scholarly journals Mechanical ventilation in SARS-CoV-2 patients: state of art

2021 ◽  
Author(s):  
Diana Ávila Reyes ◽  
Bayron David García P. ◽  
Guillermo Salazar Gutierrez ◽  
José Fernando Gómez González ◽  
David Ricardo Echeverry Piedrahita ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Management Strategies ◽  
Management Approach ◽  
Extensive Search ◽  
Therapeutic Measures ◽  
Evidenced Based ◽  
Past Experiences ◽  
Protective Mechanical Ventilation ◽  
State Of Art ◽  
Ventilation Management

COVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.

Awakening the Ubuntu episteme to embrace knowledge management in Africa

2019 ◽  
Vol 24 (1) ◽  
pp. 105-119
Author(s):  
Florence Nansubuga ◽  
John C. Munene
Keyword(s):  
Knowledge Management ◽  
Social Interactions ◽  
Management Practices ◽  
Contextual Information ◽  
Management Strategies ◽  
Management Approach ◽  
Perspective View ◽  
Content Type ◽  
Community Organisation ◽  
Past Experiences

Purpose The knowledge management (KM) models in the African organisations are influenced by the interplay between human agents from diverse societies whose experiences, values, contextual information and insights that are perceived controversial in Africa. The purpose of this paper is to elucidate the indigenous assumptions related to knowledge and its management in Africa and the perceived contradictions in the existing models by adopting the Ubuntu philosophy. Design/methodology/approach The authors used a perspective lens to examine the existing management practices and propose an integrated framework that is appropriate for the utilisation of the Ubuntu epistemic knowledge management practices and at the same time provide highlights on the perceived paradoxes and how they can be managed to improve knowledge management and people management in African societies. Findings The inductive posteriori knowledge approach is perceived to be dynamic, applicable and more desirable in the African societies as it allows organisational managers and their work teams to embrace knowledge construction, dependent on experiences in form of stories and metaphors that demonstrate successful work samples. The Ubuntu dramaturgical knowledge management approach adds value to the posteriori knowledge by refining the rhetoric stories and metaphors into empirical performance scripts that are tailored to the audiences’ expectations. Research limitations/implications The paper adapted a perspective view to explain knowledge management; therefore, it was not possible to provide empirical data on the metaphysical and dramaturgical elements that are assumed to influence knowledge management in Africa. However, based on theoretical analysis, the authors have proposed a coherent knowledge management framework based on the interaction between posteriori KM assumptions and Ubuntu dramaturgy. Practical implications Ubuntu ideology has been appreciated since it treasures interdependency and interconnectedness among people. Therefore, collaborating partners working in Africa would be expected to act as interdependent agents, whereby this interdependency is perceived as an integral part of the knowledge management process. The proposed Ubuntu knowledge management model is grounded on the posteriori knowledge approach which assumes that experience is the source of knowledge. Through social interactions and experiences sharing, organisational members can create new processes, innovative technologies and dynamic context based performance scripts that can drive productivity. Social implications The authors concluded that a coherent framework that is tailored to social interactions and contextual needs of the people and their communities can promote productive knowledge and knowledge management systems in the African contexts. Moreover knowledge management requires one to acknowledge the complexity of Ubuntu ideology in a sense that it recognises the past experiences and contributions of the diverse individuals in the same community/organisation. Originality/value This paper focused on examining how the Ubuntu philosophy can promote knowledge development and management strategies that are tailored to social and contextual needs of the organisations in Africa to curtail the perceived paradoxes in the existing knowledge management models.

A review of intraoperative lung-protective mechanical ventilation strategy

2020 ◽  
Author(s):  
Trung kien Nguyen ◽  
Duc Hanh Mai ◽  
Anh Nguyet Le ◽  
Quang Huy Nguyen ◽  
Chi Tue Nguyen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ventilation Strategy ◽  
Protective Mechanical Ventilation ◽  
Lung Protective Mechanical Ventilation

scholarly journals Brain injury after 50 h of lung-protective mechanical ventilation in a preclinical model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thiago G. Bassi ◽  
Elizabeth C. Rohrs ◽  
Karl C. Fernandez ◽  
Marlena Ornowska ◽  
Michelle Nicholas ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Neuronal Damage ◽  
Normal Lung ◽  
Preclinical Model ◽  
Negative Consequences ◽  
Mechanically Ventilated ◽  
Protective Mechanical Ventilation ◽  
Hippocampal Apoptosis ◽  
Lung Protective Mechanical Ventilation

AbstractMechanical ventilation is the cornerstone of the Intensive Care Unit. However, it has been associated with many negative consequences. Recently, ventilator-induced brain injury has been reported in rodents under injurious ventilation settings. Our group wanted to explore the extent of brain injury after 50 h of mechanical ventilation, sedation and physical immobility, quantifying hippocampal apoptosis and inflammation, in a normal-lung porcine study. After 50 h of lung-protective mechanical ventilation, sedation and immobility, greater levels of hippocampal apoptosis and neuroinflammation were clearly observed in the mechanically ventilated group, in comparison to a never-ventilated group. Markers in the serum for astrocyte damage and neuronal damage were also higher in the mechanically ventilated group. Therefore, our study demonstrated that considerable hippocampal insult can be observed after 50 h of lung-protective mechanical ventilation, sedation and physical immobility.

Mechanical ventilation management in patients diagnosed with Covid-19 who underwent pediatric openheart surgery

2021 ◽  
Vol 18 (5) ◽  
pp. 82-87
Author(s):  
Ergi̇n Arslanoğlu ◽  
Kenan Abdurrahman Kara ◽  
Fatih Yigit ◽  
Ömer Faruk Şavluk ◽  
Nihat Çine ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ventilation Management

scholarly journals Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

2020 ◽  
Author(s):  
Anja Bluth ◽  
Axel Schindelhauer ◽  
Katharina Nitzsche ◽  
Pauline Wimberger ◽  
Cahit Birdir
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Placenta Accreta ◽  
Caesarean Section Rate ◽  
Management Strategies ◽  
Management Approach ◽  
Optimal Setting ◽  
Placenta Accreta Spectrum ◽  
Management Approaches

Abstract Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

scholarly journals The correlation of respiratory system compliance and mortality in COVID-19 acute respiratory distress syndrome: do phenotypes really exist?

2021 ◽  
Vol 8 (2) ◽  
pp. 67-74
Author(s):  
Rachel L. Choron ◽  
Stephen A. Iacono ◽  
Alexander Cong ◽  
Christopher G. Bargoud ◽  
Amanda L. Teichman ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory System ◽  
Management Strategies ◽  
Respiratory System Compliance ◽  
Risk Of Death ◽  
Mortality Difference ◽  
Ventilator Management ◽  
Observational Cohort ◽  
Multivariable Regression ◽  
The Mean

Background: Recent literature suggests respiratory system compliance (Crs) based phenotypes exist among COVID-19 ARDS patients. We sought to determine whether these phenotypes exist and whether Crs predicts mortality. Methods: A retrospective observational cohort study of 111 COVID-19 ARDS patients admitted March 11-July 8, 2020. Crs was averaged for the first 72-hours of mechanical ventilation. Crs<30ml/cmH2O was defined as poor Crs(phenotype-H) whereas Crs≥30ml/cmH2O as preserved Crs(phenotype-L). Results: 111 COVID-19 ARDS patients were included, 40 phenotype-H and 71 phenotype-L. Both the mean PaO2/FiO2 ratio for the first 72-hours of mechanical ventilation and the PaO2/FiO2 ratio hospital nadir were lower in phenotype-H than L(115[IQR87] vs 165[87], p=0.016), (63[32] vs 75[59], p=0.026). There were no difference in characteristics, diagnostic studies, or complications between groups. Twenty-seven (67.5%) phenotype-H patients died vs 37(52.1%) phenotype-L(p=0.115). Multivariable regression did not reveal a mortality difference between phenotypes; however, a 2-fold mortality increase was noted in Crs<20 vs >50ml/cmH2O when analyzing ordinal Crs groups. Moving up one group level (ex. Crs30-39.9ml/cmH2O to 40-49.9ml/cmH2O), was marginally associated with 14% lower risk of death(RR=0.86, 95%CI 0.72, 1.01, p=0.065). This attenuated (RR=0.94, 95%CI 0.80, 1.11) when adjusting for pH nadir and PaO2/FiO2 ratio nadir. Conclusion: We identified a spectrum of Crs in COVID-19 ARDS similar to Crs distribution in non-COVID-19 ARDS. While we identified increasing mortality as Crs decreased, there was no specific threshold marking significantly different mortality based on phenotype. We therefore would not define COVID-19 ARDS patients by phenotypes-H or L and would not stray from traditional ARDS ventilator management strategies.

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