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[PMID]:29267506
[Au] Autor:Zhang ZJ; Zheng ML; Nie Y; Niu ZQ
[Ad] Endereço:Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China.
[Ti] Título:Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with left-sided double-lumen endobronchial tube in one-lung ventilation in thoracic surgery in the morbidly obese.
[So] Source:Braz J Med Biol Res;51(2):e6825, 2017 Dec 18.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
[Mh] Termos MeSH primário: Intubação Intratraqueal/instrumentação
Máscaras Laríngeas/normas
Obesidade Mórbida/cirurgia
Ventilação Monopulmonar/instrumentação
Procedimentos Cirúrgicos Torácicos/instrumentação
[Mh] Termos MeSH secundário: Adulto
Idoso
Método Duplo-Cego
Desenho de Equipamento
Feminino
Seres Humanos
Intubação Intratraqueal/métodos
Masculino
Meia-Idade
Ventilação Monopulmonar/métodos
Duração da Cirurgia
Dor Pós-Operatória/etiologia
Faringite/etiologia
Estudos Prospectivos
Atelectasia Pulmonar
Reprodutibilidade dos Testes
Procedimentos Cirúrgicos Torácicos/métodos
Fatores de Tempo
Resultado do Tratamento
Ventiladores Mecânicos/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:29300217
[Au] Autor:Robinson C; Hoze M; Hevener S; Nichols AA
[Ad] Endereço:Author Affiliations: UC Davis Health System (Mss Robinson, Hevener and Hoze), Sacramento, California; and Betty Irene Moore School of Nursing, University of California (Dr Nichols), Davis, Sacramento.
[Ti] Título:Development of an RN Champion Model to Improve the Outcomes of Ventilator-Associated Pneumonia Patients in the Intensive Care Unit.
[So] Source:J Nurs Adm;48(2):79-84, 2018 Feb.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Healthcare-associated infections are costly. Methods to prevent infections must be effective and provide a return on investment to be sustainable. A funded project supported the design and implementation of a unique quality and safety model, using unit-based quality and safety RN champions. The goal was to create and sustain a hospital-wide safety culture focused on preventing ventilator-associated pneumonia (VAP) by adopting the Institute for Healthcare Improvement's VAP bundle. The program began with a pilot in 7 ICUs. Using the RN champion model resulted in the reduction of the incidence of VAP, cost avoidance, and decreased length of stay. Six years later, each adult ICU reached "zero zone."
[Mh] Termos MeSH primário: Cuidados Críticos/normas
Controle de Infecções/métodos
Pneumonia Associada à Ventilação Mecânica/etiologia
Pneumonia Associada à Ventilação Mecânica/prevenção & controle
Pneumonia/terapia
Qualidade da Assistência à Saúde/normas
Ventiladores Mecânicos/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000578


  3 / 7154 MEDLINE  
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[PMID]:27772529
[Au] Autor:Fan Y; Gao F; Wu Y; Zhang J; Zhu M; Xiong L
[Ad] Endereço:Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, 430022, China.
[Ti] Título:Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis.
[So] Source:Crit Care;20(1):338, 2016 Oct 24.
[Is] ISSN:1466-609X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ventilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs). The National Healthcare Safety Network replaced traditional ventilator-associated pneumonia (VAP) surveillance with VAE surveillance in 2013. The objective of this study was to assess the consistency between VAE surveillance and traditional VAP surveillance. METHODS: We systematically searched electronic reference databases for articles describing VAE and VAP in ICUs. Pooled VAE prevalence, pooled estimates (sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)) of VAE for the detection of VAP, and pooled estimates (weighted mean difference (WMD) and odds ratio ([OR)) of risk factors for VAE compared to VAP were calculated. RESULTS: From 2191 screened titles, 18 articles met our inclusion criteria, representing 61,489 patients receiving mechanical ventilation at ICUs in eight countries. The pooled prevalence rates of ventilator-associated conditions (VAC), infection-related VAC (IVAC), possible VAP, probable VAP, and traditional VAP were 13.8 %, 6.4 %, 1.1 %, 0.9 %, and 11.9 %, respectively. Pooled sensitivity and PPV of each VAE type for VAP detection did not exceed 50 %, while pooled specificity and NPV exceeded 80 %. Compared with VAP, pooled ORs of in-hospital death were 1.49 for VAC and 1.76 for IVAC; pooled WMDs of hospital length of stay were -4.27 days for VAC and -5.86 days for IVAC; and pooled WMDs of ventilation duration were -2.79 days for VAC and -2.89 days for IVAC. CONCLUSIONS: VAE surveillance missed many cases of VAP, and the population characteristics identified by the two surveillance paradigms differed. VAE surveillance does not accurately detect cases of traditional VAP in ICUs.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva
Pneumonia Associada à Ventilação Mecânica/diagnóstico
Pneumonia Associada à Ventilação Mecânica/prevenção & controle
Respiração Artificial/efeitos adversos
Gestão da Segurança/métodos
Ventiladores Mecânicos/microbiologia
[Mh] Termos MeSH secundário: Ensaios Clínicos como Assunto/métodos
Ensaios Clínicos como Assunto/normas
Seres Humanos
Unidades de Terapia Intensiva/normas
Pneumonia Associada à Ventilação Mecânica/epidemiologia
Respiração Artificial/normas
Fatores de Risco
Gestão da Segurança/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180119
[Lr] Data última revisão:
180119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29252476
[Au] Autor:Bender SP; Tharp WG
[Ad] Endereço:From the Department of Anesthesia, University of Vermont Medical Center, Burlington, Vermont.
[Ti] Título:Are You Down With TPP? Considering Transpulmonary Pressures as Opposed to Ventilator-Measured Pressures.
[So] Source:Anesth Analg;126(1):13-15, 2018 01.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Síndrome do Desconforto Respiratório do Adulto
Ventiladores Mecânicos
[Mh] Termos MeSH secundário: Seres Humanos
Pressão
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002155


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[PMID]:29210261
[Au] Autor:Dute J
[Ti] Título:European Court of Human Rights.
[So] Source:Eur J Health Law;24(2):199-220, 2017 Apr.
[Is] ISSN:0929-0273
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Mh] Termos MeSH primário: Imperícia/legislação & jurisprudência
Transferência de Pacientes/legislação & jurisprudência
Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
[Mh] Termos MeSH secundário: Cuidados Críticos
Feminino
Seres Humanos
Incubadoras para Lactentes/provisão & distribuição
Recém-Nascido
Turquia
Ventiladores Mecânicos/provisão & distribuição
[Pt] Tipo de publicação:JOURNAL ARTICLE; LEGAL CASES
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:28926566
[Au] Autor:Zens TJ; Danobeitia JS; Chlebeck PJ; Zitur LJ; Odorico S; Brunner K; Coonen J; Capuano S; D'Alessandro AM; Matkowskyj K; Zhong W; Torrealba J; Fernandez L
[Ad] Endereço:University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.
[Ti] Título:Guidelines for the management of a brain death donor in the rhesus macaque: A translational transplant model.
[So] Source:PLoS One;12(9):e0182552, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The development of a translatable brain death animal model has significant potential to advance not only transplant research, but also the understanding of the pathophysiologic changes that occur in brain death and severe traumatic brain injury. The aim of this paper is to describe a rhesus macaque model of brain death designed to simulate the average time and medical management described in the human literature. METHODS: Following approval by the Institutional Animal Care and Use Committee, a brain death model was developed. Non-human primates were monitored and maintained for 20 hours after brain death induction. Vasoactive agents and fluid boluses were administered to maintain hemodynamic stability. Endocrine derangements, particularly diabetes insipidus, were aggressively managed. RESULTS: A total of 9 rhesus macaque animals were included in the study. The expected hemodynamic instability of brain death in a rostral to caudal fashion was documented in terms of blood pressure and heart rate changes. During the maintenance phase of brain death, the animal's temperature and hemodynamics were maintained with goals of mean arterial pressure greater than 60mmHg and heart rate within 20 beats per minute of baseline. Resuscitation protocols are described so that future investigators may reproduce this model. CONCLUSION: We have developed a reproducible large animal primate model of brain death which simulates clinical scenarios and treatment. Our model offers the opportunity for researchers to have translational model to test the efficacy of therapeutic strategies prior to human clinical trials.
[Mh] Termos MeSH primário: Morte Encefálica/fisiopatologia
Modelos Animais de Doenças
[Mh] Termos MeSH secundário: Algoritmos
Animais
Pressão Sanguínea/efeitos dos fármacos
Morte Encefálica/veterinária
Hidratação
Guias como Assunto
Frequência Cardíaca/efeitos dos fármacos
Hemodinâmica/efeitos dos fármacos
Rim/patologia
Fígado/patologia
Macaca mulatta
Monitorização Fisiológica
Pâncreas/patologia
Doadores de Tecidos
Vasoconstritores/farmacologia
Ventiladores Mecânicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Vasoconstrictor Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182552


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[PMID]:28673259
[Au] Autor:Mukerji S; MacIntyre CR; Seale H; Wang Q; Yang P; Wang X; Newall AT
[Ad] Endereço:School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. s.mukerji@unsw.edu.au.
[Ti] Título:Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections.
[So] Source:BMC Infect Dis;17(1):464, 2017 Jul 03.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS: We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS: The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS: The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
[Mh] Termos MeSH primário: Influenza Humana/prevenção & controle
Máscaras/economia
Dispositivos de Proteção Respiratória/economia
Infecções Respiratórias/prevenção & controle
Ventiladores Mecânicos/economia
[Mh] Termos MeSH secundário: China
Análise Custo-Benefício
Pessoal de Saúde
Seres Humanos
Influenza Humana/economia
Máscaras/utilização
Modelos Econômicos
Pandemias
Ensaios Clínicos Controlados Aleatórios como Assunto
Infecções Respiratórias/economia
Ventiladores Mecânicos/utilização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170705
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2564-9


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[PMID]:28646010
[Au] Autor:Ramirez II; Arellano DH; Adasme RS
[Ad] Endereço:Division of Critical Care Medicine Hospital Clínico Universidad de Chile Santiago, Chile Universidad de los Andes Santiago, Chile.
[Ti] Título:Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving-Reply.
[So] Source:Respir Care;62(7):1004-1005, 2017 07.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Respiração Artificial
Ventiladores Mecânicos
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.05648


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[PMID]:28646009
[Au] Autor:Haynes JM
[Ad] Endereço:Respiratory Therapy Department St Joseph Hospital Nashua, New Hampshire.
[Ti] Título:Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving.
[So] Source:Respir Care;62(7):1004, 2017 07.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Respiração Artificial
Ventiladores Mecânicos
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.05593


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[PMID]:28602381
[Au] Autor:Essouri S; Baudin F; Chevret L; Vincent M; Emeriaud G; Jouvet P
[Ad] Endereço:Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada; Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Kremlin Bicêtre, Paris South University, Le Kremlin Bicêtre, France. Electronic address: essourisan@gmail.com.
[Ti] Título:Variability of Care in Infants with Severe Bronchiolitis: Less-Invasive Respiratory Management Leads to Similar Outcomes.
[So] Source:J Pediatr;188:156-162.e1, 2017 Sep.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations. STUDY DESIGN: This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included. RESULTS: A total of 194 children were included. Baseline characteristics and illness severity were similar at the 2 sites. There was a significant difference between centers in the use of invasive ventilation (3% in France vs 26% in Canada; P < .0001). The number of investigations performed from admission to emergency department presentation and during the PICU stay was significantly higher in Canada for both chest radiographs and blood tests (P < .001). The use of antibiotics was significantly higher in Canada both before (60% vs 28%; P < .001) and during (72% vs 33%; P < .0001) the PICU stay. The duration of ventilatory support, median length of stay, and rate of PICU readmission were similar in the 2 centers. CONCLUSION: Important differences in the management of children with severe bronchiolitis were observed during both prehospital transport and PICU treatment. Less invasive management resulted in similar outcomes with in fewer complications.
[Mh] Termos MeSH primário: Bronquiolite/terapia
Hospitalização/estatística & dados numéricos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Ventiladores Mecânicos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Canadá
Feminino
França
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE



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