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The article discusses the Brain4Care (B4C) system, a noninvasive technique for assessing intracranial pressure (ICP). The system uses a wearable device to detect cranial microexpansions and translate them into ICP pulse waveforms. The analysis of these waveforms can provide valuable information about intracranial hemodynamics and compliance. The B4C system has shown promising results in clinical settings, but further validation studies are needed. It offers advantages over invasive techniques and has the potential to be used in various clinical situations and settings. Ongoing research and improvements may address its limitations and establish its role in neurocritical care. [Extracted from the article]

This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation. [ABSTRACT FROM AUTHOR]

Background: Hypotension is common in the post-anesthesia care unit (PACU) and intensive care unit (ICU), and is associated with adverse patient outcomes. The Hypotension Prediction Index (HPI) algorithm has been shown to accurately predict hypotension in mechanically ventilated patients in the OR and ICU and to reduce intraoperative hypotension (IOH). Since positive pressure ventilation significantly affects patient hemodynamics, we performed this validation study to examine the performance of the HPI algorithm in a non-ventilated PACU and ICU population. Materials & Methods: The performance of the HPI algorithm was assessed using prospectively collected blood pressure (BP) and HPI data from a PACU and a mixed ICU population. Recordings with sufficient time (≥3 h) spent without mechanical ventilation were selected using data from the electronic medical record. All HPI values were evaluated for sensitivity, specificity, predictive value, and time-to-event, and a receiver operating characteristic (ROC) curve was constructed. Results: BP and HPI data from 282 patients were eligible for analysis, of which 242 (86%) were ICU patients. The mean age (standard deviation) was 63 (13.5) years, and 186 (66%) of the patients were male. Overall, the HPI predicted hypotension accurately, with an area under the ROC curve of 0.94. The most used HPI threshold cutoff in research and clinical use, 85, showed a sensitivity of 1.00, specificity of 0.79, median time-to-event of 160 s [60–380], PPV of 0.85, and NPV of 1.00. Conclusion: The absence of positive pressure ventilation and the influence thereof on patient hemodynamics does not negatively affect the performance of the HPI algorithm in predicting hypotension in the PACU and ICU. Future research should evaluate the feasibility and influence on hypotension and outcomes following HPI implementation in non-ventilated patients at risk of hypotension. [ABSTRACT FROM AUTHOR]

Objective The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure. Study Design Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal–Wallis test were used to compare outcomes. Results Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar. Conclusion In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects. Key Points HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effect. HFPPV is more widely available and can mitigate the limitations faced when using HFOV. HFPPV allows for intra- or interhospital transfer of neonates with CDH. [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]

Introduction: Pneumonia is a common and devastating complication following hip fracture surgery in older patients. Time to surgery is a potentially modifiable factor associated with improved prognosis, and we aim to quantify the time-effect relationship between time to surgery and in-hospital postoperative pneumonia (IHPOP) and identify the effect of delayed surgery on the risk of IHPOP. Methods: We analyzed clinical data of older hip fracture patients (≥60 years) undergoing surgical treatments at a tertiary referral trauma center between 2015 and 2020. Restricted cubic spline (RCS) was used to fit the time-effect relationship between time to surgery and IHPOP. Based on the results of RCS, we divided patients into two groups of "early surgery" and "delayed surgery." A 1:1 propensity score matching (PSM) analysis and multivariate conditional logistic regression analysis were performed to minimize the selection bias and determine the association magnitude. Subgroup analysis was conducted to assess potential interaction effects between delayed surgery and common risk factors for IHPOP. Results: 3,118 eligible patients were included. The RCS curve showed an inverse S-shape trend and the relative risk of IHPOP decreased in the range of days 2–3 and increased on day 1 and day 3 or more post-injury, with the lowest point on day 3. PSM yielded 1,870 matched patients and delayed surgery (>3 days) was identified to be independently associated with IHPOP (relative ratio, 1.66; 95% confidence interval, 1.12–2.46; p value, 0.011). We observed positive interaction effects between delayed surgery and age of 80 years or more, female gender, COPD, heart disease, ASA score ≥3, anemia, and hypoproteinemia. Conclusion: The relative risk of IHPOP decreased in the range of 2–3 days and increased on day 1 and day 3 or more post-injury. Delayed surgery (>3 days) was identified to be independently associated with a 1.66-fold increased risk of IHPOP. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization is a commonly used method of administering drugs and measuring central venous pressure during major surgery. Chronic obstructive pulmonary disease, acute respiratory distress syndrome, and obstructive sleep apnea are among the respiratory disorders that can be treated with positive airway pressure (PAP). While PAP therapy benefits patients with respiratory disorders, its impact on central venous catheterization must be more adequately studied, particularly in the right internal jugular vein (RTIJV). Aims and Objectives: The study aimed to predict the most applicable PAP for RTIJV catheterization and to evaluate the complications with different airway pressures. Materials and Methods: This study was conducted using a comparative prospective randomized control trial study design in a tertiary care hospital. One hundred participants were selected from subjects who came for gastrointestinal tract surgery and urological surgery, and they were randomized through a computer-generated random number table. Results: Participants were divided into four different groups (A, B, C, and D), and they were subjected to four pressures 0 cmH2O, 10 cmH2O, 15 cmH2O, and 20 cmH2O, respectively. The cross-sectional area of RTIJV is significantly increased in Groups C and D compared to Groups A and B. The number of completed catheterizations was higher in Groups C and D. The number of first-pass punctures was also higher in Groups C and D. Depth of needle insertion is significantly reduced with increased pressure. Conclusion: Moderate-to-high PAPs, specifically around 15 cmH2O to 20 cmH2O, boost catheterization success. This is achieved through improved vein dilation, enhanced accuracy, and decreased needle insertion depth. [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]

The article focuses on visualizing the measured and unmeasured covariates for a multistate model, where states, exposures, and covariates are represented by different colors and nodes. It clarifies that while race and ethnicity are distinct entities, they are combined into a single node on the diagram due to their similar functional relationship with the model's states and covariates, although they are associated with different subsets of time-varying and baseline covariates.

Background: Hemophagocytic lymphohistiocytosis (HLH) patients who need intensive care usually have multiple organ failure and poor prognosis. However, the clinical characteristics, therapeutic efficacy and outcome in these critically ill HLH patients have remained unclear. Methods: We performed a retrospective study of 50 critically ill HLH patients from September 2013 to October 2022. Patients' information was collected, and the overall survival rate was estimated. Results: Fifty HLH patients need intensive care, and the median sequential organ failure assessment (SOFA) score was 8. 66.00% patients had septic shock, 60.00% had disseminated intravascular coagulation (DIC) and 56.00% had acute respiratory distress syndrome (ARDS). 64.00% patients needed vasoactive drugs, 60.00% needed invasive or non-invasive positive pressure mechanical ventilation, and 12.00% needed continuous renal replacement therapy (CRRT). Among 18 patients received the etoposide-based regimens, the median time for 17 patients to remove ECG monitoring was 13 days (4– 30 days); the median time to remove respiratory support in 10 patients was 8.5 days (4– 21 days); the median time for 5 patient to convert from dominant DIC to non-dominant DIC was 4 days (1– 14 days) and the median time for 6 patients to stop using vasoactive drugs was 10 days (2– 14 days). After 4 weeks of treatment, 7 patients were evaluated as NR, 6 achieved PR, and 5 could not be evaluated. The ORR was 55.56%. Up to the last follow-up, the OS rate of patients receiving etoposide-based regimens was 66.67%. In contrast, all 32 HLH patients in other groups died. Univariate analysis showed that PCT > 0.5 ug/L, PT prolonged > 6 s, TBil > 25umol/L, respiratory failure, renal failure, liver failure and did not receive etoposide- based regimens were the negative factors affecting survival (P = 0.001, 0.017, 0.043, 0.001, 0.000, 0.029, 0.000). Conclusion: HLH patients who need intensive care timely used etoposide-based HLH regimens might rescue critically ill patients successfully. [ABSTRACT FROM AUTHOR]

Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases. [ABSTRACT FROM AUTHOR]

The ventilation work is an important step to be completed before the start of the positive pressure explosion-proof robot. The existing explosion-proof technology uses constant pressure inflation, which will cause explosive gas to accumulate in the corner area of the cavity for a long time. In order to solve this problem, a ventilation method with periodic pulse intake is proposed. Based on the finite element method, the cleaning and ventilation process of the positive pressure explosion-proof robot is simulated and analyzed. The concentration of explosive gas in the robot cavity with time under constant pressure intake and pulse intake with different periods and amplitudes is compared. The simulation results show that the pulse intake is beneficial to the ventilation of the corner position. The period and amplitude of the pulse intake has an effect on the ventilation efficiency, when the period is the same, the greater the amplitude of the pulse intake, the higher the ventilation efficiency; when the amplitude is the same, the smaller the period of the pulse intake, the higher the ventilation efficiency. After experimental verification, the validity of the simulation results is proved. This study helps to improve the ventilation efficiency of positive-pressure explosion-proof robots and provides guidance for practical applications. [ABSTRACT FROM AUTHOR]

To compare the therapeutic effect of less invasive surfactant administration (LISA) followed by synchronized nasal intermittent positive pressure ventilation (SNIPPV) and traditional intubate-Surfactant-Extubate (InSurE) strategy for the treatment of neonatal respiratory distress syndrome (NRDS). A single-center, non-randomized and single- blinded study Tertiary neonatal intensive care unit 89 infants enrolled were preterm with gestational age < 366/7 weeks and clinically diagnosed with neonatal RDS (NRDS) Interventions: 32 infants were assigned to the LISA + SNIPPV group and 57 infants to the InSurE + nCPAP group. No statistically significant differences were noted in the baseline characteristics of the enrolled infants. A lower proportion of infants developed BPD in the LISA + SNIPPV group compared to the InSurE + CPAP group [10 (31.25%) vs. 21 (36.84%), P > 0.05]; however, there was no statistically significant difference. The number needed to treat (NNT) with LISA + SNIPPV to prevent BPD development is 18. The mortality rate was not significant between our study arms [1 (3.13%) vs 2 (3.51%), P > 0.05]. There were no statistically significant differences in the durations (days) of MV [(12.18 ± 13.89) vs. (11.35 ± 11.61), P > 0.05], oxygen therapy [(35.03 ± 19.13) vs. (39.75 ± 17.91), P > 0.05] and re-intubation rates [(0.19 ± 0.40) vs. (0.21 ± 0.45), P > 0.05] between the two study groups. In terms of complications, the incidence of patent ductus arteriosus (PDA) [24 (75.00%) vs. 27 (47.37%), P < 0.05] was higher and a lower rate of disturbed liver function [1 (3.23%) vs. 19 (33.33%), P < 0.05] were observed in the LISA + SNIPPV group. Acid–base imbalances were reportedly significantly higher in the InSurE group (P < 0.05). No significant differences in other complications were noted. In the interventional group, FiO2 requirements were significantly lower up until the 3rd week of treatment [FiO2 at day 0, (30.75 ± 4.78) vs. (34.66 ± 9.83), P < 0.05; FiO2 at day 21, (25.32 ± 3.74) vs. (29.11 ± 8.17), P < 0.05], as was RSS on days 2 [(0.77 ± 0.38) vs. (1.94 ± 0.75), P < 0.05] and 3 [(0.66 ± 0.33) vs. (1.89 ± 0.82), P < 0.05] after treatment. Additionally, infants in the standard group had a significantly prolonged hospital stay (days) [(45.97 ± 16.93) vs. (54.40 ± 16.26), P < 0.05]. The combination of LISA and SNIPPV for NRDS can potentially lower the rate of BPD, FiO2 demand and shorten the length of hospitalization. [ABSTRACT FROM AUTHOR]

Stroke-associated pneumonia (SAP) is a common complication of acute ischemic stroke (AIS). This single-center retrospective observational study aimed to identify factors associated with SAP and predictors of poor outcomes in hospitalized patients with AIS. The study included patients admitted to Chumphon Khet Udomsakdi Hospital in Thailand within 7 days of the onset of AIS between July 2019 and July 2020. The patients were divided according to whether they were diagnosed with SAP during hospitalization into a pneumonia group and a non-pneumonia (control) group. Factors associated with SAP were identified. After 3 months, the patients with AIS were divided into those with a poor outcome (modified Rankin scale [mRS] score ≥4) and those with a non-poor outcome (mRS score <4). Factors associated with a poor outcome were sought. During the study period, 342 patients (mean age 65 years, 61% men) were admitted with AIS, of whom 54 (15.8%) developed SAP. Multivariate analysis identified a failed water-swallowing test (WST; adjusted odds ratio [aOR] 87.48, 95% confidence interval [CI] 21.00–364.51, p<0.001), endotracheal intubation with invasive mechanical ventilation (aOR 12.38, 95% CI 2.44–101.35, p = 0.001), and a retained Foley catheter (aOR 5.67, 95% CI 2.03–15.83, p = 0.001) to be associated with SAP. Of the 342 patients, 112 (32.7%) had a poor outcome at 3 months, predictors of which included having hypertension as a comorbidity (aOR 2.87, 95% CI 1.18–6.98, p = 0.020), a pre-stroke mRS score ≥2 (aOR 4.53, 95% CI 1.50–12.72, p = 0.007), an initial Barthel Index score <40 (aOR 3.35, 95% CI 1.57–7.16, p = 0.002), a failed WST (aOR 5.04, 95% CI 2.00–12.74, p = 0.001), and brain edema (aOR 20.67, 95% CI 2.10–203.26, p = 0.009). This study emphasized the association of SAP with a failed WST, endotracheal intubation with invasive mechanical ventilation, and a retained Foley catheter but also identified hypertension, a pre-stroke mRS score ≥2, an initial BI score <40, a failed WST, and brain edema as predictors of a poor outcome for patients 3 months after AIS. [ABSTRACT FROM AUTHOR]

The epidermal growth factor receptor (EGFR) Thr790 Met (T790M) mutation is responsible for approximately half of the acquired resistance to EGFR-tyrosine kinase inhibitor (TKI) in non-small-cell lung cancer (NSCLC) patients. Identifying patients at diagnosis who are likely to develop this mutation after first- or second-generation EGFR-TKI treatment is crucial for better treatment outcomes. This study aims to develop and validate a radiomics-based machine learning (ML) approach to predict the T790M mutation in NSCLC patients at diagnosis. We collected retrospective data from 210 positive EGFR mutation NSCLC patients, extracting 1316 radiomics features from CT images. Using the LASSO algorithm, we selected 10 radiomics features and 2 clinical features most relevant to the mutations. We built models with 7 ML approaches and assessed their performance through the receiver operating characteristic (ROC) curve. The radiomics model and combined model, which integrated radiomics features and relevant clinical factors, achieved an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.79–0.81) and 0.86 (0.87–0.88), respectively, in predicting the T790M mutation. Our study presents a convenient and noninvasive radiomics-based ML model for predicting this mutation at the time of diagnosis, aiding in targeted treatment planning for NSCLC patients with EGFR mutations. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk factors and etiology remain unknown. Herein, we investigated the clinical characteristics of mechanically ventilated patients with COVID-19 with PTX or PM. Methods: We examined patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit of a tertiary-level emergency medical center in Tokyo, Japan between April 1, 2020. and October 31, 2021. We collected and analyzed the clinical characteristics of the patients who presented with either PTX or PM during mechanical ventilation. Results: During the study period, a total of 165 patients required mechanical ventilation, and 15 patients with PTX/PM during mechanical ventilation were selected. Three patients with obvious causes were excluded, and the remaining 12 patients were analyzed (7.3%). The mortality rate in these patients was as high as 50%, demonstrating the difficulty of treatment in the presence of PTX/PM. PTX/PM occurred 14.5 days after intubation. A peak pressure of > 30 cmH2O was only apparent in one patient, suggesting that high positive pressure ventilation may be less involved than mentioned in the literature. In addition, the inspiratory effort was not strong in our group of patients. (P0.1 was 2.1 cm H2O [1.0–3.8]). Conclusion: Various factors are associated with the development of PTX/PM in patients on mechanical ventilation for COVID-19. We did not find a strong correlation between PTM/PM and barotrauma or strong inspiratory efforts, which have been identified as potential causes in previous 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]

Background: Various forms of commonly used noninvasive respiratory support strategies have considerable effect on diaphragmatic contractile function which can be evaluated using sonographic diaphragm activity parameters. Objective: To compare the magnitude of respiratory workload decreased as assessed by thickening fraction of the diaphragm and longitudinal diaphragmatic strain while using high‑flow nasal cannula (HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent positive pressure ventilation (NIPPV) and bilevel positive airway pressure (BiPAP)] in pediatric patients after cardiothoracic surgery. Methodology: This prospective randomized controlled trial was performed at a tertiary care surgical intensive care unit in postcardiac surgery patients aged between 1 and 48 months, who were randomly allocated into three groups: 1) HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode (pressure support 8 cmH2O, PEEP 5 cmH2O), and 3) BiPAP in nCPAP mode (CPAP of 5 cmH2O). Measurements were recorded at baseline after extubation (R0) and subsequently every 12 hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively until therapy was discontinued. Results: Sixty patients were included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP group. Longitudinal strain at crura of diaphragm was lower in the BiPAP group as compared to HFNC group at R2‑R4 [R2 (‑4.27± ‑2.73 vs ‑ 8.40± ‑6.40, P = 0.031), R3 (‑5.32± ‑2.28 vs ‑8.44± ‑5.6, P = 0.015), and R4 (‑3.8± ‑3.42 vs ‑12.4± ‑7.12, P = 0.040)]. PFR was higher in HFNC than NIPPV group at baseline and R1‑R3[R0 (323 ± 114 vs 264 ± 80, P = 0.008), R1 (311 ± 114 vs 233 ± 66, P = 0.022), R2 (328 ± 116 vs 237 ± 4, P = 0.002), R3 (346 ± 112 vs 238 ± 54, P = 0.001)]. DTF and clinical parameters of increased work of breathing remain comparable between three groups. The rate of reintubation (within 48 hours of extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in HFNC) and remain comparable between groups (P = 1.0). Conclusion: BiPAP may provide better decrease in work of breathing compared to HFNC as reflected by lower crural diaphragmatic strain pattern. HFNC may provide better oxygenation compared to NIPPV group, as reflected by higher PFR ratio. Failure rate and safety profile are similar among different methods used. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non‐invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. Background: Non‐invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal‐oral NIPPV masks and discomfort in contact with the skin surface. Design: A retrospective case–control study. Methods: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under‐mask prophylactic dressings during hospitalisation. Patients were divided into the non‐FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case–control study. Results: There were significant differences between the groups in age, serum albumin, C‐reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176–2.260)], BMI [OR = 0.396 (0.210–1.784)] and corticosteroids [OR = 0.394 (0.159–1.811)], which were predictors of FPI in patients with NIPPV. Conclusions: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high‐risk and timely preventive measures to reduce FPI. Relevance to Clinical Practice: Addressing FPI‐related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks. [ABSTRACT FROM AUTHOR]

Background: Endotracheal tube cuff pressure is clinically measured by "minimal occlusion (MOC) and minimal leak (MLK) techniques" by palpating and auscultating the neck for end-inspiratory "elimination" or "allowance" of subtle air leak, respectively. This study was done to determine the validity and reliability of MOC and MLK techniques, manometric endotracheal tube cuff-pressure measurement of 20-30 cm H2O being reference standard. Materials and Methods: A prospective, observational study was conducted in adult patients requiring positive pressure ventilation in the medical intensive care unit (ICU). Two investigators independently assessed MOC and MLK twice on days 2 and 3 of intubation. ICU registrar, unaware of earlier readings, noted manometric cuff-pressure within 5 min. Inter-observer reliability was calculated using intraclass correlation coeffiient (ICC). Validity of measurement was assessed using accepted reference standard of 20-30 cm H2O by manometer. Results: Sixty patients between 17 and 82 years, on positive pressure ventilation were evaluated twice, by two investigators resulting in 240 observations. Mean manometric pressures were 15.7 + 2.6 and 12.2 + 2.4 cm H2O using MOC and MLK techniques to maintain adequate ventilation. ICC measured for reliability was high at 0.69 and 0.67 for MOC and MLK techniques. Adequate ventilation was maintained in all patients and 57 of 60 (95%) were discharged alive without significant ventilatory complications. Conclusions: Cuff pressures needed to maintain effective positive pressure ventilation was well below the accepted levels of 20-30 cm of H2O in majority patients. MOC and MLK techniques have high reliability. The result of the study has the implications on ICU ventilatory care. [ABSTRACT FROM AUTHOR]

This article discusses a study on the use of esophageal balloon catheters to measure respiratory effort and mechanics in patients receiving mechanical ventilation. The researchers used a system identification approach to improve the accuracy of these measurements. They conducted tests in a controlled setting and with patient data, and found that correcting the dynamic response of the balloon catheter improved the accuracy of resistance and compliance estimates. The study acknowledges limitations and suggests further investigation, but concludes that using esophageal pressure measurements can improve ventilator settings and decision-making. The data from the study are available upon request. [Extracted from the article]

Introduction: The Oropharyngeal Seal Pressure (OSP) achieved by the supraglottic device holds significant importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra cuff soiling, and also relates to postoperative morbidity. Supraglottic Airway Devices (SADs) have been increasingly used to mitigate the complications of endotracheal intubation. Aim: To compare the OSP in Ambu AuraGain versus I-gel SADs used in young children under general anaesthesia. Materials and Methods: The present randomised, singleblinded, interventional study included 88 patients aged between 1-5 years, weighing 10-30 kg, with American Society of Anaesthesiologists (ASA) Grade-I and II, undergoing elective inguinal and urology procedures under general anaesthesia. The children were randomly allocated to two groups of 44 each. In Group A, Ambu AuraGain was used, while in Group B, I-gel was inserted to secure the airway. The OSP was determined at the time of insertion and 30 minutes after insertion as the primary objective. The secondary objectives included the first attempt success rate, ease of SAD insertion, ease of gastric tube insertion, fiberoptic visibility of the glottic aperture, intraoperative vitals, and any adverse effects. Unpaired t-test was used to compare clinical indicators for quantitative data between the two independent groups. The Chi-square test was used for qualitative data when comparing two or more groups. The level of significance was set at a p-value <0.05. Results: The mean age in group A and group B was 3.45±1.41 years and 3.29±1.16 years, respectively. The mean weight in group A and group B was 15.13±3.67 kg and 14.25±3.18 kg, respectively. The OSP soon after insertion and 30 minutes after insertion was more in group B than group A. The p-values were 0.006 and 0.002, respectively, which were statistically significant. The first attempt success rate was higher in group A (97.7% versus 95.5%), and it was easier to insert with a shorter duration of time (17.70±2.707 versus 18±2.48 seconds). Gastric tube insertion was easier in group B (88.6% versus 84.1%), but the fiberoptic visibility was better in group A (77.3% versus 77.2%). Lesser intraoperative manipulation was required in group A (97.7% versus 93.2%), and the occurrence of postoperative complications was higher in group B. Conclusion: I-gel is better in terms of OSP, while Ambu AuraGain was superior in terms of ease of insertion, better fiberoptic visibility, and fewer postoperative complications. [ABSTRACT FROM AUTHOR]

This document provides summaries of various research studies in the field of critical care medicine. The first study focuses on extubating pediatric patients on extracorporeal membrane oxygenation (ECMO) and suggests that it may improve mobility without increasing complications. The second study examines the use of antipsychotics in treating agitation in ICU delirium and finds no significant effect. The third study explores the incidence of endocrine adverse events in lung cancer patients receiving immune checkpoint inhibitor therapy and finds higher rates compared to those not receiving the therapy. The fourth study investigates the association between mechanical ventilation and venous thromboembolism risk in critically ill children and finds an increased risk. The final study analyzes the safety and outcomes of overnight extubation in pediatric critical care and finds higher mortality rates but shorter ICU length of stay among survivors compared to daytime extubation. These studies provide valuable insights into critical care practices and patient outcomes. [Extracted from the article]

Noninvasive positive pressure ventilation (NIPPV) has been established as an effective treatment for heart failure. Positive airway pressure such as continuous positive airway pressure (CPAP) increases cardiac output (CO) in some patients but decreases it in others. However, the mechanism behind such unpredictable responses remains undetermined. We measured hemodynamic parameters of 38 cases using Swan-Ganz catheter before and after CPAP in chronic heart failure status. In those whose CO increased by CPAP, pulmonary vascular resistance (PVR) was significantly decreased and SpO2 significantly increased, but the other parameters were not changed. On the other hand, PVR was not changed, but systemic vascular resistance (SVR) was increased in those whose CO decreased by CPAP. To explain this phenomenon, we simulated the cardiovascular system using a cardiac model of time-varying elastance. In this model, it was indicated that CPAP decreases CO irrespective of cardiac function or filling status under constant PVR condition. However, when reduction of PVR by CPAP was taken into account, an increase in CO was expected especially in the hypervolemic and low right ventricle (RV) systolic function cases. CPAP would increase CO only where PVR can be reduced by CPAP therapy, especially in the case with hypervolemia and/or low RV systolic function. Understanding the underlying mechanism should help identify the patients for whom NIPPV would be effective. • Hemodynamic parameters were compared between CO increased/decreased cases by CPAP. • PVR was significantly decreased in the patients whose CO was increased by CPAP. • Theoretical analysis of the effect of CPAP using computer simulation were performed. • PVR plays an important role in the effect of CPAP on CO, while the mechanical effect of CPAP itself, the so-called transmural pressure, decrease CO. • The effects of CPAP on CO depend on the stressed volume and the RV systolic function. [ABSTRACT FROM AUTHOR]

Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong '1' or weak '2' recommendation with high 'A', medium 'B' or low 'C' quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1C). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1C). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO 2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B). [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate the efficacy of hydrocolloid dressing in preventing stage two or higher facial pressure injuries associated with the use of noninvasive positive pressure ventilation (NIPPV) devices among critically ill patients. Design: A randomized control trial. Methods: The study included 56 adult patients in intensive care units. The study participants were categorized into two groups consisting of 28 patients in each group. The control group received skincare using a fine mist of water and repositioning of the device every two to four hours, while the intervention group received a hydrocolloid dressing and repositioning of the device every two to four hours. Results: A total of 33.9% of all participants in the study had facial pressure injury. None of the patients in the intervention group who received hydrocolloid dressing developed stage two or higher facial pressure injuries. A total of 32.2% of the control group developed stage two or higher facial pressure injuries. Results indicated that the use of hydrocolloid dressing can significantly prevent the formation of stage two or higher facial pressure injuries (p < 0.001). Conclusion: The study's findings support the use of hydrocolloid dressing as a preventative measure for facial pressure injuries related to NIPPV devices. [ABSTRACT FROM AUTHOR]

Stridor is an important symptom which should not be missed, especially in a child. The etiology could be multifactorial and will require a comprehensive investigation into its management. In this case, we discuss the clinician's dilemma in reaching a diagnosis due to various factors which were present in a single patient. This rare benign laryngeal squamous polyp was eventually diagnosed in an 11-week-old boy who presented with acute stridor. The diagnostic dilemma we discuss in this case was due to multiple maternal and fetal factors. He was a premature baby, intubated at birth, there was a maternal tuberculosis infection and he also had a cutaneous hemangioma which were all part of the diagnostic dilemma faced in his management which eventually led to an acquired subglottic stenosis. Our discussion will focus on how a thorough and proper evaluation is needed especially when there are many deceptive clues or signs present in a patient. [ABSTRACT FROM AUTHOR]

Aim: we conducted this study to evaluate the effect of high-velocity nasal cannula (HVNC) compared with noninvasive positive pressure ventilation (NIPPV) in reducing the need for endotracheal intubation in patients with respiratory failure due to COPD exacerbation and the outcome in both methods. Patients and methods: Our study is a randomized controlled trial that was conducted on patients admitted to the ICU by COPD exacerbation in the critical care department and chest department in Beni-Suef University, from February 2022 to January 2023, with a sample size of 40 patients divided into two groups, group (A) consists of 20 patients subjected to NIPPV, and group (B) consists of 20 patients subjected to HVNC. Results: SO2 significantly increased from 1st hour (80.8±7.9%) to 2nd hour (93.9±1.5%). PH increased significantly in both groups, with no significant difference between the two groups after 2 hours. PCO2 decreased significantly in both groups, with more improvement in HVNC. PO2 and HCO3 didn't differ significantly after 2 hours, and there were no significant differences between the two groups. There were insignificant differences between the studied groups regarding the need for intubation, mortality, length of stay, and SAPS score, but the Borg scale was higher in the NIPPV group than the HVNC group. Conclusion: in conclusion, both HVNC and NIPPV are effective in COPD exacerbation in decreasing the carbon dioxide with more improvement in the HVNC group. There was a significant role of HVNC in decreasing intolerance and respiratory distress and the Borg dyspnea scale. [ABSTRACT FROM AUTHOR]

Objective: One in twenty newborns require resuscitation with positive pressure ventilation (PPV) at birth. Newborn face mask ventilation is often poorly performed. To address this, the potential role of respiratory function monitors (RFM) in newborn resuscitation training has been highlighted. The objective of this study was to develop a standardised training intervention on newborn PPV using an RFM with a simple visual display to identify and correct suboptimal ventilations. Methods: We adapted the framework from a simulation development guideline to create a hands-on intervention on newborn PPV using an RFM with simple visual feedback (Monivent NeoTraining). We enrolled a group of healthcare professionals to a manikin-based pilot study as part of this process, conducting a series of teaching sessions to refine the intervention. Suggested changes were gathered from participants and instructors. Our main objective was to develop a standardised, reproducible training intervention. Results: A standardised training intervention on newborn PPV was systematically developed. Twenty-six healthcare professionals working in tertiary neonatal care participated in a pilot study, consisting of eight training sessions. Each iteration of the intervention was informed by the previous session. Instructions for the delivery of teaching were standardised and a training algorithm was developed. Conclusion: RFM’s have been shown to be effective tools in research settings, addressing poor technique and face mask leak. They are not routinely used in newborn resuscitation training. To address this, we developed a standardised training intervention on newborn PPV using an RFM with simple visual feedback.

The document is a correction notice for an article titled "Contrast of oropharyngeal leak pressure and clinical performance of I-gel™ and LMA ProSeal™ in patients: A meta-analysis." The correction provides the correct version of Table 1, which includes information about the characteristics of the trials included in the meta-analysis. The trials involved infants, children, and adults undergoing different types of surgeries, with various anesthesia techniques and medications used. The table summarizes the studies' findings on leak pressure and ventilation methods. This correction is important for library patrons conducting research on the topic to ensure they have accurate information. [Extracted from the article]

This article explores the use of induction agents for emergency airway management in critically ill patients. It acknowledges the challenges and risks associated with airway management in these patients, particularly cardiovascular complications. The current induction drugs used include propofol, etomidate, ketamine, benzodiazepines, and admixture drugs like ketofol and propadate. The article emphasizes the need for further research to determine the most suitable induction agent for critically ill patients. It also mentions the limited research on the use of benzodiazepines, barbiturates, ketofol, and propadate. The article suggests that well-designed randomized controlled trials are necessary to guide clinicians in choosing the ideal induction agent for each patient and situation, ultimately improving outcomes in emergency airway management for critically ill patients. [Extracted from the article]

The article discusses ventilator-associated brain injury (VABI) as a potential complication of mechanical ventilation, presenting evidence from preclinical studies and observational data. It defines VABI as brain injury resulting directly from positive pressure mechanical ventilation, independent of other factors like sedation. It highlights the need for further research to understand the mechanisms of VABI and evaluate potential therapeutic strategies.

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]

Shallow and close-distance buried coal seam group is greatly affected by mining, and the phenomenon of multiple dimensions of air leakage and interconnection of channels is common in the coal mining face. Under the action of positive or negative pressure ventilation, a larger air leakage pressure difference is easily formed at both ends of the air leakage channel, resulting in an increasing air leakage volume in working face, the extension of the "three zones" in goaf, and the increasing risk of spontaneous combustion. This paper took Jitujing 12 coal in Daliuta Coal mine, a typical positive pressure ventilation mine, as the research object. It was concluded that the influencing factors of air leakage in shallow coal seam were as follows: air leakage channel formed by mining fissure, air leakage pressure difference formed by positive pressure ventilation, the ventilation mode and the natural wind pressure effect. The air leakage status and mode of the 12203 fully mechanized caving face under mining were investigated. It was concluded that the air leakage of the working face was mainly manifested as: surface collapse crack air leakage, face cutting, lanes and goaf air leakage in working face. Based on this, a comprehensive, multi-coverage and three-dimensional air leakage control technology was proposed. This technology was based on optimization of ventilation system, supported by grouting and spraying technologies in coal and rock fissure of roadway, coal pillar leakage risk control technology, and goaf end leakage risk control technology of working face, strengthened by local positive pressure leakage risk control technology, hydraulic flushing seam plugging technology and filling hole plugging technology, and based on the concept of foundation optimization, middle support and end treatment. The actual application was conducted in the 12203 caving face, and the air leakage volume reduced from 55-70 m3/min to 6-20 m3/min at the initial mining period, with a comprehensive reduction of 80.3%, which proved that this technology can effectively control air leakage, and provide technical reference for air leakage control in similar mine.

Introduction: Acute cardiac tamponade is a rare event during any type of interventional or surgical procedure. It can occur during electrophysiology procedures due to radiofrequency ablation, lead or catheter manipulation, transseptal puncture, laser lead extractions, or left atrial appendage occlusion device positioning. Cardiac tamponade is difficult to study in a prospective manner, and case reports and case series are important contributions to understanding the best options for patient care. Case summary: An 87-year-old Caucasian male patient breathing spontaneously developed acute tamponade during an atrial flutter ablation. Pericardial drain insertion was difficult, and hypotension failed to respond to epinephrine boluses. The patient became hypoxemic and hypercarbic, requiring intubation. Unexpectedly, the blood pressure markedly increased postintubation and remained in a normal range until the pericardium was drained. Conclusion: Spontaneous ventilation is considered important to maintain venous return to the right heart during cardiac tamponade. However, spontaneous ventilation reduces venous return to the left heart and worsens the paradoxical pulse in tamponade. Intravenous vasopressors are thought to be ineffective during cardiac tamponade. Our patient maintained pulmonary blood flow as indicated by end-tidal carbon dioxide measurements but had no measurable systemic blood pressure during spontaneous ventilation. Our case demonstrates that tracheal intubation and positive pressure ventilation can transiently improve left heart venous return, systemic perfusion, and drug delivery to the systemic circulation. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 infection is associated with worse maternal and fetal outcomes. This study aims to describe the characteristics of pregnant and postpartum women with severe Covid-19 admitted to ICU. Methods and findings: It's a retrospective cohort study evaluating pregnant and postpartum women referenced to a specialized ICU between May 2020 and June 2022. Covid-19 was confirmed with RT-PCR or rapid antigen test on a nasopharyngeal swab. Variables were described by median and IQR when numerical, and by frequency and percentage when categorical. OR with 95% CI were calculated for the evaluation of factors related to death. P-values were calculated using Pearson's ꭓ2-test, Fisher's exact test, Wilcoxon rank sum test, and Kruskall-Wallis test, and statistical significance was established as < 0·05. Missing data were excluded. All statistical analysis were performed using R software version 4.2.2. Of the 101 admissions, 85 (84·2%) were of pregnant women. Obesity (23·0%) and systemic arterial hypertension (13·0%) were the most prevalent medical conditions. Sixty-six (65·3%) were admitted using some type of oxygen support. Forty-seven (46·5%) evolved to mechanical ventilation. There were 61 events considered obstetric complications, with 8 stillbirths/fetal losses. The overall lethality was 15·8%. Pregnancy interruption, need for non-invasive mechanical ventilation, level of oxygen support at admission, prone maneuver, hemodialysis, and healthcare-related infections were factors associated with death. Evaluating the WHO 7-category ordinary scale, there was a trend of increase in the risk of death with higher punctuation, with a statistically significant difference of women with 5 (OR = 7·27; 95% IC = 1·17–194; p = 0·031) or 6 points (OR = 12·0; 95% IC = 1·15–391; p = 0·038) when compared to the ones with 3 points, i.e., of women admitted with a high-flow non-rebreathing mask or invasive mechanical ventilation, compared with the ones admitted at room air, respectively. The main limitations of this study are the relatively small number of participants, and the use of data derived of medical records—which are susceptible to misclassification and variable amounts of missing data. Conclusions: Pregnant and postpartum women with severe Covid-19 have high lethality and a high incidence of clinical and obstetric complications. These findings support that this population should be prioritized in public health strategies that address Covid-19. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) is a common life-threatening condition in critically ill patients. Itis also an important public health issue because it can cause substantial mortality and health care burden worldwide. The objective of this study was to investigate therisk factors that impact ARDS mortality in a medical center in Taiwan. Methods: This was a single center, observational study thatretrospectively analyzed data from adults in 6 intensive care units (ICUs) at Taichung Veterans General Hospital in Taiwan from 1st October, 2018to30th September, 2019. Patients needing invasive mechanical ventilation and meeting the Berlin definition criteria were included for analysis. Results: A total of 1,778 subjects were screened in 6 adult ICUs and 370 patients fulfilled the criteria of ARDS in the first 24 hours of the ICU admission. Among these patients, the prevalenceof ARDS was 20.8% and the overall hospital mortality rate was 42.2%. The mortality rates of mild, moderate and severe ARDS were 35.9%, 43.9% and 46.5%, respectively. In a multivariate logistic regression model, combination of driving pressure (DP) > 14cmH2O and oxygenation (P/F ratio)≤150 was an independent predictor of mortality (OR2.497, 95% CI 1.201–5.191, p = 0.014). Patients with worse oxygenation and a higher driving pressure had the highest hospital mortality rate(p<0.0001). Conclusions: ARDS is common in ICUs and the mortality rate remains high. Combining oxygenation and respiratory mechanics may better predict the outcomes of these ARDS patients. [ABSTRACT FROM AUTHOR]

Neuromuscular associated respiratory failure is a rare toxicity of immunotherapy for malignant tumors. In most cases, it may overlap with the symptoms of the primary disease or myocarditis, myositis and myasthenia gravis, resulting in difficult etiological diagnosis. Early detection and optimal treatment are still topics that need attention. Here, a case of 51-year-old male lung cancer patient with sintilimab-associated myasthenia gravis, myositis, and myocarditis overlap syndrome involving the diaphragm who developed severe type II respiratory failure was reported. After high-dose methylprednisolone, immunoglobulin and pyridostigmine intravenous injection with non-invasive positive pressure ventilation, the patient's symptoms improved significantly and was discharged. One year later, the patient received immunotherapy again due to tumor progression. After 53 days, he developed dyspnea again. Chest X-ray demonstrated marked elevation of the diaphragm, and the electromyogram demonstrated dysfunction of diaphragm. With rapid diagnosis and timely treatment, the patient was finally discharged safely. A comprehensive search of PubMed, EMBASE was performed to identify all previously reported cases of immune checkpoint inhibitors-associated respiratory failure. The potential mechanisms of respiratory failure caused by ICI-associated diaphragmatic dysfunction may be related to T cell-mediated immune disturbances and we proposed possible diagnostic processes. For patients with unexplained respiratory failure who are receiving immunotherapy, standardized diagnostic strategies should be implemented immediately on admission before deciding whether to conduct a more invasive diagnostic procedure or empirical treatment. [ABSTRACT FROM AUTHOR]

Atelectasis affects approximately 90% of anaesthetized patients, with laparoscopic surgery and pneumoperitoneum reported to exacerbate this condition. High-frequency oscillation therapy applies continuous positive pressure pulses to oscillate the airway, creating a pressure difference in small airways obstructed by secretions. This process helps reduce peak airway pressure, open small airways, and decrease atelectasis incidence, while also facilitating respiratory tract clearance. This study examines the efficacy of high-frequency oscillation on reduction of atelectasis in laparoscopic cholecystectomy (LC) patients under general anaesthesia, evaluated using lung ultrasound. Sixty-four patients undergoing laparoscopic cholecystectomy were randomly divided into a control group and a high-frequency oscillation (HFO) group. Both groups underwent total intravenous anaesthesia under invasive arterial monitoring. The HFO group received a 10-minute continuous high-frequency oscillation therapy during surgery, while the control group received no intervention. Lung ultrasound evaluations were performed three times: five minutes post-intubation (T1), at the end of the surgery (T2), and before leaving the Post-Anaesthesia Care Unit (PACU; T3). Blood gas analysis was performed twice: prior to induction with no oxygen supply and before PACU discharge (oxygen supply off). The HFO group displayed a significantly lower incidence of atelectasis at T3 (57.5% vs. 90.3%, OR 6.88, 95%CI (1.74 to 27.24)) compared to the control group. Moreover, the HFO group's PaO2 levels remained consistent with baseline levels before PACU discharge, unlike the control group. Although there was no significant difference in LUS scores between the groups at T1 (8.56 ± 0.15 vs. 8.19 ± 0.18, p = 0.1090), the HFO group had considerably lower scores at T2 (13.41 ± 0.17 vs.7.59 ± 0.17, p < 0.01) and T3 (13.72 ± 0.14 vs.7.25 ± 0.21, p < 0.01). Our study indicates that high-frequency oscillation effectively reduces atelectasis in patients undergoing laparoscopic cholecystectomy. Additionally, it can mitigate the decline in oxygen partial pressure associated with atelectasis. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The paper aims to bring to the fore some training methods and equipment that can improve sports performance in swimmers aged 12-14 years. The research, conducted at two swimming centres in Bucharest and Bacău, involved 32 athletes who were divided into two groups as follows: 16 in the experimental group and 16 in the control group. They were elite athletes practising swimming from the age of 5-6 years, 6 to 8 times a week. All of them performed the same in-water training for 14 weeks, but those in the experimental group also used a device to train their respiratory muscles before and after each workout, 3 x 30 inhalations. The research methods used were: literature review, pedagogical observation, experiment, mathematical statistics, and graphical method. The efficiency of the inspiratory muscles was measured using the PowerBreathe K-Series device, which recorded the values of lung capacity, inspiratory muscle strength and power, inspiratory pressure and breathing energy. The obtained results confirm the research hypotheses according to which there is a significant difference (of 36.7%) between the improved times of the two groups in favour of the experimental group, meaning 0.67 hundredths of a second for every 50 m swum in their preferred event after 14 weeks of using the device to train their respiratory muscles. [ABSTRACT FROM AUTHOR]

The establishment of adequate ventilation is the cornerstone of neonatal resuscitation in the delivery room (DR). This parallel-group, accessor-blinded randomized controlled trial compared the changes in peripheral oxygen saturation (SpO2), heart rate (HR), and cerebral regional oxygen saturation (crSO2) with the use of a T-piece resuscitator (TPR) versus self-inflating bag (SIB) as a mode of providing positive pressure ventilation (PPV) during DR resuscitation in preterm neonates. Seventy-two preterm neonates were randomly allocated to receive PPV with TPR (n = 36) or SIB (n = 36). The primary outcome was SpO2 (%) at 5 min. The secondary outcomes included the time to achieve a SpO2 ≥ 80% and > 85%, HR > 100/min, fractional-inspired oxygen (FiO2) requirement, minute-specific SpO2, HR and FiO2 trends for the first 5 min of life, need for DR-intubation, crSO2, need and duration of respiratory support, and other in-hospital morbidities. Mean SpO2 at 5 min was 74.5 ± 17.8% and 69.4 ± 22.4%, in TPR and SIB groups, respectively [Mean difference, 95% Confidence Interval 5.08 (-4.41, 14.58); p = 0.289]. No difference was observed in the time to achieve a SpO2 ≥ 80% and > 85%, HR > 100/min, the requirement of FiO2, DR-intubation, and the need and duration of respiratory support. There was no significant difference in the minute-specific SpO2, HR, and FiO2 requirements for the first 5 min. CrSO2 (%) at one hour was lower by 5% in the TPR group compared to SIB; p = 0.03. Other complications were comparable. Conclusions: TPR and SIB resulted in comparable SpO2 at 5 min along with similar minute-specific SpO2, HR, and FiO2 trends. Clinical Trial Registration: Clinical trial registry of India, Registration no: CTRI/2021/10/037384, Registered prospectively on: 20/10/2021, https://ctri.icmr.org.in/. What is Known: • Compared to self-inflating bags (SIB), T-piece resuscitators (TPR) provide more consistent inflation pressure and tidal volume as shown in animal and bench studies. • There is no strong recommendation for one device over the other in view of low certainty evidence. What is New: • TPR and SIB resulted in comparable peripheral oxygen saturation (SpO2) at 5 min along with similar minute-specific SpO2, heart rate, and fractional-inspired oxygen requirement trends. • Short-term complications and mortality rates were comparable with both devices. [ABSTRACT FROM AUTHOR]

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]

Newborn screening (NBS) for spinal muscular atrophy (SMA) is necessary, as favorable outcomes can be achieved by treatment with disease-modifying drugs in early infancy. Although SMA-NBS has been initiated in Japan, its clinical results have not been fully reported. We report the findings of the initial 2.5 years of a pilot SMA-NBS of approximately 16,000 infants conducted from February 2021 in Hyogo Prefecture, Japan. Clinical data of 17 infants who tested positive were retrospectively obtained from the NBS follow-up centers participating in this multicenter cohort observational study. Genetic testing revealed 14 false positives, and three infants were diagnosed with SMA. Case 1 had two copies of survival motor neuron (SMN) 2 and showed SMA-related symptoms at diagnosis. Case 2 was asymptomatic, with two copies of SMN2. Asymptomatic case 3 had four copies of SMN2 exon 7, including the SMN1/2 hybrid gene. Cases 1 and 2 were treated within 1 month and case 3 at 8 months. All the patients showed improved motor function scores and did not require respiratory support. The identification of infants with SMA via NBS and early treatment improved their motor and respiratory outcomes. Thus, implementation of SMA-NBS at a nationwide scale should be considered. [ABSTRACT FROM AUTHOR]

Extremely premature infants are at a higher risk of developing respiratory distress syndrome and circulatory impairments in the first few weeks of life. Administration of normal saline boluses to manage hypotension is a common practice in preterm infants. As a crystalloid, a substantial proportion might leak into the interstitium; most consequently the lungs in the preterm cohorts, putatively affecting ventilation. We downloaded and analyzed ventilator mechanics data in infants managed by conventional mechanical ventilation and administered normal saline bolus for clinical reasons. Data were downloaded for 30 min prebolus, 60 min during the bolus followed by 30 min postbolus. Sixteen infants (mean gestational age 25.2 ± 1 wk and birth weight 620 ± 60 g) were administered 10 mL/kg normal saline over 60 min. The most common clinical indication for saline was hypotension. No significant increase was noted in mean blood pressure after the saline bolus. A significant reduction in pulmonary compliance (mL/cmH2O/kg) was noted (0.43 ± 0.07 vs. 0.38 ± 0.07 vs. 0.33 ± 0.07, P = 0.003, ANOVA). This was accompanied by an elevation in the required peak inspiratory pressure to deliver set volume-guarantee (19 ± 2 vs. 22 ± 2 vs. 22 ± 3 mmHg, P < 0.0001, ANOVA), resulting in a higher respiratory severity score. Normal saline infusion therapy was associated with adverse pulmonary mechanics. Relevant pathophysiologic mechanisms might include translocation of fluid across pulmonary capillaries affected by low vascular tone and heightened permeability in extremes of prematurity, back-pressure effects from raised left atrial volume due to immature left-ventricular myocardium; complemented by the effect of cytokine release from positive pressure ventilation. NEW & NOTEWORTHY Administration of saline boluses is common in premature infants although hypovolemia is an uncommon underlying cause of hypotension. This crystalloid can redistribute into pulmonary interstitial space. In the presence of an immature myocardium and diastolic dysfunction, excess fluid can also be "edemagenic." This study on extremely premature infants (25 wk gestation) noted adverse influence on respiratory physiology after saline infusion. Clinicians need to choose judiciously and reconsider routine use of saline boluses in premature infants. [ABSTRACT FROM AUTHOR]

Mechanical ventilation is ubiquitous in critical care, and duration of ventilator liberation is variable and multifactorial. While ICU survival has increased over the last two decades, positive-pressure ventilation can cause harm to patients. Weaning and discontinuation of ventilatory support is the first step in ventilator liberation. Clinicians have a wealth of evidence-based literature at their disposal; however, more high-quality research is needed to describe outcomes. Additionally, this knowledge must be distilled into evidence-based practice and applied at the bedside. A proliferation of research on the subject of ventilator liberation has been published in the last 12 months. Whereas some authors have reconsidered the value of applying the rapid shallow breathing index in weaning protocols, others have begun to investigate new indices to predict liberation outcomes. New tools such as diaphragmatic ultrasonography have begun to appear in the literature as a tool for outcome prediction. A number of systematic reviews with both meta-analysis and network meta-analysis that synthesize the literature on ventilator liberation have also been published in the last year. This review describes changes in performance, monitoring of spontaneous breathing trials, and evaluations of successful ventilator liberation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Airway pressure is usually measured by sensors placed in the ventilator or on the ventilator side of the endotracheal tube (ETT), at the Y-piece. These remote measurements serve as a surrogate for the tracheal or alveolar pressure. Tracheal pressure can only be predicted correctly by using a model that incorporates the pressure at the remote location, the flow through the ETT, and the resistance of the ETT if the latter is a predictable function of Y-piece flow. However, this is not consistently appropriate, and accuracy of prediction is hampered. METHODS: This in vitro study systematically examined the ventilator pressure in dependence of compliance of the respiratory system (CRS), inspiratory time, and expiratory time during pressure-controlled ventilation by using a small intratracheal pressure sensor and a mechanical lung simulator. Pressures were measured simultaneously at the ventilator outlet, at the Y-piece, and in the trachea during pressure-controlled ventilation with a peak inspiratory pressure of 20 cm H2OandaPEEPof5cmH2O while changing CRS (10, 30, 60, 90, and 100 mL/cm H2O) and varying inspiratory time and expiratory time. RESULTS: Tracheal pressures were always lower (maximum 8 cm H2O during inspiration) or higher (maximum 4 cm H2O during expiration) than the pressures measured proximal to the ETT if zero-flow conditions were not achieved at the end of the breathing cycles. CONCLUSIONS: Dependent on CRS and the breathing cycle, tracheal pressures deviated from those measured proximal to the ETT under non--zero-flow conditions. Intratracheal pressure and pressure curve dynamics can differ greatly from the ventilator pressure, depending on the ventilator setting and the CRS. The small pressure sensor may be used as a measurement method of tracheal pressure via integration onto an ETT. [ABSTRACT FROM AUTHOR]