185 research outputs found
Corrigendum to Reply to: Prone position in nonintubated hypoxemic respiratory failure. New tool to avoid endotracheal intubation? [J Crit Care 30/6 (2015) Page 1416] DOI: 10.1016/j.jcrc.2015.09.008
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Fever management in SAH
No full textAn electronic literature search through August 2010 was performed to obtain articles describing fever incidence, impact, and treatment in patients with subarachnoid hemorrhage. A total of 24 original research studies evaluating fever in SAH were identified, with studies evaluating fever and outcome, temperature control strategies, and shivering. Fever during acute hospitalization for subarachnoid hemorrhage was consistently linked with worsened outcome and increased mortality. Antipyretic medications, surface cooling, and intravascular cooling may all reduce temperatures in patients with subarachnoid hemorrhage; however, benefits from cooling may be offset by negative consequences from shivering
Ventilation of coronavirus disease 2019 patients
No full textPURPOSE OF REVIEW: To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19. RECENT FINDINGS: Early reports suggested that COVID-19 is an 'atypical ARDS' with profound hypoxemia with normal respiratory system compliance (Crs). Contrarily, several more populated analyses showed that COVID-19 ARDS has pathophysiological features similar to non-COVID-19 ARDS, with reduced Crs, and high heterogeneity of respiratory mechanics, hypoxemia severity, and lung recruitability. There is no evidence supporting COVID-19-specific ventilatory settings, and the vast amount of available literature suggests that evidence-based, lung-protective ventilation (i.e. tidal volume ≤6 ml/kg, plateau pressure ≤30 cmH2O) should be enforced in all mechanically ventilated patients with COVID-19 ARDS. Mild and moderate COVID-19 can be managed outside of ICUs by noninvasive ventilation in dedicated respiratory units, and no evidence support an early vs. late intubation strategy. Despite widely employed, there is no evidence supporting the efficacy of rescue therapies, such as pronation, inhaled vasodilators, or extracorporeal membrane oxygenation. SUMMARY: Given the lack of evidence-based specific ventilatory strategies and a large amount of literature showing pathophysiological features similar to non-COVID-19 ARDS, evidence-based lung-protective ventilatory strategies should be pursued in all patients with COVID-19 ARDS
Extracorporeal membrane oxygenation
No full textSummary For the last three decades, extracorporeal lung assist (ECLA) has been employed as a life-saving therapy in few highly-specialised centres. A deeper understanding of acute respiratory distress syndrome (ARDS) pathophysiology, improved technology and the positive results of recent trials have led to a reassessment of ECLA in the clinical setting. The referral and transfer of sicker patients to specialised extracorporeal membrane oxygenation (ECMO) centres has been shown to improve clinical outcome. The CESAR (conventional ventilator support versus extracorpor-eal membrane oxygenation for severe adult respiratory failure) trial was the first positive randomised controlled trial to investigate ECMO use in adult patients with ARDS. In 2009, many healthcare systems worldwide successfully faced the influenza A (H1N1) pandemic, instituting networks of specialised intensive care units (ICUs), for transfer of the sickest patients and management with ECMO. There is also an increasing interest in new and less invasive extracorporeal techniques, primarily aimed at carbon dioxide removal, which may be more widely applied in combination with a strictly protective ventilatory strategy
“Reply on: statistics on steroids—how recognizing competing risks gets us closer to the truth about COVID-19-associated VAP”
No full textA theoretical model of oxygen delivery during veno-venous extracorporeal membrane oxygenation (ECMO)
No full textImplicit olfactory processing attenuates motor disturbances in idiopathic Parkinson’s disease
No full textMany reports in the literature indicate that idiopathic Parkinson's disease (IPD) patients have substantial olfactory dysfunctions even before motor symptoms become evident. It has not yet been clarified, however, if some form of implicit olfactory processing is preserved in this population. An olfactory visuomotor priming paradigm, which detects implicit olfactory processing in neurologically healthy participants, was utilized to investigate motor control in relation to olfactory signals in a group of IPD patients. Two control groups were also considered: 12 vascular Parkinson's disease (VPD) in whom normal olfactory abilities are typically reported and 12 neurologically healthy participants. All of the participants were asked to perform reach-to-grasp movements toward large or small targets following olfactory cues delivered by a computer-controlled olfactometer. The odor was either 'size' congruent with the target (e.g., strawberry or apple, respectively) or incongruent (e.g., apple or strawberry, respectively). A bend sensor glove (CyberGlove) was used to measure the hand kinematics. Facilitation effects were noted in all the groups with regard to movement time. If a congruent rather than an incongruent odor was delivered, the movement time of the reach-to-grasp was shortened and facilitation effects in maximum grip amplitude were noted in both the IPD and the VPD groups. The maximum grip amplitude was smaller when no odor, as compared to a congruent odor, was delivered. The present results suggest that implicit olfactory processing affects motor control in IPD patients favoring less severe bradykinesia and hand movement hypometria. Once confirmed, these findings could be useful when rehabilitation strategies are being hypothesized for these patients
The authors reply: Extracorporeal Membrane Oxygenation-Associated Infections: Carefully Consider Cannula Infections!
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