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Development of clinical tools to estimate the breathing effort during high-flow oxygen therapy: A multicenter cohort study. Pulmonology 2024:S2531-0437(24)00054-0. [PMID: 38760225 DOI: 10.1016/j.pulmoe.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Quantifying breathing effort in non-intubated patients is important but difficult. We aimed to develop two models to estimate it in patients treated with high-flow oxygen therapy. PATIENTS AND METHODS We analyzed the data of 260 patients from previous studies who received high-flow oxygen therapy. Their breathing effort was measured as the maximal deflection of esophageal pressure (ΔPes). We developed a multivariable linear regression model to estimate ΔPes (in cmH2O) and a multivariable logistic regression model to predict the risk of ΔPes being >10 cmH2O. Candidate predictors included age, sex, diagnosis of the coronavirus disease 2019 (COVID-19), respiratory rate, heart rate, mean arterial pressure, the results of arterial blood gas analysis, including base excess concentration (BEa) and the ratio of arterial tension to the inspiratory fraction of oxygen (PaO2:FiO2), and the product term between COVID-19 and PaO2:FiO2. RESULTS We found that ΔPes can be estimated from the presence or absence of COVID-19, BEa, respiratory rate, PaO2:FiO2, and the product term between COVID-19 and PaO2:FiO2. The adjusted R2 was 0.39. The risk of ΔPes being >10 cmH2O can be predicted from BEa, respiratory rate, and PaO2:FiO2. The area under the receiver operating characteristic curve was 0.79 (0.73-0.85). We called these two models BREF, where BREF stands for BReathing EFfort and the three common predictors: BEa (B), respiratory rate (RE), and PaO2:FiO2 (F). CONCLUSIONS We developed two models to estimate the breathing effort of patients on high-flow oxygen therapy. Our initial findings are promising and suggest that these models merit further evaluation.
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O-GlcNAcylation Prediction: An Unattained Objective. Adv Appl Bioinform Chem 2021; 14:87-102. [PMID: 34135600 PMCID: PMC8197665 DOI: 10.2147/aabc.s294867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND O-GlcNAcylation is an essential post-translational modification (PTM) in mammalian cells. It consists in the addition of a N-acetylglucosamine (GlcNAc) residue onto serines or threonines by an O-GlcNAc transferase (OGT). Inhibition of OGT is lethal, and misregulation of this PTM can lead to diverse pathologies including diabetes, Alzheimer's disease and cancers. Knowing the location of O-GlcNAcylation sites and the ability to accurately predict them is therefore of prime importance to a better understanding of this process and its related pathologies. PURPOSE Here, we present an evaluation of the current predictors of O-GlcNAcylation sites based on a newly built dataset and an investigation to improve predictions. METHODS Several datasets of experimentally proven O-GlcNAcylated sites were combined, and the resulting meta-dataset was used to evaluate three prediction tools. We further defined a set of new features following the analysis of the primary to tertiary structures of experimentally proven O-GlcNAcylated sites in order to improve predictions by the use of different types of machine learning techniques. RESULTS Our results show the failure of currently available algorithms to predict O-GlcNAcylated sites with a precision exceeding 9%. Our efforts to improve the precision with new features using machine learning techniques do succeed for equal proportions of O-GlcNAcylated and non-O-GlcNAcylated sites but fail like the other tools for real-life proportions where ~1.4% of S/T are O-GlcNAcylated. CONCLUSION Present-day algorithms for O-GlcNAcylation prediction narrowly outperform random prediction. The inclusion of additional features, in combination with machine learning algorithms, does not enhance these predictions, emphasizing a pressing need for further development. We hypothesize that the improvement of prediction algorithms requires characterization of OGT's partners.
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High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med 2019; 45:563-572. [PMID: 30888444 DOI: 10.1007/s00134-019-05590-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. METHODS We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods. RESULTS We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use. CONCLUSION In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
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A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals. Acta Anaesthesiol Scand 2018; 62:38-48. [PMID: 29058310 DOI: 10.1111/aas.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/10/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. METHODS Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. RESULTS All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC-ROC: 0.85, 95% CI: 0.76-0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 ± 8.6, whereas non-survivors showed a mean value of 20.1 ± 7.4 (P < 0.001). CONCLUSIONS Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.
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Ventilation during extracorporeal support. Med Klin Intensivmed Notfmed 2017; 113:26-30. [DOI: 10.1007/s00063-017-0384-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
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The ten pressures of the respiratory system during assisted breathing. Intensive Care Med 2017; 43:1504-1506. [PMID: 28289813 DOI: 10.1007/s00134-017-4748-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/26/2017] [Indexed: 01/04/2023]
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37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3). Crit Care 2017. [PMCID: PMC5374603 DOI: 10.1186/s13054-017-1628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016. Crit Care 2016; 20:347. [PMID: 31268434 PMCID: PMC5078922 DOI: 10.1186/s13054-016-1358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13054-016-1208-6.].
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A spiky pattern in the course of electrical thoracic impedance as a very early sign of a developing pneumothorax. Clin Physiol Funct Imaging 2016; 38:158-162. [PMID: 27619316 DOI: 10.1111/cpf.12385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
A pneumothorax (PTX) is a potentially lethal condition in high-risk intensive care patients. Electrical impedance tomography (EIT) has been proven to detect PTX at the bedside. A so far not described pattern in the course of thoracic impedance at an early state of PTX was observed in a pig model of ventilator-induced lung injury (VILI) used for a more extensive study. EIT was performed at a framerate of 50 Hz. Beginning of PTX at normal ventilation, manifestation of PTX at VILI ventilation (plateau pressure 42 cm H2 O) and final pleural drainage were documented. At ventilation with 8·6 ml kg-1 , early PTX findings prior to any clinical deterioration consisted in a spike-like pattern in the time course of impedance (relative impedance change referred to initial end-expiratory level). Spike amplitudes (mean ± SD) were the following: 0·154 ± 0·059 (right lung) and 0·048 ± 0·050 (left lung). At this state, end-expiratory levels (mean ± SD) were still similar, -0·035 ± 0·010 (right) and -0·058 ± 0·022 (left). After application of VILI ventilation (38 ml kg-1 ), a PTX developed slowly, being confirmed by a continuous increase in the end-expiratory level on the right side and diverging levels of +0·320 ± 0·057 (right) and -0·193 ± 0·147 (left) at full manifestation. We assume that spikes reflect a temporary change in the electrical pathway caused by leakage into the pleural cavity. This newly described phenomenon of spikes is considered to be a potentially useful indicator for a very early detection of an evolving PTX in high-risk ICU patients.
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Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery. Br J Anaesth 2016; 116:855-61. [DOI: 10.1093/bja/aew123] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 12/31/2022] Open
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Diaphragmatic function assessed during an SBT trial using m-mode ultrasonography and MIP: a pilot study. Intensive Care Med Exp 2015. [PMCID: PMC4797796 DOI: 10.1186/2197-425x-3-s1-a455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Effects of Positive End Expiratory Pressure On Regional Ventilation-Perfusion Matching And Respiratory Mechanics: A Clinical Study. Intensive Care Med Exp 2015. [PMCID: PMC4796613 DOI: 10.1186/2197-425x-3-s1-a8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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High flow nasal cannula improves lung aeration and enhances CO2 removal in hypoxemic critically ill patients. Intensive Care Med Exp 2015. [PMCID: PMC4797767 DOI: 10.1186/2197-425x-3-s1-a176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effects of high-flow nasal cannula therapy on oxygenation, lung volumes and CO2 removal in critically ill hypoxemic patients: preliminary results. Crit Care 2015. [PMCID: PMC4472978 DOI: 10.1186/cc14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Effects of positive end-expiratory pressure on lung ventilation/ perfusion matching: a clinical study. Crit Care 2015. [PMCID: PMC4470678 DOI: 10.1186/cc14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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L1-2 roots block with psoas compartment block: reply from the authors? Br J Anaesth 2014; 112:591-3. [PMID: 24535528 DOI: 10.1093/bja/aeu027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Psoas compartment block for anaesthesia during surgical repair of inguinal hernias. Br J Anaesth 2013; 111:298-9. [PMID: 23858074 DOI: 10.1093/bja/aet235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Quantitative assessment of endotracheal tube (ETT) biofilm by micro-CT scan: evaluation of the effectiveness of ETT cleaning devices. Crit Care 2013. [PMCID: PMC3642424 DOI: 10.1186/cc12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Influence of percutaneous tracheostomy on gas exchange in mechanically ventilated patients. Crit Care 2012. [PMCID: PMC3363559 DOI: 10.1186/cc10748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Long-term extracorporeal membrane oxygenation with minimal ventilatory support: a new paradigm for severe ARDS? Minerva Anestesiol 2012; 78:385-389. [PMID: 21617600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pulmonary tuberculosis can lead to acute respiratory distress syndrome (ARDS) which is associated with high mortality. We report the case of a patient with pulmonary tuberculosis and severe ARDS (PaO2/FiO2<100 mmHg) who was initially managed with advanced up-to-date treatments (protective ventilation and extracorporeal membrane oxygenation, ECMO) but failed to improve. After a month of failure and the development of bilateral pneumothoraces, we drastically changed our therapeutic strategy: we maximized ECMO support to maintain oxygenation, we greatly reduced ventilation pressures and we left the pneumothoraces undrained. From then on, the patient improved and he eventually survived. This case suggests that ECMO permits large reductions in lung inflation and ventilation to rest the lungs, while maintaining acceptable oxygenation. The combination of ECMO and markedly attenuated ventilation strategy may be effective in cases of severe ARDS.
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Usefulness of electrical activity of the diaphragm to detect intrinsic positive end-expiratory pressure during pressure support ventilation. Crit Care 2012. [PMCID: PMC3363502 DOI: 10.1186/cc10691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Electrical impedance tomography to monitor regional tidal ventilation at different pressure support levels. Crit Care 2011. [PMCID: PMC3061776 DOI: 10.1186/cc9566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Positive end-expiratory pressure improves oxygenation inducing ventral-to-dorsal tidal ventilation redistribution: an electrical impedance tomography study. Crit Care 2011. [PMCID: PMC3066864 DOI: 10.1186/cc9610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pentraxin 3 levels from bronchoalveolar lavage of critically ill patients predict lung infection. Crit Care 2011. [PMCID: PMC3066953 DOI: 10.1186/cc9699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Neurally adjusted ventilatory assist reduces asynchrony and patient effort in severe acute respiratory distress syndrome patients undergoing extracorporeal membrane oxygenation. Crit Care 2011. [PMCID: PMC3066865 DOI: 10.1186/cc9611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saturday, 17 July 2010. Cardiovasc Res 2010. [DOI: 10.1093/cvr/cvq174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Receptor for advanced glycation end products is associated with systemic and organ-specific severity of acute lung injury and acute respiratory distress syndrome. Crit Care 2010. [PMCID: PMC2934410 DOI: 10.1186/cc8426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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P6.05 ARTERIAL STIFFNESS AND CARDIAC DAMAGE PROGRESSION ARE ASSOCIATED IN ESSENTIAL HYPERTENSION PATIENTS. Artery Res 2010. [DOI: 10.1016/j.artres.2010.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Early persisting elevation of plasma Pentraxin 3 is associated with mortality and with coagulation impairment in severe sepsis and septic shock. Crit Care 2010. [PMCID: PMC2934436 DOI: 10.1186/cc8255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Prolonged mechanical ventilation after critical illness. Minerva Anestesiol 2008; 74:297-301. [PMID: 18500202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A significant number of patients that have been critically ill require mechanical ventilation for extended periods of time as they progress towards recovery. Many of these patients can be cared for outside of the Intensive Care Unit in facilities focused on stabilizing the underlying medical problems, managing ventilatory support, and planning for rehabilitation and home care. Although these units have varied administrative structures, they have reported similar encouraging rates of weaning and survival. In a recent study about such a ward at a large academic hospital, it was observed that, although the majority of patients were liberated from the ventilator and returned home with a satisfactory activity level, a significant number of patients did not; these patients eventually died after a protracted hospital stay, mostly after a consensual withdrawal of life support. In the present article, a relevant literature review is presented concerning the outcome of patients undergoing prolonged mechanical ventilation. The main focus of the research was to address how to alleviate the burden of prolonged critical illness on mechanically ventilated patients who may eventually die after a great deal of suffering, and to identify the tangible emotional and financial costs to these patients, their families, and society.
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Treatment of fractures of the vertebral limbus and spinal stenosis in five adolescents and five adults. Neurosurgery 1989; 24:595-604. [PMID: 2710305 DOI: 10.1227/00006123-198904000-00019] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Fractures of the vertebral limbus occur between the vertebral ring apophyses and the cartilaginous rim of the superior or inferior margins of the vertebral end plates. These fractures are typically seen in adolescents or young adults, since fusion in this area is not complete until the ages of 18 to 25. Of 85 cases reported, 24 occurred in adolescents. The authors present the clinical, neurodiagnostic, and surgical management of fractures of the vertebral limbus and coincident segmental spinal stenosis in a group of 5 adolescents and 5 adults. An additional category for fractures of the vertebral limbus is proposed, namely, a lesion that is not confined to the superior or inferior margins of the vertebral end plates, but that spans the full length of the vertebral body.
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