3451
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Abstract
OBJECTIVE To report a case of pH1N1 viral infection presenting as heart failure requiring mechanical extracorporeal life support. DESIGN Case report. SETTING Pediatric intensive care unit at a regional children's hospital. PATIENT Obese 15-yr-old boy who presented with pH1N1-related cardiomyopathy and respiratory failure that required extracorporeal membrane oxygenation. INTERVENTIONS Extracorporeal membrane oxygenation, echocardiography, high-frequency oscillating ventilation. MEASUREMENTS AND MAIN RESULTS Discovery of severe dilated cardiomyopathy and respiratory failure. CONCLUSIONS Patients with pH1N1 may present in profound heart failure in addition to respiratory failure. Extracorporeal membrane oxygenation may play an important role in managing these complex patients.
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3452
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Morris AH, Hirshberg E, Miller RR, Statler KD, Hite RD. Counterpoint: Efficacy of extracorporeal membrane oxygenation in 2009 influenza A(H1N1): sufficient evidence? Chest 2010; 138:778-81; discussion 782-4. [PMID: 20923797 DOI: 10.1378/chest.10-1792] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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3453
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Pericardial constriction after lung transplantation. Ann Thorac Surg 2010; 90:1361-3. [PMID: 20868850 DOI: 10.1016/j.athoracsur.2010.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 02/13/2010] [Accepted: 03/17/2010] [Indexed: 11/24/2022]
Abstract
Pericardial constriction is extremely rare after lung transplantation. We present a case and review the potential contributing factors for pericardial constriction after lung transplantation. Treatment for this condition, irrespective of the cause, remains pericardiectomy.
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3454
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Mert M, Cetin G, Yildiz CE, Ugurlucan M, Caglar IM, Ozkara A, Akcevin A, Bakay C. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease. J Cardiothorac Surg 2010; 5:87. [PMID: 20958964 PMCID: PMC2984402 DOI: 10.1186/1749-8090-5-87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/19/2010] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. PATIENTS AND METHODS In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. RESULTS Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). CONCLUSION We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.
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Affiliation(s)
- Murat Mert
- Department of Cardiovascular Surgery, Instiute of Cardiology, Istanbul University, Istanbul, Turkey.
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3455
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Bosma KJ, Taneja R, Lewis JF. Pharmacotherapy for prevention and treatment of acute respiratory distress syndrome: current and experimental approaches. Drugs 2010; 70:1255-82. [PMID: 20568833 PMCID: PMC7100688 DOI: 10.2165/10898570-000000000-00000] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The acute respiratory distress syndrome (ARDS) arises from direct and indirect injury to the lungs and results in a life-threatening form of respiratory failure in a heterogeneous, critically ill patient population. Critical care technologies used to support patients with ARDS, including strategies for mechanical ventilation, have resulted in improved outcomes in the last decade. However, there is still a need for effective pharmacotherapies to treat ARDS, as mortality rates remain high. To date, no single pharmacotherapy has proven effective in decreasing mortality in adult patients with ARDS, although exogenous surfactant replacement has been shown to reduce mortality in the paediatric population with ARDS from direct causes. Several promising therapies are currently being investigated in preclinical and clinical trials for treatment of ARDS in its acute and subacute, exudative phases. These include exogenous surfactant therapy, β2-adrenergic receptor agonists, antioxidants, immunomodulating agents and HMG-CoA reductase inhibitors (statins). Recent research has also focused on prevention of acute lung injury and acute respiratory distress in patients at risk. Drugs such as captopril, rosiglitazone and incyclinide (COL-3), a tetracycline derivative, have shown promising results in animal models, but have not yet been tested clinically. Further research is needed to discover therapies to treat ARDS in its late, fibroproliferative phase. Given the vast number of negative clinical trials to date, it is unlikely that a single pharmacotherapy will effectively treat all patients with ARDS from differing causes. Future randomized controlled trials should target specific, more homogeneous subgroups of patients for single or combination therapy.
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Affiliation(s)
- Karen J Bosma
- Department of Medicine, Division of Respirology, The University of Western Ontario, London, Ontario, Canada.
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3456
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Hammerschlag R, Milley R, Colbert A, Weih J, Yohalem-Ilsley B, Mist S, Aickin M. Randomized Controlled Trials of Acupuncture (1997-2007): An Assessment of Reporting Quality with a CONSORT- and STRICTA-Based Instrument. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:183910. [PMID: 20953418 PMCID: PMC2952291 DOI: 10.1155/2011/183910] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 07/01/2010] [Indexed: 02/05/2023]
Abstract
The present study describes the development of a comprehensive quality of reporting assessment tool and its application to acupuncture RCTs from 1997-2007. This Oregon CONSORT STRICTA Instrument (OCSI) is based on the revised CONSORT guidelines as modified by the STRICTA recommendations for acupuncture trials. Each of the resulting 27 OCSI items were applied to English language prospective RCTs that compared acupuncture, using manual and/or electro-stimulation, to no treatment, a sham procedure, or usual biomedical care. The 333 RCTs that met inclusion criteria were dispersed among 27 countries and 141 journals. Mean quality of reporting score for all articles was 63.0% (SD 16.5). Mean OCSI scores revealed a 30.9% improvement over the ten-year period (P < .001). Our findings suggest that to enhance quality of reporting, authors should better attend to seven specific OCSI items in three categories: practitioner training, adverse events, and aspects of randomization and blinding (n = 5). The broad diversity in geographical origin, publication site and quality of reporting, viewed in light of the considerable room for improvement in mean OCSI scores, emphasizes the importance of making STRICTA as well as CONSORT more widely known to journals and to the acupuncture research community.
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Affiliation(s)
- Richard Hammerschlag
- Research Department, Oregon College of Oriental Medicine, Portland, OR 97216-2859, USA
| | - Ryan Milley
- Research Department, Oregon College of Oriental Medicine, Portland, OR 97216-2859, USA
| | - Agatha Colbert
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR 97201-4848, USA
| | - Jeffrey Weih
- Department of Physical Medicine & Rehabilitation, Kaiser Permanente Northwest, Portland, OR 97227-1110, USA
| | - Beth Yohalem-Ilsley
- Research Department, Oregon College of Oriental Medicine, Portland, OR 97216-2859, USA
| | - Scott Mist
- Fibromyalgia Research Unit, Oregon Health Science University, Portland, OR 97239-3098, USA
| | - Mikel Aickin
- Program in Integrative Medicine and Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724-5052, USA
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3457
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3458
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Abstract
Despite remarkable growth in the clinical neurology literature, there is little research on peer review and biomedical publication in neurology. Biomedical publication research encompasses every step of the research process, from the methodology to the publication of research findings. Some general medical journals have served as leaders in improving scientific publication. Many medical fields have taken it upon themselves to characterize journals and peer reviewers within their own fields. Not all of these data can be applied to the clinical neurology literature; research methodologies, article types, and the journals themselves are unique to every medical field. This article reviews current publication research in the neurology literature and concludes that, to sustain and improve upon the integrity of clinical neurology research, further study is needed of the journals and the peer review process in neurology. Otherwise, the value of clinical research findings and patient care guidelines will be diminished.
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Affiliation(s)
- Victoria S S Wong
- Department of Neurology, University of California, Davis Medical Center, Sacramento, California 95817, USA.
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3459
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Smith J, Talbot D. Donation after cardiac death in the intensive care unit: The role of extracorporeal membrane oxygenation. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.cacc.2010.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3460
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Robertson LC, Allen SH, Konamme SP, Chestnut J, Wilson P. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int J Obstet Anesth 2010; 19:443-7. [PMID: 20705450 PMCID: PMC7127547 DOI: 10.1016/j.ijoa.2010.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/18/2010] [Accepted: 04/16/2010] [Indexed: 11/30/2022]
Abstract
We report a case of H1N1 2009 influenza A, in a previously fit woman at 24 weeks of gestation, who presented atypically with abdominal pain. The infection was complicated by severe respiratory failure and acute respiratory distress syndrome, requiring ventilatory support, including extra-corporeal membrane oxygenation (ECMO). This was one of the first cases of severe H1N1 disease presenting in the UK. Use of extra-corporeal membrane oxygenation for the complications of H1N1 resulted in full maternal recovery and subsequent delivery of a healthy infant.
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Affiliation(s)
- L C Robertson
- Department of Anaesthesia, Crosshouse Hospital, Kilmarnock, UK.
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3461
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Veno-arterial extracorporeal membrane oxygenation for high-risk cardiac catheterisation procedures. Heart Lung Circ 2010; 19:736-41. [PMID: 20869915 DOI: 10.1016/j.hlc.2010.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/27/2010] [Accepted: 08/17/2010] [Indexed: 11/21/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) provides circulatory or respiratory support, or both, to patients with severe but potentially reversible cardiac or respiratory failure refractory to standard therapy. The use of ECMO in the paediatric cardiac surgical population is established. Likewise, the use of ECMO for severe adult respiratory failure has recently been established and has been the subject of recent clinical trials. However, its use as a means of cardiac support in the adult population is not routine in clinical practice. We herein review the indications, technical procedure, complications and outcomes of extracorporeal membrane oxygenation as pertinent to cardiac disease in general, and specifically, to catheter-based interventions. We describe two cases of high-risk cardiac catheterisation laboratory procedures performed with veno-arterial ECMO support in adult patients who were deemed to be at unacceptably high risk for conventional open-heart surgery and cardiopulmonary bypass.
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3462
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Jordan AD, Khan MEA, Hoey ET, Rassl D, Nashef SAM. A clinico-pathological conference on constrictive pericarditis secondary to rheumatoid arthritis: a case report with expert commentary and review of the literature. Heart Lung Circ 2010; 20:24-9. [PMID: 20851679 DOI: 10.1016/j.hlc.2010.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 07/22/2010] [Accepted: 08/17/2010] [Indexed: 11/30/2022]
Abstract
Constrictive pericarditis is the commonest cardiac complication of rheumatoid arthritis (RA). Two percent of patients with RA develop significant clinical symptoms of pericarditis, which may not correlate with joint disease duration or severity. Symptoms are often vague and non-specific, which frequently delays the diagnosis and subsequent management. Surgical excision of the pericardium is the only definitive treatment option. We present the case of a 60 year-old lady with RA who presented with symptoms due to pericardial constriction and underwent radical pericardectomy.
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Affiliation(s)
- Adam D Jordan
- Department of Cardiothoracic Surgery, Papworth Hospital, Ermine Street North, Cambridge, UK.
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3463
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[Results of studies in critical care medicine in the year 2009 : update]. Anaesthesist 2010; 59:453-76. [PMID: 20405095 DOI: 10.1007/s00101-010-1718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Critical care medicine plays an important role for the medical and economic success of hospitals. Knowledge and implementation of recent relevant studies are prerequisites for high quality intensive care medicine. The aim of the present manuscript is to present an overview of the most important publications in intensive care medicine in 2009 and comment on their clinical relevance. It has to be recognized that the cited studies are chosen according to the view of the authors. In 2009 many large randomized studies with high patient numbers were published. Main topics in 2009 were the therapy of lung failure, analgosedation and sepsis therapy. New trends are bedside echocardiography and telemedicine. Unfortunately, a magic bullet has not been identified last year. The focus is still on team education and guideline-assisted therapy.
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3464
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Hackner K, Bein T, Kuehnel T, Philipp A, Wittmann S, Graf B. Geplante extrakorporale Lungenunterstützung. Anaesthesist 2010; 59:1008-12. [DOI: 10.1007/s00101-010-1763-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3465
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Wong I, Vuylsteke A. Use of extracorporeal life support to support patients with acute respiratory distress syndrome due to H1N1/2009 influenza and other respiratory infections. Perfusion 2010; 26:7-20. [PMID: 20826508 DOI: 10.1177/0267659110383342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A large proportion of critically ill H1N1/2009 patients with respiratory failure subsequently developed ARDS and, to date, about 400 patients receiving extracorporeal life support (ECLS) have been accounted for globally, with a reported survival rate from 63% to 79%. The survival rates of patients with ARDS due to non-H1N1/2009 infections are similar. There is no definite evidence to suggest that patient outcomes are changed by ECLS, but its use is associated with serious short-term complications. ECLS relies on an extracorporeal circuit, with extracorporeal membrane oxygenation (ECMO) and pumpless interventional lung assist (ILA) being the two major types employed in ARDS. Both have the potential to correct respiratory failure and related haemodynamic instability. There are only a very limited number of clinical trials to test either and, although ECLS has been used in treating H1N1/2009 patients with ARDS with some success, it should only be offered in the context of clinical trials and in experienced centres.
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Affiliation(s)
- Ivan Wong
- School of Clinical Medicine, University of Cambridge, UK.
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3466
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3467
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Extracorporeal membrane oxygenation (ECMO) pour les syndromes de détresse respiratoire aiguë (SDRA) sévères Point de vue de l’anesthésiste réanimateur. Ing Rech Biomed 2010. [DOI: 10.1016/s1959-0318(10)70007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3468
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Kirkpatrick AW, Pelosi P, De Waele JJ, Malbrain MLNG, Ball CG, Meade MO, Stelfox HT, Laupland KB. Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation? Crit Care 2010; 14:232. [PMID: 20804560 PMCID: PMC2945095 DOI: 10.1186/cc9099] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Prone ventilation (PV) is a ventilatory strategy that frequently improves oxygenation and lung mechanics in critical illness, yet does not consistently improve survival. While the exact physiologic mechanisms related to these benefits remain unproven, one major theoretical mechanism relates to reducing the abdominal encroachment upon the lungs. Concurrent to this experience is increasing recognition of the ubiquitous role of intra-abdominal hypertension (IAH) in critical illness, of the relationship between IAH and intra-abdominal volume or thus the compliance of the abdominal wall, and of the potential difference in the abdominal influences between the extrapulmonary and pulmonary forms of acute respiratory distress syndrome. The present paper reviews reported data concerning intra-abdominal pressure (IAP) in association with the use of PV to explore the potential influence of IAH. While early authors stressed the importance of gravitationally unloading the abdominal cavity to unencumber the lung bases, this admonition has not been consistently acknowledged when PV has been utilized. Basic data required to understand the role of IAP/IAH in the physiology of PV have generally not been collected and/or reported. No randomized controlled trials or meta-analyses considered IAH in design or outcome. While the act of proning itself has a variable reported effect on IAP, abundant clinical and laboratory data confirm that the thoracoabdominal cavities are intimately linked and that IAH is consistently transmitted across the diaphragm--although the transmission ratio is variable and is possibly related to the compliance of the abdominal wall. Any proning-related intervention that secondarily influences IAP/IAH is likely to greatly influence respiratory mechanics and outcomes. Further study of the role of IAP/IAH in the physiology and outcomes of PV in hypoxemic respiratory failure is thus required. Theories relating inter-relations between prone positioning and the abdominal condition are presented to aid in designing these studies.
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Affiliation(s)
- Andrew W Kirkpatrick
- Regional Trauma Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
- Department of Surgery, Calgary Heath Region and Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
- Department of Critical Care Medicine, Calgary Heath Region and Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
| | - Paolo Pelosi
- Department of Environment, Health and Safety, University of Insubria, c/o Villa Toeplitz Via G.B. Vico, 46 21100 Varese, Italy
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - Manu LNG Malbrain
- Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen 6, Belgium
| | - Chad G Ball
- Regional Trauma Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
- Department of Surgery, Calgary Heath Region and Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
| | - Maureen O Meade
- Department of Medicine, Room 2C10, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
- Department of Clinical Epidemiology and Biostatistics, Room 2C10, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
| | - Henry T Stelfox
- Department of Critical Care Medicine, Calgary Heath Region and Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
| | - Kevin B Laupland
- Department of Critical Care Medicine, Calgary Heath Region and Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9
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3469
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Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study. Intensive Care Med 2010; 36:1899-905. [PMID: 20721530 DOI: 10.1007/s00134-010-2021-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 07/02/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO). METHODS A prospective observational study of patients treated in Marseille South Hospital from October 2009 to January 2010 for confirmed influenza A (H1N1)-related ARDS. Clinical features, pulmonary dysfunction and mortality were compared between patients treated with and without ECMO. RESULTS Of 18 patients admitted, 6 were treated with veno-venous and 3 with veno-arterial ECMO after median (interquartile, IQR) duration of mechanical ventilation of 10 (6-96) h. Six ECMO were initiated in a referral hospital by a mobile team, a median (IQR) of 3 (2-4) h after phone contact. Before ECMO, patients had severe respiratory failure with median (IQR) PaO₂ to FiO₂ ratio of 52 (50-60) mmHg and PaCO₂ of 85 (69-91) mmHg. Patients treated with or without ECMO had the same hospital mortality rate (56%, 5/9). Duration of ECMO therapy was 9 (4-14) days in survivors and 5 (2-25) days in non-survivors. Early improvement of PaO(2) to FiO₂ ratio was greater in ECMO survivors than non-survivors after ECMO initiation [295 (151-439) versus 131 (106-144) mmHg, p < 0.05]. Haemorrhagic complications occurred in four patients under ECMO, but none required surgical treatment. CONCLUSIONS ECMO may be an effective salvage treatment for patients with influenza A (H1N1)-related ARDS presenting rapid refractory respiratory failure, particularly when provided by a mobile team allowing early cannulation prior to transfer to a reference centre.
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3470
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Abstract
OBJECTIVE In the management of patients with severe acute lung injury and acute respiratory distress syndrome, clinicians are sometimes challenged to maintain acceptable gas exchange while avoiding harmful mechanical ventilation practices. In some of these patients, physicians may consider the use of "rescue therapies" to sustain life. Our goal is to provide a practical, evidence-based review to assist critical care physicians' care for patients with severe acute lung injury and acute respiratory distress syndrome. DATA SOURCES We searched the PubMed database for clinical trials that examined the use of the following therapies in severe acute lung injury and acute respiratory distress syndrome: recruitment maneuvers, high positive end-expiratory pressure, prone position, high-frequency oscillatory ventilation, glucocorticoids, inhaled nitric oxide, buffer therapy, and extracorporeal life support. STUDY SELECTION All clinical trials that included patients with severe acute lung injury and acute respiratory distress syndrome were included in the review. DATA SYNTHESIS The primary author reviewed the aforementioned trials in depth and then disputed findings and conclusions with the other authors until consensus was achieved. CONCLUSIONS This article is designed to provide clinicians with a simple bedside definition for the diagnosis of severe acute respiratory distress syndrome; to describe several therapies that can be used for severe acute respiratory distress syndrome with an emphasis on the potential risks and the indications and benefits; and to offer practical guidelines for implementation of these therapies.
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3471
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Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med 2010; 36:2038-44. [DOI: 10.1007/s00134-010-1982-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 05/15/2010] [Indexed: 11/30/2022]
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3472
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Vainiola T, Pettilä V, Roine RP, Räsänen P, Rissanen AM, Sintonen H. Comparison of two utility instruments, the EQ-5D and the 15D, in the critical care setting. Intensive Care Med 2010; 36:2090-3. [PMID: 20689933 PMCID: PMC2981733 DOI: 10.1007/s00134-010-1979-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 05/11/2010] [Indexed: 01/17/2023]
Abstract
PURPOSE Reliable measures are required for proper cost-utility analysis after critical care. No gold standard is available, but the EQ-5D health-related quality of life instrument (HRQoL) has been proposed. Our aim was to compare the EQ-5D with another utility measure, the 15D, after critical illness. METHODS A total of 929 patients filled in both the EQ-5D and 15D HRQoL instruments 6 and 12 months after treatment at an intensive care or high-dependency unit. The difference in the medians and distributions of the scores of the instruments was tested with Wilcoxon signed-rank test and their association with Spearman rank correlation. Discriminatory power was compared by the ceiling effect and agreement between the instruments regarding the direction of the minimal clinically important change in the HRQoL scores between 6 and 12 months was tested with the McNemar-Bowker test and Cohen's kappa. RESULTS The utility scores produced by the instruments and their distributions were different. Agreement between the instruments was only moderate. The 15D appeared more sensitive than the EQ-5D both in terms of discriminatory power and responsiveness to clinically important change. CONCLUSION The agreement between the two utility measures was only moderate. The choice of the instrument may have a substantial effect on cost-utility results. Our results suggest that the 15D performs well after critical illness, but further large cohort studies comparing different utility instruments in this patient population are warranted before the gold standard for utility measurement can be announced.
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Affiliation(s)
- Tarja Vainiola
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland.
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3473
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Kumar TS, Zurakowski D, Dalton H, Talwar S, Allard-Picou A, Duebener LF, Sinha P, Moulick A. Extracorporeal membrane oxygenation in postcardiotomy patients: Factors influencing outcome. J Thorac Cardiovasc Surg 2010; 140:330-336.e2. [DOI: 10.1016/j.jtcvs.2010.02.034] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 01/17/2010] [Accepted: 02/13/2010] [Indexed: 11/26/2022]
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3474
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Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience. J Perinatol 2010; 30:546-52. [PMID: 20147960 DOI: 10.1038/jp.2009.193] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review outcomes of patients with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) at a level IIIC neonatal intensive care unit and to determine if pre-ECMO respiratory status can help predict mortality. STUDY DESIGN A single-center retrospective chart review was conducted on all infants with CDH treated with ECMO in the past 15 years. Demographic and clinical information, including pre-ECMO ventilatory and blood gas data, was collected. Differences between survivors and non-survivors were evaluated using independent samples t-/Mann-Whitney U-and Fisher's exact/chi (2)-tests for continuous and categorical data, respectively. Cox regression analysis was performed to evaluate predictors of survival while controlling for covariates. Significant predictors were further explored with receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis. RESULT Overall survival of the population of 62 patients treated with ECMO was 50%. Survivor and non-survivors were similar in birth weight, gestational age, gender, race and Apgar scores. Approximately 80% of patients in both groups had a left-sided defect. Less than half of patients were prenatally diagnosed in either group. Patients in the non-survivor group had associated anomalies (42 vs 23% for survivors) but this was not statistically significant (P=0.303). Non-survivors were more likely to be put on ECMO earlier, stay on ECMO longer and be operated upon later. On pre-ECMO blood gas analyses, survivors had higher pH and PaO(2), and lower oxygenation index and PaCO(2) compared with non-survivors. After controlling for covariates, a lower minimum PaCO(2) and side of defect were the only independent predictors of survival. ROC curve for minimum pre-ECMO PaCO(2) had a significant area under the curve (0.72, P=0.003). Survival was 27% in babies unable to achieve a pre-ECMO PaCO(2) <60 mm Hg whereas no patients survived if their lowest pre-ECMO PaCO(2) was >70 mm Hg. CONCLUSION Minimum achievable pre-ECMO PaCO(2) is an independent predictor of survival in patients with CDH requiring ECMO life support. These data provide useful prognostic information for counseling families and may facilitate direction of care in extreme cases where the degree of pulmonary hypoplasia may be incompatible with life.
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3475
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Polk AA, Maul TM, McKeel DT, Snyder TA, Lehocky CA, Pitt B, Stolz DB, Federspiel WJ, Wagner WR. A biohybrid artificial lung prototype with active mixing of endothelialized microporous hollow fibers. Biotechnol Bioeng 2010; 106:490-500. [PMID: 20091735 DOI: 10.1002/bit.22675] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute respiratory distress syndrome (ARDS) affects nearly 150,000 patients per year in the US, and is associated with high mortality ( approximately 40%) and suboptimal options for patient care. Mechanical ventilation and extracorporeal membrane oxygenation are limited to short-term use due to ventilator-induced lung injury and poor biocompatibility, respectively. In this report, we describe the development of a biohybrid lung prototype, employing a rotating endothelialized microporous hollow fiber (MHF) bundle to improve blood biocompatibility while MHF mixing could contribute to gas transfer efficiency. MHFs were surface modified with radio frequency glow discharge (RFGD) and protein adsorption to promote endothelial cell (EC) attachment and growth. The MHF bundles were placed in the biohybrid lung prototype and rotated up to 1,500 revolutions per minute (rpm) using speed ramping protocols to condition ECs to remain adherent on the fibers. Oxygen transfer, thrombotic deposition, and EC p-selectin expression were evaluated as indicators of biohybrid lung functionality and biocompatibility. A fixed aliquot of blood in contact with MHF bundles rotated at either 250 or 750 rpm reached saturating pO(2) levels more quickly with increased rpm, supporting the concept that fiber rotation would positively contribute to oxygen transfer. The presence of ECs had no effect on the rate of oxygen transfer at lower fiber rpm, but did provide some resistance with increased rpm when the overall rate of mass transfer was higher due to active mixing. RFGD followed by fibronectin adsorption on MHFs facilitated near confluent EC coverage with minimal p-selectin expression under both normoxic and hyperoxic conditions. Indeed, even subconfluent EC coverage on MHFs significantly reduced thrombotic deposition adding further support that endothelialization enhances, blood biocompatibility. Overall these findings demonstrate a proof-of-concept that a rotating endothelialized MHF bundle enhances gas transfer and biocompatibility, potentially producing safer, more efficient artificial lungs.
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Affiliation(s)
- Alexa A Polk
- The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pennsylvania 15213, USA
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3476
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Liu LL, Aldrich JM, Shimabukuro DW, Sullivan KR, Taylor JM, Thornton KC, Gropper MA. Special article: rescue therapies for acute hypoxemic respiratory failure. Anesth Analg 2010; 111:693-702. [PMID: 20624836 DOI: 10.1213/ane.0b013e3181e9c356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The recent H1N1 epidemic has resulted in a large number of deaths, primarily from acute hypoxemic respiratory failure. We reviewed the current strategies to rescue patients with severe hypoxemia. Included in these strategies are high-frequency oscillatory ventilation, airway pressure release ventilation, inhaled vasodilators, and the use of extracorporeal life support. All of these strategies are targeted at improving oxygenation, but improved oxygenation alone has yet to be demonstrated to correlate with improved survival. The risks and benefits of these strategies, including cost-effectiveness data, are discussed.
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Affiliation(s)
- Linda L Liu
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA 94143-0624, USA
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3477
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Abstract
The critically ill patient who requires anesthesia is frequently a concern for the anesthesiologist. In addition to having potential hemodynamic lability and coagulopathy, the critically ill patient frequently experiences profound respiratory failure. The approach to the patient requiring advanced ventilatory support requires an understanding of respiratory failure, the pathophysiology causing respiratory failure and hypoxia, the physiology of mechanical ventilation and the advanced modes of ventilation available in the intensive care unit (ICU). This article discusses the basic definitions of hypoxia and common pathologic states, reviews the physiology of mechanical ventilation and advanced forms of ventilation available in the ICU, and concludes with recommendations for the management of patients with severe respiratory failure when they are taken to the operating room.
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3478
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Francisci D, Labianca R, Roila F. Prevention and treatment of pandemic influenza in cancer patients. Ann Oncol 2010; 21:2301-2303. [PMID: 20616196 DOI: 10.1093/annonc/mdq351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- D Francisci
- Infectious Disease Clinic, "S. Maria della Misericordia" Hospital, Perugia
| | - R Labianca
- Department of Oncology and Hematology, Ospedali Riuniti, Bergamo
| | - F Roila
- Medical Oncology Division, "S. Maria" Hospital, Terni, Italy.
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3479
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Foley PJ, Morris RJ, Woo EY, Acker MA, Wang GJ, Fairman RM, Jackson BM. Limb ischemia during femoral cannulation for cardiopulmonary support. J Vasc Surg 2010; 52:850-3. [PMID: 20615644 DOI: 10.1016/j.jvs.2010.05.012] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/04/2010] [Accepted: 05/05/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation and extracorporeal cardiopulmonary support (ECMO/CPS) are potentially life-saving techniques for patients with cardiopulmonary collapse. Complications include lower extremity ischemia from femoral artery cannulation. We examined the outcomes of patients placed on ECMO/CPS, including the rate of limb ischemia. METHODS All instances of ECMO/CPS over a 3-year period (2006-2009) at a single university hospital were examined retrospectively for cannulation strategy, perfusion strategy, mortality, and limb ischemia. Potential predictors of limb ischemia with femoral artery cannulation were age, gender, body surface area (BSA), body mass index (BMI), and arterial cannula size. RESULTS Fifty-eight patients were placed on ECMO/CPS. Of these, 43 patients (74%) had femoral arterial cannulation. In 10 patients, the superficial femoral artery (SFA) was cannulated prophylactically (without antecedent limb ischemia) and perfused in the antegrade direction from a branch of the ECMO/CPS circuit. In 7 of the remaining 33 patients (21%), limb ischemia developed requiring decannulation with fasciotomy (n = 4) or additional cannulation of the SFA with branching of the ECMO/CPS circuit (n = 3). One patient with ipsilateral leg ischemia required eventual amputation. Patients with limb ischemia were significantly younger than those who did not develop limb ischemia (P = .001). BSA, BMI, and cannula size did not predict limb ischemia. Overall 30-day mortality following the initiation of ECMO/CPS was 79%. There was no correlation between limb ischemia and mortality. CONCLUSIONS Younger patients may be at increased risk for lower extremity arterial insufficiency with femoral cannulation for ECMO/CPS. Prophylactic or expectant SFA cannulation are reasonable approaches.
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Affiliation(s)
- Paul J Foley
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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3480
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Ladd BO, McCrady BS, Manuel JK, Campbell W. Improving the quality of reporting alcohol outcome studies: effects of the CONSORT statement. Addict Behav 2010; 35:660-6. [PMID: 20207490 DOI: 10.1016/j.addbeh.2010.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/07/2009] [Accepted: 02/03/2010] [Indexed: 11/15/2022]
Abstract
It is critical that the reporting of randomized controlled trials (RCTs) be transparent and comprehensive. The aim of this study was to examine if adopting standards of reporting, the Consolidated Standards of Reporting Trials (CONSORT), improved the quality of reporting of alcohol treatment outcome studies. RCTs were identified from eight journals publishing a substantial number of alcohol treatment outcome studies (n=127 RCTs) and coded for the quality of reporting according to the CONSORT guidelines. Both CONSORT adopter and non-adopter journals showed significant improvements in the quality of reporting of alcohol treatment outcome studies over time. While overall results suggested a non-significant trend for more improvement over time in the quality of reporting for adopter compared to non-adopter journals, comparison of effects sizes suggested that specific areas of reporting did significantly improve for the adopter journals. Results suggest that efforts to improve reporting such as the CONSORT guidelines can be useful and influential.
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Affiliation(s)
- Benjamin O Ladd
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), 2650 Yale Blvd SE, MSC11-6280, Albuquerque, NM 87106, USA.
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3481
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3482
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Appelboam R, Williams MP, Duffy MR. Sand aspiration: a case report and review of the radiological features and management. Anaesthesia 2010; 65:848-54. [PMID: 20569250 DOI: 10.1111/j.1365-2044.2010.06405.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We report a case of severe sand aspiration in association with near-drowning, which led to respiratory failure secondary to the acute respiratory distress syndrome, necessitating mechanical ventilation, repeated therapeutic bronchoscopic lavage, and a stay in the intensive care unit that exceeded one month.
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Affiliation(s)
- R Appelboam
- Department of Radiology, Derriford Hospital, Plymouth, UK.
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3483
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Larsson M, Talving P, Palmér K, Frenckner B, Riddez L, Broomé M. Experimental extracorporeal membrane oxygenation reduces central venous pressure: an adjunct to control of venous hemorrhage? Perfusion 2010; 25:217-23. [DOI: 10.1177/0267659110375864] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Venoarterial ECMO has been utilized in trauma patients to improve oxygenation, particularly in the setting of pulmonary contusions and ARDS. We hypothesized that venoarterial ECMO could reduce the central venous pressure in the trauma scenario, thus, alleviating major venous hemorrhage. Methods: Ten swine were cannulated for venoarterial ECMO. Central venous pressure, mean arterial pressure, portal vein pressure and portal vein flow were recorded at three different flow rates in both a hemodynamic normal state and a setting of increased central venous pressure and right ventricular load, mimicking acute lung injury. Results: Venoarterial ECMO reduced the central venous pressure (CVP sup) from 9.4±0.8 to 7.3±0.7 mmHg (p<0.01) and increased the mean arterial pressure from 103±8 to 119±10 mmHg (p<0.01) in the normal hemodynamic state. In the state of increased right ventricular load, the CVPsup declined from 14.3±0.4 to 11.0±0.7mmHg (p<0.01) and the mean arterial pressure (MAP) increased from 66±6 to 113 ±5 mmHg (p<0.01). Conclusion: Venoarterial ECMO reduces systemic venous pressure while maintaining or improving systemic perfusion in both a normal circulatory state and in the setting of increased right ventricular load associated with acute lung injury. ECMO may be a useful tool in reducing blood loss during major venous hemorrhage in both trauma and selected elective surgery.
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Affiliation(s)
| | - Peep Talving
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Louis Riddez
- Karolinska University Hospital, Stockholm, Sweden
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3484
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Mongero LB, Brodie D, Cunningham J, Ventetuolo C, Kim H, Sylvin E, Bacchetta MD. Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism. Perfusion 2010; 25:249-52; discussion 253-4. [DOI: 10.1177/0267659110375327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liquid silicone is an inert material that may be used for cosmetic procedures by physicians as well as illegally by non-medical personnel. The use of silicone may result in severe complications, disfigurement, and even death. In addition, the indications for extracorporeal membrane oxygenation (ECMO) support have been increasing as a salvage therapy for a variety of life-threatening conditions. The patient is a 27-year-old woman with no significant medical conditions who developed silicone emboli, and subsequent diffuse alveolar hemorrhage after being injected with silicone in her gluteal region without medical supervision. She became profoundly hypoxemic and suffered a brief asystolic cardiac arrest in this setting. The patient was placed on veno-venous ECMO support for 14 days. Medical care during ECMO was complicated by pulmonary hemorrhage, hemothorax, pneumothorax, and blood clot, resulting in oxygenator change-out. A modified adult ECMO circuit (Jostra QuadroxD, Maquet Cardiopulmonary, Rastatt, Germany) was used to transport the patient from a nearby community affiliate hospital and then reconfigured for the medical intensive care unit on a standard HL-20 heart-lung console. Although the use of ECMO for severe hypoxemic respiratory failure has been widely reported, to our knowledge, this is the first reported successful use of ECMO for silicone embolism syndrome associated with diffuse alveolar hemorrhage and severe hypoxemic respiratory failure.
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Affiliation(s)
- LB Mongero
- Department of Clinical Perfusion, New York Presbyterian MC/Columbia University Medical Center, New York, NY, USA,
| | - D. Brodie
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - J. Cunningham
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - C. Ventetuolo
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - H. Kim
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - E. Sylvin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - MD Bacchetta
- Department of Surgery, Cardiothoracic Division, New York Presbyterian MC/Columbia University Medical Center, New York, NY, USA
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3485
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Gómez-Caro A, Badia JR, Ausin P. [Extracorporeal lung assist in severe respiratory failure and ARDS. Current situation and clinical applications]. Arch Bronconeumol 2010. [PMID: 20937437 DOI: 10.1016/s1579-2129(11)60006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite improvements in ventilation support techniques, lung protection strategies, and the application of new support treatment, acute respiratory distress syndrome continues to have a high mortality rate. Many strategies and treatments for this syndrome have been investigated over the last few year. However, the only therapeutic measure that has systematically shown to be able to improve survival is that of low volume lung protective ventilation. Thus, using a low tidal volume prevents added lung damage by the same mechanical ventilation that is essential for life support. In this context, the use of extracorporeal lung assist systems is considered an exceptional use rescue treatment in extreme cases. On the other hand, it could be a potentially useful complementary method for an ultra-protective ventilation strategy, that is, by using even lower tidal volumes. The currently available extracorporeal lung assist systems are described in this article, including high flow systems such as traditional extracorporeal membrane oxygenation, CO₂ removal systems (interventional lung assist or iLA, with or without associated centrifugal pumps), and the new low flow and less invasive systems under development. The aim of this review is to update the latest available clinical and experimental data, the indications for these devices in adult respiratory distress syndrome (ARDS), and their potential indications in other clinical situations, such as the bridge to lung transplantation, multiple organ dysfunction syndrome, or COPD.
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Affiliation(s)
- Abel Gómez-Caro
- Instituto del Tórax, Hospital Clínic de Barcelona, Universidad de Barcelona, CIBER de enfermedades respiratorias CIBERES, España.
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3486
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Gómez-Caro A, Badia JR, Ausin P. [Extracorporeal lung assist in severe respiratory failure and ARDS. Current situation and clinical applications]. Arch Bronconeumol 2010; 46:531-7. [PMID: 20937437 DOI: 10.1016/j.arbres.2010.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 04/19/2010] [Accepted: 05/03/2010] [Indexed: 11/17/2022]
Abstract
Despite improvements in ventilation support techniques, lung protection strategies, and the application of new support treatment, acute respiratory distress syndrome continues to have a high mortality rate. Many strategies and treatments for this syndrome have been investigated over the last few year. However, the only therapeutic measure that has systematically shown to be able to improve survival is that of low volume lung protective ventilation. Thus, using a low tidal volume prevents added lung damage by the same mechanical ventilation that is essential for life support. In this context, the use of extracorporeal lung assist systems is considered an exceptional use rescue treatment in extreme cases. On the other hand, it could be a potentially useful complementary method for an ultra-protective ventilation strategy, that is, by using even lower tidal volumes. The currently available extracorporeal lung assist systems are described in this article, including high flow systems such as traditional extracorporeal membrane oxygenation, CO₂ removal systems (interventional lung assist or iLA, with or without associated centrifugal pumps), and the new low flow and less invasive systems under development. The aim of this review is to update the latest available clinical and experimental data, the indications for these devices in adult respiratory distress syndrome (ARDS), and their potential indications in other clinical situations, such as the bridge to lung transplantation, multiple organ dysfunction syndrome, or COPD.
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Affiliation(s)
- Abel Gómez-Caro
- Instituto del Tórax, Hospital Clínic de Barcelona, Universidad de Barcelona, CIBER de enfermedades respiratorias CIBERES, España.
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3487
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Guan Y, Karkhanis T, Wang S, Rider A, Koenig SC, Slaughter MS, El Banayosy A, Ündar A. Physiologic Benefits of Pulsatile Perfusion During Mechanical Circulatory Support for the Treatment of Acute and Chronic Heart Failure in Adults. Artif Organs 2010; 34:529-36. [DOI: 10.1111/j.1525-1594.2010.00996.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3488
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Pandis N, Polychronopoulou A, Eliades T. An assessment of quality characteristics of randomised control trials published in dental journals. J Dent 2010; 38:713-21. [PMID: 20546823 DOI: 10.1016/j.jdent.2010.05.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/31/2010] [Accepted: 05/14/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the quality of reporting of randomised clinical trials (RCTs) published in dental specialty journals. METHODS The journals possessing the highest impact factor (2008 data) in the six major dental specialties were included in the study. The contents of the 24 most recent issues of each journal were hand-searched and research articles identified as randomised controlled trials (RCTs) were selected. Quality evaluation was performed using the modified Consolidated Standards of Reporting Trials (CONSORT) statement checklist. The data were analysed using descriptive statistics followed by univariate and multivariate examination of statistical associations (alpha=0.05). RESULTS Ninety-five RCTs were identified with generally suboptimal scores on quality reporting on key CONSORT areas. Significant differences were found among journals with the Journal of Clinical Periodontology achieving the highest score, followed by the American Journal of Orthodontics and Dentofacial Orthopedics. There was a positive association between quality score and number of authors, involvement of statistician/epidemiologist, and multicentre trials. CONCLUSIONS The quality scores of RCTs in major dental journals are considered suboptimal in key CONSORT areas. This receives critical importance considering that improved quality of RCTs is a fundamental prerequisite for improved dental care.
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Affiliation(s)
- Nikolaos Pandis
- Department of Community and Preventive Dentistry, School of Dentistry, University of Athens, Greece
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3489
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Platts D, Fraser JF, Mullany D, Burstow D. Left Ventricular Endocardial Definition Enhancement Using Perflutren Microsphere Contrast Echocardiography during Peripheral Venoarterial Extracorporeal Membranous Oxygenation. Echocardiography 2010; 27:E112-4. [DOI: 10.1111/j.1540-8175.2010.01184.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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3490
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Welch SA, Snowden LN, Buscher H. Pandemic (H1N1) 2009 influenza, pregnancy and extracorporeal membrane oxygenation. Med J Aust 2010; 192:668. [DOI: 10.5694/j.1326-5377.2010.tb03675.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/11/2010] [Indexed: 11/17/2022]
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3491
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Ricci Z, Cruz DN, Ronco C. Intensive care. Nephrol Dial Transplant 2010; 25:678-83. [PMID: 20185413 DOI: 10.1093/ndt/gfq005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zaccaria Ricci
- Department of Pediatric Cardiosurgery, Bambino Gesù Hospital, Rome, Italy.
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3492
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Extracorporeal membrane oxygenation in pandemic flu: Insufficient evidence or worth the effort?*. Crit Care Med 2010; 38:1484-5. [DOI: 10.1097/ccm.0b013e3181e08fff] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3493
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Mitchell MD, Mikkelsen ME, Umscheid CA, Lee I, Fuchs BD, Halpern SD. A systematic review to inform institutional decisions about the use of extracorporeal membrane oxygenation during the H1N1 influenza pandemic. Crit Care Med 2010; 38:1398-404. [PMID: 20400902 PMCID: PMC4162635 DOI: 10.1097/ccm.0b013e3181de45db] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To systematically evaluate the effect of extracorporeal membrane oxygenation on survival in adults with acute respiratory failure and to help inform institutional decisions about implementing an extracorporeal membrane oxygenation program or transferring patients to experienced extracorporeal membrane oxygenation centers during the H1N1 influenza pandemic. DATA SOURCES National Guideline Clearinghouse, MEDLINE, EMBASE, Agency for Healthcare Research and Quality Evidence-based Practice reports, National Institute for Health and Clinical Excellence, Cochrane Library, International Network of Agencies for Health Technology Assessment, and citation review. STUDY SELECTION Studies of extracorporeal membrane oxygenation in adult acute respiratory failure, reporting mortality rates for at least 10 patients in extracorporeal membrane oxygenation and nonextracorporeal membrane oxygenation groups. DATA EXTRACTION Mortality rates were abstracted for all patients and for patients with influenza. Risk ratios were meta-analyzed using random-effects methods and assessed for heterogeneity. DATA SYNTHESIS There are no evidence-based clinical guidelines on the use of extracorporeal membrane oxygenation in patients with influenza. Three randomized controlled trials and three cohort studies evaluated extracorporeal membrane oxygenation in patients with acute respiratory failure; none reported specifically on patients with influenza. Meta-analysis of the randomized controlled trials revealed significant heterogeneity in risk of mortality. The summary risk ratio found by the meta-analysis was 0.93 (95% confidence interval, 0.71 to 1.22). The most recent trial found a reduction in mortality and severe disability at 6 months among patients in whom extracorporeal membrane oxygenation was considered. Observational studies suggest that extracorporeal membrane oxygenation for acute respiratory failure resulting from viral pneumonia is associated with improved mortality compared with other etiologies of acute respiratory failure. CONCLUSIONS The best evidence to guide decisions regarding the use of extracorporeal membrane oxygenation for patients with influenza stems from trials of extracorporeal membrane oxygenation for acute respiratory failure of all etiologies, among which significant heterogeneity exists, and from case series describing outcomes of extracorporeal membrane oxygenation in patients with influenza. Thus, there is insufficient evidence to provide a recommendation for extracorporeal membrane oxygenation use among patients with respiratory failure resulting from influenza. However, clinicians should consider extracorporeal membrane oxygenation within the context of other salvage therapies for acute respiratory failure.
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Affiliation(s)
- Matthew D. Mitchell
- Center for Evidence-based Practice, University of Pennsylvania Health System
| | - Mark E. Mikkelsen
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania
| | - Craig A. Umscheid
- Center for Evidence-based Practice, University of Pennsylvania Health System
- Division of General Internal Medicine, Department of Medicine, Hospital of the University of Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Ingi Lee
- Center for Evidence-based Practice, University of Pennsylvania Health System
- Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania
| | - Barry D. Fuchs
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania
| | - Scott D. Halpern
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
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3494
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Raoof S, Goulet K, Esan A, Hess DR, Sessler CN. Severe Hypoxemic Respiratory Failure. Chest 2010; 137:1437-48. [DOI: 10.1378/chest.09-2416] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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3495
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A meta-analysis of the efficacy and safety of recombinant activated factor VII for patients with acute intracerebral hemorrhage without hemophilia. J Clin Neurosci 2010; 17:685-93. [DOI: 10.1016/j.jocn.2009.11.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 10/11/2009] [Accepted: 11/22/2009] [Indexed: 11/17/2022]
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3496
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Peris A, Cianchi G, Biondi S, Bonizzoli M, Pasquini A, Bonacchi M, Ciapetti M, Zagli G, Bacci S, Lazzeri C, Bernardo P, Mascitelli E, Sani G, Gensini GF. Extracorporeal life support for management of refractory cardiac or respiratory failure: initial experience in a tertiary centre. Scand J Trauma Resusc Emerg Med 2010; 18:28. [PMID: 20487571 PMCID: PMC2879235 DOI: 10.1186/1757-7241-18-28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 05/21/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals. Methods At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation. Results A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62% survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50%. No patients on V-A ECLS support after cardiac arrest survived (N = 4). Conclusions In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.
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Affiliation(s)
- Adriano Peris
- Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy
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3497
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Matthay MA, Idell S. Update on acute lung injury and critical care medicine 2009. Am J Respir Crit Care Med 2010; 181:1027-32. [PMID: 20460547 PMCID: PMC3269230 DOI: 10.1164/rccm.201001-0074up] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/12/2010] [Indexed: 01/23/2023] Open
Affiliation(s)
- Michael A Matthay
- Department of Medicine, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0624, USA.
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3498
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Gow KW, Lao OB, Leong T, Fortenberry JD. Extracorporeal life support for adults with malignancy and respiratory or cardiac failure: The Extracorporeal Life Support experience. Am J Surg 2010; 199:669-75. [DOI: 10.1016/j.amjsurg.2010.01.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 12/12/2022]
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3499
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Fatal Outcome of Recombinant Factor VIIa in Heart Transplantation With Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2010; 89:1643-5. [DOI: 10.1016/j.athoracsur.2009.09.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/23/2022]
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3500
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Ouattara A, Decoene C, Janvier G. [Are there limits to extracorporeal circulation?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2010; 29:337-338. [PMID: 20400259 DOI: 10.1016/j.annfar.2010.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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