AnatomyDiseasesAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPhenomena and ProcessesHealth Care
Airway ExtubationVentilator WeaningIntubation, IntratrachealAirway ObstructionAirway RemodelingLaryngeal EdemaDevice RemovalAirway ResistanceRespiration, ArtificialAnesthesia Recovery PeriodRespiratory InsufficiencyTracheostomyAnesthesia, GeneralBronchiRespiratory SystemPositive-Pressure RespirationIntensive Care UnitsBronchial HyperreactivityAirway ManagementRespiratory Distress Syndrome, NewbornContinuous Positive Airway PressureRespiratory Mucosa
Airway Extubation
Removal of an endotracheal tube from the patient.
Ventilator Weaning
Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.
Intubation, Intratracheal
A procedure involving placement of a tube into the trachea through the mouth or nose in order to provide a patient with oxygen and anesthesia.
Airway Obstruction
Any hindrance to the passage of air into and out of the lungs.
Airway Remodeling
The structural changes in the number, mass, size and/or composition of the airway tissues.
Laryngeal Edema
Abnormal accumulation of fluid in tissues of any part of the LARYNX, commonly associated with laryngeal injuries and allergic reactions.
Device Removal
Removal of an implanted therapeutic or prosthetic device.
Airway Resistance
Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow.
Respiration, Artificial
Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2).
Anesthesia Recovery Period
The period of emergence from general anesthesia, where different elements of consciousness return at different rates.
Respiratory Insufficiency
Failure to adequately provide oxygen to cells of the body and to remove excess carbon dioxide from them. (Stedman, 25th ed)
Tracheostomy
Surgical formation of an opening into the trachea through the neck, or the opening so created.
Anesthesia, General
Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery.
Bronchi
The larger air passages of the lungs arising from the terminal bifurcation of the TRACHEA. They include the largest two primary bronchi which branch out into secondary bronchi, and tertiary bronchi which extend into BRONCHIOLES and PULMONARY ALVEOLI.
Respiratory System
The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about.
Positive-Pressure Respiration
A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.
Intensive Care Units
Hospital units providing continuous surveillance and care to acutely ill patients.
Bronchial Hyperreactivity
Tendency of the smooth muscle of the tracheobronchial tree to contract more intensely in response to a given stimulus than it does in the response seen in normal individuals. This condition is present in virtually all symptomatic patients with asthma. The most prominent manifestation of this smooth muscle contraction is a decrease in airway caliber that can be readily measured in the pulmonary function laboratory.
Airway Management
Evaluation, planning, and use of a range of procedures and airway devices for the maintenance or restoration of a patient's ventilation.
Respiratory Distress Syndrome, Newborn
A condition of the newborn marked by DYSPNEA with CYANOSIS, heralded by such prodromal signs as dilatation of the alae nasi, expiratory grunt, and retraction of the suprasternal notch or costal margins, mostly frequently occurring in premature infants, children of diabetic mothers, and infants delivered by cesarean section, and sometimes with no apparent predisposing cause.
Continuous Positive Airway Pressure
A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. (On-Line Medical Dictionary [Internet]. Newcastle upon Tyne(UK): The University Dept. of Medical Oncology: The CancerWEB Project; c1997-2003 [cited 2003 Apr 17]. Available from: http://cancerweb.ncl.ac.uk/omd/)
Respiratory Mucosa
The mucous membrane lining the RESPIRATORY TRACT, including the NASAL CAVITY; the LARYNX; the TRACHEA; and the BRONCHI tree. The respiratory mucosa consists of various types of epithelial cells ranging from ciliated columnar to simple squamous, mucous GOBLET CELLS, and glands containing both mucous and serous cells.

Risk factors and outcomes after unplanned extubations on the ICU: a case-control study. (1/49)

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Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. (2/49)

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Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. (3/49)

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Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder. (4/49)

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Are guidelines for non-invasive ventilation during weaning still valid? (5/49)

Noninvasive ventilation (NIV) has gained increasing acceptance over the years to reduce endotracheal intubation, pneumonia and to prevent or treat respiratory failure in patients with different diagnoses. The international consensus conference, and the British society guidelines on NIV ventilation have analyzed its use during the weaning phase concluding that there were still conflicting results of its use. However, recent clinical trials have shown clear clinical benefits on the use of NIV in several patient populations during the weaning period. Acute respiratory failure (ARF) during the weaning process is the main object of recently published studies. The latest published randomized trials on the application of NIV for acute respiratory failure following extubation failed to demonstrate any favorable outcome. Even so, the use of NIV during the process of weaning in patients experiencing multiple weaning failure or as a preventive therapy in patients at higher risk of respiratory deterioration showed improved clinical outcomes only in chronic obstructive pulmonary disease and in particular in hypercapnic patients. Reduced invasive mechanical ventilation, tracheostomy and lower mortality rate at 90 days were the major advantages.  (+info)

Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. (6/49)

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Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence. (7/49)

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Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery. (8/49)

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Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness | Disfagia Brasil
Macht M; Wimbish T; Clark BJ; Benson AB; Burnham EL; Williams A; Moss M Crit Care; 15(5): R231, 2011. INTRODUCTION: Dysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively…
https://disfagiabrasil.com/2012/11/22/postextubation-dysphagia-is-persistent-and-associated-with-poor-outcomes-in-survivors-of-critical-illness-2/
Unplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review | Acta Biomedica Atenei ParmensisUnplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review | Acta Biomedica Atenei Parmensis
Background and aim: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk. Methodology: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded. Results: 21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary
https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/6869
Intensive Care Medicine: AbstractIntensive Care Medicine: Abstract
Initial RSBI was similar in Extubation Success and Extubation Failure groups (77.0 ± 4.8, 77.0 ± 4.8, p = ns). Nevertheless, RSBI tended to remain unchanged or decreased in the Extubation Success group; in contrast RSBI tended to increase in the Extubation Failure group because of either increased RR and/or decreased VT (p , 0.001 for mean percent change RSBI over time), indicating worsening of the respiratory pattern. Quantitatively, only 7/63 subjects of the Extubation Success group demonstrated increased RSBI ≥20% at any time during the SBT. In contrast, in the Extubation Failure group, RSBI increased in all subjects during the SBT, and eight of nine subjects demonstrated an increase greater than 20%. Thus, with a 2-h SBT the optimal threshold was a 20% increase (sensitivity = 89%, specificity = 89%). Similar results were obtained at 30 min (threshold = 5% increase). Percent change of RSBI predicted successful extubation even when initial values were ≥105.. ...
http://icmjournal.esicm.org/Journals/abstract.html?doi=10.1007/s00134-009-1735-6
EA4275 / UMR INSERM U1246 - SPHERE
Sustained-release morphine sulfate (SRMS) is a painkiller used in oncology. The purpose of our study was to assess its efficacy on postoperative morphine requirements in elective spine surgery. This was a placebo-controlled, randomized, double-blind study. Adults scheduled for spine surgery under general anesthesia were orally administered SRMS (30 mg) or a placebo 2 h before surgery. Primary endpoint was postoperative cumulated morphine consumption through patient-controlled analgesia (PCA) during the 12 h following extubation. Statistical analysis was performed using a sequential method, the triangular test. The study was stopped after the sixth analysis (51 patients had been included; placebo: 26, SRMS: 25). Age, weight, sex ratio, type of surgery, intra-operative sufentanil consumption, anesthesia duration and time to extubation were similar in the two groups. Morphine consumption through PCA during the 12 h following extubation was significantly lower in the SRMS group (mean +/- SD: 10.5 ...
http://je.anaqol.org/index.php?file=editonepubli.php&idpublir=16
Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children ...Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children ...
This quality improvement study assesses the association of a multicenter quality improvement initiative targeting all intubated neonatal and pediatric patients
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2764080?resultClick=1
Plus itPlus it
This project was initiated with a voice of the customer survey to assess cultural readiness for change. During the define phase of this process improvement, the NICU moved from an open bay design to private rooms. The walking distance between patients and the size of the new single-patient room NICU (4 times the square footage of the open unit) required the staff to adjust to new workflows. This transition presented some initial difficulty, especially with the simultaneous implementation of some of the improvements. We anticipated that the 2 caregivers to turn model would be the most difficult to implement, but staff were able to adapt. Survey results demonstrated to our process improvement team that the culture did not support the perception that unplanned extubations were always an unpreventable event. The majority of respiratory and nursing staff reported that at least some of the unplanned extubations were preventable. The free text portion of the survey provided a number of comments from ...
http://rc.rcjournal.com/content/61/12/1567
Clinical Evaluation of Swallowing Disorders as a Predictor of Extubation Failure - Full Text View - ClinicalTrials.govClinical Evaluation of Swallowing Disorders as a Predictor of Extubation Failure - Full Text View - ClinicalTrials.gov
Patients with failed extubation stay significantly longer in an intensive care unit (ICU) and have a higher mortality rate, than those intubated successfully. Reintubation is associated with life-threatening complications and a poor prognosis. Functional respiratory tests are frequently used as weaning parameters, however, they are not accurate enough to predict extubation failure. The incidence of swallowing dysfunction is underestimated, mainly among patients whose intubation lasts longer than 48 h.We previously observed that the assessment of the swallowing function and oropharyngeal motricity, conducted by the physiotherapist before extubation could be helpful for making decisions to extubate patients intubated for over 6 days. The objective of this study is to validate a scale previously devised and used for physiotherapist bedside evaluation of the swallowing function and oropharyngeal motricity, among patients intubated for over 6 days, to determine whether this scale is a good predictor ...
https://clinicaltrials.gov/ct2/show/NCT00780078?recr=Open&cond=%22Poisoning%22&rank=20
Most recent papers with the keyword procedures in ICU | Read by QxMDMost recent papers with the keyword procedures in ICU | Read by QxMD
Study Objectives: Following extubation in the intensive care unit (ICU), upper airway (UA) edema and respiratory depressants may promote UA dysfunction. We tested the hypothesis that opioids increase the risk of sleep apnea early after extubation. Methods: 56 ICU patients underwent polysomnography the night after extubation. Airflow limitation during wakefulness was identified using bedside spirometry. Correlation and ordinal regression analyses were used to quantify effects of pre-extubation opioid dose on post-extubation Apnea-Hypopnea-Index (AHI) and severity of sleep apnea and whether or not inspiratory airway obstruction (ratio of maximum expiratory and inspiratory flow at 50% of vital capacity (MEF50/MIF50)≥1) during wakefulness predicts airway obstruction during sleep ...
https://www.readbyqxmd.com/keyword/93627
Publications - Purdue I-Eat Research LabPublications - Purdue I-Eat Research Lab
Retrospective Clinical Studies: Using Existing Data to Inform Current Research (WEB2800): Online ASHA CEU course highlighting the article: Postextubation Dysphagia in Critical Patients: A First Report from the Largest Step- Down Intensive Care Unit in Greece, by Malandraki, Markaki, Georgopoulos, Psychogios, & Nanas. Available at: https://shar.es/1RHdZh. Kantarcigil, C. & Malandraki, G.A. (2016). The Rise of Telehealth in the United States: The present and the future of dysphagia telerehabilitation. Invited article on Dysphagia Cafe website. Available at: http://dysphagiacafe.com/2016/08/24/rise-telehealth-united-states-present-future-dysphagia-telerehabilitation/. Purdue I-EaT Swallowing Research Lab Engagement Event Announcement. Pals of Cerebral Palsy. Media coverage by the Purdue Health Sciences media: Available at: http://www.purdue.edu/newsroom/releases/2015/Q2/open-house-event-to-focus-on-swallowing-disorders,-cerebral-palsy.html. Malandraki, G.A. (2014). International Faculty Spotlight ...
https://www.purdue.edu/i-eatlab/publications/
Venkataraman, Shekhar | Department of Critical Care MedicineVenkataraman, Shekhar | Department of Critical Care Medicine
Venkataraman ST, Fuhrman BP, Howland DF, DeFrancisis MA. Positive end-expiratory pressure-induced, calcium-channel-mediated increases in pulmonary vascular resistance in neonatal lambs. Critical care medicine. 1993 Jul;21(7):1066-76.. Khan N, Brown A, Venkataraman ST. Predictors of extubation success and failure in mechanically ventilated infants and children. Critical care medicine. 1996 Sep 1;24(9):1568-79.. Venkataraman ST, Khan N, Brown A. Validation of predictors of extubation success and failure in mechanically ventilated infants and children. Critical care medicine. 2000 Aug 1;28(8):2991-6.. Randolph AG, Wypij D, Venkataraman ST, Hanson JH, Gedeit RG, Meert KL, Luckett PM, Forbes P, Lilley M, Thompson J, Cheifetz IM. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA. 2002 Nov 27;288(20):2561-8.. ► Full listing on Pub Med ...
https://www.ccm.pitt.edu/node/183
Emergence Phenomena: Are we (EPs) the weakest link in cardiac arrest?Emergence Phenomena: Are we (EPs) the weakest link in cardiac arrest?
That leaves the final piece of the puzzle - that of monitoring - and this happens in the ED when the cardiac arrest victims arrive. Therein lies the weakest link - ourselves. How often, when we receive cardiac arrest victims, do actually think about, monitor, or make subtle changes to improve the quality of CPR? Do we check that the mechanical CPR on the patient is actually providing adequate flow? Or when manual CPR is performed, do we check on its quality? Do we aggressively check compression timing, depth, adequate recoil and minimal hands-off time? Do we routinely use end-tidal CO2 monitoring to guide CPR and assess cardiac output ...
https://singem.blogspot.com/2015/10/are-we-eps-weakest-link-in-cardiac.html
Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool - PEDINFOPerformance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool - PEDINFO
An evaluation of the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of adverse events (AE). Reviews of 3814 charts at 16 centers showed that experts agreed with the tool in the identification of an AE 92% of the time. Triggers included medications (e.g., vitamin K after warfarin or hepatotoxic medications with elevated transaminases), hospital care (e.g., pressure ulcer, low O2 sats), healthcare-associated infections, hospital outcomes like readmissions, surgical events (e.g., abrupt drop in hematocrit after surgery, return to surgery), and ICU-related events like unplanned extubations and neonatal IVH.. Landrigan 2016 (Pediatrics) , PubMed 27221286 , Author Search ...
http://pedinfo.org/performance-of-the-global-assessment-of-pediatric-patient-safety-gapps-tool/
Through with flying colorsThrough with flying colors
Of course the doc told me everything that could go wrong. And everything he is at risk for due to his history and being hard to extubate. I already had a huge headache. And I didnt even meet the doc who did it, only the anethesiologist. So when it was over no one came in to tell me how it looked. They just called my name and told me I could go back. So I assumed they were able to extubate him ok, if he was in PACU instead of heading to PICU. I got back to him and he was wide awake! I was like, did you guys even take him back yet, this is so not Jaxson. Look at those wide eyes, fingers in the mouth ...
http://jaxsonsfight.blogspot.com/2009/01/through-with-flying-colors.html
Reliability of respiratory pressure measurements in ventilated and non-ventilated patients in ICU: an observational study |...Reliability of respiratory pressure measurements in ventilated and non-ventilated patients in ICU: an observational study |...
Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare maximum respiratory pressures measured through an intubation catheter with the same measurements using a standard mouthpiece in extubated patients. A prospective observational study was carried out in adults who had been under ventilation for at least 24 h and for whom extubation was planned. Maximal respiratory pressure measurements were carried out before and 24 h following extubation. Ninety patients were included in the analyses (median age: 61.5 years, median SAPS2 score: 42.5 and median duration of ventilation: 7 days). Maximum respiratory pressures measured through the intubation catheter were as reliable as measurements through a standard mouthpiece (difference in maximal inspiratory pressure:
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0362-1/tables/1
Want to reduce reintubation rates? - ESICMWant to reduce reintubation rates? - ESICM
Post-extubation respiratory failure causes between 5-30% of patients to require reintubation, which is associated with increased mortality. Spontaneous breathing trials aim to evaluate when a patient is ready for extubation and involves a trial of T-tube, low level pressure support or continuous positive airway pressure for varying durations ranging from 30 to 120 minutes. It was hypothesised that a rest period after a spontaneous breathing trial will improve extubation rates.. Method. A parallel, two-arm, prospective, randomised controlled trial in 17 Spanish Medical-Surgical ICUs aimed to test this hypothesis. From October 2013 to January 2015, 470 mechanically ventilated patients who had been receiving Mechanical Ventilation for at least 12 hours were enrolled.. If spontaneous breathing trial (SBT) was successful they were either extubated immediately (Control group) or reconnected to the ventilator with the previous ventilator parameters for 1 hour of rest and then extubated (Rest ...
https://www.esicm.org/article-review-reconnect-mv-reintubation-rct-icm/
Plus itPlus it
An interesting study by Tulaimat and Mokhlesi1 regarding the accuracy and reliability of extubation decisions that recently appeared in the Journal merits additional comment. The implicit study question is whether an informed decision to extubate following a successful spontaneous breathing trial is any better than random chance. By study design, the clinical vignettes were selected so that, if a decision to extubate was made by coin flip, without any clinical information, the sensitivity and specificity (as defined in the study) would be expected to reach 50%. It was disappointing that, overall, experienced clinicians performed marginally better than a coin flip in predicting extubation success (ie, 57% sensitivity), but they were highly inaccurate in predicting weaning failure (ie, 31% specificity).. In a post hoc analysis, clinicians whose extubation decision-making was relatively aggressive achieved a higher sensitivity (62%), whereas clinicians whose extubation decision-making was ...
http://rc.rcjournal.com/content/57/2/328
Benefits of early extubation after cardiovascular surgery | Zenaida Carbon | John Muir Health, Concord Medical Center, USA ...Benefits of early extubation after cardiovascular surgery | Zenaida Carbon | John Muir Health, Concord Medical Center, USA ...
Zenaida Carbon abstract presented on Benefits of early extubation after cardiovascular surgery at Euro Nursing 2019 | Conferenceseries Ltd
https://europe.nursingconference.com/abstract/2019/benefits-of-early-extubation-after-cardiovascular-surgery
Incidence and primary causes of unplanned extubation in a neonatal intensive care unitIncidence and primary causes of unplanned extubation in a neonatal intensive care unit
The average number of hospitalized newborns was 43.4 per day. The average number of newborns under MV was 22.4 per day. The average number of tracheostomized newborns was 4.4 per day, and the average number of intubated (non-tracheostomized) newborns was 17.9 per day. The mean duration of MV prior to UE was 11.2 days (range 1 to 39 days). Most UE (50%) occurred during the first 7 days of MV (Table 1). The following clinical signs suggested the occurrence of UE: audible weeping in 22 cases (26.8%), exteriorization of tubes in 22 cases (26.8%), cyanosis in 19 cases (23.2%), worsening of the respiratory pattern in 10 cases (12.2%), gastric contents in the ETT in six cases (7.3%), and bradycardia in three cases (3.7%). An average of 1.51 clinical signs were suggestive of UE per event. The following primary causes of UE were identified and analyzed in the present study: patient agitation in 30.8% of cases (24); inappropriate handling of patients during the performance of procedures (e.g., blood ...
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2012000300005&lng=en&nrm=iso&tlng=en
International Liver Transplantation Society » Education » Post-transplant Concerns: Early extubation: Risks, benefits and...International Liver Transplantation Society » Education » Post-transplant Concerns: Early extubation: Risks, benefits and...
We use cookies to ensure that we give you the best experience on our website. By continuing to use this site you are agreeing to our use of cookies.OkPrivacy policy ...
https://ilts.org/education/lectures/post-transplant-concerns-early-extubation-risks-benefits-and-patient-selection/
Karen S. Sibert, MDKaren S. Sibert, MD
There are two schools of thought about how to extubate patients at the conclusion of general anesthesia: Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patients head bleats, Open your eyes! Take a deep breath! Or: Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence ...
https://www.kevinmd.com/blog/post-author/karen-s-sibert
Optiflow FAQs | Fisher & Paykel HealthcareOptiflow FAQs | Fisher & Paykel Healthcare
Using Optiflow Nasal High Flow therapy as a first-line treatment (both pre-intubation and post-extubation) may reduce patient escalation, across the care continuum, resulting in better patient outcomes.
https://www.fphcare.com/en-ca/hospital/adult-respiratory/optiflow/frequently-asked-questions/
Optiflow FAQs | Fisher & Paykel HealthcareOptiflow FAQs | Fisher & Paykel Healthcare
Using Optiflow Nasal High Flow therapy as a first-line treatment (both pre-intubation and post-extubation) may reduce patient escalation, across the care continuum, resulting in better patient outcomes.
https://www.fphcare.com/us/hospital/adult-respiratory/optiflow/frequently-asked-questions/
Nasal cannulae | definition of nasal cannulae by Medical dictionaryNasal cannulae | definition of nasal cannulae by Medical dictionary
Looking for online definition of nasal cannulae in the Medical Dictionary? nasal cannulae explanation free. What is nasal cannulae? Meaning of nasal cannulae medical term. What does nasal cannulae mean?
https://medical-dictionary.thefreedictionary.com/nasal+cannulae
The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time...The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time...
Resuscitation. 2014 Sep;85(9):1287-90. doi: 10.1016/j.resuscitation.2014.06.013. Epub 2014 Jun 28. Randomized Controlled Trial; Research Support, Non-U.S. Govt
https://www.ncbi.nlm.nih.gov/pubmed/24983200?dopt=AbstractPlus
Dexmedetomidine in Patients After Intracranial Surgery - Full Text View - ClinicalTrials.govDexmedetomidine in Patients After Intracranial Surgery - Full Text View - ClinicalTrials.gov
The PASTrial is a non-commercial, multi-center, randomized, placebo-controlled, double blinded clinical trial. The study compares dexmedetomidine versus normal saline (placebo) in patients after intracranial surgery with delayed extubation. In dexmedetomidine group, infusion (0.4μg/kg/h) is started when patients are admitted to neuro-intensive care unit for postoperative recovery. In control group, patients receive normal saline infusion at the same rate and volume in dexmedetomidine group. The patients level of sedation is assessed by Sedation-Agitation Scale (SAS) per hour. Midazolam is administered in 0.3-0.5 mg bolus or continuous infusion as SAS above 4. The study is designed primarily to compare the percentage of patients with agitation and requiring midazolam infusion in the 2 study arms ...
https://clinicaltrials.gov/ct2/show/NCT01445639?recr=Open&cond=%22Nervous+System+Diseases%22&rank=17
Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children | DIAL.pr -...Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children | DIAL.pr -...
BACKGROUND: The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children. METHODS: Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff PET) and an uncuffed TT group (Mallinckrodt, Portex, Rüsch, Sheridan). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H(2)O with a pressure release valve. Data are mean (SD). RESULTS: A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor ...
https://dial.uclouvain.be/pr/boreal/object/boreal:125616
Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery<...
TY - JOUR. T1 - Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery. AU - Varghese, Joby. AU - Kutty, Shelby. AU - Abdullah, Ibrahim. AU - Hall, Sandra. AU - Shostrom, Valerie. AU - Hammel, James M.. N1 - Publisher Copyright: © 2016 The Society of Thoracic Surgeons Copyright: Copyright 2017 Elsevier B.V., All rights reserved.. PY - 2016/11/1. Y1 - 2016/11/1. N2 - Background We sought to identify preoperative and intraoperative predictors of immediate extubation (IE) after open heart surgery in neonates. The effect of IE on the postoperative intensive care unit (ICU) length of stay (LOS), cost of postoperative ICU care, operating room turnover, and reintubation rates was assessed. Methods Patients younger than 31 days who underwent cardiac surgery with cardiopulmonary bypass (January 2010 to December 2013) at a tertiary-care childrens hospital were studied. Immediate extubation was defined as successful extubation before termination of ...
https://jhu.pure.elsevier.com/en/publications/preoperative-and-intraoperative-predictive-factors-of-immediate-e
Different effects of cardiac and diaphragm function assessed by ultrasound on extubation outcomes in difficult-to-wean patients...Different effects of cardiac and diaphragm function assessed by ultrasound on extubation outcomes in difficult-to-wean patients...
Among 60 patients, 29 cases developed respiratory failure within 48 h, and 14 cases were re-intubated or died within 1 week, respectively. Multivariate logistic regression analysis showed that E/Ea (average) after SBT [odds ratio (OR) 1.450, 95% confidence intervals (CI) 1.092-1.926, P = 0.01] and left ventricular ejection fraction were associated with respiratory failure. The AUC of E/Ea (average) after SBT was 0.789, and a cut-off value ≥ 12.5 showed the highest diagnostic accuracy with a sensitivity and specificity of 72.4% and 77.4%, respectively. Furthermore, in the respiratory failure subgroup only DE (average) after SBT was associated with re-intubation (OR 0.690, CI 0.499-0.953, P = 0.024). The AUC of DE (average) after SBT was 0.805, and a cut-off value ≤ 12.6 mm showed the highest diagnostic accuracy with a sensitivity and specificity of 80% and 68.4%, respectively.. CONCLUSIONS ...
https://www.physiciansweekly.com/different-effects-of-cardiac-and-diaphragm-function-assessed-by-ultrasound-on-extubation-outcomes-in-difficult-to-wean-patients-a-cohort-study/
Tidig extubering efter hjärtkirurgi : Intensivvårdssjuksköterskans kunskap om tidig extubering och deras syn på faktorer som...Tidig extubering efter hjärtkirurgi : Intensivvårdssjuksköterskans kunskap om tidig extubering och deras syn på faktorer som...
Early extubation of cardiac surgery patients has become increasingly important. The assessment of the patient before an early extubation is crucial and the intensive care nurses (ICU nurses) in this estimation is there for very important.. The aim of this study was to examine critical care nurses knowledge of early extubation, and what view ICU nurse has about factors that affect the time to extubation of cardiac surgery patients.. A quantitative approach with descriptive and comparative design was used. Selection was all ICU nurses at a thoracic intensive care unit who were clinically active in patient care.. The study showed that ICU nurses had good knowledge of why an early extubation was essential. However, the knowledge about the units extubation criteria was low. ICU nurses felt that the criteria for the cardiac surgery patients on the unit was adequate. The time target of 90 minutes was reasonable. No relationship existed between professional experience and knowledge of the extubation ...
http://uu.diva-portal.org/smash/record.jsf?pid=diva2:725565
Article Full Text - Methodist JournalArticle Full Text - Methodist Journal
The cross-clamp is then released, and the remainder of the procedure is performed as the patient is warmed. The PTFE graft that was anastomosed to the inferior caval vein is now carried up to the undersurface of the pulmonary artery, to either the site of the prior atriopulmonary anastomosis or a site more medial, and a patch is placed on the site of the old atriopulmonary anastomosis. As the patient is warmed and started on low-dose inotropic support, the bidirectional superior cavopulmonary anastomosis is performed with running prolene suture. The patient is then ventilated and weaned from cardiopulmonary bypass, and the epicardial pacing system is placed with the heart beating. We have used bipolar steroid eluting leads for the atrial and ventricular lead placement. These are then connected to a dual-chamber device with atrial antitachycardia capabilities.14 The completed operation is shown in Figure 7.12. RESULTS. In our series, the operative mortality was 3 out of 149 patients (2%). One ...
https://journal.houstonmethodist.org/article-full-text/1071/149-fontan-conversions/featured-guest-editor-citation/1084/letter-to-the-editor-in-response-to-%E2%80%9Ccardiac-autonomic-neuropathy-in-diabetes-mellitus%E2%80%9D/
intubation Archives - RT: For Decision Makers in Respiratory Careintubation Archives - RT: For Decision Makers in Respiratory Care
Implementing an evidence-based standardized approach of care for ventilated neonatal patients will reduce unplanned extubations in the NICU, and Respiratory Therapy departments should take the lead in developing a performance improvement project.. ...
https://rtmagazine.com/tag/intubation/
emergency department | The Trauma Proemergency department | The Trauma Pro
Many patients are intubated in the emergency department who need brief control of their airway or behavior. In some cases, the condition requiring intubation resolves while they are still in the department. Most of the time these patients are admitted, typically to an ICU bed, for extubation. This is expensive and uses valuable resources. Is it possible to safely extubate these patients and possibly send them home?. Maryland Shock Trauma and Mount Sinai Medical Center looked at their experience in extubating selected patients in the ED. They looked at a series of 50 patients who were intubated for combativeness, sedation, or seizures. A specific protocol was followed to gauge whether or not extubation should be attempted.. None of the patients who were extubated per protocol required unplanned reintubation. One patient underwent planned reintubation when taken to the OR for an orthopedic procedure. 16% of patients were able to be discharged home from the ED.. Bottom line: A subset of patients ...
https://thetraumapro.com/tag/emergency-department/
Very long, hands-off fermentation suggestions? - pickles | Ask MetaFilterVery long, hands-off fermentation suggestions? - pickles | Ask MetaFilter
Im happy to ferment stuff either on the counter or in the fridge (though I generally find that things ferment so slowly in the fridge that its not really worth the trouble). My kitchen is cool now, probably in the mid sixties, but should warm up to the seventies over the course of the month. My husband will be around to burp jars occasionally, but I dont expect him to remember to do it on the regular and I dont think hes up for anything more involved than that ...
https://ask.metafilter.com/332368/Very-long-hands-off-fermentation-suggestions
Leaders must learn to be hands-off | HRD New ZealandLeaders must learn to be hands-off | HRD New Zealand
Business leaders should take a step back and embrace diversity of thought in employees to unlock their full potential, says leadership expert.
https://www.hcamag.com/nz/news/general/leaders-must-learn-to-be-hands-off/141224
Great Zs: Telebation
The use of telemedicine here also promises interesting possibilities. If we can treat a patient remotely by telling somebody else what to do, does that mean anesthesiologists can work from home? Imagine hiring some medical student, or even a premed student to sit in the OR for you. Using telemedicine you can have him intubate the patient for you. You can then electronically monitor the patients vitals and tell the student what meds to give. At the end of the case the student will show you the train of fours and then you tell him to reverse and extubate the patient while you are sitting at home in your PJs watching CNBC on your 52 inch LCD. This would be even cheaper for the hospital than hiring a bunch of CRNAs ...
http://www.blog.greatzs.com/2009/12/telebation.html
Intrapulmonary arteriovenous shunting may be a universal phenomenon in patients with the superior cavopulmonary anastomosis: a...Intrapulmonary arteriovenous shunting may be a universal phenomenon in patients with the superior cavopulmonary anastomosis: a...
BCPA is increasingly used for interim palliation of complex cyanotic congenital heart disease.2 10 Excellent intermediate term palliation is achieved and the advantages over a systemic to pulmonary arterial shunt are well established.11-13 However, it is well recognised that progressive systemic arterial desaturation occurs and a number of factors have been proposed to explain this.14-16 This includes macroscopic PAVM which have long been recognised as a serious late complication of the cavopulmonary anastomosis.1 The finding of similar abnormalities in chronic liver disease lead to the suggestion that the loss of hepatic factor from the pulmonary circulation might be responsible for these changes.4 17If loss or reduced concentrations of hepatic factor are implicated in the development of PAVM, then pulmonary arteriovenous shunting (a right to left shunt) should occur early following BCPA, and PAVM merely represent the end stage of the process.. Various methods are now available for the ...
http://heart.bmj.com/content/83/4/425
High-flow nasal cannula therapy for support of breathing in children | CochraneHigh-flow nasal cannula therapy for support of breathing in children | Cochrane
We reviewed evidence on the effectiveness of high-flow nasal cannula (HFNC) therapy in supporting childrens breathing. We found 11 studies in children.. Background. HFNC therapy delivers a mixture of air and oxygen via tubing that sits just inside the nostrils. For children hospitalized with breathing difficulties caused by conditions such as pneumonia or trauma or after surgery, HFNC therapy may help to support their breathing. This may reduce the need for other forms of breathing support such as life support. HFNC therapy can be used within the hospital ward setting, the emergency department or the intensive care unit. This Cochrane review is important because it assesses available evidence on the safety and effectiveness of HFNC compared with other forms of respiratory support, to help inform clinicians caring for children with breathing difficulties.. Search date. We searched medical databases from the 1950s until April 2013.. Study characteristics. We included studies on children from four ...
https://www.cochrane.org/CD009850/EMERG_high-flow-nasal-cannula-therapy-support-breathing-children
Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubaciónValor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación
GONZALEZ-CASTRO, A. et al. Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success. Med. Intensiva [online]. 2011, vol.35, n.9, pp.529-538. ISSN 0210-5691.. Purpose: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. Design: A prospective, observational cohort study conducted from 1 September 2010 to 1 March 2011. Setting: General intensive care unit (G-ICU) of a third level university hospital. Patients or participants: The study included patients on mechanical ventilation (MV) for over 12hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the ...
http://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S0210-56912011000900001&lng=es&nrm=iso&tlng=en
The Functionally Univentricular Heart | JACC: Journal of the American College of CardiologyThe Functionally Univentricular Heart | JACC: Journal of the American College of Cardiology
The question regarding long-term outcome in patients with a functionally univentricular heart undergoing a Fontan procedure based on whether there is right or left ventricular morphological dominance is one that has been investigated for many years. The paper in this issue of the Journal by dUdekem et al. (1) from the Royal Childrens Hospital in Melbourne, Australia, found that in their nearly 30-year series reviewing 499 patients, right ventricular dominance was the single most important risk factor for death. Their other conclusion was that this risk factor seemed to be important only before the bidirectional superior cavopulmonary anastomosis (BSCPA). The interesting speculation is that earlier BSCPA may potentially modify the risk factor of right ventricular morphology. Both of these conclusions are important for clinicians to consider when guiding patients along a Fontan pathway, especially when considering timing of BSCPA and cardiac transplantation as an alternative.. Their review (1) ...
http://www.onlinejacc.org/content/59/13/1186
Plus itPlus it
Objectives: To evaluate the impact of a mechanical ventilation protocol applied by a respiratory therapist (RT) on the outcomes in COPD patients.. Methods: A novel mechanical ventilation protocol was initiated by a respiratory therapist. Outcomes of patients during a 6-month period were compared to those of patients treated by physicians without a protocol during the preceding 6 months.. Results: A total of 170 patients were enrolled. Extubation success was higher (98% vs. 78%, p= 0.014) and median durations of weaning, mechanical ventilation (Figure 1) and ICU stay (Figure 2) were shorter in the protocol group (2 vs. 26 hours, log rank p , 0.001, 3.1 vs. 5 days, log rank p , 0.001 and 6 vs. 12 days, log rank p , 0.001 respectively). ...
http://erj.ersjournals.com/content/42/Suppl_57/P4930
Heated, Humidified High-Flow Nasal Cannula Versus Nasal CPAP for Respiratory Support in Neonates | Articles | PediatricsHeated, Humidified High-Flow Nasal Cannula Versus Nasal CPAP for Respiratory Support in Neonates | Articles | Pediatrics
FIGURE 2 Infants randomly assigned to nCPAP (black line) had significantly shorter duration of study support mode compared with infants randomly assigned to HHHFNC (gray line); P , .01. There were no significant differences between study groups for duration of ventilator support (dotted lines) or time to wean to room air (dashed lines) in the 7 days after study entry. RA, room air. ...
http://pediatrics.aappublications.org/content/131/5/e1482.figures-only
BPD | All Things NeonatalBPD | All Things Neonatal
by winnineo , Nov 12, 2015 , Neonatal. In 2018 where do we stand on this question? Upcoming retrospective trials and work by EPIQ-4 may help to resolve this issue. In the meantime what does the existing evidence say?. The decision to extubate an extremely low birthweight infant is one of the most common sources of disagreement and anxiety in the NICU. As a resident, I recall an unwritten rule that no baby under 750g will have a trial of extubation as they will most certainly fail. As time went on however, studies suggested that not only is this a false statement but also that the duration of intubation was directly correlated with risk of BPD. As Danan described, for infants less than a 1000g, delaying extubation when they had reached minimal settings did not result in lower rates of BPD. Moreover 60 - 70% of infants who have such extubation attempts are not reintubated within a week, so it is possible to have success.. The detractors however express concern about the 30-40% who do require ...
http://allthingsneonatal.com/tag/bpd/page/3/
Just the 6 of usJust the 6 of us
Matthew was weaned from his sedative last night at 6pm. He awoke around 9 pm and he had a rough night. He was awake; but the doctor didnt want to extubate him (I wont go into any details on this other than we had a very frustrated nurse and mom by morning). So all night he coughed and cried and fought the tube. Even though he is intubated, you can tell he is crying by his facial expressions. You cant hear it, but you can tell. So, I didnt sleep well because I was up and down with him trying to comfort him. I was happy when morning came because I was sure they would pull the tube. This morning, his lab work showed that his phenobarbital level (a medication used to control seizures) was still low in his blood. It was a little confusing to the neurologist because he was getting this medication twice a day orally and also daily IV boluses. His blood levels, though would not go up and had even decreased today. So they doubled his IV dose. Immediately after that dose he feel asleep and was ...
http://soldatke6.blogspot.com/2009/11/matthew-was-weaned-from-his-sedative.html
Notes from Dr. RW: July 2010Notes from Dr. RW: July 2010
27 patients died or were successfully extubated within 48 h, and, as per our study design, were excluded from the study and statistical analysis. Patients receiving no sedation had significantly more days without ventilation (n=55; mean 13·8 days, SD 11·0) than did those receiving interrupted sedation (n=58; mean 9·6 days, SD 10·0; mean difference 4·2 days, 95% CI 0·3-8·1; p=0·0191). No sedation was also associated with a shorter stay in the intensive care unit (HR 1·86, 95% CI 1·05-3·23; p=0·0316), and, for the first 30 days studied, in hospital (3·57, 1·52-9·09; p=0·0039), than was interrupted sedation. No difference was recorded in the occurrences of accidental extubations, the need for CT or MRI brain scans, or ventilator-associated pneumonia. Agitated delirium was more frequent in the intervention group than in the control group (n=11, 20% vs n=4, 7%; p=0·0400 ...
http://doctorrw.blogspot.pt/2010/07/
Breathing Easy Using Extubation in the OR | Cardiovascular BusinessBreathing Easy Using Extubation in the OR | Cardiovascular Business
Many cardiac surgery programs support early extubation of suitable CABG patients once they enter intensive care, based on clinical and economic benefits. Now some hospitals have shifted extubation to the cardiac operating room (OR) for a wide range of patients, young and old, with good results.
http://www.cardiovascularbusiness.com/topics/structural-heart/breathing-easy-using-extubation-or
Západočeská univerzita - PublikaceZápadočeská univerzita - Publikace
Comparison of the modifications of the Viennese method of manual perineal protection (VMPP) and hands-off delivery techniques by applying basic principles of mechanics with assessments of tensions within perineal structures using a novel biomechanical model of the perineum. Evaluation of the role of the precise placements of the accoucheur?s posterior (dominant) thumb and index finger in perineal tissue tension when performing a modified Viennese method of MPP ...
http://www.zcu.cz/research/publications/?id=43907585
Enigma 2020 Conference Program | USENIXEnigma 2020 Conference Program | USENIX
It is time to reckon with the security implications of the laissez-faire approach that has dominated Internet regulation. Since the late 1980s, this US-led, hands-off approach has facilitated unprecedented technical innovation. Competition and technological progress have driven down the price of resources like hosting and domains. While cheaper prices do benefit everyday users, near-general availability and low prices have the unintended consequence of enabling the inevitable elements of the human condition that are often kept in check by law and regulations. In short, laissez-faire governance was reasonable for infrastructures used by a small group of expert users but now comes at the cost of real harm and threats to individuals, organizations, and society at large.. In this talk, we focus on the multi-stakeholder approach to governance of Internet domain names and addresses that in part results from this laissez-faire approach. While technically open to all, meaningful participation in ...
https://www.usenix.org/conference/enigma2020/program
Labor<...Labor<...
Early In the pandemic, OSHA drew scathing criticism for a hands-off approach to a crisis that has claimed the lives of hundreds of essential workers. More recently, the agency began ramping up enforcement. Despite the burst of activity, a FairWarning review shows that inspectors are mostly responding to deaths or hospitalizations, as required by law, rather than flagging unsafe conditions before more workers get infected. ...
https://www.fairwarning.org/category/labor/
Easy Crock Pot BBQ Chicken Wings | eHowEasy Crock Pot BBQ Chicken Wings | eHow
A crock pot is a type of electric slow cooker. It uses a light heating element that heats food very slowly, which also means its one of the most hands-off cooking methods. A crock pot works especially well for foods that risk making a mess of your oven, such as BBQ chicken wings.
https://www.ehow.com/way_5525162_easy-pot-bbq-chicken-wings.html
How to Boil Chicken: 13 Steps (with Pictures) - wikiHowHow to Boil Chicken: 13 Steps (with Pictures) - wikiHow
If youre looking for another hands-off way to cook chicken, try boiling it. Decide if you want to cook an entire chicken or make pieces for a meal. You can customize the flavor of the juicy meat by boiling it in stock or cider, for...
https://www.wikihow.com/Boil-Chicken
Blog - Coach on a BoatBlog - Coach on a Boat
It can be scary to let go of control, especially when youre handing it to a volunteer as opposed to a paid employee. That said, delegating and empowering others is the way to keep them truly engaged. If youve done a good job recruiting and getting the right volunteers into the right roles, then handing over the reins becomes a lot easier. So, resist the urge to jump in and save the day. That doesnt mean you should be totally hands-off, especially if you sense that something isnt getting done. Problematic situations when you are leading an activist volunteer group can be terrific opportunities to continue the important ongoing discussion about expectations and commitment level.. ...
https://coachonaboat.net/blog/

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