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Background: Patients with severe respiratory failure due to COVID‐19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno‐venous (V‐V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V‐V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID‐19 and acute respiratory failure due to spontaneous PM. Methods: This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID‐19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V‐V ECMO support (V‐V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission. Results: Twenty‐two patients were included in this study (invasive ventilation group: 13 [59%]; V‐V ECMO group: 9 [41%]). The V‐V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12–0.97], p = 0.04). Five (38%) patients in the V‐V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V‐V ECMO support within 30 days from ICU admission. Three (33%) patients in the V‐V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48–45.3], p = 0.18). Conclusions: Preliminary data suggest that V‐V ECMO without invasive ventilation may improve survival in COVID‐19‐related acute respiratory failure due to spontaneous PM. The study's retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution. [ABSTRACT FROM AUTHOR]

Aim: To analyse the evidence of non‐invasive neurally adjusted ventilatory assist (NIV‐NAVA) in preterm neonates compared to nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). Methods: We performed a systematic review and meta‐analysis of randomised controlled trials and included studies where NIV‐NAVA was analysed in preterm (<37 gestational weeks) born neonates. Our main outcomes were the need for endotracheal intubation, the need for surfactant therapy, and reintubation rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: A total of five studies were included. The endotracheal intubation rate was 25% in the NIV‐NAVA group and 26% in the nCPAP group (RR 0.91, CI: 0.56–1.48). The respective rates for surfactant therapy were 30% and 35% (RR 0.85, CI: 0.56–1.29). The reintubation rate in neonates previously invasively ventilated was 8% in the NIV‐NAVA group and 29% in the nCPAP/NIPPV group (RR 0.29, 95%CI: 0.10–0.81). Evidence certainty was rated as low for all outcomes. Conclusions: NIV‐NAVA as the primary respiratory support did not reduce the need for endotracheal intubation or surfactant therapy. NIV‐NAVA seemed to reduce the reintubation rate after extubation in pre‐term neonates. [ABSTRACT FROM AUTHOR]

Introduction Design Methods Results Conclusion Non‐ventilator hospital‐acquired pneumonia (NV HAP) is a common complication for hospitalized patients. NV HAP develops when patients aspirate oral secretions containing pathogenic bacteria. Appropriate oral hygiene can help mitigate NV HAP development. Hospital staff, including nursing assistants, play an important role in ensuring that these cares are completed.A quasi‐experimental pre–post design was used to evaluate outcomes before and after implementation of a structured oral hygiene education program.A structured oral hygiene program was developed and implemented in a large quaternary hospital. Change in NA knowledge, attitudes, and behaviors before and after implementation of the oral hygiene program was evaluated. Retrospective patient outcomes before and after the intervention were analyzed to detect changes in NV HAP rates.Following the education, nursing assistant knowledge of recommended frequency of oral care for patients who are NPO increased (67.2% vs. 82.1%, p = 0.003). NAs were more likely to report oral hygiene tools including oral suctioning (80.8% vs. 90.2%, p = 0.005) and toothbrushes (89.3% vs. 95.3%, p = 0.031). The unadjusted incidence of NV HAP was significantly lower in the post‐intervention cohort (0.25%) compared to the pre‐intervention cohort (0.74%), p < 0.001. In the adjusted model, non‐invasive positive pressure ventilation increased the odds of NV HAP by nearly sevenfold (AOR = 6.88, 95% CI: 3.99, 11.39).Focused education for NAs is an effective strategy to increase knowledge related to oral hygiene. Implementing a structured oral hygiene program for NAs appears to be a promising practice to decrease NV HAP. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusions To describe the use and the relation to outcome of different ventilation strategies in a contemporary, large, prospective registry of cardiogenic shock patients.Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.6%) underwent non‐invasive ventilation (NIV), and 363 (55.3%) underwent invasive mechanical ventilation (iMV). Patients in the iMV group were significantly younger compared to those in the NIV and OT groups (63 vs. 69 years, p < 0.001). There were no significant differences between groups regarding cardiovascular risk factors. Patients with SCAI B and C were more frequently treated with OT and NIV compared to iMV (65.1% and 65.4% vs. 42.6%, respectively, p > 0.001), while the opposite trend was observed in SCAI D patients (12% and 12.2% vs. 30.9%, respectively, p < 0.001). All‐cause mortality at 24 h did not differ amongst the three groups. The 60‐day mortality rates were 40.2% for the iMV group, 26% for the OT group, and 29.3% for the NIV group (p = 0.005), even after excluding patients with cardiac arrest at presentation. In the multivariate analysis including SCAI stages, NIV was not associated with worse mortality compared to iMV (hazard ratio 1.97, 95% confidence interval 0.85–4.56), even in more severe SCAI stages such as D.Compared to previous studies, we observed a rising trend in the utilization of NIV among cardiogenic shock patients, irrespective of aetiology and SCAI stages. In this clinical scenario, NIV emerges as a safe option for appropriately selected patients. [ABSTRACT FROM AUTHOR]

Background: Off‐label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear. Objectives: To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10–27 days postnatal) and progressively evolving (28th‐day–36th‐week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36‐weeks postmenstrual age (PMA). Methods: We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time‐dependent confounding by respiratory status using marginal structural models. Results: Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28‐days–36‐weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49). Conclusion: Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction. [ABSTRACT FROM AUTHOR]

Summary: Frailty increases peri‐operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri‐operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri‐operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027–1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642–2488), approximately 2.6‐fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri‐operative cardiac arrest compared with patients of the same age not living with frailty. [ABSTRACT FROM AUTHOR]

Different rat strains are used in various animal models of pulmonary hypertension and right ventricular (RV) failure. No systematic assessment has been made to test differences in RV response to pressure overload between rat strains. We compared RV adaptation to pulmonary trunk banding (PTB) in Wistar (W), Sprague Dawley (SD), and Fischer344 (F) rats by hemodynamic profiling focusing on diastolic function. Age‐matched male rat weanlings were randomized to sham surgery (W‐sham, n = 5; SD‐sham, n = 4; F‐sham, n = 4) or PTB (W‐PTB, n = 8; SD‐PTB, n = 8; F‐PTB, n = 8). RV function was evaluated after 5 weeks by echocardiography, cardiac MRI, and invasive pressure‐volume measurements. PTB caused RV failure and increased RV systolic pressures four‐fold in all three PTB groups compared with sham. W‐ and SD‐PTB had a 2.4‐fold increase in RV end‐systolic volume index compared with sham, while F‐PTB rats were less affected. Diastolic and right atrial impairment were evident by increased RV end‐diastolic elastance, filling pressure, and E/e' in PTB rats compared with sham, again F‐PTB the least affected. In conclusions, PTB caused RV failure with signs of diastolic dysfunction. Despite a similar increase in RV systolic pressure, F‐PTB rats showed less RV dilatation and a more preserved diastolic function compared with W‐ and SD‐PTB. [ABSTRACT FROM AUTHOR]

Stenosis in the anastomotic site or venous limb of an arteriovenous fistula (AVF) is the most frequent cause of AVF failure. Percutaneous angioplasty with a standard or high-pressure balloon is the first-line treatment for AVF stenosis due to its higher technical success rate (90%) and lower complication rate (4%). Almost 20% of stenosis cases are resistant or undilatable by regular-pressure balloon angioplasty due to fibrosis, leading to technical failure or restenosis. Alternative therapies, such as atherectomy devices or cutting balloons, are expensive and difficult to obtain in low-income developing countries. We successfully treated resistant AVF stenosis with a coronary OPN-NC ® ultra-high-pressure balloon and produced a good angiographic result with technical success. Coronary hardware is easily available and relatively cheaper compared to dedicated peripheral balloons or devices in our country due to reuse, which can be a boon in such type of cases. According to the standard hospital protocol, Cathlab hardware was reused. [ABSTRACT FROM AUTHOR]

Objective: To describe the incidence, etiology, clinical signs, diagnostics, treatments, and outcome of noniatrogenic traumatic pneumomediastinum (TPM) in dogs and cats. Design: Retrospective study of cases (2005–2022). Setting: University veterinary teaching hospital. Animals: Fifty‐two patients (29 dogs, 23 cats). Measurements and Main Results: Data collected from the medical records included signalment, physical examination findings, animal trauma triage (ATT) score, clinicopathological data, imaging data, surgical intervention, length of hospitalization, supportive care, complications, and outcome. Most dogs presented with tachycardia and tachypnea, while cats presented with hypothermia and tachypnea. Subcutaneous emphysema, pneumothorax, and dyspnea were the most common clinical signs for both species. The median calculated ATT score was 3.5 in dogs and 4 in cats. The most common radiographic abnormalities other than pneumomediastinum were pneumothorax and lung contusions. The overall mortality rate was 18%, with a significantly higher survival rate in dogs (26/28 dogs [93%], 15/22 cats (68%); P = 0.03). Outcome was unknown in 1 dog and 1 cat. The only significant difference in treatment between survivors and nonsurvivors was the requirement in dogs for positive pressure ventilation. The median hospitalization period was 2 days for both species, with a shorter hospitalization in the nonsurvivors (0.6 vs 2 days, respectively; P = 0.006). Conclusions: TPM is an infrequent pathology in veterinary medicine and may be seen without an externally obvious injury. The most common causes for TPM in dogs were vehicular trauma and bite wounds, while high‐rise syndrome was the most common cause in cats. Most of the cases have concurrent pneumothorax and require thoracocentesis; however, direct intervention to treat TPM is not usually required. The vast majority of cases did not undergo surgery to treat TPM. The prognosis for dogs with TPM was good but was guarded for cats. [ABSTRACT FROM AUTHOR]

Expiratory central airway collapse (ECAC) comprising excessive central airway collapse (EDAC) and tracheobronchomalacia. Treatment is challenging for severe cases that are not candidates for surgical management. We report a case of severe ECAC successfully managed with continuous positive airway pressure (CPAP) therapy. A 75‐year‐old female patient status post right pneumonectomy, presented with chronic cough. Dynamic bronchoscopy evaluation showed severe EDAC which improved with intraprocedural noninvasive positive pressure (NIPPV) therapy. Due to patients' comorbidities, she was not a candidate to surgical tracheobronchoplasty. Therefore, we attempted pneumatic stenting with long‐term CPAP therapy resulting in improvement of symptoms and functional capacity. The long‐term efficacy of pneumatic stenting has not been clearly established yet. Literature review of management of ECAC with NIPPV consist primarily of case reports and there is only one clinical trial being conducted to assess the efficacy of CPAP therapy in ECAC. While NIPPV arises as a sufficient alternative for management of severe ECAC, larger scale studies are needed to prove the real efficacy of NIPPV in this setting. [ABSTRACT FROM AUTHOR]

A study published in Acta Paediatrica compared the use of facemasks and binasal prongs as respiratory interfaces for preterm infants receiving continuous positive airway pressure (CPAP). The study found that facemasks resulted in significant fluctuations in CPAP pressure, potentially due to mask leaks and poor positioning. The variability in pressure levels was higher with facemasks compared to binasal prongs. The study suggests that further research is needed to understand the impact of different facemask applications and to determine the optimal respiratory interface for neonatal care. [Extracted from the article]

Objective: To analyze the optimal postextubation respiratory support in pediatric cardiac surgery patients. Design: Systematic review of randomized controlled trials. Setting: Pediatric or neonatal intensive care units. Participants: All aged children (<16 years) having cardiac surgery and postoperative invasive ventilation. Intervention: Noninvasive respiratory support, including high flow nasal cannula (HFNC), conventional oxygen therapy (COT), noninvasive positive pressure ventilation (NIPPV), continuous positive pressure (CPAP), and noninvasive high‐frequency oscillatory ventilation (NHFOV). Measurement and Main Results: Studies were not pooled for statistical synthesis due to the limited number and quality of the included studies. Risk ratios with 95% confidence intervals were calculated for individual studies. A total of 167 studies were screened and six were included. The risk of bias was low in one, high in one, and had some concerns in four of the studies. Extubation failure (defined as reintubation) was the main outcome of interest. Risk ratio for reintubation was 0.10 (CI 0.02–0.40) and 1.07 (CI 0.16–7.26) in HFNC versus COT, 0.49 (CI 0.05–5.28) in HFNC versus NIPPV, 0.40 (CI 0.08–1.94) in HFNOV versus CPAP, 0.75 (CI 0.26–2.18) in HFNOV versus NIPPV, and 1.37 (CI 0.33–5.73) in CPAP versus NIPPV. Treatment durations did not differ between the groups. Conclusion: We did not find clear evidence of a difference in reintubation rates and other clinical outcomes between different noninvasive ventilation strategies. Evidence certainty was assessed to be very low due to the risk of bias, the small number of included studies, and high imprecision. Future quality studies are needed to determine the optimal postextubation support in pediatric cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy positive pressure ventilation (TPPV) is associated with complications in patients with amyotrophic lateral sclerosis (ALS), particularly tracheostomy tube‐related problems. Aim: To determine the frequency of patients with ALS who received TPPV that have tracheal enlargement and factors associated with changes in tracheal diameter. Methods: We included 43 patients with ALS undergoing TPPV who were admitted at Sayama Neurological Hospital in October 2019. The tracheal diameter at the height of the tracheostomy tube cuff was measured radiographically at specific time points. Tidal volume, inspiratory maximum pressure (PIP), dynamic lung compliance (Cdyn), tracheostomy tube cuff data, and patient demographic information and data were also collected. Results: The frequency of tracheomegaly was 60.5% at the initial data collection. The differences in tracheal diameter between the first measurement, after 12 months, and between 3 and 12 months were significant. ΔTracheal diameter correlated with TPPV duration, PIP, Cdyn, ΔPIP, ΔCdyn, and tracheal diameter. Multiple regression analysis, with Δtracheal diameter as the objective variable and TPPV duration, Cdyn, and tracheal diameter as explanatory variables, revealed an adjusted R‐square value of 0.36. Conclusion: Tracheomegaly and more enlarged tracheal diameters over time were more frequently observed in patients with ALS receiving TPPV. Furthermore, the trachea dilates over time and the tracheal diameter was related to baseline TPPV time, Cdyn, and tracheal diameter. Patients with shorter baseline TPPV duration, higher baseline Cdyn, and smaller baseline tracheal diameter were more likely to have larger tracheal diameters. Therefore, early prevention is important. [ABSTRACT FROM AUTHOR]

Purpose: Although many studies have investigated the association between psoriasis and chronic obstructive pulmonary disease (COPD), the causal relationship between psoriasis and COPD is still unknown. Methods: We employed bidirectional Mendelian randomization to investigate the causal relationship between psoriasis and COPD. Genetic instruments for exposure were selected from two distinct genome‐wide association study databases. Single nucleotide polymorphisms associated with exposures at the genome‐wide significance level (p < 5 × 10^−8) and exhibiting low linkage disequilibrium (r^2 < 0.001) were chosen as instrumental variables. Causality was assessed using multiple MR methods, including Inverse‐Variance Weighted (IVW), MR‐Egger, Weighted Median, Simple Mode, and Weighted Mode. A significance level of p < 0.05 was considered statistically significant. Heterogeneity was examined using Cochran's Q test, and MR‐Egger regression was employed to detect pleiotropy. The robustness and reliability of the results were further evaluated through leave‐one‐out analysis. Results: We found a positive causal association between psoriasis and COPD [IVW: odds ratio (OR): 1.0006; p = 0.0056]. Heterogeneity and pleiotropy have not been discovered, so the results of the study are reliable. In the reverse analysis, no causal association between CPOD and psoriasis was found. Conclusion: Our findings revealed that psoriasis was associated with an elevated risk of COPD. However, no causal association between COPD and psoriasis was identified in our study. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine (DEX) is a centrally acting sympatholytic sedative. Abundant evidence from the intensive care unit and other settings demonstrates that the use of DEX is associated with improved sedation‐related outcomes. There is a paucity of data on the use and efficacy of DEX in the emergency department (ED). Methods: We performed a prospective single‐center observational cohort study of patients treated with intravenous DEX for any indication in the ED. We performed serial bedside evaluations of sedation depth and delirium and administered standardized questionnaires to ED physicians about their use of DEX. We assessed the incidence of hemodynamic adverse events (HAEs; bradycardia or hypotension), clinically significant HAEs (HAEs accompanied by clinical intervention or discontinuation of DEX), sedation‐related ED outcomes, and clinician perception of DEX effectiveness. Results: We enrolled 75 patients treated with DEX in the ED during our study period. The most common indication for DEX was noninvasive positive pressure ventilation (32 patients, 43%). DEX was administered in the ED for a median of 2.6 h (interquartile range [IQR] 1.6–4.9 h), with a median infusion rate of 0.3 μg/kg/h (IQR 0.2–0.4 μg/kg/h). Clinically significant HAE occurred in nine patients (12%, 95% CI 6%–22%). Other sedative or analgesic infusions were administered in the ED to 21 patients (28%). Clinicians felt DEX was highly effective (median [IQR] effectiveness score of 5 [3–5] on a 5‐point Likert scale). The median (IQR) ED Richmond Agitation Sedation Scale post‐DEX was −1 (−4 to 0). Conclusions: DEX is used in the ED for diverse indications. Additional data from larger cohorts and comparative studies are required to determine the precise incidence of clinically significant HAE associated with DEX use in the ED. ED clinicians have a positive perception of the effectiveness of DEX. [ABSTRACT FROM AUTHOR]

Post‐thrombotic syndrome (PTS) is a common complication after deep vein thrombosis (DVT) and has a major impact on physical symptoms, quality of life (QoL) and economic costs. Relatively simple lifestyle interventions as physical exercise might reduce PTS severity and increase QoL. To evaluate the direct and long‐term effects of physical activity in patients with an acute or previous DVT. We conducted a systematic review through an additional search from 2007 up to March 2022, to complement the comprehensive systematic review of Kahn et al. Articles evaluating the effect of exercise after a DVT including symptoms, QoL and the incidence and severity of PTS, were included. Quality of the studies was assessed using a GRADE‐like checklist and results were reported according to the PRISMA Statement. Ten studies were included, seven randomized controlled trials and three cohort studies. We identified three types of physical activity based on timing and duration; (1) early mobilisation in the acute phase of the DVT; (2) short duration exercise 1 year after DVT and (3) prolonged exercise during follow‐up after a previous DVT. Early mobilisation showed improvement in QoL and pain reduction and after 2 years it resulted in a significant reduction of PTS severity. Prolonged supervised exercise resulted in improvement of QoL. In addition, positive effects on symptoms of venous insufficiency and muscle functions were observed. None of the included studies reported an increased risk of PTS or worsening of symptoms due to physical activity. Physical exercise after a DVT is safe, improves QoL, reduces pain and decreases PTS severity. Lifestyle intervention such as guided individualized training programs can be a useful supplementary therapy for patients after a DVT or for PTS patients. Optimal training programs may be identified by further studies that improve patient‐oriented outcomes for both adults and children after a DVT. [ABSTRACT FROM AUTHOR]

This study systematically evaluated the effect of hydrocolloid dressings on facial pressure ulcers in patients receiving non‐invasive positive pressure ventilation (NIPPV). The Embase, PubMed, Cochrane Library, CNKI, VIP, Chinese Biomedical Literature Database and Wanfang databases were searched for randomised controlled trials on the use of hydrocolloid dressings in patients receiving NIPPV published from the inception of each database to August 2023. The literature was independently screened, data were extracted by two authors based on the inclusion and exclusion criteria, and the quality of the included literature was assessed. The meta‐analysis was performed using Stata 17.0. Thirteen studies including 1248 patients were included, with 639 patients in the intervention group and 609 patients in the control group. Meta‐analysis showed that the hydrocolloid dressing significantly reduced the incidence of facial pressure ulcers in patients with NIPPV (odds ratio = 0.16, 95% confidence intervals: 0.11–0.24, p < 0.001). Hydrocolloid dressings are effective in reducing the incidence of facial pressure ulcers in patients receiving NIPPV. However, because of the small number of included studies, this conclusion needs to be confirmed with larger samples and high‐quality clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical and ocular abnormalities in a case of Developmental Delay with Gastrointestinal, Cardiovascular, Genitourinary, and Skeletal Abnormalities (DEGCAGS syndrome). Methods: A clinical report. Case description: An infant born to a consanguineous Middle Eastern family who was delivered by cesarean section because of in utero growth restriction, premature labor, and breech presentation. Post‐partum medical problems included hypotension, generalized hypotonia, bradycardia, apnea requiring resuscitation and positive pressure ventilation, facial dysmorphia, skeletal malformations, and disorders of the gastrointestinal, immune, urinary, respiratory, cardiac, and visual systems. The family reported that a previous child had severe hypotonia at birth and was given the diagnosis of hypoxic ischemic encephalopathy; that child remains on a ventilator in a chronic care facility. Our patient was found to be homozygous for a novel pathogenic missense variant in theZNF699 zinc finger gene on chromosome 19p13 causing a syndrome known as Developmental Delay with Gastrointestinal, Cardiovascular, Genitourinary, and Skeletal Abnormalities (DEGCAGS syndrome). We review this variable syndrome, including abnormalities of the visual system not described previously. Conclusions: We describe the 15th child to be presumably identified with the DEGCAGS syndrome and the first individual with homozygous missense variants in the ZNF699 gene who had complete clinical examination and detailed retinal imaging. [ABSTRACT FROM AUTHOR]

This article discusses a study that compared the effectiveness of a two-handed hold versus a one-handed hold when delivering positive pressure ventilation (PPV) to newborn infants. The study found that the two-handed hold resulted in significantly lower mask leak compared to the one-handed hold. The findings suggest that the two-handed technique may be superior in reducing mask leak during PPV. However, the study was conducted using a neonatal manikin model, so further clinical trials are needed to validate these results in real-life situations. [Extracted from the article]

Aims: Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. Methods: This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. Results: Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty‐two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea‐esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in‐hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non‐invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. Conclusion: Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6‐week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Papilledema is thought to be the hallmark sign of increased intracranial pressure (ICP). Distension of the subarachnoid space within the optic nerve sheath is also commonly reported in MR studies as an indirect sign of increased ICP. Hypothesis: General anesthesia and positive pressure ventilation might result in changes in optic sheath diameter (OSD) observed on clinical brain MRI. Study Type: Retrospective. Population: One hundred forty‐five patients (154 MRI scans, 7.3 years ± 5.1); 97 studies in the anesthesia group (4.4 years ± 3.4) of which 22 had papilledema, and 57 in the non‐anesthesia group (12.3 years ± 3.2), of which 28 had papilledema. Field Strength/Sequence: 1.5T or 3.0T volumetric T2 images. T2 images were obtained from different vendors. Assessment: OSD, optic nerve diameter (OND), and peri‐optic cerebrospinal fluid (CSF) were measured manually on T2‐weighted MR images for various population subgroups (with and without anesthesia; with or without papilledema). The correlation between these measurements and the clinical diagnosis of papilledema was evaluated via receiver operating characteristic (ROC) analysis. Statistical Tests: Chi‐square test; Mann–Whitney Test; Spearman's test and ROCs; Interclass correlation coefficient, P = 0.05. Results: General anesthesia resulted in significantly larger mean OSD in patients with or without papilledema (7.3 ± 1.0 mm vs. 6.1 ± 1.1 mm and 6.7 ± 1.0 mm vs. 5.4 ± 0.9 mm, respectively). In the non‐anesthesia group, the average OSD values (6.1 ± 1.1 mm) were significantly higher in papilledema patients compared to non‐papilledema patients (5.4 ± 0.9 mm), with larger peri‐optic CSF rim (1.6 ± 0.4 mm vs. 1.3 ± 0.3 mm). In the anesthesia group, OND was significantly larger in papilledema patients (3.4 ± 0.4 mm vs. 3.1 ± 0.5 mm), though the average peri‐optic CSF rim did not reach a significance in papilledema compared with non‐papilledema patients (2.0 ± 0.3 mm vs. 1.8 ± 0.4 mm, P = 0.06). In patients with general anesthesia, peri‐optic CSF rim had a limited correlation with increased ICP. Data Conclusion: In the pediatric population, imaging findings of increased OSD on brain MRI might be related to general anesthesia rather than increased ICP. The interpretation of optic nerve sheath distention should be reported cautiously in conjunction with anesthesia status, especially in the pediatric population. Evidence Level: 4 Technical Efficacy: 5 [ABSTRACT FROM AUTHOR]

Brachycephalic obstructive airway syndrome (BOAS) comprises a group of anatomical upper respiratory tract abnormalities that collectively result in various degrees of upper respiratory tract obstruction. Stenotic nares is a common feature of BOAS, and in dogs, the main cause is axial deviation of the alar cartilage. In contrast, narrowing of the nares in cats is predominantly the result of a redundant skin fold at the junction of the ventral floor of the nostrils and the haired skin of the lip. Three brachycephalic cats with inspiratory obstruction were referred to the surgery department of the Veterinary Teaching Hospital of Ferdowsi University of Mashhad, Iran. The predominant cause of obstruction was nostril stenosis due to the presence of redundant skin on the ventral floor of the nares. All three cats underwent surgical correction using a single pedicle advancement flap technique, which was first described by Berns et al. (2020). All three cats had positive outcomes, with no surgical complications and no episodes of respiratory distress reported within a 9‐month follow‐up. Appropriate surgical treatment of feline patients with stenotic nares can result in good long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: Pressure‐controlled face mask ventilation (PC‐FMV) with positive end‐expiratory pressure (PEEP) after apnoea following induction of general anaesthesia prolongs safe apnoea time and reduces atelectasis formation. However, depending on the set inspiratory pressure, a delayed confirmation of a patent airway might occur. We hypothesised that by lowering the peak inspiratory pressure (PIP) when using PC‐FMV with PEEP, confirmation of a patent airway would not be delayed as studied by the first return of CO2, compared with manual face mask ventilation (Manual FMV). Methods: This was a single‐centre, randomised controlled non‐inferiority trial. Seventy adult patients scheduled for elective day‐case surgery under general anaesthesia with body mass index between 18.5 and 29.9 kg m−2, American Society of Anesthesiologists (ASA) classes I–III, and without anticipated difficult FMV, were included. Before the start of pre‐oxygenation and induction of general anaesthesia, participants were randomly allocated to receive ventilation with either PC‐FMV with PEEP, at a PIP of 11 and a PEEP of 6 cmH2O or Manual FMV, with the adjustable pressure‐limiting valve set at 11 cmH2O. The primary outcome variable was the number of ventilatory attempts needed until confirmation of a patent airway, defined as the return of at least 1.3 kPa CO2. Results: The return of ≥1.3 kPa CO2 on the capnography curve was observed after mean ± SD, 3.6 ± 4.2 and 2.5 ± 1.9 ventilatory attempts/breaths with PC‐FMV with PEEP and Manual FMV, respectively. The difference in means (1.1 ventilatory attempts/breaths) had a 99% CI of −1.0 to 3.1, within the accepted upper margin of four breaths for non‐inferiority. Conclusion: Following induction of general anaesthesia, PC‐FMV with PEEP was used without delaying a patent airway as confirmed with capnography, if moderate pressures were used. [ABSTRACT FROM AUTHOR]

In another report of surgical management of enterolithiasis, mean surgery time was 128 ± 31 min (range 70-200 min) with 13% requiring 1 enterotomy, 83% of surgeries requiring 2 enterotomies and 4% requiring 3 enterotomies (Torrent Crosa et al., [29]). While lumen diameter is not limiting for closure of right dorsal colon enterotomies, it is important to be precise with conservative suture bite sizes and minimal inversion when closing descending colon enterotomies. Enteroliths, faecaliths, ingested foreign bodies and bezoars are examples of focal intraluminal obstructions that can lodge in inaccessible parts of the gastrointestinal tract (Hanson & Schumacher, [10]; Hassel, [11]; Klohnen, [17]; Oreff et al., [22]; Pierce et al., [24]). [Extracted from the article]

Cough‐ and asthma‐like symptoms are common adverse reactions to angiotensin‐converting enzyme inhibitors (ACEi). However, attributing these symptoms to the use of ACEi might be masked by clinical confounders. We report a 68‐year‐old female residing in a long‐term acute‐care facility for patients requiring prolonged invasive mechanical ventilation treated for years with ACEi. Daily reversible bouts of life‐threatening severe bronchospasm gradually developed over 6 weeks and abruptly resolved following the cessation of ACEi treatment. The late appearance of bronchospasm and the unique clinical setup of chronic invasive ventilation in a patient with smoking‐related chronic obstructive lung disease are among the principal confounders that delay the identification of the causative association between ACEi and respiratory compromise. Chronic positive pressure ventilation may also conceal small airway reactivity and obstruction, similar to auto‐positive end‐expiratory pressure (auto‐PEEP). Conceivably, angiotensin receptor blockers should be preferred over ACEi in such patients. [ABSTRACT FROM AUTHOR]

A study was conducted to determine if air leakage around supraglottic airway devices (SADs) used during general anesthesia generates high concentrations of respiratory aerosol, which could pose a risk of airborne disease transmission to healthcare providers. The study involved monitoring aerosol levels during positive pressure ventilation with and without intentional leaks in two UK hospitals. The results showed that SADs did not generate high concentrations of respiratory aerosol, even with a large airway leak. These findings suggest that SADs should not be classified as aerosol-generating procedures and do not require additional airborne precautions. [Extracted from the article]

Summary: The amount of aerosol generation associated with the use of positive pressure ventilation via a supraglottic airway device has not been quantified. We conducted a two‐group, two‐centre, prospective cohort study in which we recruited 21 low‐risk adult patients scheduled for elective surgery under general anaesthesia with second‐generation supraglottic airway devices. An optical particle sizer and an isokinetic sampling probe were used to record particle concentrations per second at different size distributions (0.3–10 μm) during use as well as baseline levels during two common activities (conversation and coughing). There was a median (IQR [range]) peak increase of 2.8 (1.5–4.5 [1–28.1]) and 4.1 (2.0–7.1 [1–18.2]) times background concentrations during SAD insertion and removal. Most of the particles generated during supraglottic airway insertion (85.0%) and removal (85.3%) were < 3 μm diameter. Median (IQR [range]) aerosol concentration generated by insertion (1.1 (0.6–5.1 [0.2–22.3]) particles.cm−3) and removal (2.1 (0.5–3.0 [0.1–18.9]) particles.cm−3) of SADs were significantly lower than those produced during continuous talking (44.5 (28.3–70.5 [2.0–134.5]) particles.cm−3) and coughing (141.0 (98.3–202.8 [4.0–296.5]) particles.cm−3) (p < 0.001). The aerosol levels produced were similar with the two devices. The proportion of easily inhaled and small particles (<1 μm) produced during insertion (57.5%) and removal (57.5%) was much lower than during talking (99.1%) and coughing (99.6%). These results suggest that the use of supraglottic airway devices in low‐risk patients, even with positive pressure ventilation, generates fewer aerosols than speaking and coughing in awake patients. [ABSTRACT FROM AUTHOR]

Objective: To report a case of systemic gas embolism associated with removal of a chest drain perforating a lung lobe in a dog undergoing sternotomy under general anesthesia and intermittent positive pressure ventilation. Case Summary: An 8‐year‐old Cocker Spaniel underwent an exploratory thoracotomy via median sternotomy for surgical management of pyothorax that was treated conservatively for 7 days prior to referral following bilateral chest drain placement. The surgical procedure consisted of a subphrenic mediastinectomy and pericardiectomy. During surgery, it became apparent that the right drain was perforating the right middle lung lobe. Sudden desaturation and rapid hemodynamic deterioration occurred after the drain was removed. A systemic gas embolism was suspected on the basis of clinical signs and results of an arterial blood gas analysis, and immediate supportive treatment was started with an adequate response. Once the surgical procedure was completed, a clear "mill wheel" sound was audible on cardiac auscultation and point‐of‐care cardiac ultrasound confirmed the presence of gas bubbles in the cardiac chambers. The dog recovered from anesthesia and was managed in the intensive care unit where arterial blood gas analyses were nearly normal and the dog made a full recovery. New or Unique Information Provided: In people, there are reports of fatal air embolism related to the use of chest drains. To our knowledge, this is the first case report in dogs of a systemic gas embolism during open‐chest surgery caused by a chest drain perforating a lung lobe. Immediate recognition and aggressive treatment of this life‐threatening condition should be provided in order to achieve a favorable outcome. [ABSTRACT FROM AUTHOR]

Summary: The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non‐cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in‐hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. Patients were allocated randomly to airway management with a supraglottic airway device or a tracheal tube. Between August 2016 and April 2020, 2900 patients were studied, of whom 2751 were included in the primary analysis (1387 with supraglottic airway device and 1364 with a tracheal tube). Pre‐operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1–2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference −5.6% (95%CI −8.7 to −2.5), risk ratio 0.78 (95%CI 0.67–0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra‐operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube. [ABSTRACT FROM AUTHOR]

Summary: There are concerns about the validation and accuracy of currently available consumer sleep technology for sleep‐disordered breathing. The present report provides a background review of existing consumer sleep technologies and discloses the methods and procedures for a systematic review and meta‐analysis of diagnostic test accuracy of these devices and apps for the detection of obstructive sleep apnea and snoring in comparison with polysomnography. The search will be performed in four databases (PubMed, Scopus, Web of Science, and the Cochrane Library). Studies will be selected in two steps, first by an analysis of abstracts followed by full‐text analysis, and two independent reviewers will perform both phases. Primary outcomes include apnea–hypopnea index, respiratory disturbance index, respiratory event index, oxygen desaturation index, and snoring duration for both index and reference tests, as well as the number of true positives, false positives, true negatives, and false negatives for each threshold, as well as for epoch‐by‐epoch and event‐by‐event results, which will be considered for the calculation of surrogate measures (including sensitivity, specificity, and accuracy). Diagnostic test accuracy meta‐analyses will be performed using the Chu and Cole bivariate binomial model. Mean difference meta‐analysis will be performed for continuous outcomes using the DerSimonian and Laird random‐effects model. Analyses will be performed independently for each outcome. Subgroup and sensitivity analyses will evaluate the effects of the types (wearables, nearables, bed sensors, smartphone applications), technologies (e.g., oximeter, microphone, arterial tonometry, accelerometer), the role of manufacturers, and the representativeness of the samples. [ABSTRACT FROM AUTHOR]

Cranio‐spinal volume and pressure changes associated with the cardiac‐cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion‐sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volume–pressure dynamics at the cranio‐cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. Evidence Level: 2. Technical Efficacy: 5. [ABSTRACT FROM AUTHOR]

Objectives: Current diagnosis of nonalcoholic fatty liver disease (NAFLD) relies on biopsy or MR‐based fat quantification. This prospective study explored the use of ultrasound with artificial intelligence for the detection of NAFLD. Methods: One hundred and twenty subjects with clinical suspicion of NAFLD and 10 healthy volunteers consented to participate in this institutional review board‐approved study. Subjects were categorized as NAFLD and non‐NAFLD according to MR proton density fat fraction (PDFF) findings. Ultrasound images from 10 different locations in the right and left hepatic lobes were collected following a standard protocol. MRI‐based liver fat quantification was used as the reference standard with >6.4% indicative of NAFLD. A supervised machine learning model was developed for assessment of NAFLD. To validate model performance, a balanced testing dataset of 24 subjects was used. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy with 95% confidence interval were calculated. Results: A total of 1119 images from 106 participants was used for model development. The internal evaluation achieved an average precision of 0.941, recall of 88.2%, and precision of 89.0%. In the testing set AutoML achieved a sensitivity of 72.2% (63.1%–80.1%), specificity of 94.6% (88.7%–98.0%), positive predictive value (PPV) of 93.1% (86.0%–96.7%), negative predictive value of 77.3% (71.6%–82.1%), and accuracy of 83.4% (77.9%–88.0%). The average agreement for an individual subject was 92%. Conclusions: An ultrasound‐based machine learning model for identification of NAFLD showed high specificity and PPV in this prospective trial. This approach may in the future be used as an inexpensive and noninvasive screening tool for identifying NAFLD in high‐risk patients. [ABSTRACT FROM AUTHOR]

COVID‐19, chronic obstructive pulmonary disease (COPD), heart failure (HF), and pneumonia can lead to acute respiratory deterioration. Prompt and accurate diagnosis is crucial for effective clinical management. Chest X‐ray (CXR) and chest computed tomography (CT) are commonly used for confirming the diagnosis, but they can be time‐consuming and biased. To address this, we developed a computationally efficient deep feature engineering model called Hybrid‐Patch‐Alex for automated COVID‐19, COPD, and HF diagnosis. We utilized one CXR dataset and two CT image datasets, including a newly collected dataset with four classes: COVID‐19, COPD, HF, and normal. Our model employed a hybrid patch division method, transfer learning with pre‐trained AlexNet, iterative neighborhood component analysis for feature selection, and three standard classifiers (k‐nearest neighbor, support vector machine, and artificial neural network) for automated classification. The model achieved high accuracy rates of 99.82%, 92.90%, and 97.02% on the respective datasets, using kNN and SVM classifiers. [ABSTRACT FROM AUTHOR]

Summary: Adequate inflation of the endotracheal tube (ETT) cuff is important to avoid leakage of anaesthetic gases or aspiration of gastric contents and to allow positive pressure ventilation. However, overinflation or herniation of the cuff can cause tracheal mucosal damage and in rare cases even obstruction of the ETT. ETT obstruction due to the cuff itself may be an underrecognised phenomenon in equine practice and we aim to create awareness with this retrospective case series (n = 3). Cases identified between 2014 and 2021 with (partial) ETT obstruction due to cuff overinflation or cuff herniation at the Utrecht University Equine Clinic were selected. Anaesthesia records were examined and presented. Two cases occurred in foals and one in a pony. In each case, high airway pressure was encountered and no or minimal thoracic excursions were visible. In all three cases, cuff deflation led to immediate normalisation of ventilation parameters. When presented with an intubated patient that is difficult to ventilate and high airway pressures exist, ETT cuff overinflation or herniation should be considered as a possible cause; rapid cuff deflation should be included in algorithms for management of ventilation failure due to suspected airway obstruction. [ABSTRACT FROM AUTHOR]

Objectives: Diaphragmatic dysfunction has been reported as a cause of dyspnea, and its diagnosis can be made using ultrasound. Diaphragmatic ultrasound is mainly used to predict respiratory failure in chronic conditions. The use of diaphragmatic ultrasound has also risen in acute settings, such as emergency departments (EDs). However, the number of studies on its use still needs to be increased. The present study aimed to find the incidence of diaphragmatic dysfunction in the ED. Methods: This prospective cohort study was conducted in an ED. We enrolled patients aged greater than 18 years who presented with dyspnea. Diaphragmatic excursion and diaphragmatic thickness techniques were performed. The primary outcome was the incidence of diaphragmatic dysfunction. The secondary outcomes were the associations between diaphragmatic dysfunction and the composition of respiratory therapies within 24 hours, intubation within 24 hours, and 7‐day mortality. Results: A total of 237 patients were analyzed. The incidences of diaphragmatic dysfunction assessed by diaphragmatic excursion and diaphragm thickness were 22.4 and 32.1%, respectively. Patients with sepsis and cancer had the highest incidences. Diaphragmatic dysfunction assessed by both techniques was not associated with the composition of respiratory support therapies within 24 hours, intubation within 24 hours, or 7‐day mortality. Conclusions: The incidence of diaphragmatic dysfunction in dyspneic patients in the ED ranged from 22.4 to 32.1%, depending on the ultrasound technique. Diaphragmatic dysfunction was not associated with the composition of respiratory support therapies, intubation, or mortality. [ABSTRACT FROM AUTHOR]

This article discusses the variation in the amount of leakage containing inhalational anaesthetics in the breathing circuits of anaesthesia machines. The authors challenge the claim made by Mulier et al. that leak is constant, arguing that the amount of leak is actually proportional to the pressure difference between the interior and exterior of the breathing circuit. They conducted an experiment using a high-fidelity simulator and found that leaks seldom occur during low-flow anaesthesia if the leak level is below 300 ml.min-1. They also note that modern anaesthesia machines with automatic leak testing and pressure-regulated ventilation modes should have negligible system leaks. [Extracted from the article]

This article discusses the use of mask ventilation and oxygen supplementation in German delivery rooms from 2008 to 2022. The study analyzed data on perinatal health in Germany and found that the frequency of mask ventilation increased significantly during this time period, while the use of supplementary oxygen decreased. The proportion of preterm births also decreased. The findings suggest that more infants have been born in a poor clinical condition in Germany, despite the decrease in preterm births. The study highlights the importance of appropriate training in mask ventilation for healthcare professionals. Further research is needed to determine which neonates require resuscitative interventions and why. [Extracted from the article]

Aim: International Liaison Committee on Resuscitation (ILCOR‐2020) report recommend starting delivery room resuscitation of all preterm neonates of <35 weeks' gestation with 21–30% oxygen. However, the correct initial oxygen concentration for resuscitation of preterm neonates in delivery room is inconclusive. In this blinded, randomised, controlled trial, we compared room air with 100% oxygen for oxidative stress and clinical outcomes in delivery room resuscitation of preterm neonates. Methods: Preterm neonates 28–33 weeks' gestation requiring positive pressure ventilation at birth were randomly allocated to room air or 100% oxygen. Investigators, outcome assessors and data analysts were blinded. Rescue 100% oxygen was used whenever trial gas failed (need for positive pressure ventilation >60 s or chest compression). Primary outcome: Plasma 8‐isoprostane levels at 4 h of age. Secondary outcomes: mortality by discharge, bronchopulmonary dysplasia, retinopathy of prematurity and neurological status at 40 weeks post‐menstrual age. All subjects were followed till discharge. Intention to treat analysis was carried out. Results: A total of 124 neonates were randomised to room air (n = 59) or 100% oxygen (n = 65). Isoprostane level at 4 h was similar in both the groups (median (interquartile range): 280 (180–430) vs. 250 (173–360) pg/mL, P = 0.47). No difference was observed in mortality and other clinical outcomes. Room air group had higher treatment failures (27 (46%) vs. 16 (25%); relative risk (RR) 1.9 (1.1–3.1)) and took longer time to establish regular respiration (230 ± 231 vs. 182 ± 261, mean difference = 48 (40, 136) seconds). Conclusions: In preterm neonates 28–33 weeks' gestation requiring resuscitation in the delivery room, room air (21%) is not the correct concentration to initiate resuscitation. Larger controlled trials involving multiple centres in low‐ and middle‐income countries are immediately required for a conclusive answer. [ABSTRACT FROM AUTHOR]

Objective: Endotracheal intubation is a common procedure in the medical intensive care unit (MICU), but it carries risk of complications including, but not limited to, subglottic stenosis (SGS) and tracheal stenosis (TS). Current literature suggests identifiable risk factors for the development of airway complications. This study is a comprehensive evaluation of potential risk factors in patients who developed SGS and TS following endotracheal intubation in our MICU. Methods: Patients intubated in our MICU were identified from 2013 to 2019. Diagnoses of SGS or TS within 1 year of MICU admission were identified. Data extracted included age, sex, body measurements, comorbidities, bronchoscopies, endotracheal tube size, tracheostomy, social history, and medications. Patients with prior diagnosis of airway complication, tracheostomy, or head and neck cancer were excluded. Univariate and multivariate logistic regressions were performed. Results: A total of 136 patients with TS or SGS were identified out of a sample of 6603 patients intubated in the MICU. Cases were matched to controls who did not develop airway stenosis based on identical Charlson Comorbidity Index scores. Eighty six controls were identified with a complete record of endotracheal/tracheostomy tube size, airway procedures, sociodemographic data, and medical diagnosis. Regression analysis showed that SGS or TS were associated with tracheostomy, bronchoscopy, chronic obstructive pulmonary disease, current tobacco use, gastroesophageal reflux disease, systemic lupus erythematosus, pneumonia, bronchitis, and numerous medication classes. Conclusion: Various conditions, procedures, and medications are associated with an increased risk of developing SGS or TS. Level of evidence: 4. This study evaluates risk factors for the development of subglottic stenosis and tracheal stenosis for adult patients who underwent endotracheal intubation in the medical intensive care unit at a tertiary care referral hospital. [ABSTRACT FROM AUTHOR]

Background: Prehospital anesthesia may lead to circulatory collapse after severe hemorrhage. It is possible that permissive hypoventilation, refraining from tracheal intubation and accepting spontaneous ventilation, decreases this risk, but it is not known if oxygen delivery can be maintained. We investigated the feasibility of permissive hypoventilation after class III hemorrhage and whole blood resuscitation in three prehospital phases: 15 min on‐scene, 30 min whole blood resuscitation, and 45 min after. Study Design and Methods: 19 crossbred swine, mean weight 58.5 kg, were anesthetized with ketamine/midazolam and hemorrhaged to a mean (SD) 1298 (220) mL (33%) and randomized to permissive hypoventilation (n = 9) or positive pressure ventilation with FiO2 21% (n = 10). Results: In permissive hypoventilation versus positive pressure ventilation, indexed oxygen delivery (DO2I) decreased to mean (SD) 4.73 (1.06) versus 3.70 (1.13) mL min−1 kg−1 after hemorrhage and increased to 8.62 (2.09) versus 6.70 (1.56) mL min−1 kg−1 at completion of resuscitation. DO2I, indexed oxygen consumption (VO2I), and arterial saturation (SaO2) did not differ. Permissive hypoventilation increased the respiratory rate and increased pCO2. Positive pressure ventilation did not deteriorate circulation. Cardiac index (CI), systolic arterial pressure (SAP), hemoglobin (Hb), and heart rate did not differ. Discussion: Permissive hypoventilation and positive pressure ventilation were equally effective to maintain oxygen delivery in all phases. A respiratory rate of 40 was feasible, showing no signs of respiratory fatigue for 90 min, indicating that whole blood resuscitation may be prioritized in select patients with severe hemorrhage and spontaneous breathing. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) can improve respiratory mechanics and gas exchange, but different airway pressures have not been compared in foals. Hypothesis/Objectives: Assess the effect of different airway pressures during CPAP and PSV have on respiratory function in healthy foals with pharmacologically induced respiratory insufficiency. We hypothesized that increased airway pressures would improve respiratory mechanics and increased positive end‐expiratory pressure (PEEP) would be associated with hypercapnia. Animals: Six healthy foals from a university teaching herd. Methods: A prospective, 2‐phase, 2‐treatment, randomized cross‐over study design was used to evaluate sequential interventions in sedated foals using 2 protocols (CPAP and PSV). Outcome measures included arterial blood gases, spirometry, volumetric capnography, lung volume and aeration assessed using computed tomography (CT). Results: Sedation and dorsal recumbency were associated with significant reductions in arterial oxygen pressure (PaO2), respiratory rate, and tidal volume. Continuous positive airway pressure was associated with improved PaO2, without concurrent hypercapnia. Volumetric capnography identified improved ventilation:perfusion (V/Q) matching and increased carbon dioxide elimination during ventilation, and spirometry identified decreased respiratory rate and increased tidal volume. Peak inspiratory pressure was moderately associated with PaO2 and lung volume. Improved pulmonary aeration was evident in CT images, and lung volume was increased, particularly during CPAP. Conclusions and Clinical Importance: Both CPAP and PSV improved lung mechanics and gas exchange in healthy foals with induced respiratory insufficiency. [ABSTRACT FROM AUTHOR]

Aim: The aim was to study the prevalence of bradycardia at birth in newborns requiring positive pressure ventilation (PPV), distribution of first measured heart rate (HR), changes in HR before start of PPV and HR response to PPV. Methods: A population‐based study including newborns ≥30 weeks' gestation receiving PPV at birth. HR was captured immediately after birth and continuously throughout resuscitation using the dry‐electrode ECG device NeoBeat. Time of birth was registered in the Liveborn app. Provision of PPV was captured by video. Results: We included 98 newborns receiving PPV at birth. Among newborns with HR measured within 60 s after birth, median (quartiles) first HR was 112 (84, 149) bpm recorded 19 (14, 37) s after birth, of which 33% had first HR <100 and 10% had first HR <60 bpm respectively. First HR was widely distributed. Median HR at start PPV 69 s after birth was 129 bpm. In newborns with an initial low HR, HR typically remained low for 20 s of PPV before increasing rapidly over the next 20–30 s. Conclusions: First measured HR was ≥100 bpm in two thirds of newborns receiving PPV. In bradycardic infants, HR did not increase until after 20 s of PPV. [ABSTRACT FROM AUTHOR]

Controlling adhesion on demand is essential for many manufacturing and assembly processes such as microtransfer printing. Among various strategies, pneumatics‐controlled switchable adhesion is efficient and robust but currently still suffers from challenges in miniaturization and high energy cost. In this paper, a novel way to achieve tunable adhesion using low pressure by inducing sidewall buckling in soft hollow pillars (SHPs) is introduced. It is shown that the dry adhesion of these SHPs can be changed by more than two orders of magnitude (up to 151×) using low activating pressure (≈−10 or ≈20 kPa). Large enough negative pressure triggers sidewall buckling while positive pressure induces sidewall bulging, both of which can significantly change stress distribution at the bottom surface to facilitate crack initiation and reduce adhesion therein. It is shown that a single SHP can be activated by a micropump to manipulate various lightweight objects with different curvatures and surface textures. Here, it is also demonstrated that an array of SHPs can realize selective pick‐and‐place of an array of objects. These demonstrations illustrate the robustness, simplicity, and versatility of these SHPs with highly tunable dry adhesion. [ABSTRACT FROM AUTHOR]

Pulmonary air leak is the most common complication of lung surgery, with air leaks that persist longer than 5 days representing a major source of post-surgery morbidity. Clinical management of air leaks is challenging due to limited methods to precisely locate and assess leaks. Here, we present a sound-guided methodology that enables rapid quantitative assessment and precise localization of air leaks by analyzing the distinct sounds generated as the air escapes through defective lung tissue. Air leaks often present after lung surgery due to loss of tissue integrity at or near a staple line. Accordingly, we investigated air leak sounds from a focal pleural defect in a rat model and from a staple line failure in a clinically relevant swine model to demonstrate the high sensitivity and translational potential of this approach. In rat and swine models of free-flowing air leak under positive pressure ventilation with intrapleural microphone 1 cm from the lung surface, we identified that: (a) pulmonary air leaks generate sounds that contain distinct harmonic series, (b) acoustic characteristics of air leak sounds can be used to classify leak severity, and (c) precise location of the air leak can be determined with high resolution (within 1 cm) by mapping the sound loudness level across the lung surface. Our findings suggest that sound-guided assessment and localization of pulmonary air leaks could serve as a diagnostic tool to inform air leak detection and treatment strategies during video-assisted thoracoscopic surgery (VATS) or thoracotomy procedures. [ABSTRACT FROM AUTHOR]

Background: Avoiding endotracheal intubation and using nasal continuous positive airway pressure as the initial treatment is recommended in infants with respiratory distress syndrome (RDS), and modes of lesser invasive surfactant administration have recently been reported. We report a pilot study assessing the feasibility of surfactant therapy using a bronchofiberscope (STUB) in RDS. Methods: Surfactant was administered to 31 preterm infants (gestational age range of 28 weeks 0 days to 36 weeks 6 days) diagnosed with RDS, through the working channel of the bronchofiberscope or endotracheal tubes. Patient characteristics, outcomes, adverse events, and comorbidities were assessed in the two groups. Results: Twelve infants received STUB. Two of the 12 infants (17%) needed subsequent intubation and additional surfactant administration. Nineteen infants received surfactant through endotracheal tubes. Four of the 19 infants (21%) required additional surfactants. There was no significant difference in the number of infants that needed additional surfactant (p = 1.00). Gestational age, birthweight, length of hospitalization, adverse events, such as desaturations and bradycardias, and comorbidities were similar between the two groups. Days of invasive ventilation were significantly shorter in the STUB group (p = 0.0002). Conclusion: STUB was feasible in this small cohort and reduced the need for intubation to 17%, leading to fewer days of invasive ventilation, without increasing comorbidities and adverse events. To the best of our knowledge, this is the first study to administer surfactants using bronchofiberscopes. [ABSTRACT FROM AUTHOR]

Background: Viral respiratory infections are one of the main causes of hospitalization in children. Even if mortality rate is low, 2% to 3% of the hospitalized children need mechanical ventilation. Risk factors for admission to the pediatric intensive care unit (PICU) are well known, while few studies have described risk factors for invasive ventilator support and prolonged hospitalization. Methods: A retrospective study including all patients aged between 2 and 18 months with a confirmed viral respiratory infection, requiring admission to PICU from September to March between 2015 and 2019, was conducted at Bambino Gesù Children's Hospital in Rome, Italy. Results: One hundred ninety patients were enrolled, with a median age of 2.7 months; 32.1% had at least one comorbidity, mainly prematurity. The most frequent isolated viruses were RSV‐B, rhinovirus, and RSV‐A; 38.4% needed mechanical ventilation. This subgroup of patients had lower median birth weight compared with patients not requiring mechanical ventilation (2800 g vs. 3180 g, p = 0.02); moreover, comorbidities were present in 43.8% of intubated patients and in 24.8% of patients treated with non‐invasive ventilation (p = 0.006). Viral coinfection did not result to be a risk factor for mechanical support, while virus–bacteria coinfection was significantly associated with mechanical ventilation (p < 0.001). Similar risk factors were identified for prolonged hospitalization. Conclusions: Early identification of patients who could have a sudden respiratory deterioration and need of mechanical ventilation is crucial to reduce complications due to orotracheal intubation and prolonged hospitalization in PICU. Further studies are needed to define high‐risk group of patients and to design targeted interventions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. Methods: The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. Results: The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision‐making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. Conclusion: Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit. [ABSTRACT FROM AUTHOR]