mechanical ventilation
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Pornpanit Dissaneewate ◽  
Methasit Suksintharanon ◽  
Chulin Chewakidakarn ◽  
Wich Orapiriyakul ◽  
Apipop Kritsaneephaiboon

Early internal fixation of rib fractures in the setting of flail chest has proven benefits over traditional conservative treatment. This can decrease pneumonia, time on mechanical ventilation, length of stay in intensive care units, need for tracheostomy and increase in the pulmonary function test. However, there are few reports regarding on how to restore the costochondral junction, or costal cartilage in cases of anterior or anterolateral flail chest involving cartilage matrix of the ribs or costochondral joint. This case report describes a surgical technique to restore the costochondral junction with plate osteosynthesis and the results. 

Bioengineered ◽  
2022 ◽  
Vol 13 (2) ◽  
pp. 2346-2359
Wei Wei ◽  
Zhentao Sun ◽  
Shifeng He ◽  
Wanyue Zhang ◽  
Sai Chen ◽  

Giorgia Dalpiaz ◽  
Lorenzo Gamberini ◽  
Aldo Carnevale ◽  
Savino Spadaro ◽  
Carlo Alberto Mazzoli ◽  

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Jan Maláska ◽  
Jan Stašek ◽  
František Duška ◽  
Martin Balík ◽  
Jan Máca ◽  

Abstract Background Since December 2019, SARS-CoV-2 virus has infected millions of people worldwide. In patients with COVID-19 pneumonia in need of oxygen therapy or mechanical ventilation, dexamethasone 6 mg per day is currently recommended. However, the dose of 6 mg of dexamethasone is currently being reappraised and may miss important therapeutic potential or may prevent potential deleterious effects of higher doses of corticosteroids. Methods REMED is a prospective, open-label, randomised controlled trial testing the superiority of dexamethasone 20 mg (dexamethasone 20 mg on days 1–5, followed by dexamethasone 10 mg on days 6–10) vs 6 mg administered once daily intravenously for 10 days in adult patients with moderate or severe ARDS due to confirmed COVID-19. Three hundred participants will be enrolled and followed up for 360 days after randomization. Patients will be randomised in a 1:1 ratio into one of the two treatment arms. The following stratification factors will be applied: age, Charlson Comorbidity Index, CRP levels and trial centre. The primary endpoint is the number of ventilator-free days (VFDs) at 28 days after randomisation. The secondary endpoints are mortality from any cause at 60 days after randomisation; dynamics of the inflammatory marker, change in WHO Clinical Progression Scale at day 14; and adverse events related to corticosteroids and independence at 90 days after randomisation assessed by the Barthel Index. The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days. The study will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic. Discussion We aim to compare two different doses of dexamethasone in patients with moderate to severe ARDS undergoing mechanical ventilation regarding efficacy and safety. Trial registration EudraCT No. 2020-005887-70. NCT04663555. Registered on December 11, 2020

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Haijun Huang ◽  
Chenxia Wu ◽  
Qinkang Shen ◽  
Yixin Fang ◽  
Hua Xu

Abstract Background The ability of end-tidal carbon dioxide (ΔEtCO2) for predicting fluid responsiveness has been extensively studied with conflicting results. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising (PLR) test in patients with mechanical ventilation. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. Q test and I2 statistics were used for study heterogeneity and publication bias was assessed by Deeks’ funnel plot asymmetry test. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias. Results Overall, six studies including 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 in four studies was 5%, one was 5.8% and the other one was an absolute increase 2 mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI 0.72–0.85) and 0.90 (95% CI 0.77–0.96), respectively. The DOR was 35 (95% CI 12–107). The pooled AUROC was 0.81 (95% CI 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted. Conclusions Though the limited number of studies included and study heterogeneity, our meta-analysis confirmed that the ΔEtCO2 performed moderately in predicting fluid responsiveness during the PLR test in patients with mechanical ventilation.

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262315
Christian Karagiannidis ◽  
Corinna Hentschker ◽  
Michael Westhoff ◽  
Steffen Weber-Carstens ◽  
Uwe Janssens ◽  

Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

2022 ◽  
Tian-Ran. Li ◽  
Lan-Ping. Shi ◽  
Yong-Gang. Jia ◽  
Ricky Wing Tong. Lau ◽  
Xia-Zhen. Pan

Abstract Background:Although the circuit condensate, an ideal bacterial reservoir, may flow into the humidifier reservoir (HR), no study has investigated if HR-colonized bacteria colonize other circuit locations with airflow. Therefore, the objective of this study was to explore if bacterial growth in the HR leads to bacterial colonization in the ventilator circuit. Methods: A randomized controlled experiment was performed in a public tertiary hospital in Guangdong Province, China. In vitro mechanical ventilation models (n = 60), divided into sterile water samples (n = 30) and broth samples (n = 30), were established. Sterile water was used for humidification in the ventilation models. The sterile water group contained either Acinetobacter baumannii (n = 15) or Pseudomonas aeruginosa (n = 15) in humidifier water. The broth group was similar to the sterile water group, but brain heart infusion broth was added to the HR. After 24, 72, and 168 h of continuous ventilation, bacteria in the humidifier water and at different circuit locations were sampled and cultured, and the results were analyzed by the Chi-square test. The difference in bacterial concentration at the HR outlet was analyzed by the F test, and P < 0.05 was considered statistically significant.Results:Bacterial culture results of the sterile water samples were negative. Bacteria in the humidifier water continued to proliferate in the broth group, and the bacterial concentration at different times was not significantly different (P > 0.05). With prolonged ventilation, the bacterial concentration at the HR outlet increased (P < 0.05). During continuous ventilation, no bacterial growth occurred at 10 cm from the HR outlet and the Y-piece of the ventilator circuit. The bacterial concentration at the HR outlet was higher in the P. aeruginosa group than in the A. baumannii group (P < 0.05).Conclusions:Sterile water in the HR was not conducive to bacterial growth. Although bacteria grew in the HR and could reach the HR outlet, colonization of other circuit locations was unlikely.

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