Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.

Association of body weight on pulmonary function tests in young individuals (aged 18- 40 years)- A cross-sectional study

This was a prospective cross-sectional study conducted to evaluate association of waist, hip and thigh circumferences on respiratory parameters among young healthy adults. A total of 180 volunteers of different weight categories; including underweight, normal weight, over weight and obese people were recruited by using non-probability convenient sampling technique. Non-smoker males and females (non-pregnant), aged between 18-40 years with no pulmonary and cardiac disease were included in the study. Waist circumference, mid-thigh circumference, hip circumference and respiratory parameters were measured. The results showed a significant association between waist circumference with forced vital capacity (FVC) (r = 0.188, p = 0.011), average tidal volume (VT) (r = 0.160, p = 0.032), inspiratory reserve volume (IRV) (r = 0.388,p<0.001), vital capacity (VC) (r = 0.312, p<0.001), total lung capacity (TLC) (r = 0.385, p<0.001), and functional residual capacity (FRC) (r = 0.477, p<0.01), and a negative association with forced expiratory volume in 1 second (FEV1) (r = -0.148, p = 0.048) and FEV1/FVC ratio (r = -0.246, p<0.001). Significant association was not observed between waist circumference and expiratory reserve volume (ERV) (r = 0.071, p = 0.344). In the present study, increased waist, hip, and thigh circumferences were found to be negatively associated with FEV1 and FEV1/FVC ratio. Spirometry should be performed in obese and overweight young healthy adults even if they are asymptomatic, as early preventive measures can be taken to reduce the resulting morbidity.

RESPIRATORY PARAMETERS OF COVID-19 PATIENTS AFTER THE PRONE POSITION

<p>Hypoxemia is a condition when there is a lack of oxygen levels in the blood, especially from the arteries. In the early stages of COVID-19, several mechanisms such as intrapulmonary shunting, loss of pulmonary perfusion regulation, intravascular micro thrombus, and impaired diffusion capacity can contribute to the development of arterial hypoxemia, although there is no increase in respiratory work. The prone position is one of the most widely used therapies for patients with hypoxemia because the dorsal area has a large number of alveolar units that are not compressed by the weight of the abdominal cavity and mediastinum, thus creating a more efficient area for gas exchange. This study aimed to determine the effect of the prone position on changes in respiratory parameters of COVID-19 patients. This study used the descriptive correlation method on 27 respondents with purposive sampling. Each respondent was given a prone position for three hours and being observed before, during the three-hour, and after one hour of the prone position administration”. The results of the descriptive analysis of this study showed that the majority of respondents were middle adulthood (63%) with 70% of the respondents being male, 59% having a history of hypertension, and 85% experiencing coagulation disorders. The change in the mean respiratory rate during one hour of supination after three hours of prone position in males was greater than that in females although the mean decrease in oxygen saturation was the same. This shows that the prone position for three hours accompanied by oxygen therapy made an improvement in respiratory status in COVID-19 patients, although it needs further investigation with more respondents and different research methods.</p>

Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Delirium complicating regular use of psychoactive substances remains one of the major issues of critical care, toxicology, and psychiatry. However, the pathogenetic mechanisms of delirium development in patients with 1,4-butanediol poisoning have been poorly studied until now.The aim of the study was to reveal specific patterns of delirium in patients with 1,4-butanediol poisoning as well as to study the changes in systemic hemodynamic parameters, respiratory function, and body fluid compartments during the treatment.Material and methods. The study was prospective and treatment-randomized. Forty-eight male patients aged 20 to 45 years with delirium and acute 1,4-butanediol poisoning were enrolled. Of them, 24 patients were administered with succinate-containing drug 40 ml daily, 24 patients received standard treatment without antihypoxic agents. We studied the evolution of delirium, changes in anaerobic metabolism parameters, systemic hemodynamics, respiratory function, and the volume of fluid compartments. Impedance measurement method adjusted for interference was used in the study.Results. At the «peak» of delirium (days 1–3), the hyperdynamic circulation, increased systemic arterial tone, stroke output, respiratory function parameters, and metabolic lactate acidosis were recorded. A decrease in total fluid volume and extracellular fluid volume was clearly observed during day 1 of intoxication delirium along with increased permeability of cell membranes. On day 3 of delirium, a decrease in intracellular fluid volume and increase in extracellular fluid volume were noted. After the cytoflavin administration, shorter delirium duration (7.5 [6; 8] days), more rapid correction of lactate acidosis, stabilization of respiratory parameters and stabilization of cell membrane permeability by day 5 were found. In the control group, delirium persisted for up to 14 [11; 15] days (z=-5.9; P=0.00011) with more frequent development of complications such as nosocomial pneumonia (χ2=8.4, P<0.001).Conclusion. The severity of delirium in acute poisoning with 1,4-butanediol was associated with metabolic lactate acidosis, changes in systemic hemodynamics and pulmonary function. A positive effect of adjunctive antihypoxic therapy with succinate-containing agent on cardio-respiratory parameters, cell membrane permeability, water balance due to elimination of tissue hypoxia and prompt switching to tissue aerobic metabolism has been found.

The Effect of Bromelain (Anaheal) on Clinical and Para-Clinical Parameters in Hospitalized COVID-19 Patients

The severity of COVID-19 disease and its mortality may be due to a localized vascular problem owing to the activation of bradykinin B1 receptors on endothelial cells in the lungs that occur following inflammation. Bromelain acts as an anti-inflammatory factor and can lower the level of bradykinin in the serum and tissues. Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari Hospital in Tehran were included in the study after providing full explanations and obtaining written consent. The 40 patients with mild to moderate symptoms were randomly divided into the control group (No: 20) and sample (No: 20). In the sample group, a dose of 200 mg bromelain was given to patients every 8 hours. In the control group, placebo capsules were administered exactly at the above intervals. Clinical and paraclinical factors (including SaO2, RR body temperature, MAP, HR, CRP, ESR, AST, ALT, Bil, BUN, Cr, WBC, Lymph, LDH, Plt were evaluated on a regular basis for up to five days. The results were evaluated using t-test and SPSS21 software. After treatment, the sample (Bromelain) group indicated significant improvement in SaO2, RR, HR, AST, ALT, BUN, ESR, LDH, and WBC and Lymphocyte count (P<0.05). Other factors did not have a significant difference with the control group. Bromelain causes improvement in some clinical symptoms such as respiratory parameters and para clinical items of mild to moderate hospitalized COVID-19 patients, so it can be a promising treatment. Furthered evaluation of larger groups is recommended.

L,Varying Chest Compression Rates During Neonatal Cardiopulmonary Resuscitation: A Randomized Controlled Animal Trial

Background To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary resuscitation would have a shorter time to ROSC.Methods Newborn piglets (n=7/group) were anesthetized, intubated, instrumented and exposed to 45 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to a CC rate of 180/min or 90/min. CC was performed using an automated chest compression machine. Hemodynamic and respiratory parameters and applied compression force were continuously measured.Results The mean (SD) time to ROSC was 91 (34) and 256 (97) sec for CC rates of 180/min and 90/min, respectively (p=0.08). The number of piglets that achieved ROSC was 7 (100%) and 5 (71%) with 180/min and 90/min CC rates, respectively (p=0.46). Hemodynamic parameters (i.e., diastolic and mean blood pressure, carotid blood flow, stroke volume, end-diastolic volume, left ventricular contractile function) and respiratory parameters (i.e., minute ventilation, peak inflation and peak expiration flow) were all improved with a CC rate of 180/min.Conclusion Time to ROSC and hemodynamic and respiratory parameters were all improved, with a CC rate of 180/min vs. 90/min. Higher CC rates during neonatal resuscitation warrant further investigation.

Complex respiratory and motor rehabilitation program in a patient with post-pulmonary tuberculosis conditions and multiple sequelae after SARS-CoV-2 infection: case report

Introduction: A great variety of medical issues can occur after the COVID-19 infection including fatigue, muscle weakness, locomotor disability, self-care dysfunction, polyneuropathy, persistent dyspnea on exertion and a hypercoagulable state. Materials and methods: This paper presents the case of a nonsmoker 49-year-old male with right lung lower lobe lobectomy for post tuberculosis bronchiectasis and diabetes mellitus, who developed multiple serious physicals, neurological, hematological and respiratory consequences, related to critical COVID-19 infection and prolonged hospitalization, Results: A favorable evolution of the patient’s respiratory sequels and motor impairment on both lower limbs was noticed after a complex individualized rehabilitation program started in the post COVID-19 Rehabilitation Department of Balneal and Rehabilitation Sanatorium, Techirghiol, Romania, consisting in better functional parameters and exercise tolerance, significant improvement in daily activities, remission of exertional dyspnea, social and family reintegration. Conclusions: multidisciplinary approach and complex individualized programs of rehabilitation is required after a critical form of COVID in a patients known with tuberculosis, and other complex pathologies, in order to restore physical function and mobility and optimize respiratory parameters. Keywords: COVID-19, Rehabilitation, Tuberculosis,

Automatic Air Volume Control System for Ventilation of Two Patients Using a Single Ventilator: A Large Animal Model Study

The COVID-19 pandemic outbreak led to a global ventilator shortage. Hence, different strategies to use a single ventilator to support multiple patients are considered. A mechatronic system Ventil divides and automatically controls gas volume pumped through two channels and was successfully validated in independent lung ventilation. We used Ventil in a series of experiments on a large animal model to verify its usability for ventilation in two patients using a single ventilator. The results of investigations on 12 pigs showed that the physiological level of respiratory parameters was maintained for 24 hours. Application of Ventil did not lead to injuries in the lungs, as indicated by CT scan analysis. We conclude that ventilation using Ventil can be considered safe in patients subjected to deep sedation without spontaneous breathing efforts.