1,721,020 research outputs found
ECMO-weaning facilitated by neurally adjusted ventilatory assist (NAVA): a case for principal clarification
No full textAbstract The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has become increasingly prevalent, particularly in respiratory disease pandemics such as H1N1-influenza and SARS-CoV-2. This surge has emphasized the importance of clear therapy recommendations, improved accessibility to ECMO technology, established ECMO teams, and structured networks to ensure access to specialized care throughout the course of the disease for patients with severe ARDS. Although the initiation criteria for VV-ECMO are well defined, treatment strategies while on ECMO regarding e.g., ventilator management or ECMO weaning strategies remain variable and with lack of consensus. NAVA (Neurally Adjusted Ventilatory Assist), as an assisted mechanical ventilation modality, offers real-time electromyographic feedback, which has been shown to enhance prolonged weaning processes from mechanical ventilation. We present a case of penetrating thoracic trauma complicated by ARDS, successfully managed with VV-ECMO. NAVA was employed to monitor and facilitate ECMO. This approach integrates ECMO weaning with ventilation settings, considering both gas exchange lung function, such as carbon dioxide removal, and respiratory mechanics in the form of neuromuscular coupling. This is a new approach to VV-ECMO weaning. More research is planned to validate the efficacy of this method in conjunction with additional parameters, such as diaphragm activity evaluated sonographically in a randomized design. This case underscores the potential of NAVA in VV-ECMO weaning, offering a promising avenue for optimizing patient care and outcomes
Sequential use of extracorporeal devices to avoid mechanical ventilation in a patient with complicated pulmonary fibrosis
No full textPreemptive veno-venous ECMO support in a patient with anticipated difficult airway: A case report
No full textThis report presents a case of endotracheal metastasis in which elective veno–venous extracorporeal membrane oxygenation (VV ECMO) was used to undergo tracheal laser-surgery prior to establishment of a definitive airway. Specifically, we describe the respiratory and airway management in an adult patient from the preclinical phase throughout elective preoperative ECMO implantation to postoperative ECMO weaning and decannulation in the Intensive Care Unit. This case report lends further supports to the idea that the extracorporeal membrane oxygenation could be electively used to provide safe environment for surgery in situations where the standard maneuvers of sustaining adequate gas exchange are anticipated to fail.Open-Access-Publikationsfonds 202
Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series
No full textNeurally adjusted ventilatory assist vs. pressure support ventilation in critically ill patients: an observational study
No full textBackground: During neurally adjusted ventilatory assist (NAVA), the inspiratory support is controlled by the patients' respiratory drive influenced by an operator-controlled gain factor (NAVA level). The purpose of our observational study was to transfer patients from conventional pressure support ventilation (PSV) to NAVA safely. We compared two approaches to set the NAVA level and evaluated the effect of NAVA. Methods: We studied mechanically ventilated patients capable of spontaneous breathing. For the change of the ventilator mode, we used a NAVA level calculated to generate a peak inspiratory pressure equal to PSV. We compared this NAVA level with a NAVA level determined by a NAVA level titration. Ventilatory and haemodynamic data were recorded during an observational period of 6 h. Results: All 20 patients included in the study could be transferred from PSV to NAVA and completed the observation interval. Setting the NAVA level according to prior PSV settings proved to be a feasible approach, but in 75% of our patients, we modified the NAVA level according to the titration results. Gas exchange and ventilatory mechanics during the observation interval remained stable. Conclusions: The ventilator mode NAVA seems to be well tolerated in a heterogeneous group of critically ill patients. Pre-setting of the NAVA level during PSV can result in an overestimation of the required ventilator support. An additional titration of the NAVA level ads valuable information although difficult to interpret in some cases.Maquet Critical Car
Rescue therapies for acute respiratory distress syndrome: What to try first?
No full textPurpose of review Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure adequate oxygenation and survival. This review provides a summary and assessment of treatment options that can be beneficial when the standard approach fails. Recent findings 'Life-threatening' conditions or refractory hypoxemia during mechanical ventilation are more a matter of personal rating than an objective diagnosis based on defined and/or unanimously agreed thresholds that would mandate the use of rescue therapies. Although the outcome might vary with different rescue procedures, most of them will improve oxygenation. Prone positioning maintains a predominant role as rescue therapy in severe hypoxemia and does not only improve oxygenation in but also survival of ARDS patients. Recruitment maneuvers can have temporary positive effects. Inhaled nitric oxide, as well as high-frequency oscillatory ventilation might acutely improve oxygenation and can be used as a 'bridge' to alternative rescue therapies, but neither provides any survival advantage by itself and might even be detrimental. Although increasingly employed in other than the rescue indication, extracorporeal membrane oxygenation should still primarily be used in patients who do not respond to differentiated mechanical ventilation, which includes a careful evaluation of nonextracorporeal membrane oxygenation rescue therapies that might be combined in order to overcome the life-threatening situation. Early involvement of an ARDS or extracorporeal membrane oxygenation center should be considered to ensure optimal care. Summary A well timed, multimodal approach is required for patients with ARDS suffering from life-threatening hypoxemia. Understanding the limits of each type of rescue measure is of vital importance
The potential effect of albumin replacement on immune modulation and sphingosine 1-phosphate dynamics
No full textA retrospective cohort analysis of factors influencing continuous antibiotic therapy with ampicillin
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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