics and sedatives are widely used for critically ill children admitted to the Pediatric Intensive Care Unit (PICU). Animal studies have indicated that exposure of the immature brain to these agents may cause neurodegeneration. In human adults, studies have shown an inverse association between cumulative doses of benzodiazepines and neurocognitive functioning. Literature on this association in children is scarce. This study aims to explore the impact of benzodiazepines and opioids on neurocognitive development in children. Methods: Children aged 6-12 years admitted to our PICU (age ≤10 months) for respiratory insufficiency due to severe viral lower respiratory tract infections were included. All children required mechanical ventilation for which they also received midazolam and morphine. Healthy peers, matched with patients on age, sex and socio-economic status, acted as controls. We assessed full-scale IQ (FSIQ) and computerized tests of attention, learning and memory, executive functioning and sensory and motor functioning. Results: Included were 41 patients (24 males) and 41 controls (17 males). Mean (SD) age of patients and controls was 8.6 (0.8) and 8.9 (1.0) years, respectively. Preliminary results indicate that, compared to healthy peers, children in the exposure group have a significantly lower FSIQ (d=-0.56, p = 0.02); and a significantly poorer verbal memory, including both short (d=-0.47, p = 0.04) and long-term memory (d=-0.50, p = 0.03). Other results await analyses. Conclusions: Preliminary results suggest that children with a history of mechanical ventilation and exposure to midazolam and morphine are at risk of decreased neurocognitive functioning.

Heterotopic Ossification in Guillain-Barre ́ Syndrome- A Dual Case Report

Heterotopic Ossification (HO) is formation of atypical, lamellar bone within a soft tissue surrounding major joints. It is well documented as a complication following spinal cord injury and traumatic brain injury; however, it is quite rarely seen in lower motor neuron conditions like Guillain-Barre Syndrome (GBS). Here, we present two cases of GBS (both young males) with Bilateral hip pain who were diagnosed HO on the basis of radiological study while still admitted in the Intensive Care Unit (ICU). Both of them had history of mechanical ventilation, tetraparesis and prolonged immobilisation. There are very few reports of HO in GBS and if detected early, it improves the functional outcome.

Anesthetic management of a 12-year-old child with Kagami-Ogata syndrome for pectus excavatum: a case report

BackgroundKagami-Ogata syndrome (KOS) is due to abnormal gene expression in the 14q32.2 imprinted region. Laryngomalacia and bell-shaped thorax of children with KOS can affect airway management of general anesthesia.Case presentationA 12-year-old girl with KOS had a mechanical ventilation history and underwent pectus excavatum repair for cosmetic reasons. Although she had undergone invasive thoracic surgery under general and epidural anesthesia, her respiratory rate and tidal volume were stable with adequate pain control mainly through epidural analgesia at the end of the surgery. We examined her larynx by a bronchoscope. Then, we successfully extubated her after confirming the normal movement of her larynx.ConclusionsWhen patients with KOS undergo pectus excavatum repair, anesthesiologists should prevent postoperative respiratory failure by providing adequate postoperative analgesia. Evaluation of airway patency and respiratory pattern before extubation is critical.

Expanded Comorbidity Definitions Improve Application of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) for Children and Young Adults with Non-Malignant Diseases Receiving Allogeneic Hematopoietic Cell Transplantation

Expanded Comorbidity Definitions Improve Application of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) for Children and Young Adults with Non-Malignant Diseases Receiving Allogeneic Hematopoietic Cell Transplantation

Non-Infectious Pulmonary Toxicity after Allogeneic Hematopoietic Cell Transplantation (HCT): A Center for International Blood and Marrow Transplant Research (CIBMTR) Study

Introduction Early non-infectious pulmonary toxicity (NIPT) is a significant HCT complication and comprises diffuse alveolar hemorrhage (DAH), idiopathic pneumonia syndrome (IPS), and cryptogenic organizing pneumonia (COP) with an overall incidence ranging 1-10%. Treatment options are primarily immunosuppressive therapy and supportive care with limited efficacy. Mortality in IPS, for example, approaches 60-80% (PMID: 21531955). Therefore, to better identify potentially high-risk patients (pts) we performed a registry-based analysis of the incidence, risk factors, and outcomes of early NIPT after HCT. Methods This retrospective study included adult pts undergoing allogenic HCT for hematologic malignancies and non-malignant disorders as reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) (2008-2017). Data analyses were divided into four common disease categories (AML/ALL, CML/MDS/MPN, NHL/CLL/PCD, and non-malignant diseases) to minimize statistical interactions in the multivariate model. The primary outcome was the incidence of and risk factors for individual NIPT and a composite of the three NIPT (IPS, DAH, COP); the secondary outcome was overall survival (OS). Multivariable Cox proportional hazards regression models were developed to identify the risk factors for NIPT and OS. In addition to baseline pre-transplant covariates, post-transplant neutrophil recovery (&amp;gt;500/mcL x 3 consecutive days), platelet recovery (&amp;gt;20k/mcL x 3 consecutive days, without transfusion in 7 previous days) and grade 2-4 acute GVHD were included as time-dependent covariates in the multivariable models. Results Characteristics of 21,587 adult pts are shown in Table 1. Median age at HCT was 54 years, 59% were male, and 39% had KPS &amp;lt;90. Median follow-up was 49 months. Per the HCT-Comorbidity Index (HCT-CI), 15% and 24% of pts had a severe (FEV1 and/or DLCO≤65%, dyspnea at rest, requiring supplemental oxygen) and moderate (FEV1 and/or DLCO 66-80%, dyspnea on slight activity) pulmonary comorbidity, respectively. Pre-transplant, 3% of pts had a history of mechanical ventilation, 5% had a history of pulmonary fungal infection, and 40% reported a smoking history. Most pts had a matched sibling or unrelated donor (68%) and received peripheral blood graft (71%). Myeloablative conditioning was used in 49% pts, and 39% received total body irradiation (TBI). Table 2 shows the cumulative incidence of early NIPT amongst pts in the four disease categories. Multivariable analysis in the AML/ALL group identified TBI-based conditioning, grade 2-4 acute GVHD, HCT-CI score of 1-3, and prior autologous HCT were associated with increased risk of NIPT, while platelet recovery decreased the risk of NIPT. In the CML/MDS/MPN group, smoking history, grade 2-4 acute GVHD and HCT-CI scores of 2-5+ were associated with increased risk of NIPT, while non-TBI and non-myeloablative TBI conditioning and platelet recovery were associated with a lower risk. In the NHL/HD/CLL/PCD group, a higher risk of NIPT was seen with severe pulmonary comorbidity pre-HCT and chronic GVHD, while platelet recovery and non-TBI regimens were associated with a lower risk. In the non-malignant disease group, both neutrophil and platelet recovery were associated with a lower risk of NIPT. Furthermore, the multivariable analysis for OS (Table 2) showed across all disease groups, NIPT increased the risk of mortality (vs. no NIPT; HR of 4.3 in AML/ALL, 4.1 in CML/MDS/MPN, 3.5 in NHL/CLL/PCD, 6.8 in non-malignant diseases; p&amp;lt;0.0001). Conclusions This large registry-based analysis of allogeneic HCT pts highlights several risk factors for the development of early NIPT including smoking history, severe pulmonary comorbidity, myeloablative TBI conditioning, and acute and/or chronic GVHD. Identification of these risk factors can enhance appropriate selection of pts prior to HCT. We also found that post-transplant, platelet and neutrophil recovery was associated with a reduced risk of NIPT. Furthermore, early NIPT is associated with a several-fold higher mortality risk in the current era despite significant advances in supportive care. Future studies are needed to optimize risk factors such as conditioning regimen and graft source selection to reduce the risk of early NIPT. Disclosures Ustun: Kadmon: Honoraria. Hamilton:Syndax Pharmaceuticals: Consultancy, Honoraria. Majhail:Anthem, Inc.: Consultancy; Incyte: Honoraria; Nkarta Therapeutics: Honoraria; Mallinckrodt: Honoraria. Sorror:Jazz Pharmaceutical: Other: Honorarium for Advisory role. . Stadtmauer:Amgen Inc, Celgene Corporation, Janssen Biotech Inc, Novartis, Onyx Pharmaceuticals, an Amgen subsidiary, Takeda Oncology: Consultancy. Pasquini:Bristol Myers Squibb: Consultancy; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Other; Novartis: Research Funding; Kite: Research Funding.

The East-Freeman Automatic Vent: An interesting footnote in the history of mechanical ventilation.

An example of the East-Freeman Automatic Vent from Oxford was found in the early anaesthesia equipment collection at St George Hospital, Sydney. It weighs less than 200g and is representative of a group of miniature ventilators that were described in the 1960s, including the Minivent from South Africa and the Microvent from Canada. All relied on a pressure-operated inflating valve that was described in 1966 by Mitchell and Epstein from Oxford. The ventilators were compact, portable and were powered by the gas supply from the anaesthesia machine or other driving source that distended a reservoir bag. The main problem was that they could stick in the inspiratory phase. This led to pressure in the lungs rising towards the driving pressure. There was a risk of barotrauma to the patient if the system was not promptly disconnected. While theyhad provided an alternative to hand bagging, they were superseded, as more sophisticated and safer ventilators became widely available.

The history of mechanical ventilation

The aim of mechanical ventilation is to substitute physiological respiratory function. The boom of mechanical ventilation came during the XVIII century with the development of Reanimation Societies in Europe, who promoted the use of positive pressure ventilation modes. This type of ventilation caused new complications due to excessive positive pressure in the airway. Therefore, during the XIX century negative pressure ventilation predominated, which became essential during the second half of the 19th century and first half of the 20th century. Positive pressure ventilation was relegated to operating rooms until 1952, when it was imposed over negative pressure ventilation during the Copenhagen polio epidemic. Björn Ibsen contributed significantly to this change of ventilation paradigm, which led to the latest ventilation strategies and the development of the actual intensive care units.

Risk Factors Associated with Acute Kidney Injury in Neonates and Infants Following Open Heart Surgery

BACKGROUND: The complexity of surgical cardiac procedures is on the rise, resulting in prolonged cardiopulmonary bypass time and stay in the intensive care unit. One major complication of cardiac surgery is acute kidney injury. The aim of this study is to investigate the incidence and risk factors associated with acute kidney injury following open heart surgery. METHODOLOGY: This is a retrospective cohort study that involved chart review of patients &lt;1 year old who underwent open heart surgery from January 2012 to December 2017 in a tertiary cardiovascular referral center. Preoperative characteristics included age, gender, weight, cardiac diagnosis, baseline serum creatinine, history of mechanical ventilation and cardiac catheterization and pre operative medications given. Intra-operative characteristics included cardiopulmonary bypass and cross clamp time of cardiac surgery, and degree of hypothermia . Post operatively, urine output, systolic blood pressure, mean arterial pressure, highest serum creatinine and blood urea nitrogen were recorded. RESULTS: Sixty one (61) patients were included in the study. Nine patients (15%) developed post-operative acute kidney injury, two of which underwent peritoneal dialysis. Lowest systolic blood pressure and lowest mean arterial pressure were noted to be significant in the development of acute kidney injury with odds ratio of 0.95 (p=0.049) and 0.93 (p=0.025), respectively. The duration of mechanical ventilation was also significantly increased in patients who developed acute kidney injury (p=0.028). CONCLUSION: Lowest systolic blood pressure and lowest mean arterial pressure are significant risk factors for acute kidney injury in neonates and infants following open heart surgery. KEYWORDS: acute kidney injury, acute renal failure, cardiac surgery in infants, congenital heart disease, cardiopulmonary bypass time

Clinical phenotype as a predictor of outcome in mechanically ventilated chronic obstructive pulmonary disease patients

BackgroundThe outcome in patients with chronic obstructive pulmonary disease (COPD) who need mechanical ventilation (MV) is altered by several factors such as severity of the disease, severity of acute exacerbation, advanced age, the cause of exacerbation, and development of complications.AimThis study aimed to assess the outcome of clinical phenotypes of MV COPD patients who were admitted to the respiratory ICU in 2014 and the influencing factors.Patients and methodsThis prospective study included 106 MV COPD patients. All patients underwent a thorough medical history, routine and specific investigations including: chest radiography, high-resolution computed tomography, serum immunoglobulin E, total and differential leukocytic count, serial arterial blood gases immediately before intubation, during MV and just before weaning.ResultsThere were many predictors of bad outcome with statistical significance such as: older age (62.94±12.5 vs. 57.81±12.6 years), higher temperature on admission (37.48 ±0.67 vs. 37.20±0.42°C), higher serum of HCO3 on admission (42.5±4.5 vs. 38.9±7.8 mEq/l), longer duration of MV (12.05±4.4 vs. 4.8±1.84 days), higher last year number of exacerbations (1.94±0.9 vs. 1.47±0.6 times), with shorter duration from last exacerbation (40.4±1.2 vs. 50.5±2.04 days), dyspnea as the main presenting symptom, past history of MV, occurrence of complications during MV, emphysema phenotype (52.7 vs. 22.8%).ConclusionPast history of MV, emphysema phenotype, duration of MV, higher last year number of exacerbations, and shorter duration since the last exacerbation are reliable predictors of poor outcome and mortality in MV COPD patients with acute on top of chronic respiratory failure.

Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age.

.Factors affecting growth and development in extremely low birth weight infants (ELBWIs) born small for gestational age (SGA) have not been precisely elucidated. We performed a retrospective analysis of ELBWIs born SGA who were treated in the neonatal intensive care unit of Kawaguchi Municipal Medical Centre, Japan. A total 244 ELBWIs were born from 2003 to 2010, and 31 were born with weight and height below the 10th percentile for their gestational age. Among the 31 ELBWIs born SGA, we excluded 9 who died before they reached 3 yr of age or who had severe developmental retardation. A total of 16 patients (weight, 510–998 g; GA, 28w0d–32w5d) who were followed until age 3 yr were eligible for our study. At age 3 yr, 94% and 88% of ELBWIs were above the −2 standard deviation (SD) for height and weight, respectively. A history of mechanical ventilation was associated with height. The average score of the full developmental quotient (DQ) was 85, and 63% (10/16) of ELBWIs scored more than 85. Lower Apgar score (≤ 7) was a risk factor for lower DQ scores in motor development and full development. Our study revealed that most ELBWIs born SGA were more than −2 SD below the mean for height and body weight.