Mechanical Ventilation Treatment Research Articles

ICU Professionals’ Experiences of Caring for Conscious Patients Receiving MVT

Over the last decade, caring for patients who are conscious while receiving mechanical ventilator treatment has become common in Scandinavian intensive care units. Therefore, this study aimed to describe anesthetists', nurses', and nursing assistants' experiences of caring for such patients. Nine persons were interviewed. A hermeneutic method inspired by Gadamer's philosophy was used to interpret and analyze the interview text. Staff members found it distressing to witness and be unable to alleviate suffering, leading to ethical conflicts, feelings of powerlessness, and betrayal of the promises made to the patient. They were frustrated about their inability to understand what the patients were trying to say and often turned to colleagues for help. When caring for conscious patients, it takes time to get to know them and establish communication and a trusting relationship.

Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study

Objective: To evaluate the incidence, mortality and influencing factors for the development of Acute Kidney Injury (AKI) at admission or during Intensive Care Unit (ICU) stay. Methods: We conducted a prospective, epidemiological survey, in ICU for two years and the data of 97 patients admitted to ICU for medical illness was analyzed. Patients with AKI were categorized by serum creatinine and urine output into 3 stages. Stage 1 was defined as an absolute increase (within 48 hours) in serum creatinine of more than or equal to 0.3 mg/dl, or oliguria of less than 0.5ml/kg per hour for more than six hours. Stage 2 was defined as doubling of serum creatinine, or a urinary output lower than 0.5ml/kg /h for 12 h. Stage 3 was defined as tripling of serum creatinine or a urinary output lower than 0.3 ml/kg/h for 24 h, or anuria for 12 h. Results: Sixty patients ( 62 %) had AKI. AKI patients tended to be older and usually had antecedent of heart disease, a high Simplified Acute Physiology Score version II at admission, more use of mechanical ventilation and vasopressor treatment, more shock, more severe sepsis, more hyperosmolar hyperglycemic state (HHS) and higher mortality. In multivariate analysis, SAPS II score >30, antecedent of heart disease and shock were independent risk factors for development of AKI at admission or during ICU stay. Conclusion: AKI had a high incidence and a high mortality in medical ICU’s patients. Antecedent of severe underlying diseases, heart disease and hemodynamic failure were independent risk factors of AKI.

Pregnancy Complicated by Listeriosis

Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. Pregnant women are at high risk of listeriosis, but the symptoms are non-specific and diagnosis is difficult. Here, we report a case of listeriosis complicating pregnancy and causing severe neonatal infection that was successfully rescued by antibiotic therapy. A 21-year-old pregnant woman (gravida 4, para 2, abortion 1) presented at 35 weeks' gestation with abdominal pain and fever. She came to our hospital due to regular uterine contractions and fever. While the cause of her fever was being investigated, continuous fetal heart rate monitoring showed persistent fetal tachycardia. However, she delivered the baby vaginally two hours after admission. A female baby was delivered, weighing 2328 g, with Apgar scores of 1, 6 and 7 at 1, 5 and 10 minutes, respectively. After birth, the infant was flaccid and cyanotic without respiratory activity. She was intubated and received mechanical ventilation and empirical antibiotic treatment with Ampicillin and Cefotaxime. Persistent pulmonary hypertension developed and high frequency ventilation with inhalated nitric oxide was given. Listeria monocytogenes was isolated from the blood culture. After treatment, her condition gradually improved at the 15th day. However, the next day her respiratory condition deteriorated and she was intubated again. Antibiotics were shifted to Vancomycin and Meropenem. Caspofungin was also prescribed due to possible fungal infection. After a 14- day course of treatment, she was discharged on the 45th day after birth. Neonatal listeriosis often causes neonatal death. Ampicillin is the first treatment of choice for listeriosis and can significantly improve neonatal outcome. Pregnant women are advised to take additional precautions while consuming and handling foods. Obstetricians should be also familiar with this life-threatening disease.

Heart rate variability of transported critically ill neonates

Determining heart rate variability (HRV) in infants is a useful measure of physiological stability. Transport of ill neonates imposes a measurable degree of stress. A prospective observational study on 58 critically ill neonates, transported to an intensive care unit (ICU) was performed. HRV during the 24-h period before, during and after transport, heart rate (HR), mean arterial pressure and transport risk index of physiologic stability (TRIPS) score were observed. The median HRV total power value of 40.80 ms(2) was set as the cutoff value, and neonates with values below this were designated as the low-HRV group (l-HRV; n=29), and those above this as the high-HRV group (h-HRV; n=29). The h-HRV group had a significantly lower HR at retrieval and 1 h after admission and a significant 2- and 4-day shorter duration of mechanical ventilation and ICU treatment compared to the l-HRV group. Spearman's correlations between total power and duration of mechanical ventilation (ρ=-0.346; P<0.01) and ICU treatment (ρ=-0.346; P<0.01) were significant. Transported neonates were also tested for differences in HRV and other physiological and demographic parameters between the transport mode and time. No differences were found, except that the nighttime ambulance group had a statistically higher HRV compared to the daytime ambulance group. Higher HRV of group of neonates, who did not differ in illness severity TRIPS score from the lower HRV group, is associated with a faster and significant decrease in HR after transport and a 2- and 4-day shorter duration of mechanical ventilation and ICU treatment.

Non-Hodgkin's Lymphoma Presenting as a Primary Endobronchial Tumor - A Case Report

Non-Hodgkin’s lymphoma (NHL) involving the endobronchial tree is uncommon, and the initial presentation of NHL as an endobronchial tumor is extremely rare. Several clinical reports have described bronchial-associated lymphoid tissue (BALT) lymphoma as an endobronchial lesion. A 77 year old male hospitalized in another hospital for acute breathlessness and mechanically ventilated. He was shifted to Delhi Heart And Lung Institute because of failed extubation after 3 days of mechanical ventilation and reintubated .Past History of intubation was present 1 month back and diagnosed as a case of acute bronchitis. On evaluation at another hospital, the patient was found to have normal chest radiograph. Chest examination revealed findings consistent assisted ventilatory breath sounds associated with bilateral ronchi. Blood investigations were within normal limit. Contrast enhanced computed tomography of the chest revealed endoluminal soft tissue mass lesion at carina significantly obliterating bilateral main bronchi.USG Whole Abdomen revealed mild hepatomegaly and left renal cortical cyst measuring 4×5 cm and grade l BPH.Fibreoptic bronchoscopy revealed a globular smooth mass causing near complete obstruction of left main bronchus. Histopathological examination of the endobronchial biopsy showed tumor cells have a round or oval nucleus that appears vesicular because of margination of chromatin at the nuclear membrane, but large multilobed or cleaved nuclei predominate in some cases . Immunohistochemical staining was positive for LCA, CD20, and CD79a and negative for CD3, CD5, CD30, NSE, CK, Ki67, Chromogranin and Synaptophysin. While in the hospital, the patient was managed with mechanical ventilation and symptomatic treatment. FOB and rigid Bronchoscope, debulking of tumour growths was done using electrocautery snare. Patient was continued on overnight mechanical ventilation and extubated after one day. Post extubation, patient remained alright without any respiratory distress and discharged in stable condition. Latter on patient followed in Rajiv Gandhi Cancer Hospital. He underwent PET scan of whole body, which revealed normal study. Patient was managed with chemotherapeutic agents and he is still alive after 3 years of management without any symptoms. NHL rarely presents as an endobronchial growth and only histopathology can differentiate it from other benign and malignant endobronchial masses. SAARC Journal of Tuberculosis, Lung Diseases &amp; HIV/AIDS; 2012; IX(2) 37-40 DOI: http://dx.doi.org/10.3126/saarctb.v9i2.7978

Comparison of mechanically ventilated patients with three types of

ABSTRACTBackground and aim: Communication is one of the most essential needs of humanbeings.Mechanical ventilation compromises patients’ ability to communicate their needs. Thisresearch was conducted to assess the effect of three methods of communication with patientsreceiving mechanical on their satisfaction in Arak hospitals 1389(2010).Method and materials: This randomized clinical trial was conducted in Intensive Care Units ofValey Asr, Amir Al Momenin and Ghods hospitals in Arak ,Iran. 60 patients who were admitted inICU and were receiving mechanical ventilation were included in the study. These patients wererandomly allocated in three groups.During a 12 hours period researcher used 1 method ofcommunication for each group of these patients. These mrthods of communication included :A:Communicational board (words & letters). B: Communicational board (pictures & letters). C: Theconventional method. Data were collected using a questionnaire. The questionnaire consisted ofthree parts: demographic variables, medical history and satisfaction with communicationmethod.Validity of the instrument was assured by content validity index. , Cronbach's alpha wasused to determine the reliability of the iinstrument. SPSS, version 16 was used for data analysis.Findings:There was not a significant difference among three groups in terms of age, gender, meanlength of stay in the ICU before mechanical ventilation treatment. The mean satisfaction scoreswere 2.58, 3.83 and 4.10 for conventional communication group, communication board A ( words& letters) and communication board B( pictures and letters) respectively. There was a significantdifference among three groups in terms of their satisfaction with communication method(P<0.001).The one way analysis of variance indicated that using communication boards A & Bsignificantly increased patient satisfaction.Conclusion: Using communication boards facilitates communication with mechanically ventilatedpatients and increase their satisfaction.*Corresponding Author: Ziba Farahani Borzabadi, Borzabadi Farahani. Dept.of Nursing, Facultyof Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, IranEmail: ziba_farahani_2000@Yahoo.com-Cabe C (2004). Nurse – patient communication: an exploration of patient’s experiences. Journal of ClinicalNursing.13(1) 41-49.-Elder N et al. (2008). Nurse's perception of error communication and reporting in intensive care unit. Journal of PatientSafety. 4 (3)162-168.-Ghamari zare A et al (2008) [Quality of nurse's performance and patient's satisfaction in cardiac care units]. Tabib eShargh Journal 10 (1) 27-36. (Persian)-Imani-Pour M [Quasi experimental research on anxiety and satisfaction of patients undergoing open cardiac surgeryhaving intubation in selective hospital of Tehran Medical university 2001] MSc Thesis in nursing. Tehran University ofMedical Science.(Persian)-Kozier B et al (2008). Fundamental of Nursing Concept and Procedure. 8th edition. New Jersey: Prentice-Hall. Inc.-Patak L Gawlinski A Fung I et al (2006) Communication boards in critical care: patients’ views.Applied NursingResearch 19(4) 182-190-Potter P Perry A (2005). Fundamental of Nursing.7th edition. St.Louis: Mosby.-Price A (2004). Intensive care nurses' experiences of assessing and dealing with patient's psychological needs. Nursingin Critical Care. 9(3):134-142.-Rask MT et al (2009). Effects of an intervention aimed at improving nurse-patient communication in an oncologyoutpatient clinic. Cancer Nursing.32 (1)1-11-Schulmeister L et al (2005). Quality of life quality of care, and patient satisfaction: Perceptions of patient undergoingoutpatient autologous stem cell transplantation. Oncology Nursing Forum. 32 (1) 57-59-Stovesky B et al. (1988). Comparison of two types of communication methods used after cardiac surgery with patientswith endotracheal tubs. Heart& Lung.17 (3) 281-289.-Taylor C Lillis C Lemone P (2008).Fundamental of Nursing: The Art and Science of Nursing Care. 6 th edition.Philadelphia: Lippincott. Co-Trovo De Araujo M Paes Da Silva M (2004). Communication with dying patient –perception of intensive care unitsnurses in Brazil. Journal of Clinical Nursing. 13 (5) 143-153.

Maternal and fetal recovery after severe respiratory failure due to influenza: a case report

BackgroundDuring pregnancy women are at increased risk of severe complications to influenza infection, including death of mother or fetus, especially if chronic comorbid medical conditions such as diabetes mellitus are present.Case presentationA 36 years old Caucasian pregnant woman with type 1 diabetes underwent mechanical ventilation in gestation week 27 for severe respiratory failure due to influenza and pneumonia. For three weeks during and following her most severe illness, fetal growth could not be detected and the umbilical flows and amniotic fluid volumes were affected too. The possibility of preterm delivery and extracorporeal membrane oxygenation (ECMO) treatment were considered, however the patient and her fetus recovered gradually on conservative treatment. Under close surveillance the pregnancy continued until term, with delivery of an infant with appropriate weight for gestational age.ConclusionPreterm delivery and decreased birth weight were reported for women with antepartum pneumonia. Mechanical ventilation and ECMO treatment for severe respiratory failure in pregnancy are life threatening conditions and have been associated with preterm delivery. It remains uncertain if delivery improves the respiratory status of a critically ill woman, and the fetal condition is likely to improve, if the maternal condition is stabilized.Severe respiratory insufficiency requiring mechanical ventilation in a diabetic pregnant woman with influenza was successfully treated conservatively. Despite clear signs of impaired fetal condition in the acute phase, watchful waiting resulted in delivery of a normal weight infant at term.

Clinical characteristics of respiratory virus infection in children admitted to an intensive care unit

Purpose: To investigate the clinical characteristics and the risk factors for mechanical ventilator treatment and incidence of complications in children admitted to an intensive care unit (ICU) with detected respiratory viruses. Methods: Eighty-two patients who were detected respiratory viruses by multiplex real-time polymerase chain reaction from nasopharyngeal aspirates were enrolled among the 123 children admitted to ICU with acute respiratory manifestations during the study period from January 2006 to December 2012. Results: Detection rate of respiratory viruses were 66% and 13 patients (16%) had two viruses isolated. The most common respiratory virus isolated was respiratory syncytial virus (RSV) (35%) followed by rhinovirus (19%), adenovirus (13%), parainfluenza virus (11%), influenza virus (11%), human metapneumovirus (6%), and human coronavirus (5%). Pneumonia (70%) was the most common clinical diagnosis. The mean age of patient with RSV infection was the youngest and with influenza virus infection was the oldest among other viruses infection (mean ± standard deviation, 5.9 ± 10.1 months vs. 51.0 ± 26.1 months; P= 0.01). Forty Patients (49%) who had the underlying diseases were not associated with incidence of mechanical ventilator treatment and complications. Bacterial coinfection with respiratory virus was the significant risk factor of mechanical ventilator care and incidence of complications (odds ratio [OR], 50.003; 95% confidence interval [CI], 3.955–632.144; P= 0.003, and OR, 15,569; 95% CI, 1.803–134.452; P= 0.013). Conclusion: The significant morbidity of pediatric patient admitted to ICU with respiratory virus infection (RVI) was associated with bacterial coinfection. Furthermore, multicenter study should be performed to investigate the epidemiology of RVI in pediatric patients admitted to ICU in domestic. (Allergy Asthma Respir Dis 2013;1:370-376)

Opportunity lost: End‐of‐life discussions in cancer patients who die in the hospital

End-of-life discussions are associated with decreased use of life-sustaining treatments in patients dying of cancer in the outpatient setting, but little is known about discussions that take place during terminal hospitalizations. To determine the proportion of patients assessed by the clinical team to have decisional capacity on admission, how many of these patients participated or had a surrogate participate in a discussion about end-of-life care, and whether patient participation was associated with treatments received. Retrospective review. Inpatient. Adult patients with advanced cancer who died in the hospital between January 1, 2004 and December 31, 2007. Of the 145 inpatients meeting inclusion criteria, 115 patients (79%) were documented to have decisional capacity on admission. Among these patients, 46 (40%) were documented to lose decisional capacity prior to an end-of-life discussion and had the discussion held instead by a surrogate. Patients who had surrogate participation in the end-of-life discussions were more likely to receive mechanical ventilation (56.5% vs 23.2%, P < 0.01), artificial nutrition (45.7% vs 25.0%, P = 0.03), chemotherapy (39.1% vs 5.4%, P <0.01), and intensive care unit (ICU) treatment (56.5% vs 23.2%, P <0.01) compared to patients who participated in discussions. There was no difference between palliative treatments received. The majority of patients with advanced cancer are considered to have decisional capacity at the time of their terminal hospitalization. Many lose decisional capacity before having an end-of-life discussion and have surrogate decision-makers participate in these discussions. These patients received more aggressive life-sustaining treatments prior to death and represent a missed opportunity to improve end-of-life care.

Patterns of Patient-Ventilator Asynchrony as Predictors of Prolonged Mechanical Ventilation

Patient-ventilator asynchrony has been associated with adverse outcomes. The largest body of investigation has focused on ineffective ventilator triggering. Nevertheless, the effect of other patterns of asynchrony on patient outcomes is unknown. The purpose of this study was to assess the performance of specific patterns of asynchrony in their ability to predict prolonged mechanical ventilation. Patients mechanically ventilated within 48 hours of intensive care unit admission were included. Subjects with tracheostomy, mechanical ventilation dependency and treatment with neuromuscular blockers were excluded. Asynchrony patterns were collected on daily evaluations for three days. Analysed patterns were missed, double and auto-triggering, dish-out and overshoot of the pressure waveform, delayed termination and auto-positive end-expiratory pressure. Pattern-specific and composite asynchrony indices were calculated. Demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) II, PaO2/FiO2, positive end-expiratory pressure (PEEP) and Richmond Agitation Sedation Scale were collected. Receiver operating characteristic curves to assess the ability of each index to predict prolonged mechanical ventilation were constructed. Twenty-eight patients were deemed eligible. The average age was 54±17, with 71% of male gender. APACHE II, PaO2/FiO2 and PEEP were 18±7, 249±117 and 5.8±2.4 respectively. Richmond Agitation Sedation Scale was -3.1±1.3. The average number of days on mechanical ventilation was 5.4±6.5. Areas under the curve (AUC) for missed and double-triggering indices were 0.66±0.12 and 0.60±0.12 respectively. AUC for the dish-out index was 0.88±0.09. AUC for overshoot, delay termination and composite indexes were 0.55±0.12, 0.62±0.12 and 0.70±0.10 respectively. Dish-out index is the best predictor of prolonged mechanical ventilation, compared with other patterns of patient-ventilator asynchrony.

Circulating microRNAs in Patients with Shiga-Toxin-Producing E. coli O104:H4 Induced Hemolytic Uremic Syndrome

BackgroundIn early May 2011, an outbreak of hemorrhagic colitis associated with hemolytic–uremic syndrome (HUS) first developed in Northern Germany and spread to 15 other countries in Europe. The outbreak-strain O104:H4, which combined virulence factors of typical enteroaggregative and Shiga-Toxin–producing E. coli was associated with an unusual high rate of hemolytic uremic syndrome. Also an unexpected high rate of coma and seizures leading to mechanical ventilation and ICU treatment was observed. MicroRNAs are small ribonucleotides orchestrating gene expression. We tested whether circulating microRNAs in serum of HUS patients during the 2011 epidemics are altered in this patient cohort and related to clinical manifestations.Methodology/Principal FindingsWe profiled microRNAs using RNA isolated from serum of patients and healthy age-matched controls. The results were validated in 38 patients at baseline, 29 patients during follow-up and 21 age-matched healthy controls by miRNA-specific quantitative RT-PCR. Circulating levels of miR-24, miR-126 were increased in HUS patients versus controls. There was no association between these microRNAs and renal function or the need for renal replacement therapy. In contrast, levels of miR-126 were associated with neurological symptoms at baseline and during follow-up. In addition, miR-126 (on admission) and miR-24 (on admission and during follow-up) were associated with platelet count.Conclusions/SignificanceCirculating microRNAs are strongly altered in this patient cohort and associated with neurological symptoms as well as platelet count.

61 Association of Vitamin D Receptor Gene Polymorphisms and Bronchopulmonary Dysplasia

Background and aimsVitamin D is considered as an important regulator of fetal lung development and innate immune system. Its functions involved in susceptibility and resistance to infections and pulmonary diseases...

Risk and Prognostic Factors of Inpatient Mortality Associated with Unintentional Insecticide and Herbicide Poisonings: A Retrospective Cohort Study

IntroductionPesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings.MethodsWe performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).ResultsThere were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42).ConclusionsWe demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.

People's experiences of being mechanically ventilated in an ICU: A qualitative study

In previous studies people receiving mechanical ventilation treatment have described experiencing distress over their inability to speak and feelings such as anxiety. More research is needed to improve their experience in the intensive care unit and promote recovery. The aim of this study was to describe the intensive care unit experiences of people undergoing mechanical ventilation. Qualitative, personal interviews were conducted during 2011 with eight people who were mechanically ventilated in an intensive care unit in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Two themes emerged, with four and three categories, respectively. Being dependent for survival on other people and technical medical equipment created a sense of being vulnerable in an anxious situation and a feeling of uncertainty about one's own capacity to breathe. Having lines and tubes in one's body was stressful. Being given a diary and follow-up visit to the intensive care unit after the stay were important tools for filling in the missing time, but there was also one participant who did not want to remember his stay in the intensive care unit. To be dependent on other people and technical medical equipment for survival creates a sense of being delivered into the hands of others, as the people being mechanically ventilated could not trust their body to function.

Simulation of the effect of airway disease on respiratory airways

Airway disease such as tumours and asthma lead to lung injuries. Therefore, a better understanding of airway mechanics parameters is very important to avoid lung injuries in patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine as well as pulmonary medicine. The objective of this study was to investigate the role of airway diseases such as asthma and tumours on airway mechanics parameters using coupled fluid–solid computational analysis. The results obtained indicate that both tumours and asthma greatly affect the airway mechanics parameters (airflow velocity increased by about 15% and the strains increased by about 40%). Strain results of this study highlight significant changes in levels of airway parameters, which may translate into higher health risk associated with airway tumours and the asthmatic airways. These results combined with optimization suggest that it is possible to develop mechanical ventilation protocols to avoid lung injuries in patients.

Communication when patients are conscious during respirator treatment—A hermeneutic observation study

The aim of this study was to observe, interpret and describe nurses' communication with conscious patients receiving mechanical ventilation treatment (MVT) in an intensive care unit (ICU), and to examine if such communication could be interpreted as caring. Hermeneutic observational study inspired by the philosophy of Gadamer. Nineteen patients were observed on several occasions for a total of 66 hours, when conscious during MVT. A form of caring communication was identified and interpreted as comprising seven themes: being attentive and watchful, being inclusive and involving, being connected, remaining close, being reassuring and providing security, keeping company and using humour and using a friendly approach. Communication that mediated a non-caring approach was also identified and described under two thematic headings, i.e. being neglectful and being absent. Caring is communicated by the caring act of "standing-by" the patient. Caring or non-caring is communicated in non-verbal and verbal communication, in the words used, the tone of voice and behaviour, as well as in the performance of nursing care activities.

Study on the weaning method of mechanical ventilation in the treatment of 51 patients with acute severe respiratory failure caused by organophosphate poisoning

Objective To explore the weaning method of mechanical ventilation in the treatment of acute severe respiratory failure caused by organophosphate poisoning.Methods The clinical features and weaning situation of 51 patients with acute severe respiratory failure caused by organophosphate poisoning by the treatment of mechanical ventilation were retrospectively analyzed.Results In 51 cases,45 cases were cured,the survival rate was 88.2％ and 6 cases died,the fatality rate 11.8％.Conclusion Early ventilator to rescue and choose opportunity for weaning could directly impact on the qualitv of life of patients,and improve outcomes,and reduce mortality. Key words: Organophosphate poisoning ; Mechanical ventilation; Weaning

A model-based decision support system for critiquing mechanical ventilation treatments

A computerized system for critiquing mechanical ventilation treatments is presented that can be used as an aide to the intensivist. The presented system is based on the physiological model of the subject's respiratory system. It uses modified versions of previously developed models of adult and neonatal respiratory systems to simulate the effects of different ventilator treatments on the patient's blood gases. The physiological models that have been used for research and teaching purposes by many researchers in the field include lungs, body tissue, and the brain tissue. The lung volume is continuously time-varying and the effects of shunt in the lung, changes in cardiac output and cerebral blood flow, and the arterial transport delays are included in the system. Evaluation tests were done on adult and neonate patients with different diagnoses. In both groups combined, the differences between the arterial partial pressures of CO(2) predicted by the system and the experimental values were 1.86 ± 1.6 mmHg (mean ± SD), and the differences between the predicted arterial hemoglobin oxygen saturation values, S(aO2), and the experimental values measured by using pulse oximetry, S(pO2), were 0.032 ± 0.02 (mean ± SD). The proposed system has the potential to be used alone or in combination with other decision support systems to set ventilation parameters and optimize treatment for patients on mechanical ventilation.

Short‐term and long‐term mortality following pediatric intensive care

The aim of the present study was to examine short-term and long-term mortality following discharge from the pediatric intensive care unit (PICU). This was a prospective observational study. Data collected consisted of demographics, severity scores, procedures, treatment, need for and duration of mechanical ventilation (MV), length of PICU and hospital stay, and mortality at PICU and hospital discharge, at 3 and 6 months and at 1 and 2 years. A total of 300 patients (196 boys and 104 girls), aged 54.26 ± 49.93 months, were included in the study. Median (interquartile range) Pediatric Risk of Mortality (PRISM III-24) score was 7 (3-11) and predicted mortality rate was 11.16%. MV rate was 67.3% (58.3% at admission) for 6.54 ± 14.15 days, and length of PICU and hospital stay was 8.85 ± 23.28 days and 20.69 ± 28.64 days, respectively. Mortality rate at discharge was 9.7% and cumulative mortality rate thereafter was 12.7%, 15.0%, 16.7%, 19.0%, and 19.0% at hospital discharge, 3 months, 6 months, 1 year and 2 years, respectively. Significant risk factors of PICU mortality were inotrope use, PRISM III-24 score >8, MV, arterial and central venous catheterization, nosocomial infection, complications, and cancer. Independent predictors of mortality at discharge were inotrope use and PRISM III-24 score, whereas predictors of mortality at 2 years were comorbidity and cancer. A 2 year follow-up period seems sufficient for a comprehensive mortality analysis of PICU patients. Severity of critical illness is the key factor of short-term mortality, whereas comorbidity is the major determinant of long-term mortality.

Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience

Background/PurposeTo assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele. MethodsFrom 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date. ResultsThere were 12 boys and 8 girls. Thirteen had prenatal ultrasound diagnosis at a mean gestational age of 23 weeks. The mean gestational age at delivery was 37 weeks, and mean birth weight was 2.5 kg. Nineteen had other anomalies and/or medical problems, 18 of them multiple. The most common was pulmonary hypoplasia (70%). Mechanical ventilation and/or oxygen treatment was required in 15 (75%) for a mean of 10 weeks. SSD was used as primary sac treatment in 5 and secondary treatment in 15 (after Silon pouch 11, Op-site 3, povidone-iodine 1). Six omphalocele sacs were ruptured within the first 5 days of life. SSD was used for a mean of 6 months at a cost of $1 per day. Complications included 2 instances of staphylococcal sepsis and 1 jejunal perforation inside a Silon pouch. Six (30%) died from pulmonary hypoplasia at a mean age of 18 weeks. There were 14 (70%) survivors who went home after a mean of 14 weeks. Of the 14 survivors, 12 had ventral hernias repaired (18 operations with 2 recurrences), and 2 remain with their original ventral hernia. ConclusionsInitial topical coverage with SSD is associated with excellent outcomes for infants with giant omphalocele who cannot undergo immediate closure.