Sep 15th, 2019 - BACKGROUND: Donepezil, rivastigmine and galantamine are popular cholinesterase inhibitors used to manage the symptoms of Alzheimer disease and other dementias; regulatory agencies in several countries warn about a possible risk of rhabdomyolysis with donepezil, based on information from case reports. Our goal was to investigate the 30-day risk of admission to hospital with rhabdomyolysis associ...
Battisti, A. et. al.
Mar 11th, 2019 - Barotrauma is physical tissue damage caused by a pressure difference between an unvented space inside the body and surrounding gas or fluid. The damage is due to shear or overstretching of tissues. As a gas-filled space expands or contracts, it can cause damage to the local tissue. Occasionally, tears in tissue can allow gas to enter the body through the initial trauma site. This causes potenti...
Dec 13th, 2019 - More than half of patients who undergo prolonged mechanical ventilation experience an acute laryngeal injury (ALgI), and the injury is associated with worse breathing and speaking at 10 weeks, according to a study published in Critical Care Medicine (2019 Dec;47:1669-1706). The researchers, led by Alexander Gelbard, MD, of Vanderbilt Medical Center, Nashville, Tenn.
Phil Porte, MDedge News
Dec 9th, 2019 - Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.
Nov 19th, 2019 - A 2-day course of prophylactic antibiotic therapy can lower the risk of early ventilator-associated pneumonia (VAP) in cardiac arrest patients, a new study suggests. Investigators compared administration of amoxicillin-clavulanate vs placebo in adult patients on mechanical ventilation following out-of-hospital cardiac arrest and treated with targeted temperature management. Although fewer patie...
Naresh A. Dewan MD, FCCP
Nov 14th, 2019 - The conventional approach to treat hypoventilation has been to use noninvasive ventilation (NIV), while continuous positive airway pressure (CPAP) that does not augment alveolar ventilation improves gas exchange by maintaining upper airway patency and increasing functional residual capacity. Why, then, are we debating the use of CPAP vs NIV in the treatment of obesity hypoventilation syndrome (.
Oct 23rd, 2019 - Noninvasive ventilation is a well-known life-sparing option during acute exacerbations of chronic obstructive pulmonary disease (COPD), but its effectiveness for severe, but stable disease has been difficult to establish. "European data are showing that we need to do things differently," said Lisa Wolfe, MD, from Northwestern University in Chicago. "The new thrust is to do two things," she told...
Oct 20th, 2019 - A new tool for managing delirium and agitation in emergency room patients over age 65 features five steps: assess, diagnose, evaluate, prevent, and treat (ADEPT). Older patients frequently present at emergency rooms with agitation, behavioral changes, or confusion, but delirium is often underrecognized. Research has shown delirium among hospitalized patients is predictive of prolonged hospital ...
Oct 14th, 2019 - More conservative oxygen therapy during mechanical ventilation in intensive care does not appear to increase the number of ventilator-free days or reduce mortality, according to a study published online in the New England Journal of Medicine. Diane Mackle of the Medical Research Institute of New Zealand and her co-authors wrote that hyperoxemia in adults undergoing mechanical ventilation has be.
Oct 14th, 2019 - Lowering the oxygen-saturation target in intensive care unit (ICU) patients showed no disadvantage relative to usual care either in the number of days patients needed mechanical ventilation or in overall survival, according to a randomized trial of 1,000 patients in Australia and New Zealand. For the main study outcome of ventilator-free days, the medians were 21.3 and 22.1 days, respectively, ...
Ted Bosworth, MDedge News
Oct 13th, 2019 - MADRID – In patients managed on mechanical ventilation in an intensive care unit following cardiac surgery, a fully automated system provides more reliable ventilatory support than highly experienced ICU nurses, suggest results of a randomized trial. The study’s control group received usual care, which means that nurses adjusted mechanical ventilation manually in response to respiratory rate, t.
Oct 10th, 2019 - NEW YORK (Reuters Health) - In ICU patients at high risk of postextubation respiratory failure, noninvasive ventilation (NIV) along with high-flow nasal oxygen applied immediately after extubation reduces the rate of reintubation, a new randomized trial shows. As many as 20% of patient ready to be separated from a ventilator experience extubation failure leading to reintubation, Dr. Arnaud Thil...
Steve Cimino, MDedge News
Sep 20th, 2019 - Long-term home noninvasive ventilation (LTH-NIV) has conditional value for patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD), according to a new guideline from a European Respiratory Society task force. “Our recommendations, based on the best available evidence, can guide the management of chronic hypercapnic respiratory failure in COPD patients aimed at improving p.
Ashima Sahni, MD, Lisa Wolfe, MD
Sep 6th, 2019 - Noninvasive ventilation (NIV) supports patient’s breathing without the immediate need for tracheotomy or intubation. The Center for Medicare and Medicaid Services (CMS) defines respiratory assist devices (RAD) as bi-level devices with back-up respiratory rate capability, which provide noninvasive modes of ventilation for respiratory insufficiency or sleep-related respiratory disorders in a home.
Sep 3rd, 2019 - ARTERIAL BLOOD GAS TESTING: DAILY VS CLINICALLY INDICATED Arterial blood gas testing has value for managing patients undergoing mechanical ventilation, and it is one of the most commonly performed diagnostic tests in the ICU. It provides reliable information about the patient’s oxygenation and acid-base status.
Aug 21st, 2019 - Many patients with spinal cord injury (SCI) need mechanical ventilatory support. One type of support is diaphragm pacing, which stimulates the diaphragm, helping the person breathe.
Aug 20th, 2019 - The Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) are investigating more than 150 cases of severe pulmonary disease in multiple states that have occurred among users of electronic cigarette (e-cigarette) products in fewer than 2 months, the CDC reported in an August 21 media statement. A total of 153 possible cases of pulmonary illness associated...
Jun 13th, 2019 - NEW YORK (Reuters Health) - Pressure-support appears to be better than T-piece ventilation for spontaneous-breathing trials, a randomized trial suggests. Spontaneous-breathing trials (SBT) are used to evaluate the readiness of patients receiving mechanical ventilation for extubation and liberation from ventilatory support. Pressure-support ventilation (PSV) and T-piece ventilation lasting 30 mi...
May 19th, 2019 - Dexmedetomidine fell short for reducing 90-day mortality as the primary sedative for patients on mechanical ventilation, according to results of the randomized, controlled, open-label SPICE III trial, which was presented at the annual meeting of the American Thoracic Society and simultaneously published in the New England Journal of Medicine. “Among patients undergoing mechanical ventilation in.
Apr 28th, 2019 - In-hospital delirium is a predictor of readmission, emergency department visits, and discharge to a location other than home, recent research shows. The development of delirium in the hospital setting impacts about 12.5% of general medical admissions and as many as 81% of intensive care unit patients. Earlier research has shown delirium among hospitalized patients is predictive of prolonged hos...