Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation. Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation. Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5). Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

Download Full-text

Ultrasound-guided vascular access in intensive/acute cardiac care

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0025 ◽

2021 ◽

pp. 314-322

Author(s):

Richard Paul

Keyword(s):

Ph Value ◽

Fluid Management ◽

Disease Process ◽

Blood Gas Analysis ◽

Underlying Disease ◽

Gas Analysis ◽

Cardiac Care ◽

Acid Base ◽

Electrolyte Disorders ◽

Arterial Blood Gas

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects on the human body. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, an approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

Download Full-text

Selected Aspects of Evaluating Knowledge Management Quality in Contemporary Enterprises

Information ◽

10.3390/info11050244 ◽

2020 ◽

Vol 11 (5) ◽

pp. 244

Author(s):

Olga Sobolewska ◽

Agnieszka Bitkowska

Keyword(s):

Information Technology ◽

Knowledge Management ◽

International Organizations ◽

Online Survey ◽

Business Activity ◽

Management Quality ◽

It Systems ◽

Process Perspective

The main aim of the article was to estimate select aspects of knowledge management quality evaluations in contemporary enterprises from theoretical and practical perspectives. Measuring knowledge management is the biggest challenge for both theoreticians and practitioners. The survey was addressed to organizations conducting business activity in Poland. The research was carried out in 2019 in the form of an online survey. For international organizations, the survey was intended for representatives of these companies’ local branches. It has been shown that the factors that most strongly affect the quality of knowledge are directly related to infrastructure and information technology systems (IT systems). The article contributes to managerial practice by pointing out the importance of evaluating knowledge management quality from the process perspective. The article’s originality lies in the contribution to the literature of evaluating knowledge management quality by empirically analyzing it in contemporary enterprises. The results of research in the field involving assessing the quality of knowledge management have shown the need to focus not only on information technology tools (IT tools) related to infrastructure, but also on the processes approach, taking into account the priority role of the employees.

Download Full-text

Scalp Pruritus: Review of the Pathogenesis, Diagnosis, and Management

BioMed Research International ◽

10.1155/2019/1268430 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

Ploysyne Rattanakaemakorn ◽

Poonkiat Suchonwanit

Keyword(s):

Therapeutic Strategy ◽

Skin Diseases ◽

Underlying Disease ◽

Review Article ◽

Skin Changes ◽

Underlying Condition ◽

Appropriate Treatment ◽

Underlying Diseases ◽

Frequent Problem

Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic challenge. Scalp pruritus may be localized to the scalp or extended to other body areas. It is sometimes not only associated with skin diseases or specific skin changes, but also associated with lesions secondary to rubbing or scratching. Moreover, scalp pruritus may be difficult to diagnose and manage and may have a great impact on the quality of life of patients. It can be classified as dermatologic, neuropathic, systemic, and psychogenic scalp pruritus based on the potential underlying disease. A thorough evaluation of patients presenting with scalp pruritus is important. Taking history and performing physical examination and further investigations are essential for diagnosis. Therapeutic strategy comprises removal of the aggravating factors and appropriate treatment of the underlying condition. All treatments should be performed considering an individual approach. This review article focuses on the understanding of the pathophysiology and the diagnostic and therapeutic management of scalp pruritus.

Download Full-text

The role of pre-hospital blood gas analysis in trauma resuscitation

World Journal of Emergency Surgery ◽

10.1186/1749-7922-5-10 ◽

2010 ◽

Vol 5 (1) ◽

pp. 10 ◽

Cited By ~ 20

Author(s):

Milla Jousi ◽

Janne Reitala ◽

Vesa Lund ◽

Ari Katila ◽

Ari Leppäniemi

Keyword(s):

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Trauma Resuscitation

Download Full-text

Blood gas analysis

10.1093/med/9780199687039.003.0018_update_001 ◽

2018 ◽

Author(s):

Richard Paul ◽

Paul Grant

Keyword(s):

Ph Value ◽

Fluid Management ◽

Disease Process ◽

Blood Gas Analysis ◽

Underlying Disease ◽

Gas Analysis ◽

Blood Gas ◽

Acid Base ◽

Electrolyte Disorders ◽

Arterial Blood

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, a six-step approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

Download Full-text

Blood gas analysis: acid–base, fluid, and electrolyte disorders

10.1093/med/9780199687039.003.0018 ◽

2015 ◽

Author(s):

Richard Paul ◽

Pavlos Myrianthefs ◽

George Baltopoulos ◽

Shaun McMaster

Keyword(s):

Ph Value ◽

Fluid Management ◽

Disease Process ◽

Blood Gas Analysis ◽

Underlying Disease ◽

Gas Analysis ◽

Blood Gas ◽

Acid Base ◽

Electrolyte Disorders ◽

Arterial Blood

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, a six-step approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.

Download Full-text

The role of on the job training in the blood gas analysis process. BGA retraining

Clinica Chimica Acta ◽

10.1016/j.cca.2019.03.1374 ◽

2019 ◽

Vol 493 ◽

pp. S651

Author(s):

L. Rossi ◽

I. Batini ◽

D. Mazzei ◽

G. Pellegrini ◽

F. Naldi ◽

...

Keyword(s):

Job Training ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Analysis Process ◽

On The Job Training

Download Full-text

Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design

Health and Quality of Life Outcomes ◽

10.1186/s12955-015-0229-1 ◽

2015 ◽

Vol 13 (1) ◽

Cited By ~ 39

Author(s):

Camelia Rohani ◽

Heidar-Ali Abedi ◽

Ramesh Omranipour ◽

Ann Langius-Eklöf

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Religious Coping ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Predictive Role ◽

A Prospective Study

Download Full-text

Cardiovascular, respiratory and sedative effects of intramuscular alfaxalone, butorphanol and dexmedetomidine compared with ketamine, butorphanol and dexmedetomidine in healthy cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x17742289 ◽

2017 ◽

Vol 20 (10) ◽

pp. 973-979 ◽

Cited By ~ 3

Author(s):

Jeannette Cremer ◽

Carolina H Riccó

Keyword(s):

Blood Gas Analysis ◽

Random Order ◽

Gas Analysis ◽

Rank Test ◽

Quality Of Recovery ◽

Arterial Blood ◽

Parametric Data ◽

Signed Rank Test ◽

Over Time

Objectives The aim of the study was to evaluate the cardiorespiratory effects, quality of sedation and recovery of intramuscular alfaxalone–dexmedetomidine–butorphanol (ADB) and ketamine–dexmedetomidine–butorphanol (KDB), in cats. Methods Nine adult, healthy cats (6.63 ± 1.42 kg) were enrolled in a blinded, randomized, crossover experimental design. Cats were sedated twice intramuscularly, once with ADB (alfaxalone 1 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), and once with KDB (ketamine 5 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), in random order. Data collected included heart rate (HR), arterial blood pressure and blood gas analysis, respiratory rate and sedation score. Analysis of variance with Bonferroni post-hoc correction was used for parametric data, and a Wilcoxon signed rank test was used for non-parametric data. Significance was set at P <0.05. Results Total sedation time was shorter for ADB (90.71 ± 15.12 mins vs 147.00 ± 47.75 mins). Peak sedation was observed within 15 mins in both groups. Quality of recovery was excellent in both groups. HR decreased over time in both groups. Diastolic and mean arterial pressure decreased over time for ADB, becoming significant after 30 mins. All cardiovascular variables were within the clinically acceptable range in both groups. Arterial partial pressure of oxygen was significantly decreased from baseline for KDB at all time points (73 ± 2.5 mmHg [9.7 ± 0.3 kPa] vs ADB 83 ± 2.6 mmHg [11 ± 0.3 kPa]). Hypoventilation was not observed. Conclusions and relevance Both protocols produced acceptable cardiovascular stability. Sedation and recovery quality were good, albeit sedation was shorter with ADB. Although oxygenation was better maintained in the ADB group, all sedated cats should receive oxygen supplementation.

Download Full-text