scholarly journals Meralgia Paresthetica after Prone Positioning Ventilation in the Intensive Care Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Christian Svendsen Juhl ◽  
Martin Ballegaard ◽  
Morten H. Bestle ◽  
Peer Tfelt-Hansen
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prone Position ◽  
Prone Positioning ◽  
External Compression ◽  
Meralgia Paresthetica ◽  
Anterolateral Thigh ◽  
Femoral Cutaneous Nerve ◽  
Patient Reported

Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by external compression of the nerve during its course close to the anterior superior iliac spine. We present a case of a patient with acute respiratory distress induced byLegionellapneumonia who was admitted to the intensive care unit (ICU) for mechanical ventilation. In the ICU, the patient received one session of prone position ventilation for 8.5 consecutive hours. At evaluation six months later, the patient reported persistent bilateral numbness of the anterolateral thigh, which he complained had begun right after he woke up at the ICU. He was referred for further neurological and neurophysiological examination and was diagnosed with bilateral MP, a condition never previously described as a complication to mechanical ventilation in prone position in the ICU.

Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill

2020 ◽  
Vol 29 (2) ◽  
pp. 140-144
Author(s):  
Ashleigh Malinowski ◽  
Neal J. Benedict ◽  
Meng-Ni Ho ◽  
Levent Kirisci ◽  
Sandra L. Kane-Gill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Patient Reported Outcomes ◽  
Surgical Trauma ◽  
Related Factors ◽  
Patient Reported ◽  
Sedation And Analgesia ◽  
Patients Experience

Background Patient-reported outcomes are essential to understand the relationship between patients’ perception of sedation and clinicians’ assessments of sedation. Objectives To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia. Methods This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes. Results A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P < .001) were associated with a higher agitation index. Conclusion Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients’ experience.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

Lateral Femoral Cutaneous Neuropathy—Meralgia Paresthetica

2018 ◽  
Author(s):  
Srinivas Chiravuri
Keyword(s):  
Treatment Modalities ◽  
Invasive Treatment ◽  
External Compression ◽  
Meralgia Paresthetica ◽  
Initial Management ◽  
Nerve Structure ◽  
Anterolateral Thigh ◽  
Femoral Cutaneous Nerve ◽  
Dorsal Rami ◽  
Direct Nerve

Meralgia paresthetica is characterized by anterolateral thigh pain, paresthesia, or dysesthesia without motor weakness. This is due to idiopathic or iatrogenic injury to the lateral femoral cutaneous nerve (LFCN, dorsal rami of L2-L3). Risk factors include obesity, diabetes, and external compression near the inguinal ligament’s attachment to the anterior superior iliac spine. Diagnosis is based on clinical presentation and electrodiagnostic studies. Initial management includes behavioral modification, physical therapy, and pharmacotherapy. More invasive treatment modalities include LFCN infiltration, pulsed radiofrequency, direct nerve stimulation, and spinal cord stimulation. Ultrasound-guided neurectomy is also an effective way to localize the nerve structure and ensure complete nerve transection.

scholarly journals Fluid balance in pediatric patients in prone position: a pragmatic study

2019 ◽  
Vol 65 (6) ◽  
pp. 839-844
Author(s):  
Rosirene Maria Frohlich Dall’ Agnese ◽  
Petrônio Fagundes de Oliveira Filho ◽  
Caroline A. D. Costa ◽  
Cristian T. Tonial ◽  
Francisco Bruno ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Prone Position ◽  
Fluid Balance ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Cumulative Fluid Balance

SUMMARY OBJECTIVE: To verify the association between prone position, increased diuresis, and decreased cumulative fluid balance in critically ill pediatric patients who underwent mechanical ventilation (MV) for pulmonary causes and describe adverse events related to the use of the position. METHODS: This is a retrospective observational study. Patients aged between 1 month and 12 years who underwent MV for pulmonary causes, between January 2013 and December 2015, were selected and divided between those who were put on prone position (PG) and those who were not (CG) during the hospitalization at the Pediatric Intensive Care Unit (PICU). Data were analyzed longitudinally from D1 to D4. RESULTS: A total of 77 patients (PG = 37 and CG = 40) were analyzed. The general characteristics of both groups were similar. In the comparison between the groups, there was no increase in diuresis or decrease in cumulative fluid balance in the prone group. In the longitudinal analysis of D1 to D4, we saw that the PG presented higher diuresis (p = 0.034) and a lower cumulative fluid balance (p = 0.001) in D2. Regarding the use of diuretics, there was greater use of furosemide (P <0.001) and spironolactone (P = 0.04) in the PG. There was no increase in adverse events during the use of the prone position. CONCLUSION: The prone position was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients who underwent to MV for pulmonary causes.

scholarly journals Tracheal resection following prolonged intubation in a COVID-19 patient

2021 ◽  
pp. 51-52
Author(s):  
A Milner
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Subglottic Stenosis ◽  
Tracheal Resection ◽  
Prone Positioning ◽  
Prolonged Intubation

Only six months into the SARS-CoV-2 epidemic in South Africa, we present the first post-coronavirus disease (COVID-19) subglottic stenosis seen at Morningside Clinic. Ten weeks prior to the current admission, this 48-year old patient with diabetes, obesity and hypertension developed severe COVID-19 pneumonia. He was admitted to the intensive care unit (ICU) for 14 days of mechanical ventilation and intermitted prone positioning for optimal V/Q matching.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Derivation and validation of a search algorithm to retrospectively identify mechanical ventilation initiation in the intensive care unit

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan J Smischney ◽  
Venu M Velagapudi ◽  
James A Onigkeit ◽  
Brian W Pickering ◽  
Vitaly Herasevich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Search Algorithm
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