Comparison of outcomes of infants with giant omphaloceles over two decades

2020 ◽  
pp. 1-5
Author(s):  
R.E. Witt ◽  
M. Singhal ◽  
A.J. Vachharajani
Keyword(s):  
Mechanical Ventilation ◽  
Medical Records ◽  
Invasive Mechanical Ventilation ◽  
Informed Decision Making ◽  
Membrane Oxygenator ◽  
Associated Anomalies ◽  
Single Institution ◽  
Extracorporeal Membrane Oxygenator ◽  
Pulmonary Vasodilators ◽  
Improved Outcomes

BACKGROUND: The purpose of this study was to compare the outcomes of infants with giant omphalocele (GO) born in two different epochs over two decades at a single institution. Specifically, it examined whether the utilization of selective pulmonary vasodilators and extracorporeal membrane oxygenator (ECMO) in the management of pulmonary hypertension in the second epoch were associated with improved outcomes. METHODS: The medical records of all patients diagnosed with GO at a large children’s hospital from January 1, 1996 to December 31, 2016 were reviewed and divided into two epochs. Patients were classified as having an isolated GO or GO with minor or major associated anomalies. GO was defined as a defect more than or equal to 5 cm in size and/or liver in the sac. RESULTS: During the study period, 59 infants with GO were identified. The duration of invasive mechanical ventilation was significantly shorter among the survivors from the second epoch (p = 0.03), with none greater than seven days. There were no significant differences in the outcomes of survival to NICU discharge and length of stay (LOS) between infants in the two epochs. CONCLUSIONS: Infants with GO who required invasive mechanical ventilation for more than seven days did not survive in the second epoch. Survival did not improve with uses of selective pulmonary vasodilators and ECMO. This information could be shared with families during prenatal and postnatal counselling to facilitate informed decision making regarding goals of care.

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

2015 ◽  
Vol 35 (4) ◽  
pp. 58-66 ◽  
Author(s):  
Rachel A. Joseph
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Technological Advances ◽  
Improved Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Careful Handling ◽  
Preterm Babies

Worldwide, about 15 million infants are born prematurely each year. Technological advances, including invasive mechanical ventilation, play a major role in the survival of extremely preterm babies. Those who survive may have prolonged morbid conditions that result in long-term sequelae. Nurses face several challenges during the hospitalization of these infants. Vigilant care, monitoring, and careful handling of the infants can prevent infections and long-term complications. Newer, less invasive technologies are promising for improved outcomes in extremely preterm infants.

scholarly journals Spontaneous pneumothorax, with or without pulmonary cysts, in patients with COVID-19 pneumonia

2021 ◽  
Vol 15 (10) ◽  
pp. 1404-1407
Author(s):  
Javier Leonardo Galindo ◽  
Luisa Fernanda Jiménez ◽  
Juan Ricardo Lutz ◽  
María Alejandra Izquierdo ◽  
Viviana Lucía Rivillas ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Medical Records ◽  
Spontaneous Pneumothorax ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Ventilator Weaning ◽  
Radiologic Findings ◽  
Pulmonary Cysts ◽  
Rare Manifestation

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Pneumothorax is a rare manifestation of the disease. This report is a description of a series of patients with COVID-19 and spontaneous pneumothorax, some of them with associated pulmonary cysts. Methodology: Cases were collected retrospectively. We included clinical data from medical records and described radiologic findings. Patients that developed pneumothorax during mechanical ventilation were excluded. Results: Ten cases were included in this report, nine of them were male. The median age of our series was 62 years (IQR = 57-68). The median days since the onset of symptoms until the development of pneumothorax was 27 (IQR = 17-31), most cases developed after the second week of the diagnosis of pneumonia. Two cases required invasive mechanical ventilation, but pneumothorax occurred after ventilator weaning. Three cases showed subpleural pulmonary cysts. Conclusions: Cysts and pneumothorax are rare manifestations of SARS-CoV-2 pneumonia with mechanisms not completely understood. This report highlights the role of CT scan in diagnosis of COVID-19 complications.

Ambulatory care of non-invasive mechanical ventilation in COPD patients with global decompensated respiratory acidosis

Pneumologie ◽  
2017 ◽  
Vol 71 (S 01) ◽  
pp. S1-S125
Author(s):  
EJ Soto Hurtado ◽  
P Gutiérrez Castaño ◽  
JJ Torres ◽  
MD Jiménez Fernández ◽  
M Pérez Soriano ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ambulatory Care ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Non Invasive ◽  
Copd Patients

scholarly journals Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
J.-L. Diehl ◽  
N. Peron ◽  
R. Chocron ◽  
B. Debuc ◽  
E. Guerot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dead Space ◽  
Respiratory Mechanics ◽  
Invasive Mechanical Ventilation ◽  
Endothelial Damage ◽  
Circulating Endothelial Cells ◽  
Pulmonary Mechanics ◽  
High Peep ◽  
Gas Exchanges ◽  
Physiological Dead Space

Abstract Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Methods Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1–4] day after intubation (median [IQR]). Measurements and main results Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1–44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721–2434] mL. Gas exchanges were characterized by hypercapnia 55 [44–62] mmHg, high physiological dead-space (VD/VT): 75 [69–85.5] % and ventilatory ratio (VR): 2.9 [2.2–3.4]. VD/VT and VR were significantly correlated: r2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12–46] cells per mL and 1483 [999–2217] ng/mL, respectively. Conclusions We observed early in the course of COVID-19 ARDS high VD/VT in association with biological markers of endothelial damage and thrombosis. High VD/VT can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process.

Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

2021 ◽  
pp. 1-10
Author(s):  
Guglielmo Consales ◽  
Lucia Zamidei ◽  
Franco Turani ◽  
Diego Atzeni ◽  
Paolo Isoni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Kidney Injury ◽  
Protective Ventilation ◽  
Retrospective Observational Study ◽  
Organ Support ◽  
Chronic Obstructive

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO<sub>2</sub> with very low extracorporeal blood flows (&#x3c;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO<sub>2</sub>R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO<sub>2</sub>R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO<sub>2</sub> clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO<sub>2</sub>R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

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